Book Recommendation: So, you think you may be trans... A critical guide to the debate around trans identities for parents, teachers and others involved with caring for children and young people.

News Commentary

Gender Health Query recommends the book by Tim Davies, 'So, you think you may be trans... A critical guide to the debate around trans identities for parents, teachers and others involved with caring for children and young people.

This book covers many of the issues addressed on our website. The book is factual and written with compassion. Some topics include the history of the trans movement, a clear description of gender ideology, and the complex issue regarding gender dysphoric minors and mental health.

Book description:

In the last ten years there has been a meteoric rise in the number of children and young people self-identifying as 'trans' and seeking to transition to the opposite gender. This is a global phenomenon, apparent throughout the English-speaking world, Europe, South America and beyond. In England and Wales, the explosion in referrals to gender identity clinics has resulted in long waiting lists and, in 2022, to the proposal to reconfigure and extend NHS gender identity services for children and young people.
The response to this development encouraged by the World Professional Association for transgender Health and many official medical bodies (and endorsed by trans-activist organisations) is 'affirmative care': accepting what a child says on the basis that only they can know their 'true' gender identity.
There are now dozens of books available providing parents, teachers and other carers with step-by-step guides to facilitating the child or young person's transition. This is not one of them!
In the last few years, increasing numbers of young adults have appeared on on-line platforms expressing 'transition regret' and seeking to de-transition. At the same time, medical authorities in a number of countries - Finland, Sweden, France, England - have rejected affirmative care and adopted a much more cautious approach to treating minors suffering from gender dysphoria.
All of this leaves parents, teachers, residential care workers, etc. in an invidious position. How should they best support a child or young person who tells them that they're trans? Clearly, there are people for whom transition offers the chance to relieve deeply-felt distress about being 'trapped in the wrong body'. But, equally clearly, there are many troubled youngsters caught up in this new social phenomenon who wrongly believe that transitioning offers a quick fix for more deep-seated problems.
This book aims to provide parents, teachers and others with caring responsibilities with the knowledge and understanding they need to feel confident in responding to gender-questioning children and adolescents. It is not a step-by-step route guide, but a guide to the terrain.
The book provides a brief history of transsexuality, suggests why there has been this explosive growth in cases (and why it is adolescent girls who have been the most affected), explores what children and adolescents might mean when they say they're 'trans' and takes an in-depth look at the medical debate around diagnosis, assessment and treatment. In addition, it examines the role of what has been called 'gender ideology' and - in order to contextualise the debate surrounding trans youngsters -provides a commentary on the wider debate surrounding girls' and women's sex-based rights.

GHQ Endorses Affirmation Generation, a Documentary About the Affirmative Model & the Damage it is Doing to Gender Dysphoric Young People.

News Commentary

Transitioning so many gender dysphoric young people is proving to be doing a lot go damage. The new Affirmation Generation documentary, released on Vimeo is a good overview of what is going on with the explosion in trans-identification and the gleeful enthusiasm to medicalize it.

Show notes:
medical ethics
12 experts, 6 detransitioners,
45 medical articles

We are pleased with this documentary. It is respectful and rational. We are grateful to the producers and participants and hope that more people become aware of this medical scandal as more harmed young people come forward.

Update (03/07/23): Trans activists successfully had this video taken down from Vimeo. However, at a later time they reinstated it.

TOPIC UPDATES FOR 2023: TOPIC 1- DO CHILDREN & TEENS WITH SERIOUS GENDER DYSPHORIA EVER DESIST FROM THE DYSPHORIA. YES

Topic Updates for 2023: TOPIC 1 (Part 2)

Original Topic Post= 1) DO CHILDREN & TEENS WITH SERIOUS GENDER DYSPHORIA EVER DESIST FROM THE DYSPHORIA. YES

We are updating our Topics in 2023 with the most recent and relevant information regarding over-medicalized youth and identity confusion due to queer theory/gender ideology. Since the launch of our website in 2019, only more information has come to light validating our view that pediatric transition is dangerous for children and teens. We support honest and open inquiries regarding this topic. Our focus relates to protecting lesbian, gay, and bisexual youth from harm, and we want the best long-term health outcomes for all youth, regardless of identity or orientation.

One of the main reasons why LGB people are so concerned about the move to transition cognitively immature minors socially and medically is that they may desist from wanting to be the opposite sex or find less invasive ways to cope. Desistance/persistence research is very relevant to protecting LGB and other youth from the culture, parents, and health professionals tracking them into medical pathways they otherwise may avoid if given proper support and allowed to mature.

The increasing but unproven narrative in the “gender affirmative” movement is that no therapy can resolve gender dysphoria, and social and medical transition are the only options. Here is a case study where an individual resolved gender dysphoria with therapy by addressing homophobia, making this study pertinent to the concerns of GHQ:

Behavioral treatment of transsexualism: A case report:

Patients who believe themselves to be transsexual seek only confirmation of their diagnosis so that they may proceed with their pre-chosen course of management: hormones and surgery. Their syntonic emotional set generates resistance to any other therapeutic direction. Despite this attitude, it is the therapist's responsibility to assess each case individually and to decide, with the patient, on realistic goals even if they be different from the original one. This case emphasizes this need since a probing history revealed underlying conflict and anxiety related to severe homophobia. With revelation of the homophobia, various behavioral techniques could be used therapeutically. These resulted in acceptance of lesbianism as a life style. Careful assessment of patients with self-diagnoses of transsexualism can sometimes uncover a different etiology to which appropriate therapy can be applied.

There is a critical study, Singh et al. (2021), called A Follow-Up Study of Boys With Gender Identity Disorder. It shows high rates of desistance in boys with DSM-diagnosed gender dysphoria. Many desisters grew up to be gay men, as indicated in previous studies. The results- 139 participants, 17 (12.2%) were persisters, and the remaining 122 (87.8%) were desisters. This is a very high rate of desistance from a clinical diagnosis, thus involving some amount of distress. These were not just “boys who liked pink.”

It appears persisters on average will be the most “gender variant,” which is not surprising:

Compared to the reference group, the biphilic/androphilic persisters tended to be older at the time of the assessment in childhood, were from a lower social class background, and, on a dimensional composite of sex-typed behavior in childhood were more gender-variant. The biphilic/androphilic desisters were more gender-variant compared to the gynephilic desisters. Boys clinic-referred for gender identity concerns in childhood had a high rate of desistance and a high rate of a biphilic/androphilic sexual orientation. The implications of the data for current models of care for the treatment of gender dysphoria in children are discussed.

But this doesn't mean no desisters fell into this range, given these are averages. In fact, many did. There was more detailed information in the dissertation by Devita Singh that was the basis for this paper. One measure of particular interest was a composite score of each subject's scores on several tests that may indicate more intense levels of dysphoria or gender nonconformity:

As can be seen from Table 15, the childhood sex-typed behavior measures on which the groups differed were significantly correlated.24 From these six measures (first drawn person on the Draw-a-Person, free play, Gender Identity Interview, cross-sex peer preference on the Playmate and Play Style Preferences Structured Interview, 21 cross-sex toy preference on the Playmate and Play Style Preferences Structured Interview, and the Gender Identity Questionnaire for Children), a composite score of childhood sex-typed behavior was derived for each participant by taking the average of the six variables 25 (each expressed as z-scores). Thus, the composite score was expressed as a z-score. A higher composite z-score indicates more cross-gender behavior at assessment (Fig. 2).

 We see that the differences between the Draw-a-Person test, was not significantly different between the persisters and homosexual desisters:

On the Draw-a-Person, there was one significant post-hoc contrast. The bisexual/ homosexual persisters were, on average, significantly more likely to draw a female first compared to the heterosexual desisters (p = .04). The comparison between the bisexual/ homosexual desisters and heterosexual desisters approached significance (p = .09), with the bisexual/homosexual desisters showing a greater tendency to draw a female first. The comparison between the bisexual/homosexual persisters and bisexual/homosexual desisters was not significant (p > .05)

Also:

The bisexual/homosexual persisters had a 274% increase in odds of having a higher composite score (i.e., more childhood cross-gender behavior)…

 And regarding desisters:

The bisexual/homosexual desisters had a 48% increase in odds of having a higher composite score compared to the heterosexual desisters.

We see that a significant number of homosexual desisters, a larger group than the persisters (N=66 v n=16), fell into the range of the persisters’ z-score. This is the population Gender Health Query is most concerned about, very gender nonconforming and cross-sex identified boy children, who now will be reinforced in body dissociation and possibly medicalized at puberty before testosterone exposure to their brains during the maturation process.

The paper discovers the most relevant variables, as seen below. Interestingly, lower socioeconomic status increases the likelihood of persistence, and they suggest these families may be more likely to have negative views of homosexuality and prefer a trans status in their child.

To evaluate the influence of childhood sex-typed behavior and demographic variables on group outcome at follow-up, a multinomial logistic regression was performed using the composite score and the demographic variables on which the groups differed26–age at assessment, IQ, and social class–as predictor variables. It can be seen from Table 16 that both social class and the composite score of childhood sex-typed behavior were significant predictors of group outcome at follow-up in the first model which compared the bisexual/ homosexual persisters to the bisexual/homosexual desisters

Dr. Ken Zucker stated on his twitter account the study has flaws but:

I think that this is the best follow-up study to date in terms of the sample size and the methods of assessment. It does, of course, have its flaws, but I think that the data speak for themselves.

See the entire thread here https://threadreaderapp.com/thread/1376412138227503104.html

 Zucker notes in a tweet thread:

This will probably be the last follow-up study in the literature that tracks longer-term psychosexual development of children (i.e., those seen clinically for the first time between the ages of 3-12 years) during an era where "treatment"--when there was treatment--came in a...

variety of shapes and forms. But the one type of "treatment" (with one exception) that these children did not receive was what is now known as pre-pubertal social transition. Thus, this follow-up study can be used as a comparative benchmark with regard to the persistence and...

desistance of gender dysphoria for any new follow-up studies that look at persistence and desistance among children who socially transitioned prior to puberty. I have argued elsewhere (Zucker, 2018) and in the Discussion that pre-pubertal social transition (where it is...

implemented by parents, on their own, without any clinical input from "professionals" or at the suggestion of professionals, or in combination is a form of psychosocial treatment of gender dysphoria...just of a very different kind.

We did internet searches to see if any “LGBTQ” organizations such as the HRC, PFLAG, or The Trevor Project referenced this study, given they are recommending social and medical transition of children and teens. They have not, to our knowledge. We believe these entities have become a danger to pre-gay and lesbian youth despite putting LBG in their names. Their purpose is exclusively promoting the interests of current trans activism, medicalizing children/teens, and replacing sex-based rights in law with gender identity.

The high desistance rate in the above study that took place at a time when they were not being "affirmed" is in stark contrast to an extremely high persistence rate in a follow-up study by The Trans Youth Project regarding fully "affirmed" minors called “Gender Identity 5 Years After Social Transition.”

RESULTS
We found that an average of 5 years after their initial social transition, 7.3% of youth had retransitioned at least once. At the end of this period, most youth identified as binary transgender youth (94%), including 1.3% who retransitioned to another identity before returning to their binary transgender identity. A total of 2.5% of youth identified as cisgender and 3.5% as nonbinary. Later cisgender identities were more common among youth whose initial social transition occurred before age 6 years; their retransitions often occurred before age 10 years.

This paper will be discussed in more detail in an update to Topic 4 due to their avoidance of contemplating that they are tracking would-be desisters into trans identities, and that this could account for their drastically higher persistence rates versus prior studies.

The same group of researchers published a paper called Retransitioning: The experiences of youth who socially transition genders more than once that focused on the youth who keister from a cross-sex identity. Their use of the term “retransition” is the new preferred parlance of affirmative model advocates.

They state:

Conclusions: These findings largely do not support common concerns about retransitions. In supportive environments, gender diverse youth can retransition without experiencing rejection, distress, and regret.

This comment lends no proof one way or the other that the affirmative protocol is or isn’t significantly increasing the likelihood that youths will medicalize.

The study Progression of Gender Dysphoria in Children and Adolescents: A Longitudinal Study tracked youth from an insurance database:

METHODS
A cohort of 958 gender-diverse (GD) children and adolescents who did not have a gender dysphoria–related diagnosis (GDRD) or GAHT at index were identified. Rates of first GDRD and first GAHT prescription were compared across demographic groups.

And:

The STRONG cohort includes participants from Kaiser Permanente (KP) integrated health care systems in Georgia, Northern California, and Southern California.

They found that some youth with gender dysphoria diagnosis were not dysphoric post puberty. It also appears females may be less likely to desist than males:

Both Dutch studies found that most participants did not experience gender dysphoria beyond puberty. This result is consistent with our observation that less than one-third of children presenting with GD behaviors received a GDRD and only approximately one-quarter initiated hormone therapy during follow-up. The Dutch researchers also reported a greater likelihood of unalleviated gender dysphoria in children who presented at an older age and among AFAB participants, both results in agreement with our findings.

A study, Karrington (2022), published by a trans-identified individual in Transgender Health, is called “Defining Desistance: Exploring Desistance in Transgender and Gender Expansive Youth Through Systematic Literature Review.” It claims that desistance isn’t a relevant concept for study. Desistance in the paper is defined below:

Thirty definitions of desistance were found, with four overarching trends: desistance as the disappearance of gender dysphoria (GD) after puberty, a change in gender identity from TGE to cisgender, the disappearance of distress, and the disappearance of the desire for medical intervention.

The conclusion of the paper obviously advocates for the affirmative model trans activists are demanding. Not bothering with tracking social and medical influences on persistence/desistance serves their priorities:

Conclusions: This review demonstrates the dearth of high-quality hypothesis-driven research that currently exists and suggests that desistance should no longer be used in clinical work or research. This transition can help future research move away from attempting to predict gender outcomes and instead focus on helping reduce distress from GD in TGE children.

Another trans activist produced a similar paper, Ashley (2022), called “The Clinical Irrelevance of “Desistance” Research for Transgender and Gender Creative Youth.”

Lisa Selin Davis, who has been writing on this subject, discussed desistance research in an article for Skeptic called “Trans Matters: An Overview of the Debate, Research, and Policies.”

She also reported on an individual case of desistance in an article titled “A Desister’s Tale.” The article concludes:

Children and their families should know about the desistance literature, and that the way they feel now, no matter how intensely, isn’t necessarily a sign of how they’ll feel in the future. By exposing them to a diversity of stories, including Ash’s, we can restore balance to the discussion in a way that may help many distressed young people navigate a difficult and confusing time.

Individual cases of desistance are also in “’Desistance’ in two cases of transgender men” on Why Evolution is True.

Despite the existence of desistance, WPATH is removing any recommendation for age restrictions on medicalizing minors.

Elkadi et al. (2023), a paper called “Developmental Pathway Choices of Young People Presenting to a Gender Service with Gender Distress: A Prospective Follow-Up Study,” discusses desistance rates:

This prospective case-cohort study examines the developmental pathway choices of 79 young people (13.25–23.75 years old; 33 biological males and 46 biological females) referred to a tertiary care hospital’s Department of Psychological Medicine (December 2013–November 2018, at ages 8.42–15.92 years) for diagnostic assessment for gender dysphoria (GD) and for potential gender-affirming medical interventions. All of the young people had attended a screening medical assessment (including puberty staging) by paediatricians. The Psychological Medicine assessment (individual and family) yielded a formal DSM-5 diagnosis of GD in 66 of the young people. Of the 13 not meeting DSM-5 criteria, two obtained a GD diagnosis at a later time. This yielded 68 young people (68/79; 86.1%) with formal diagnoses of GD who were potentially eligible for gender-affirming medical interventions and 11 young people (11/79; 13.9%) who were not. Follow-up took place between November 2022 and January 2023. Within the GD subgroup (n = 68) (with two lost to follow-up), six had desisted (desistance rate of 9.1%; 6/66), and 60 had persisted on a GD (transgender) pathway (persistence rate of 90.9%; 60/66). Within the cohort as a whole (with two lost to follow-up), the overall persistence rate was 77.9% (60/77), and overall desistance rate for gender-related distress was 22.1% (17/77). Ongoing mental health concerns were reported by 44/50 (88.0%), and educational/occupational outcomes varied widely. The study highlights the importance of careful screening, comprehensive biopsychosocial (including family) assessment, and holistic therapeutic support. Even in highly screened samples of children and adolescents seeking a GD diagnosis and gender-affirming medical care, outcome pathways follow a diverse range of possibilities.

This abstract confirms DSM diagnosed minors do desist from the clinical definitions of gender dysphoria as listed in the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” which is supposed to have more rigid criteria, reducing the likelihood of defining desisters as “true trans.” The desistance rate is still low compared to prior studies where children were not affirmed in their gender dysphoria and cross-sex identification which is concerning. We can also see two of the minors who didn’t receive an initial DSM diagnoses, wound up with one later. The affirmation of gender dysphoria in youth with forming identities is a severe risk to these minors as transition regret appears to be increasing.

Topic 8 deals with detransition and regret. One can find many examples are LGB youth.

See Original Post 1) DO CHILDREN & TEENS WITH SERIOUS GENDER DYSPHORIA EVER DESIST FROM THE DYSPHORIA. YES

More blog posts relating to this Topic are here.

CONTINUE TO TOPIC 2:

Hormone blockers, trans youth, & permanent side effects such as sterility & loss of sexual function
Medical consequences of hormone blockers, cross-sex hormones, surgery, to gender dysphoric & trans youth

Stats for Gender: A New Resource for Accurate Information Regarding Gender Dysphoria

News Commentary

Stats for Gender (statsforgender.org) is an organization that has formed recently to provide people with legitimate resources regarding gender dysphoria. There is a lot of misinformation and spin in the press regarding gender dysphoric youth and the trans movement in general. This also extends to medical bodies that fail to describe gender dysphoria research accurately. This is particularly true in regards to desistance and suicide risk. Stats for Gender will be a good resource for those seeking accurate information. GHQ does it’s best to source our material and examine data in legitimate ways regarding gender dysphoria research. References can be found in links at the end of each “Topic.”

WPATH Members Provide Uncontested Validation of GHQ Mission

News Commentary

Going back as far as 2014 and earlier, parents, desisters, detransitioners, LGB people, health professionals, autism experts, and some trans people have been ringing alarm bells about the safety of pediatric medical transition for gender dysphoric minors under "the affirmative model." This model may involve social transition at age three, puberty blockers at age ten, and surgery and cross-sex hormones as young as thirteen. WPATH is a very pro-medical transition organization that promotes "Standard of Care" but is strongly influenced by activists highly motivated to transition children medically. Despite this, three of its members have been speaking out about the dangers that are surrounding "the affirmative model." They are Marci Bowers, an MtF surgeon who specializes in vaginoplasty, and Erica Anderson and Laura Edwards-Leeper, who are mental health professionals. Their concerns are regarding reckless mental health practices that rapidly transition youth with little assessment, the considerable increase in female young people wanting medical transition, and the reality placing male tweens on puberty blockers (and then cross-sex hormones) ruins their sexual function for the rest of their lives and requires dangerous and experimental bottom surgeries due to stunted genital growth.

These are the very concerns our organization has raised since 2019, and our board members have raised since 2015. Because affirmative model advocates such as Johanna Olson-Kennedy, Diane Ehrensaft, Michelle Forcier, Jack Turban, and Kristina Olson have so misled the public to believe in the health and safety of this protocol, any person who raised the concerns these WPATH members are now has been painted as a "bigot," a "concern troll," and a "transphobe,” often accompanying verbal abuse and threats to one’s career.

We are glad the WPATH members are speaking out now. We'd like to believe this is in good faith and not solely motivated by fears of lawsuits. The fact that they have done this creates a new reality that there will be no more plausible deniability this can harm in the future. This protocol should have received more scrutiny years ago:

Top Trans Doctors Blow the Whistle on ‘Sloppy’ Care

What Do We Mean By “Gender Affirming Care?” A Conversation with Dr. Laura Edwards-Leeper

News in Trans Medical Treatment Side-Effects

News Links

GHQ covers the side-effects of medical transition for gender dysphoria in Topic 2. We are tagging recent news articles to update that section.

1) There is contradictory information regarding the risk of blood clots and stroke. Two newer studies do not show elevated risk of blood clots.

“Venous Thrombotic Risk in Transgender Women Undergoing Estrogen Therapy: A Systematic Review and Metaanalysis” (Kahn 2019) states the risk of hormone therapy is similar to that of women who are on birth control pills.

“Effects of Gender-Affirming Hormones on Lipid, Metabolic, and Cardiac Surrogate Blood Markers in Transgender Persons” (Defreyne 2019) attributes risk thromboembolic morbidity to the use of estradiol, no longer prescribed and thus more recent regimens are safer. They also state evidence on cardiometabolic disease is inconclusive.

2) “Physiologic Response to Gender-Affirming Hormones Among Transgender Youth" (Olson 2018) indicates that some young females being given testosterone may already be pre-hypertensive. In two females in the study, after 2 years of testosterone, the BP went from normal to hypertensive, and triglycerides increase, HDL decreases. A normal range is under 120 SBP. Elevated is 120-129. HTN is 130 and up. SBP went from 115 to 128 but is described in the paper as "not clinically significant:"

RESULTS: Of the initial 101 participants, 59 youth had follow-up physiologic data collected between 21 and 31 months after initiation of hormones available for analysis. Metabolic parameters changes were not clinically significant, with the exception of sex steroid levels, intended to be the target of intervention.

3) "Effects of testosterone therapy on lipid profile in trans men during a 6-month prospective clinical study" (Tancic-Gajic EPATH presentation) indicates testosterone therapy may lower HDL (good) cholesterol.

Short term testosterone therapy in transgender men was associated with increases in BMI and with decreases in HDL-cholesterol. Long-term studies are needed to assess the long-term cardiometabolic risks of testosterone therapy in trans men.

4) “Suppressing Puberty by GnRHa: Unresolved concerns” (Meyer-Bahlburg EPATH presentation) reviews the data indicating concerns for the use of hormone blockers in children/teens:

Results and Conclusions

Animal models: Studies of the effects of prolonged GnRHa treatment in juvenile sheep have shown sex-specific im- pacts on emotion and behavior regulation (Wojniusz et al., 2011), impairment of long-term spatial memory (Hough et al., 2017a) which persisted after GnRHa discontinuation (Hough et al., 2017b), sex-specific effects on gray-matter and amygdala volume (Sex on Brain European Research Group - SOBER, et al., 2013), and on sex-biased gene ex- pression of the amygdala (Nuruddin et al., 2013).

Children with CPP: Two modest-sized studies showed impairment of Wechsler IQ of about 1⁄2 standard deviation, affecting especially the Performance IQ (Mul et al., 2001; Wojniusz et al., 2016; Hayes, 2017).
Adolescents with GD: A case study showed a significant drop in working memory, which did not reverse after GnRHa treatment ended (Schneider et al., 2017). In a study of a small sample, GnRHa treatment did not affect executive functioning in terms of the Tower-of-London task (Staphorsius et al., 2015).

In conclusion, the very limited findings from sheep studies as well as from small human samples raise significant concerns about possible long-term adverse side effects of prolonged GnRHa treatment on brain development. Urgently needed are: (a) systematic studies of GnRHa effects on the developing brain in animal models that are more closely guided by the evidence regarding brain organization during puberty; (b) corresponding (preferably prospective) studies of pertinent behaviors and underlying brain structure and function in human clinical samples undergoing GnRHa treatment.

5) There are two papers about two incidences of adolescent females with venous thromboembolism, a life-threatening condition.

“Hormone Therapy and Venous Thromboembolism in a Transgender Adolescent” (Stanley 2018):

Abstract
Venous thromboembolism can be precipitated by both genetic and acquired factors, but the role of testosterone therapy is less clear. Here, we present a 17-year-old transgender adolescent, transitioning from female to male, receiving both estrogen and testosterone therapy, who developed a pulmonary embolism without an underlying genetic thrombophilic condition. As transgender medical care evolves, the use of testosterone as cross-sex hormone therapy in adolescents is likely to increase. Our review suggests that care must be taken when initiating treatment with testosterone, and modification of other thrombophilic risks should be explored before starting therapy in this population.

“Venous Thromboembolism in a Transgender Adolescent on Testosterone Therapy: A Case Report and Literature Review.” (Fan 2020):

Abstract
The incidence of pediatric venous thromboembolism (VTE) has been increasing in the past few decades and can be associated with significant mortality and morbidity. There are known risk factors associated with VTE, including estrogen therapy. However, the relationship between testosterone and VTE remains unclear. Here, we present a 17-year-old female-to-male transgender patient without a history of inherited thrombophilia, who developed pulmonary embolism while receiving testosterone injections for gender dysphoria. Despite the limited data on testosterone and the risk of VTE, health care providers should counsel patients and family about the possible increased risk of VTE when starting testosterone.

6) Hormone blockers have negative impacts on bone health but cross-sex hormones may not to the same extent.

“Hormone therapy in transgender patients is safe for bone”

Transwomen are more likely to have a lower bone mineral density (BMD) before beginning hormone therapy, compared with male reference populations, but there are no short- or long-term risks to bone health over the life of a transperson who receives hormone therapy, according to a presentation at the annual meeting of the American Society for Bone and Mineral Research.

“Hormonal treatment of transgender people is safe with respect to bone,” said Martin den Heijer, MD, PhD, of the VU University Medical Center in Amsterdam.

This article did say after ten years, there was an increased risk of osteoporosis and hip fracture.

7) “Brain Maturation, Cognition and Voice Pattern in a Gender Dysphoria Case under Pubertal Suppression” (Schneider 2017) shows puberty blockers may cause as much as a ten-point drop in IQ points but this is not mentioned in the abstract. The abstract doesn't mention that IQ fell from 80 to 70 after GnRHa. Also, IQ normally increases between age 8 and 16.

8) “The Pediatric Endocrine Society’s Statement on Puberty Blockers Isn’t Just Deceptive. It’s Dangerous:”

The Pediatric Endocrine Society recently issued a statement claiming that the effects of puberty-blocking medications on normal puberty are reversible. Has the FDA determined that there is scientific evidence to validate this claim? Have there been any rigorous long-term studies addressing this question? Is social transition truly harmless? Is it ethical to continue this experiment on children? The answer to all of those questions is no.

The author, who strongly opposes pediatric medical transition, lays out other negative health consequences to medically transitioning minors here. He also states the even if the medical establishment deems puberty blockers to be dangerous, cross-sex hormones alone won’t be enough to stop masculinization in males on estrogen.

9) Trans people experience very high rates of sexual dysfunction (Kerckhof 2019).

“New study provides insight into the sexual dysfunctions experienced by transgender individuals:”

Transgender individuals tend to report experiencing more sexual problems than the general population, according to new research published in The Journal of Sexual Medicine. But the prevalence of sexual dysfunction is highest among transgender individuals who do not receive gender-affirming surgeries…

“At the same time, the study shows us that even after gender-affirming interventions, both trans women and trans men still suffer from a specific number of sexual complaints. These individuals in the female spectrum experience orgasm difficulties (1 in 3), pain complaints during intercourse (1 in 4) and a fear of sexual contact (1 in 5),” Elaut said…

Like all research, the study includes some limitations. The study used a cross-sectional design — so it is unclear if gender-affirming interventions reduce sexual dysfunction or if people with better sexual functioning are more likely to undergo such operations…

The study, “Prevalence of Sexual Dysfunctions in Transgender Persons: Results from the ENIGI Follow-Up Study“, was authored by Mauro E. Kerckhof, Baudewijntje P. C. Kreukels, Timo O. Nieder, Inga Becker-Hébly, Tim C. van de Grift, Annemieke S. Staphorsius, Andreas Köhler, Gunter Heylens, and Els Elaut.

10) We are adding several articles and the negative side-effects steroids have on the female body:

“Performance Enhancing Anabolic Steroid Abuse in Women”

“Why Anabolic Steroid Addiction Is More Dangerous for Women—and How to Get Help"

"Psychiatric and medical effects of anabolic-androgenic steroid use in women"

Detransition and Gender Dysphoria

News Links

Detransition and regret rates appear to be increasing. Most regretters appear to be biological females and lesbians. Below are several links to articles about desistance and detransition.

1) This research paper acknowledges the complications in treating gender dysphoria in minors. Cases of desistance are reviewed.

“‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficulties:”

Abstract

As the number of young people referred to specialist gender identity clinics in the western world increases, there is a need to examine ways of making sense of the range and diversity of their developmental pathways and outcomes. This article presents a joint case review of the authors caseloads over an 18-month period, to identify and describe those young people who presented to the Gender Identity Development Service (GIDS) with gender dysphoria (GD) emerging in adolescence, and who, during the course of assessment, ceased wishing to pursue medical (hormonal) interventions and/or who arrived at a different understanding of their embodied distress. From the 12 case‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficultiesTaking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficultiess identified, 2 case vignettes are presented. Implications for the development of clinical practice, service delivery and research are considered.

2) Finland plans to study transition regret and detransition.

“Study aims to chart transition regret in Finland:”

"I wish I'd never done it"

Twenty-seven year-old Nita said her mental health problems were not adequately addressed before she began a medical female to male transition.

Nita said she's not alone and that she knows several people who have transitioned back to their original gender.

Irreversible effects

Nita began transitioning to male in her 20s, saying she approached transitioning lightly, akin to getting a tattoo. To make her body more masculine, Nita took testosterone and had a mastectomy.Study aims to chart transition regret in Finland

“The whole trans process injected meaning into my life. There was a constant goal to work towards,” she explained. “Now it bothers me that I’m a 27-year-old woman who sounds like a teenage boy.”

3) Carey Callahan has been an outspoken detransitioned women who is part of a group for individuals who have, or want to seek, medical transition services called Gender Care Consumer Advocacy Network. She addresses the libertarian transition environment under “informed consent.”

“Gender identity is hard but jumping to medical solutions is worse:”

The day I knew I should quit my job answering phones at the transgender health-care clinic in California was the day a caller (let’s use the name Betty) threatened her in-home caretaker with a knife during the call. As the caretaker begged our clinic’s nurse to track down Betty’s doctor and tell him that Betty was having a psychotic episode, Betty stood between her and the apartment’s front door with a kitchen knife. Betty had poorly controlled paranoid schizophrenia, and often called the clinic agitated, alternately whispering and screaming about government agents stalking her. Betty was also a trans woman whom most people regarded as male, the sex of her birth. 

The clinic followed the “informed-consent” protocol: its mission was to provide transgender patients who otherwise lacked access to health care with injections, skin patches and pills of feminising or masculinising hormones without having to pass through a series of requirements and assessments—known as “gatekeeping”—that restricted access in the past.

In medicine broadly, informed-consent refers to the ethical requirement that a clinician administering a treatment communicate to the patient the anticipated risks and benefits, as well as reasonable alternatives to the treatment. Yet for transition medicine in America, informed-consent programmes do not require clinical documentation, beyond patient reports, of the patient’s gender dysphoria over time (ie, a feeling of mismatch between one’s biological sex and gender identity) and readiness for medical interventions. 

Gatekeeping horror stories are notorious in the transgender community.

4) Lisa Marchiano is an LCSW who works with detransitioned people.

“The Ranks of Gender Detransitioners Are Growing. We Need to Understand Why:”

The young women with whom I have worked became trans identified during adolescence. They frequently did so in the context of significant family dysfunction or complex psycho-social issues. Sexual assault and sexual harassment were common precursors. A majority had an eating disorder at the time they became trans identified. Since detransitioning, most now understand themselves to be butch lesbians. In our work together, they traced complex histories of coming to terms with their homosexuality. Some faced vicious homophobic bullying before they announced their trans identification…

Dismissing detransition as a “panic” stirred up by biased media outlets does a grave disservice to the real men and women who are struggling through the difficult experience of detransition. It isn’t good science—or good journalism—to ignore a category of people simply because their pain is politically inconvenient.

5) The BBC has also recently covered the topic of detransition here and here.

6) Dr. Lisa Littman is doing a research study on desistance and detransition.

7) A video on “Detrantransition and Retransition” from National LGBT Health Information.

8) Several videos below cover individuals’ experiences with transition regret:

“A Woman's Place is marching on together (Leeds, 22nd November 2019) Thomasin Pick”

“Thoughts on butch erasure (FTM detransition)”

9) Storm Ryan, a well-known trans Youtuber, is very alarmed at the exploding numbers of trans-identified teens.

“my last trans vid ever”

Nature and Nurture- Trans and LGB Research Update

News Links

Brain Research

Researchers (Gliske 2019) propose some new theories about the cause of gender dysphoria that goes beyond the popular “pink brain/blue brain” narrative that emphasizes cross-sex brain similarities (true in homosexual transexuals, not in autogynephilic transexuals). The term this paper uses for this is “cross-sex brain theory.” The authors point to regions in the brain relating to dissociation from the body and anxiety about the body and the networks between brain regions. This is different from the more common and simplistic view of innate brain sex. Gliske uses the term “multisense.” Below is a summation of the findings:

We hypothesize that in individuals with gender dysphoria, the aspects of chronic distress, gender atypical behavior, and incongruence between perception of gender identity and external primary sex characteristics are all directly related to functional differences in associated brain networks. We evaluated previously published neuroscience data related to these aspects and the associated functional networks, along with other relevant information. We find that the brain networks that give individuals their ownership of body parts, that influence gender typical behavior, and that are involved in chronic distress are different in individuals with and without gender dysphoria, leading to a new theory—that gender dysphoria is a sensory perception condition, an alteration in sense of gender influenced by the reflexive behavioral responses associated with each of these networks. This theory builds upon previous work that supports the relevance of the body ownership network and that questions the relevance of cerebral sexual dimorphism in regards to gender dysphoria. However, our theory uses a hierarchical executive function model to incorporate multiple reflexive factors (body ownership, gender (a)typical behavior, and chronic distress) with the cognitive, reflective process of gender identity…

After considering this hypothesis, we present a new theory of gender dysphoria, consistent with the latest neuroscience data, that stands in contrast to the common opposite brain sex theory and builds upon the work relating body perception with gender dysphoria (Burke et 112  al., 2017b; Manzouri et al., 2017; Manzouri and Savic, 2019). We denote this new theory the multisense theory of gender dysphoria. This new theory focuses on function, including sense of gender and its inputs, rather than male/female dichotomy in anatomical size and shape (the focus of the opposite brain sex theory). For clarity, in this document we use “sense of gender” to refer to the emergent sense arising from the function of multiple networks, and “brain sex” to refer to anatomical characteristics of the brain relative to male/female dichotomy. We also use the term “transgender” throughout this manuscript, though recognize that some references instead use the word transsexual to refer to the same concept. We observe, based on previously published data, that the primary mechanism behind the experience of gender dysphoria appears not to be that the anatomical brain sex is opposite to gender assigned at birth. Instead, we propose that systemic changes in functional networks, specifically the distress, social behavioral and body-ownership networks, result in the incongruence between sense of gender and gender assigned at birth.

Newsweek published an article that contains critiques of the paper’s positions and Gliske’s suggestion that there may be other alternatives to help GD beyond medical treatment. In current gender discourse, there tends to be strong pushback if any person suggests it would be a better outcome to avoid genital surgery, mastectomy, and the known negative side-effects of taking high doses of cross-sex hormones:

Simona Giordano, an expert in gender identity and Reader in Bioethics at The University of Manchester Law School, who did not work on the study, told Newsweek she was surprised Gliskesuggested altering neural structures and networks is less invasive than providing gender-affirming treatment.

Giordano also argued Gliske's suggestions for treatment would "get rid of gender incongruence," and expressed concern this amounts to a form of "medical conversion." 

While understanding the mechanisms of sexual orientation and gender identification is a "legitimate scientific effort," Giordano argued, she said "science that singles out gender minorities as subjects of study might inadvertently suggest that there is an underlying medical problem."

"Should we use these hypothetical therapies, we would no longer have gender dysphoria sufferers because we would no longer have transgender people," she said.  

Giordano highlighted that various international organizations, such as UNESCO, and the Council of Europe, have called de-pathologization of gender diversity. Last year, the World Health Organisationrenamed gender identity disorder as gender incongruence to "reflect the international consensus that gender diversity is not a disorder or illness," she said.

Professor Catherina Becker, acting director of the Centre for Discovery Brain Sciences at the U.K.'s University of Edinburgh, who did not work on the paper, also critiqued the work. She commented in a statement: "The present paper is a review and reinterpretation of other studies without providing significant new experimental or epidemiological data.

Here are two other articles from The Daily Mail and Inverse.

Biological Factors in In Identity & Orientation

A new study (Nila, 2019) confirms the fraternal birth order (FBO) effect noted in homosexual males in an Indonesian population:

Abstract

Male homosexual preference (MHP) is an evolutionary enigma because it is partially heritable and imposes a fertility cost. In occidental societies, homosexual men are feminized at various levels and they have more older brothers than heterosexual men. To evaluate whether femininity and the fraternal birth order (FBO) effect are universal features of MHP or not, we collected original data from homosexual men, heterosexual men, and heterosexual women from Java (Indonesia). Facial photographs were used to test whether homosexual faces are feminized when compared with heterosexual ones. We found that faces manipulated to resemble the average face of homosexual men are perceived as facially feminized, suggesting that homosexual men are facially feminized compared to heterosexual men, although a higher facial femininity was not captured by morphological analyses. Then, family data were used to detect differences in siblings’ composition between homosexuals and heterosexuals. Homosexual men displayed a higher number of older brothers than heterosexual men, even when sibship size was controlled for, suggesting that the FBO effect exists in Indonesian populations. Independent of sexual orientation, men with older brothers seem more feminized than those without older brothers, consistent with the immune origin of the FBO effect. In conclusion, MHP in Indonesia is partially feminized and they have more older brothers. Such features are also associated with MHP in other cultural contexts, suggesting a cross-cultural effect of men homosexual preference. An evolutionary explanation is available for the feminizing effect, although the FBO effect remains unexplained even if proximal mechanisms start to be identified.

A new study (Rahman 2019) reviewing the populations of lesbian, gay, and bisexual people in various countries supports arguments for innate sexual orientation:

Abstract

The prevalence of women’s and men’s heterosexuality, bisexuality, and homosexuality was assessed in 28 nations using data from 191,088 participants from a 2005 BBC Internet survey. Sexual orientation was measured in terms of both self-reported sexual identity and self-reported degree of same-sex attraction. Multilevel modeling analyses revealed that nations’ degrees of gender equality, economic development, and individualism were not significantly associated with men’s or women’s sexual orientation rates across nations. These models controlled for individual-level covariates including age and education level, and nation-level covariates including religion and national sex ratios. Robustness checks included inspecting the confidence intervals for meaningful associations, and further analyses using complete-cases and summary scores of the national indices. These analyses produced the same non-significant results. The relatively stable rates of heterosexuality, bisexuality, and homosexuality observed across nations for both women and men suggest that non-social factors likely may underlie much variation in human sexual orientation. These results do not support frequently offered hypotheses that sexual orientation differences are related to gendered social norms across societies.

A quote from the article appears to show possible cultural influence on whether or not men will identify as gay and there is more variability in countries around women and bisexuality:

However, prevalence rates of men’s homosexual identity were more variable, across nations, than prevalence rates of women’s lesbian identity, p = .009. When sexual orientation was assessed in terms of participants’ same-sex attraction, women were more variable than men, across nations, in their prevalence of being moderately attracted to the same sex, p < .004. However, women and men did not differ significantly in the variability of their prevalence of not being attracted to the same sex and being predominantly attracted to the same sex (all ps > .05).

There appear to be more gay men than lesbians but more bisexual females than bisexual males:

However, a higher percent of men (4.9%) than women (2.1%) reported a homosexual identity, t(54) = 5.22, p < .001, whereas a lower percent of men (5.1%) than women (7.2%) reported a bisexual identity, t(54) = − 3.25, p = .002

In summary:

Finally, the relatively small cross-nation SDs reported in Table 4—particularly for prevalence rates for homosexual identities and predominant same-sex attractions—suggest substantial consistency across nations. Thus, despite the existence of variations across nations, sexual orientation rates were nonetheless relatively stable across nations.

A study on feminine Samoan males (called fa ‘afafina) reveals men who have sex with feminine (intact) males display a variety of orientation patterns from bisexual to primarily homosexual or heterosexual. This shows that these men are a diverse group. Ray Blanchard, a gender dysphoria expert and psychologist, coined the term gynoandromorphalia for males who are interested in trans MtFs or cross-dressing males. But it appears this may be a diverse group:

Abstract

In Samoa, feminine natal males who possess male-typical genitalia are known locally as fa’afafine. Some Samoan men express sexual interest in fa’afafine, whereas others do not. To assess the sexual orientation of men who are sexually interested in fa’afafine, we collected sexual attraction ratings and viewing times of Samoan men’s and women’s faces. Study 1 (N = 130) focused on men who were insertive or versatile during anal sex with fa’afafine partners. These men were compared to each other, as well as to males (i.e., men and fa’afafine) who were exclusively sexually interested in either women or men. Study 2 (N = 180) compared men who had sex with fa’afafine and women; men who had sex with fa’afafine, women, and men; and men who had sex with fa’afafine and men. These men were compared to each other, as well as to males who were exclusively sexually interested in either women or men. These studies suggest that men who have sex with fa’afafine are a heterogeneous group. A small portion of the men who are sexually interested in fa’afafine shows a relatively bisexual pattern of sexual attraction ratings and viewing times, namely men who have sex with fa’afafine, men, and women. In contrast, a larger number of men who were sexually interested in fa’afafine responded in a manner similar to men who were exclusively sexually interested in either women or men. The present research suggests that additional insights into male sexual orientation can be garnered by focusing on how sexuality is expressed in non-Western cultural contexts.

Social Contagion

GHQ reviews the large rise in young people identifying as trans in Topic 10 and Topic 11. A parent group called the Kelsey Coalition made a post reviewing some more recent statistics concerning the large increases of trans-identification in teenagers:

-In Oregon, 6% of 8th graders and 5.5% of 11th graders identify as transgender or non-binary. 2019 Oregon Health Teens Survey. 

-In Hawaii, over 3% of over 38,000 public high school students surveyed identify as transgender. Hawaii Sexual and Gender Minority Health Report (2018):

-2% of Minnesota 8th grade girls identify as transgender, while an additional 3% were not sure. Minnesota 2019 Student Survey

-Among Wisconsin high school students, 1% identified as non-binary, 1% as gender fluid, 1% as transgender, and 2% were not sure. Dane County, Wisconsin Youth Assessment Survey, 9th-12th Grade Report (2018). Among Wisconsin middle school students, 2% identify as non-binary, 1% as transgender, and 3% were nv County, Wisconsin Youth Assessment Survey, 7th-8th Grade Report (2018).

-Surveys of Maine high school students found 1.5% identify as transgender and 1.6% of students were unsure of their gender identification. Maine Integrated Youth Health Survey (2017)

This paper reviews the data indicating a major increase in trans-identified young people in Nordic countries:

Abstract

Purpose: To explore whether the increase observed in referrals to child and adolescent gender identity services (GIDSs) has been similar in four Nordic countries and in the UK.

Materials and methods: Numbers of referrals per year in 2011–2017 were obtained from all GIDS in Denmark, Finland, Norway, Sweden and the UK and related to population aged <18.

Results: A similar pattern of increase in referral rates was observed across countries, resulting in comparable population adjusted rates in 2017. In children, male:female birth sex ratio was even; in adolescents, a preponderance of females (birth sex) was observed, particularly in Finland.

Conclusions: The demand for GIDSs has evolved similarly across Nordic countries and the UK. The reasons for the increase are not known but increased awareness of gender identity issues, service availability, destigmatization as well as social and media influences may play a role.

Body dysmorphia around gender isn’t the only body dysmorphia increasing rapidly. More you females are seeking labiaplasty surgery:

Dr Naomi Crouch, a leading adolescent gynaecologist, said she was concerned GPs were referring rising numbers of young girls who wanted an operation.

Labiaplasty, as the surgery is known, involves the lips of the vagina being shortened or reshaped.

The NHS says it should not be carried out on girls before they turn 18.

In 2015-16, more than 200 girls under 18 had labiaplasty on the NHS. More than 150 of the girls were under 15…

Anna - not her real name - considered having labiaplasty from the age of 14.

"I just picked up from somewhere that it wasn't neat enough or tidy enough and I think I wanted it to be smaller.

"People around me were watching porn and I just had this idea that it should be symmetrical and not sticking out.

"I thought that was what everyone else looked like, because I hadn't seen any normal everyday [images] before then.

"I remember thinking, 'If there's surgery for it, then clearly I'm not the only one who wants this done, and maybe it won't be that big a deal.'."

References

Gander, K. (2019, December 12). Transgender People Suffering From Gender Dyphoria May Have Key Brain Differences, Scientist Says. Newsweek. Retrieved from https://www.newsweek.com/transgender-people-gender-dysphoria-brain-differences-scientist-1475013

Kaitiala, R, Bergman, H., Carmichael, P., de Graaf, N., Rischel, K., Frisen, L. (2019). Time trends in referrals to child and adolescent gender identity services: a study in four Nordic countries and in the UK.

Mackenzie, J. (2017, July 3). Vagina surgery 'sought by girls as young as nine.' BBC. Retrieved from https://www.bbc.com/news/health-40410459

Nila, S., Crochet, P., Barthes, J., Rianti, P., Juliandi, B., Suryobroto, B., Raymond, M. (2019). Male Homosexual Preference: Femininity and the Older Brother Effect in Indonesia. Evolutionary Psychology. doi.org/10.1177/1474704919880701

Petterson, J. L., Dixson, B.J., Little, A. C. (2020). Heterogeneity in the Sexual Orientations of Men Who Have Sex with Fa’afafine in Samoa. Archives of Sexual Behavior, 1-13. https://doi.org/10.1007/s10508-020-01646-6

Rahman, Q., Xu, Y., Lippa, R.A. et al. (2019). Prevalence of Sexual Orientation Across 28 Nations and Its Association with Gender Equality, Economic Development, and Individualism. Archives of Sex Behavior, 1-12 doi.org/10.1007/s10508-019-01590-0

Gender Dysphoria and Other Mental Health Issues are Rising in Teens

News

This post will add information about the rising rates of gender dysphoria and other mental health issues.

Recent Trans Mental Health Studies Criticized

Michael Biggs has been criticizing a study involving giving puberty blockers to tweens/teens, Costa (2015), that claims puberty blockers are psychologically beneficial. This study is from the Gender Identity Services (GIDS) in Britain, and Biggs writes the benefits to the patients may be exaggerated by the researchers:

RESULTS

At baseline, GD adolescents showed poor functioning with a CGAS mean score of 57.7 ± 12.3. GD adolescents' global functioning improved significantly after 6 months of psychological support (CGAS mean score: 60.7 ± 12.5; P < 0.001). Moreover, GD adolescents receiving also puberty suppression had significantly better psychosocial functioning after 12 months of GnRHa (67.4 ± 13.9) compared with when they had received only psychological support (60.9 ± 12.2, P = 0.001).

CONCLUSION: 

Psychological support and puberty suppression were both associated with an improved global psychosocial functioning in GD adolescents. Both these interventions may be considered effective in the clinical management of psychosocial functioning difficulties in GD adolescents.

He has published a letter about the Costa study stating the claim that blockers are beneficial is suspect.

“A Letter to the Editor Regarding the Original Article by Costa et al: Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents with Gender Dysphoria:”

He wrote another article about puberty blockers and the adverse effects on bone health which the researchers in the study also appear to downplay.

A Swedish study about trans people has been published using data from the registered Swedish public. This a beneficial longitudinal survey from an estimated 95% of their population. The study finds trans people have much higher rates for mental health problems and suicide risk.

“Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study:”

Results:

Compared with the general population, individuals with a gender incongruence diagnosis were about six times as likely to have had a mood and anxiety disorder health care visit, more than three times as likely to have received prescriptions for antidepressants and anxiolytics, and more than six times as likely to have been hospitalized after a suicide attempt. Years since initiating hormone treatment was not significantly related to likelihood of mental health treatment (adjusted odds ratio=1.01, 95% CI=0.98, 1.03)…

But they state that with more time past medical transition attempts to access mental health services goes down. They say in the study this justifies medical transition: UPDATE: THE AMERICAN JOURNAL OF PSYCHIATRY NOW STATES THE DATA DOES NOT INDICATE SURGERY IMPROVES MENTAL HEALTH AND HAS ISSUED CORRECTIONS AFTER MULTIPLE LETTERS TO THE EDITOR EXPOSING THE STUDY’S FLAWS

However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (adjusted odds ratio=0.92, 95% CI=0.87, 0.98).

Conclusions:

In this first total population study of transgender individuals with a gender incongruence diagnosis, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.

Mark Regenerus is a researcher out of the University of Austin who appears to have an anti-homosexual/bisexual bias. He wrote a much-criticized study that claims children of LGB parents do poorly and filed an amicus brief against same-sex marriage in federal court. Almost all research on children of gay or lesbian couples over the last several decades shows that children in gay/lesbian households do as well as other children. The study lumped in any single parent, divorced parent, or those with transient same-sex experiences all in together. This isn’t a comparison with a two parent home. The study was also criticized for sloppy data gathering and analysis. Criticism of Regnerus may be found here and the story was covered in the Washington Post and elsewhere. Due to this track record, GHQ corroborated his claims about the Swedish study.

Regnerus explains the data gathered in the study is very sound:

This is as good as it gets when it comes to studying transgender medical experiences and outcomes.

Like Biggs, Regnerus states the researchers’ claims of benefit of medical transition are inflated:

Data from a new study show that the beneficial effect of surgery for transgender people is so small that a clinic may have to perform as many as 49 gender-affirming surgeries before they could expect to prevent one additional person from seeking subsequent mental health treatment. Yet that’s not what the authors say. That the authors corrupted otherwise-excellent data and analyses with a skewed interpretation signals an abandonment of scientific rigor and reason in favor of complicity with activist groups seeking to normalize infertility-inducing and permanently disfiguring surgeries…

First, a word about the hormones: the study found no mental health benefits for hormonal interventions in this population. There is no effect of time since initiating hormone treatment on the likelihood of subsequently receiving mental health treatment. Given the surge in interest, demand, and supply of hormonal therapies to self-identified transgender persons today, you would think that it is a solution that pays obvious benefits in reduced subsequent need—over time—for treatment of mood or anxiety disorder, or hospitalization after a suicide attempt. Yet there was no statistically significant effect. In fact, the confidence intervals actually reveal a nearly significant aggravating effect of hormonal treatment on subsequent mental health needs.

It is the surgical effect, however, that has grabbed all the attention. Bränström and Pachankis detected a statistically significant effect of time since last “gender-affirming” surgery on reduced mental health treatment. The adjusted (for controls) odds ratio for this was 0.92, meaning that, among respondents diagnosed with “gender incongruence” who then received gender-affirming surgical treatment, the odds of being treated for a mood or anxiety disorder (in 2015) were reduced by about 8 percent for each year since the last surgery. In other words, it would appear that the surgery—or more typically, the series of surgeries—benefited their mental health.

The numbers are crunched here:

But the authors discuss a “linear decrease” in seeking subsequent mental health care that is simply not visible in the study’s graphs, where post-surgical mental health treatment hovers stably around 35 percent among those in their first nine years after surgery, and then drops to only 21 percent of those patients who are in their tenth (or higher) year since their last surgery. However, only 19 total respondents reported their last surgery as having been completed 10 or more years ago. By contrast, 574 (out of 1,018 total) reported their last surgery as having been conducted less than two years ago. (Surgical treatment is clearly surging.) This means that the apparently helpful overall effect of surgery is driven by this comparatively steep drop in mood/anxiety treatment among only 19 patients. By the math, that would seem to indicate that four out of these 19 Swedes (i.e., 21 percent) sought help in 2015 for mood/anxiety problems.

While the study reports the adjusted odds ratio of the overall effect of time since surgery (0.92), which I cannot replicate without having data access, you don’t need the data to calculate an unadjusted odds ratio from the information presented there. This can tell us the baseline effect of time since surgery on receiving mood and anxiety treatment, only without the controls (like age, income, etc.). Doing this reveals the fragility of the study’s key finding: if a mere three additional cases among these 19 had sought mental health treatment in 2015, there would appear to be no discernible overall effect of surgery on subsequent mental health. The study’s trumpeted conclusion may hinge on as few as three people in a data collection effort reaching 9.7 million Swedes, 2,679 of whom were diagnosed with gender incongruence and just over 1,000 of whom had gender-affirming surgery…

Another helpful statistic I calculated is called the NNT, or “Number Needed to Treat.” It’s a measure of clinical impact. In this study, the NNT appears to be a staggering 49, meaning the beneficial effect of surgery is so small that a clinic may have to perform 49 gender-affirming surgeries before they could expect to prevent one additional person from seeking subsequent mental health assistance 1. If no other treatment was available, or the treatment was not invasive and the hazards were insignificant, clinics might consider surgery a low-risk but low-payoff approach. But none of those applies here. Conducting 49 surgeries to secure one additional patient who benefits? Unheard of.

He goes on to criticize the optimistic interpretation of the research as justification for risky medical treatments:

Physicians should not be pushed to prescribe such profoundly consequential treatment by threat of call-out, malpractice suits, patient demand, or—in this case—the overreaching interpretations of quality data. Clinicians are being bullied into writing a radical prescription based on fear, not on sensible conclusions from empirical data…

This is not how normal medical research works.

He also criticizes a study on conversion therapy and suicidality here. He argues the framing was sloppy and conclusions overconfident.

First…

Psychiatrist and longtime gender identity expert Stephen Levine highlights the quandary facing professionals attempting to counsel transgender patients on the biological, social, and psychological risks posed by any treatment approach. Such risks are real and ought to be discussed. This is what ethical informed consent does. But in the USTS survey lingo, an ethical discussion of risk could be interpreted by the patient as “trying to stop you being trans.” In other words, obtaining informed consent may constitute GICE…

Second, the data come from a nonrandom, opt-in survey—the USTS—that only targeted networked, self-identified transgender or nonbinary persons by advertising their survey among “active transgender, LGBTQ, and allied organizations.” There’s nothing wrong with collecting data using a nonrandom approach like this—I’ve done it myself and will do it again. The problem is when such data are delivered to the reader, as these were, in a way that suggests the conclusions would be consonant with everyone who has identified as transgender or experienced gender identity disorder or dysphoria…

Third, building on the dubious perception of representativeness, the authors report “confidence intervals” for their statistical “estimates.” Why they do so is beyond me. It’s a charade.

Fourth, the authors seem largely uninterested in putting their implied causation—that past conversion attempts affect present mood and suicidality—to the test. Instead, a subtext of injustices committed against the respondents infuses the study, suggesting a decidedly external locus of control in the lives of transgender Americans…

Trans Youth, Mental Health, and Suicide Risk

*Suicide ideation is socially contagious in young people and caution in reporting is warranted to not sensationalize it or make things appear hopeless to troubled people. If you or someone you know is struggling with depression or has had thoughts of harming themselves or taking their own life, there's help for you and hope. The National Suicide Prevention Lifeline (1-800-273-8255) provides 24/7, free, confidential support for people in distress, as well as best practices for professionals and resources to aid in prevention and crisis situations.

GHQ strives to cover the issue of suicide risk as objectively as possible, and we never advocate shunning a transgender youth or minimizing their distress. One can find an objective review of the data around trans people and suicide risk in Topic 15 and a summary here.

A case study of a youth who attempted suicide despite a supportive environment provides salient quotes about current trans demographics:

Gender dysphoria (GD) among adolescents is not uncommon. A recent survey among high school students found that 1.2-2.7% considered themselves transgender or uncertain of gender [1-2]. Reports also suggest an increasing number of adolescents referred to specialized gender identity clinical services for the treatment of gender dysphoria [3]. Any clinician who cares for young patients should be well informed of the impact gender dysphoria and related treatments have on mental health. Awareness of the increased prevalence of depression, anxiety, and suicidal ideation among these individuals can prepare healthcare providers to anticipate and respond appropriately to their presentation.

A 2017 chart review from a transgender clinic in Cincinnati found that among youth aged 12-22 with a diagnosis of gender dysphoria, 58% had another psychiatric diagnosis, and 30.3% reported at least one suicide attempt [4]. Two similar studies support these findings, with attempted suicide rates of 31% and 26% among transgender or gender dysphoric adolescents [2, 5].

Recent cohorts of trans-identified youth seem to focus on weight issues heavily:

Discussion

While the long-term outcome of this patient remains to be seen, this is a significant example of the psychiatric complexity of gender dysphoria. Despite outpatient treatment and supportive family, this patient suffered from persistent suicidal ideation. The repeated expressions of extreme dissatisfaction with appearance were notable. It has been found that among transgender youth, a significantly greater proportion of those who had attempted suicide expressed weight-related body dissatisfaction than those who had not. They also had a higher rate of negative assessment by others of appearance [5]. More recently, another study confirmed a significant correlation between suicidality and a desire for weight change among adolescents with gender dysphoria [4]. There has long been a natural association between body dissatisfaction and gender dysphoria; however, these reports and this case highlight the importance of assessing the degree and characterization of body dissatisfaction as they may contribute to suicidal risk.

Just for perspective, several studies on the overall declining mental health and an increase in suicide risk in teens and young adults are included here:

Business Insider

Suicide rate for people aged 10 to 24 increased by 56% between 2007 to 2017, according to new data from the CDC.

-For children aged 10 to 14, the suicide rate tripled between 2007 to 2017 after years of decline.

-Suicide had increased among millennials, but the data suggests Gen Z might be most at risk for mental illness.

Social media seems to be a reason many people believe is a factor since the rise of it coincides with these increases:

Social media might be fueling the increase in mental illness, as Gen Z is the first truly digital generation. Pew Research Center found 45% of teens aged 13 to 17 said they use the internet "almost constantly." Over-use of social media can cause loneliness, depression, and anxiety, the Anxiety and Depression Association of America reported.

“Are Mental Health Disorder Rates in Youth Really Increasing?”

A 2019 Gallup poll found that sadness, anger, and fear have risen for the second consecutive year around the world.

However, it is also true that we’ve experienced a burgeoning of resources, the highest education rates ever in the country’s history, and an overall decreasing violent crime rate. The same innovations that are said to be isolating also allow us to express ourselves, connect with others around the world, and stay informed. Steven Pinker, a professor of psychology at Harvard University, showed that despite the bleak worldview of the 24/7 news cycle, many metrics reveal that we are living in the most peaceful time in human history.

A Rolling Stone article emphasizes the need to provide youth with support and hope:

That said, research does indicate that early intervention in the form of initiatives like suicide screening at emergency rooms and pediatricians’ offices does play a role in helping to prevent suicide, as does exposure to positive stories about people recovering from feelings of suicidal ideation. Which is why it’s important to interpret the CDC’s finding not as cause for panic or rampant speculation, but as a call for heightened awareness for teens who may be at increased risk.

Johnathan Haidt, the author of Coddling of the American Mind, discusses these increases in mental health problems. He also notes the fact that females are most at risk and offers some suggestions about how to approach this issue:

In 2018 Micheal Biggs (mentioned earlier) wrote an article about these increases affecting girls disproportionately when it comes to gender dysphoria for 4thwavenow (“A community of parents & others questioning the medicalization of gender-atypical youth”):

Micheal Biggs/4thwavenow: “Attempted suicide by American LGBT adolescents”

The graph above shows the estimated odds of a student reporting attempted suicide, compared to heterosexual boys. As the Advocate emphasized, teens who identified as female-to-male transgender had the highest risk of attempted suicide; the odds were four times higher than for heterosexual boys. What went unnoticed is that the risk was just as high for bisexual girls.

The next highest rates (triple the odds compared to heterosexual boys) were for bisexual boys, lesbian girls and for kids who identified as nonbinary. The latter’s sex was not recorded, but the majority are likely to be female; other survey evidence suggests that two-thirds of trans-identified adolescents are female (Eisenberg et al. 2017).

The next highest rates (roughly double the odds for heterosexual boys) were for gay boys, for male-to-female transgender kids, and for kids who were unsure of their gender identity (whose sex was not recorded). Finally, heterosexual girls had a significantly higher risk than heterosexual boys.

Stephanie Davies-Arai and Nic Williams’ critique of Stonewall’s School Report suggested that “[t]he ‘transgender’ category may just serve to cover up the scale of suicide attempts and self-harm rates of girls and young women.” Their conjecture is vindicated by this survey evidence from the United States.

“Reason Lost to Suicide in Trans Debate” is an article that lays out the politicization of the suicide issue in the debate around pediatric medical transition. There is increased suicide risk in dysphoric young people and at the same time this is often exaggerated and used to get the public to comply with activist demands:

Also troubling is the activist mantra that kids will kill themselves if the trans project encounters any obstacle, personal or political. Lil­lian says: “I don’t understand why this one mental health condition is the exception to international best practice around how we talk about suicide.” Some suicide appears contagious, hence the well-known advice: don’t harp on the risk for a specific group, don’t imply taking your life is a default option, don’t catastrophise setbacks, don’t oversimplify the causes of suicide. Activists rediscover the risk of suicide contagion when they misrepresent media coverage that questions their narrative.

This is an older survey but is included here for its interesting conclusion that people with alternative identities such as nonbinary and FtM are at greater risk for sexual assault:

ustranssurvey.org

ustranssurvey.org

There is a strong push to stop trans identity and gender dysphoria itself from being defined as a mental illness by trans activists and some doctors who provide trans healthcare. An example is provided by Dr. Micheal Frist and Dr. Jack Drescher who want it redefined in the next ICD-11 (“International Classification of Diseases”) and the DSM (a mental health diagnostic manual). They want it defined as a type of physical body defect that needs to be corrected and thus defined purely as a medical issue.

In the below screencap, Dr. Ray Blanchard mentions theories relating gender dysphoria to other body dysmorphias and paraphilias. He asks if those who have made this connection would argue for the same thing to apply to these other conditions. He is demonstrating that trans identity is politicized in ways other body dysmorphias aren’t:

@BlanchardPhD

References:

Attempted suicide by American LGBT adolescents. (2018, October 28). Retrieved from https://4thwavenow.com/2018/10/23/attempted-suicide-by-american-lgbt-adolescents/

Biggs, M. (2019). A Letter to the Editor Regarding the Original Article by Costa et al: Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents with Gender Dysphoria. The Journal of Sexual Medicine 16(12) 2043. doi.org/10.1016/j.jsxm.2019.09.002

Biggs, M. (2019, July 29). The Tavistock’s Experiment with Puberty Blockers. Department of Sociology and St Cross College, University of Oxford. Retrieved from http://users.ox.ac.uk/~sfos0060/Biggs_ExperimentPubertyBlockers.pdf

Bränström, R., Pachankis, J.E. (2019). Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. The American Journal of Psychiatry. doi.org/10.1176/appi.ajp.2019.19010080

D. Carpenter. (2015, May 10). A “reality check” for the Regnerus study on gay parenting [UPDATED]. The Washington Post. Retrieved from https://www.washingtonpost.com/news/volokh-conspiracy/wp/2015/05/10/new-criticism-of-regnerus-study-on-parenting-study/

Cheng, S., Powell, B. (2015). Measurement, methods, and divergent patterns: Reassessing the effects of same-sex parents. Social Science Research 52, 615-626. doi.org/10.1016/j.ssresearch.2015.04.005

Costa, R., Dunsford, M., Skagerberg, E, Holt, V., Carmichael, P., Colizzi, M. (2015). Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents with Gender Dysphoria. The Journal of Sexual Medicine 12(11), 2206 - 2214. doi.org/10.1111/jsm.13034

Day, D.S., Saunders, J.J., Matorin, A. (2019). Gender Dysphoria and Suicidal Ideation: Clinical Observations from a Psychiatric Emergency Service. Cureus. doi: 10.7759/cureus.6132

Dickson, E. (2019 October 18). Teen Suicide Is on the Rise and No One Knows Why. Rolling Stone. Retrieved from https://www.rollingstone.com/culture/culture-news/teen-suicide-study-increase-why-900711/?fbclid=IwAR0PUvjFbmcal-fZ4easCS266R37otmCguB-9T1gulKCylWnJTWNkWBag-M

Baiocco, R., Carone, N., Ioverno, S., Lingiardi, V. (2018). Same-Sex and Different-Sex Parent Families in Italy. Journal of Developmental & Behavioral Pediatrics 39(7). 555–563. doi: 10.1097/DBP.0000000000000583

Haidt, J. (n.d.). How to improve mental health using ideas from the book. The Coddling. Retrieved from https://www.thecoddling.com/better-mental-health

Kiersz, A., Akhtar, A. (2019, October 17). Suicide is Gen Z's second-leading cause of death, and it's a worse epidemic than anything millennials faced at that age. Business Insider. Retrieved from https://www.businessinsider.com/cdc-teenage-gen-z-american-suicide-epidemic?fbclid=IwAR0xFdMxxECTrJFnyKpSjUAxS8f6rq44ITk6LE7Pc0ooxEGcsnv-ZqrZnmk&utm_campaign=sf-insider-main&utm_medium=social&utm_source=facebook.com

Lane, B. (2019, November 2). Reason Lost to Suicide in Trans Debate. The Australian. Retrieved from https://www.theaustralian.com.au/inquirer/reason-lost-to-suicide-in-trans-debate/news-story/af31e3357a4ec08f9a3e91227b3424bf

Noam, G. (2019, November, 7). Are Mental Health Disorder Rates in Youth Really Increasing? Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/the-inner-life-students/201911/are-mental-health-disorder-rates-in-youth-really-increasing

Regnerus, M. (2019, September 18). Does “Conversion Therapy” Hurt People Who Identify as Transgender? The New JAMA Psychiatry Study Cannot Tell Us. Public Discourse. Retrieved from https://www.thepublicdiscourse.com/2019/09/57145/

Regnerus, M. (2015). How different are the adult children of parents who have same-sex relationships? Findings from the New Family Structures Study. Social Science Research 41(4). 752-770. doi.org/10.1016/j.ssresearch.2012.03.009

Regnerus, M. (2019, November 13). New Data Show “Gender-Affirming” Surgery Doesn’t Really Improve Mental Health. So Why Are the Study’s Authors Saying It Does? Public Discourse. Retrieved from https://www.thepublicdiscourse.com/2019/11/58371/

The Rocky Road to Removing Gender Dysphoria from DSM-5. (2019, November 1). Retrieved from https://newyorkcomingout.org/events/event/the-rocky-road-to-removing-gender-dysphoria-from-dsm-5

The Report from the 2015 U.S. Transgender Survey. (2015). Retrieved from http://www.ustranssurvey.org

Turban J.L., Beckwith N., Reisner S.L., Keuroghlian A.S. (2019). Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults. JAMA Psychiatry(11), 1-9. doi:10.1001/jamapsychiatry.2019.2285

Several New Groups Have Formed to Question the Safety of Medically Transitioning Minors with Gender Dysphoria And The Affirmative Model

News

Several new groups/organizations have formed to question the safety of social and medical transition of minors and young adults with gender dysphoria. These concerns are all in line with the concerns listed on the Gender Health Query website.

Rethinking Identity Medicine is based in the United States and says they will focus on best mental health practices and standards of care.

The MISSION of ReIME is to promote the highest standards of care and ethics in the area of identity medicine for children and youth.  To this end, we gather, curate and distribute up-to-date evidence-based information on best practices that ensure individualized, developmentally appropriate standards of care and treatment related to gender and identity non-conformity, variations and dysphoria. Our GOAL is to better inform individuals, friends, family members, communities including clinicians and policy makers at all levels who are seeking information to best safeguard the long term interests and physical autonomy of such children and youth.

We support the right of minors and young people to explore identities, including sexuality and gender that are developmentally appropriate. And that care is required to prevent prematurely foreclosing such exploration that may lead to permanent, invasive medical procedures.

Gender Identity Challenge is a group in Sweden and Norway.

Ever more parents feel that their child or adolescent wants to change their gender without previous warning. We wonder what has brought this about and how to deal with this phenomenon called

Rapid Onset Gender Dysphoria - ROGD

KIRJO is a group in Finland.

The transgender phenomenon is based on gender ideology which harms our society in many ways. It is now time to start the conversation about gender ideology. Is gender dysphoria the new anorexia?

PS. The word “Kirjo” is a Finnish equivalent to the English term “spectrum” (of color or types of people). You can follow and join us here.

Baywater Support is a group of parents from Britain and Ireland who wish to have a more cuatious approach to medicalizating minors:

We are a group of parents in the UK and Ireland who have been brought together by our experiences of parenting children with gender dysphoria or who have declared a transgender identity.

Having looked for the best support for our children, we have found only the 'affirmative' approach to their new identity, backed up by affirmative environments in schools and elsewhere. We've found little scope to explore the new identity as a young person's solution to trauma or distress, as a response to the challenges of adolescence, or to understand its role within underlying mental health or developmental contexts

A new consumer rights organization called Gender Care Consumer Advocacy Network has formed to support people questioning their gender, trans people, and detransitioners seeking mental health and medical services.

Their Mission:

Our mission is to empower recipients of gender transition-related care to become healthy and whole.

They have created a patients bill of rights:

GCCAN is a consumer rights group for any person who has previously or is currently receiving gender care related services. Our aim is to empower consumers of gender-transition related care to get the best health care possible.

GCCAN was founded by gender care consumers because we determined that the level of care we receive during or after gender care treatment is inadequate to achieve healthy mental and physical outcomes. Members of our group have been subject to harms from inadequate gender care services, and our goal is to reduce or mitigate similar harms to other consumers. The current delivery of care does not match established best-practice protocols. Established institutions often fail to balance the interests of consumers with the interests of gender care providers. We seek improvements to accountability, provider education, holistic care protocols, medical research, and public policies. We deserve better.

GCCAN is a registered 501(c)(3) consumer-run nonprofit organization that is non-partisan and non-ideological. Our membership represents many perspectives and experiences, and GCCAN is inclusive to all gender care consumers. As a result, our focus is on every consumer's wellbeing. We advocate for more informed consumers and better gender health care, under the presumption that the best outcome is different for each person. Our Consumer Bill of Rights outlines the necessary improvements to gender care that we seek.

News in Detransition

News

Over the last several weeks, there have been multiple articles on the once rare and under studied topic of detransition.

Charlie Evans is a bisexual woman and is starting a detransition advocacy organization. This is an article by Evans on Medium:

“The medicalization of gender non conforming children, and the vulnerability of lesbian youth”

More from her can be found here https://medium.com/@charlie.evans

This is a link to the crowdfunded page for the detransition advocacy organization:

“The Detransition Advocacy Network”

And a petition asking the public health service in Britain to study and support detransitioners:

“Support Detransitioners at the National Institutes of Health”

Two articles about detransition and Charlie Evens:

'Hundreds' of young trans people seeking help to return to original sex”

“Why is the progressive world so hostile to detransitioners?”

Evans identified as male for nearly a decade, but then changed her mind. And Evans is not alone. She says she has been in touch with hundreds of other young people who have detransitioned, mostly people in their early 20’s. Some of these individuals have had full gender reassignment surgery, and regret it. All are trying to figure out how to move forward and live happy, healthy lives.

There is a new detransition resource in Sweden:

“För mer kunskap och stöd kring detransition”

This is a Dutch documentary on detransition:

“Transgender Regret - A Dutch Documentary”

Below is a video of a story of a detransitioned woman who fit the definition of DSM-5 gender dysphoria from childhood and transitioned as an adult. She believes transition helped prevent her from committing suicide but also run from her butch identity:

“Thoughts of a detransitioned woman”

A personal story of homophobia and transition regret:

“I Spent a Year as a Trans Man. Doctors Failed Me at Every Turn”

At the time, you wouldn’t have been able to tell I was gay just from looking at me. I had long, blond hair, wore makeup, and carried myself rather femininely. But in my head, I knew I was gay—though I was more of a self-loathing gay. 

The truth is, I didn’t like gays, and didn’t want to be associated with them. Yet there I was, dating only other girls…

At age 18, I started seeing a bunch of transgender men’s “success stories” on Instagram. The trans men talked about how something had always “felt off” with them, and they said people couldn’t tell they had been the opposite sex after their transition.

Their stories all seemed to have a happy ending—and it made me rather jealous. 

Here I was getting frowned upon for holding hands with my girlfriend in public, feeling like I’m constantly being judged by everyone, while transgenders could date their same-sex significant other while looking like the opposite sex. 

I resented that and began to envy the transgenders. I looked into it for myself.

Stonewall UK added to the discourse by attempting to debunk some recent narratives emerging about detransition and attributing it to transphobia. These points run contrary to most recent stories about detransition. Many deransitioners claim they never report their detransition to any official entity and that they feel transition was a mistake:

”Dispelling myths around detransition”

Jesse Singal, who has been reporting on the contentious issue of pediatric medical transition and detransition, discussed some problems with the Stonewall UK statement on his personal blog:

”LGBT People Deserve Accurate Information From LGBT Organizations: But they aren't getting it”

The blog is behind a paywall, but he posted some of his commentary on social media:

Andrew Sullivan is joining the ranks of LGB people who are concerned about tranistion regret in LGB and other youth. He has written an article about detransition called “The Hard Questions About Young People and Gender Transitions:”

The widespread consensus today is that detransitioning is so rare even mentioning it borders on transphobic. But in reality, absolutely no one knows how rare detransitions are currently — the small set of research studies detransition skeptics present as evidence that it is very uncommon all come from vastly different contexts, in some cases decades-old, and arguably don’t capture what’s going on in 2019. These women live every day with the consequences of their decision: tenacious facial hair (one has to shave every three days) and body hair, deeper voices, permanently enlarged clitorises. They also suffer from the effects of “binding,” i.e. wearing a breast corset of sorts, to flatten their chests, so they can pass more easily as men. “I have back issues, lower lung capacity, and permanent dents around my shoulders,” one told me. “Every now and again, I have to push a rib back in to breathe,” another recounts. “I have permanent bruising,” another explains. “Serious back issues,” says another, who cannot carry a backpack for long without pain. “We get ‘sir’ed at Dunkin’ Donuts every time,” one joked…

By their own accounts, they had been adamantly trans in their teens. “I was the student trying to get a professor fired because he wouldn’t allow theyand them to be used for a singular person in my papers … I threatened my parents and friends with suicide. It became part of my identity to be suicidal. I screamed at my parents about this, even though I knew I wasn’t going to kill myself.” One went by the pronouns xe and xer and flew into a rage if she was misgendered. Once they had transitioned, and felt miserable nonetheless, they felt that this too was just part of being transgender. One talked of “the hunger to suffer.” Another spoke of “using your pain to validate your own destruction.”

A website called Canadian Gender Report has posted an informal survey of the r/detrans sub Reddit. Given that there is no formal attempt to study detransition at this time, informal surveys such as this one, and the one referenced, are the only efforts available to help understand this population.

References:

Canadian Gender Report. (2019, October 17). From trans to detransitioner – what can we learn from this growing trend? Retrieved from https://genderreport.ca/detransitioners-what-can-we-learn/

Evans, C. (2019, Septmember 9). The medicalization of gender non conforming children, and the vulnerability of lesbian youth. Medium. Retrieved from https://medium.com/@charlie.evans/the-medicalization-of-gender-non-conforming-children-and-the-vulnerability-of-lesbian-youth-10d4ac517e8e

Emmons, L. (2019, October 10). Why is the progressive world so hostile to detransitioners? The Post Millennial. Retrieved from https://www.thepostmillennial.com/why-is-the-progressive-world-so-hostile-to-detransitioners/

Lockwood, S. (2019, October 5). 'Hundreds' of young trans people seeking help to return to original sex. Sky News. Retrieved from https://news.sky.com/story/hundreds-of-young-trans-people-seeking-help-to-return-to-original-sex-11827740

Russell, N. (2019, October 8) What The First Nonbinary American Wants The Supreme Court To Know About Transgenderism. The Federalist. Retrieved from https://thefederalist.com/2019/10/08/what-the-first-nonbinary-american-wants-the-supreme-court-to-know-about-transgenderism/#.XZyM1mqNpSM.twitter

Singal-Minded. (2019, October 9). LGBT People Deserve Accurate Information From LGBT Organizations. Retrieved from https://jessesingal.substack.com/p/lgbt-people-deserve-accurate-information

Stella, C. (2016, September 3). Female detransition and reidentification: Survey results and interpretation. Retrieved from https://guideonragingstars.tumblr.com/post/149877706175/female-detransition-and-reidentification-survey

Stonewall UK. (2019, October 9). Dispelling myths around detransition. Retrieved from https://www.stonewall.org.uk/about-us/news/dispelling-myths-around-detransition

Sullivan, A. (2019, November 1). The Hard Questions About Young People and Gender Transitions. New York Magazine. Retrieved from http://nymag.com/intelligencer/2019/11/andrew-sullivan-hard-questions-gender-transitions-for-young.html?utm_medium=s1&utm_campaign=di&utm_source=tw

Thoughts of a detransitioned woman. (2019, September 27). Retrieved from https://www.youtube.com/watch?feature=youtu.be&v=aVse3ZKD9hA

Wright, S. (2019, October 7). I Spent a Year as a Trans Man. Doctors Failed Me at Every Turn. The Daily Signal. Retrieved from https://www.dailysignal.com/2019/10/07/i-spent-a-year-as-a-trans-man-doctors-failed-me-at-every-turn/

Tavistock's Hormone Blocker Study Cleared but They Admit Blockers are Given for Cosmetic Reasons, not to provide "Time for Exploration"

News

Due to criticisms of the study (also here) in the UK on hormone blockers given to gender dysphoric children to stop normal puberty, the Health Research Authority investigated the study. They claim it meets their ethical standards. The report can be found here. They describe the purpose of the original blockers study below:

The study 'Early pubertal suppression in a carefully selected group of adolescents with gender identity disorders' was developed in 2010 in response to broadening use of early pubertal suppression treatments across Europe, in the USA and in Australia. There were debates about the evidence of benefits and safety, and whether young adolescents could consent to treatments due to the potential for unknown risks or harms in the future. Some clinicians argued that the consequences of non-treatment were likely to be greater than those of treatment.

Michael Biggs, an Oxford sociologist who has been criticizing the study, comments below:

The Health Research Authority (HRA) has just published its investigation into the 2010 experiment with puberty blockers, or more precisely its role in giving ethical approval and oversight. The investigation was prompted by research published on Transgender Trend in March 2019, with an update in July (the full paper is here). The HRA report’s conclusions are predictably bland. Firstly, ‘the research team involved in the design and delivery of the study … worked in accordance with recognised practice for health research, and in some areas such as patient involvement and transparency were ahead of normal practice at the time’ (p. 11). Secondly, ‘The HRA has acted within its Standard Operating Procedures and its normal practice in relation to this study’ (p. 10).

He goes on to highlight that the main reason they are giving youth hormone blockers is so they pass better later and not to allow time for identity exploration. Identity exploration is often the reason affirmative model advocates give for putting youth on these powerful drugs that stop normal hormonal development by affecting the pituitary gland. Some of those quotes, as well as questionable claims hormone blockers are “fully reversible,” can be found here.

Dr. Biggs from “The astonishing admission in the Health Research Authority report: The purpose of puberty blockers is to commit children to permanent physical transition”:

On close reading, however, the report contains an astonishing admission. The paragraph deserves to be quoted in full:

“It would have reduced confusion if the purpose of the treatment had been described as being offered specifically to children demonstrating a strong and persistent gender identity dysphoria at an early stage in puberty, such that the suppression of puberty would allow subsequent cross-sex hormone treatment without the need to surgically reverse or otherwise mask the unwanted physical effects of puberty in the birth gender. The present study was not designed to investigate the implications on persistence or desistence of offering puberty suppression to a wider range of patients, it was limited to a group that had already demonstrated persistence and were actively requesting puberty blockers. (p. 5, my own emphasis added in bold)”

In fact the 2010 research protocol declared that one of its three aims was ‘[t]o evaluate persistence and desistence of the gender identity disorder and the continued wish for gender reassignment’ (Early pubertal suppression in a carefully selected group of adolescents with gender identity disorder, proposal submitted to Central London REC 2, November 2010, obtained under Freedom of Information from the HRA; italics added). History is being rewritten to alter the rationale for the experiment. It is not clear whether this revisionist history originates with the HRA, or whether the HRA is conveying the current views of the experiment’s chief investigator, Professor Russell Viner (Professor in Adolescent Health at University College London) or his co-investigator, Dr Polly Carmichael (Director of the Gender Identity Development Service, GIDS).

Whatever the source, this is a clear admission that puberty blockers were the first stage on the predestined path to cross-sex hormones. After four assessment interviews, a child of 12 would be consenting in effect to a lifetime of drug dependence and the loss of fertility and the probable loss of sexual functioning. Because the “treatment” was intended to enhance the child’s desire to change sex, it naturally exacerbated her or his gender dysphoria. ‘Worsening behavioural and emotional symptoms of dysphoria’, the HRA notes cheerily, ‘would therefore not in itself be unexpected’ (p. 6).

Micheal Biggs goes on to discuss what he believes to be other ethical problems with the study in the full article.

Two BBC reporters have covered this story in, “Questions remain over puberty-blockers, as review clears study”.

References:

Biggs, M. (2019, March 5). Tavistock’s Experimentation with Puberty Blockers: Scrutinizing the Evidence. Transgendertrend. Retrieved from https://www.transgendertrend.com/tavistock-experiment-puberty-blockers/

Biggs, M. (2019, July 22). Tavistock’s Experiment with Puberty Blockers: an Update. Transgendertrend. Retrieved from https://www.transgendertrend.com/tavistock-experiment-puberty-blockers-update/

Biggs, M. (2019, October 17). The astonishing admission in the Health Research Authority report: The purpose of puberty blockers is to commit children to permanent physical transition. Transgendertrend. Retrieved from https://www.transgendertrend.com/health-research-authority-puberty-blockers-commit-children-permanent-physical-transition/

Clay R. A. (2018). Embracing a gender-affirmative model for transgender youth. APA: CE Corner (49)8, 29. Retrieved from https://www.apa.org/monitor/2018/09/ce-corner

Cohen, D., Barnes, H. (2019, October 15). Questions remain over puberty-blockers, as review clears study. BBC. Retrieved from https://www.bbc.com/news/health-50046579

NHS Health Research Authority, (2019, October 14). Investigation into the study 'Early pubertal suppression in a carefully selected group of adolescents with gender identity disorders.' Retrieved from https://www.hra.nhs.uk/about-us/governance/feedback-raising-concerns/investigation-study-early-pubertal-suppression-carefully-selected-group-adolescents-gender-identity-disorders/

Two new studies on Gender Dysphoria in Minors

News

We are updating our site with two new studies about minors with gender dysphoria, one that shows a slight improvement in mental well-being in more recent cohorts, and one that calls into question the efficacy of social transition.

The researchers in the Netherlands, who started the hormone blocker to cross-sex hormone protocol, released a study called “Re-evaluation of the Dutch approach: are recently referred transgender youth different compared to earlier referrals?”

The Dutch clinic is seeing large increases in the number of females seeking transition. This is the case in all western countries.

Arnoldussen (2019)

They comment on this increasing number of females:

One suggested theory to explain this shift is that it is easier for birth-assigned females to be open about their transgender feelings, since they experience less stigma when they behave masculine than birth-assigned males who behave in a more feminine manner [16, 31, 32, 33].

Gender clinicians rarely consider the alternative, that masculine girls are bullied for being masculine and don’t value themselves as gender nonconforming girls. Several detransitioned lesbian/bi youth have said this was the case for them and there is evidence homophobic bullying of gender nonconforming youth (also never referenced in these studies) fuels trans identification.

Contrary to other studies with high rates of mental health issues, they note a slight improvement in their recent cohort:

In addition, although we hypothesized that is was possible that present referrals had more psychological problems, the opposite seems the case. Our analyses showed that psychological functioning of the referred adolescents improved somewhat over time. This could be explained by a subtle improvement in externalizing problems and better peer relations. It might be the case that it has become easier to openly identify as transgender in recent years, so that recent referrals do not have to stand up as fiercely for themselves as earlier referrals. In addition, they seem more accepted by peers.

The clinic expresses no concern about social contagion, as other scientists/doctors are, and attribute these increases to more youth coming out and feeling accepted. They also cite superficial similarities to earlier cohorts and recent cohorts, including a large increase in females, to possibly insinuate the groups are the same.

This may suggest that in the early years, only the tip of the iceberg of the actual number of transgender youth was presented to a transgender clinic and this iceberg has come to surface in recent years.

Wong (2019), "Childhood social gender transition and psychosocial well-being: A comparison to cisgender gender-variant children," is another recent study examining the mental health of youth who have been socially transitioned. The sample size is decent, 266 children. Unlike the Trans Youth Project studies often used to justify early social and medical transition, this study has a control group. And unlike Olson (2016), these socially transitioned young people may not have significantly improved mental health.

A quote from the results, emphasis ours:

Results: There was little evidence that psychosocial well-being varied in relation to gender transition status. Parents of CGV children were generally accepting of childhood gender variance, but only poor peer relations predicted lower psychological well-being among these children. Conclusion: Socially transitioned children appear to experience similar levels of psychosocial challenges as CGV children. While further research is needed to evaluate possible effects of childhood social gender transition on well-being, this study suggests experiences of psychosocial challenges among gender-variant children require monitoring irrespective of transition status, and relationships with peers may be especially important to consider.

They report peer relations is a key factor. Poor peer relations actually drives some children towards trans-identification as cited above. It’s worth exploring if more acceptance for gender-variant behavior reduces the need for medical transition to conform to heterosexual gender and sexuality norms.

References:

Arnoldussen, M., Steensma, T.D., Popma, A. et al. Re-evaluation of the Dutch approach: are recently referred transgender youth different compared to earlier referrals? European Child & Adolescent Psychiatry. 1-9 doi.org/10.1007/s00787-019-01394-6

Lane, Bernard. (2019, September 25). Trans care inquiry backed. The Australian. Retrieved from https://www.theaustralian.com.au/nation/doctors-back-inquiry-on-kids-trans-care/news-story/6f352bc99da430b194620a2605e8a50d

Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3), e20153223. doi:10.1542/peds.2015-3223

Wong, W. I., van der Miesen, A., Tjonnie G., F., MacMullin, L., & VanderLaan, D. (2019). Childhood social gender transition and psychosocial well-being: A comparison to cisgender gender-variant children. Clinical Practice in Pediatric Psychology,7(3), 241-253. doi.org/10.1037/cpp0000295

Articles Covering Medical Risks of Treating Trans Youth

News Commentary

GHQ is a pro-LGBT website. However, liberal-leaning news sites refuse to address any of the possible downsides to minors medically treated for gender dysphoria. Two recent articles on conservative news sites review some of these downsides. The problem with this dynamic is that it polarizes the issue in a way that it should not be. The overall health and safety of all youth should be the goal.

The article in The Federalist “Gender Clinic Doctor: Plenty Of Kids I’m Giving Trans Drugs Have Already Been Prostitutes” speaks to the precarious mental health of trans-identified youth who are being put on powerful hormones, often with little follow-up. It also speaks to the poor quality of Johanna Olson-Kennedy’s NIH study due to high rates of “lost to follow-ups.” This is a common problem in trans research.

At that conference Olson-Kennedy described the mental-health struggles of her cohort of patients. “Thirty percent of my sample had moderate to severe depression symptoms. Thought about suicide, 49 percent. . . . Attempted suicide, over 30 percent. . . . A lot of drug use . . . A lot of kids were sexually active, and a not insignificant number of my kids have actually done . . . sex work [prostitution].” Many patients, she reported, have been homeless or in foster care.

Olson-Kennedy also admitted that 40 percent of her patients, to whom presumably she administered GAT, were “lost” to follow-up since her previous study. Are these kids still even alive? We’ll never know, but the good doctor apparently is content to assume the best.

The conservative website PJ Media “Medical Expert: Doctors Are Actually Giving Trans Kids a Disease, and It's Child Abuse” reviews some of the realities of giving youth large doses of cross-sex hormones.

Some quotes about the side-effects of medical transition from Dr. Laidlaw, an endocrinologist:

"I call it a development blocker — it’s actually causing a disease," Dr. Michael Laidlaw, an independent private practice endocrinologist in Rocklin, Calif. who consults with Sutter Roseville Medical Center, told PJ Media. The disease in question is hypogonadotropic hypogonadism. It occurs when the brain fails to send the right signal to the gonads to make the hormones necessary for development…

While endocrinologists — doctors who specialize in hormones and the endocrine system — are familiar with the disease and gladly treat it when a patient has been diagnosed, many of them are effectively causing their patients to contract the same disease in an attempt to affirm gender identity, Laidlaw said…

When people are given far more of the opposite sex hormone than their bodies can handle, they are at "increased risk for cardiovascular disease, cardiovascular death, deep vein thrombosis. They’ve looked at adults taking these hormones and have seen already these cardiovascular risks." When these drugs are administered to children, "one would presume it's the same or even worse, in the long run."…

In a healthy human body, the pituitary gland "sends signals to the gonads to produce testosterone or estrogen." By preventing this natural secretion of hormones, Lupron in kids "blocks development of their organs, and their growth is stunted. If it’s started in early puberty, these kids will not develop mature sperm or eggs, they will be infertile. If they have gonads removed, they will be sterilized."

"They’re going to end up with lower bone density, perhaps stunted brain development," the doctor explained. "A lot of the brain impact is unknown. There seems to be some brain development that is sex hormone-dependent."

He comments on how young the children are who are on these drugs:

Indeed, two doctors involved in the transitioning of children, Ilana Sherer and Johanna Olson-Kennedy, explained in a video that they give "puberty blockers" to children at age 8 or 9, when they are in third and fourth grades. Olson-Kennedy has received a $5.7 million grant from the National Institutes of Health (NIH) for a 5-year study on mastectomies done on girls as young as 13. The documents unearthed due to Laidlaw's FOIA request showed the minimum age for cross-sex hormones in the study had been lowered to 8 in 2017.

It’s obvious in the tone of articles on sites like this that they are not supportive of LGBT issues. At times they even make statements that diminish the reality of trans people’s experiences. It would be in the best interests of dysphoric youth to have non-politicized discussions about the risks of medical transition in the news beyond right-wing websites.

Reference:

O'Niel, T. (2019, August 25). Medical Expert: Doctors Are Actually Giving Trans Kids a Disease, and It's Child Abuse. PJ Media. Retrieved from https://pjmedia.com/trending/medical-expert-doctors-are-actually-giving-trans-kids-a-disease-its-child-abuse/

We do not have open comments on the Gender Health Query website. But that doesn’t mean we aren’t interested in what you have to say. If you have a comment, blog post idea, or any other feedback, we would be interested if the information can be supported by science research, an informed opinion, real-world observations, or personal experiences. Please contact us.

4 Recent Articles Highlight the Conflicts Between Trans Policies & Free Speech Rights

News

There have been several recent articles about trans youth policies in schools and the rights of other students and faculty in regards to gender ideology. New gender ideology being promoted by activists states biological sex is literally what one declares it to be and that there are multiple gender identities. Gender ideology is coming into conflict with other people’s viewpoints and rights to belief about biological sex, protecting female sports, and sex-based changing areas in schools. A section examining these issue on the GHQ website can be found here.

“Civil rights inquiry to look at transgender policy” is an article about the federal Office for Civil Rights launching an investigation into males with gender dysphoria competing on female sports teams. Evidence increasingly shows males have an advantage even post medical transition.

“Department of Education to Probe Athletic Program Allowing Transgender Females to Compete With Girls” is another article covering the same story.

“'I will NOT refer to you with female pronouns': Duval teacher snubs transgender student's request” is an article about how a teacher is refusing to use the preferred pronouns of a male student who identifies as a girl.

“Ohio School District Will Not Punish Boy for Using 'Wrong Pronoun' When Referring to Transgender Friend” is an article about a school’s decision not to punishing a boy for calling a biological, gender dysphoric male a boy.

Russel et al., 2018 shows respecting the pronouns of trans-identified youth helps their mental health. On the other hand, forcing others to believe in gender identity or third genders that require special pronouns conflicts with others’ rights to free thought and speech that would violate the US Constitution.

References:

Associated Press. (2019, August 8). Civil rights inquiry to look at transgender policy. ESPN. Retrieved from https://www.espn.com/high-school/story/_/id/27346657/civil-rights-inquiry-look-transgender-policy

Bunting, Deborah. (2019, August, 2019). Ohio School District Will Not Punish Boy for Using 'Wrong Pronoun' When Referring to Transgender Friend. CBN News. Retrieved from https://www1.cbn.com/cbnnews/us/2019/august/ohio-school-district-will-not-punish-boy-for-using-wrong-pronoun-when-referring-to-transgender-friend

First Coast News. (2019, August 14). I will NOT refer to you with female pronouns': Duval teacher snubs transgender student's request. Retrieved from https://www.firstcoastnews.com/article/news/education/i-will-not-refer-to-you-with-female-pronouns-duval-teacher-snubs-transgender-students-request/77-7567acd6-1b5c-45eb-a1fd-ba1fc8d89691

Kookogey, C. (2019, August 8). Department of Education to Probe Athletic Program Allowing Transgender Females to Compete With Girls. The Daily Signal. Retrieved from https://www.dailysignal.com/2019/08/08/department-of-education-opens-probe-of-athletic-program-allowing-transgender-females-to-compete-with-girls/

Russell, S.T., Pollitt, A.M., Li, G., Grossman, A.H. (2018). Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth. Journal of Adolescent Health 63(4) , 503–505. doi.org/10.1016/j.jadohealth.2018.02.003

We do not have open comments on the Gender Health Query website. But that doesn’t mean we aren’t interested in what you have to say. If you have a comment, blog post idea, or any other feedback, we would be interested if the information can be supported by science research, an informed opinion, real-world observations, or personal experiences. Please contact us.

Psychologist Ken Zucker Releases a New Paper on Gender Dysphoria

News Commentary

Psychologist Ken Zucker has released a paper called “Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues” discussing various issue around gender dysphoria covered on the GHQ website. These include the increase of natal females reporting they have gender dysphoria, suicidality, rapid onset gender dysphoria, and debates surrounding treatment.

Below is one quote regarding an explanation Zucker and other gender clinicians have for the increase of natal females identifying as trans or non-binary:

For example, per- haps behavioral masculinity (or behavioral “androgyny”) in birth-assigned females is subject to less social ostracism than behavioral femininity in birth-assigned males. If this conjecture is correct, then perhaps fewer birth-assigned males feel com- fortable coming out as transgender and, therefore, are less likely to present at specialized gender identity clinics. It is conceiva- ble, therefore, that, with further destigmatization, it will become easier for birth-assigned males to “come out” as transgender and the sex ratio will move closer to parity. Another possibility is related to the observation that gender-variant/gender noncon- forming behavior is more common in birth-assigned females than in birth-assigned males (from childhood onwards). If this is, in fact, the case, then it would imply that there would be a greater percentage of birth-assigned females at the “gender- atypical” side of the bell curve. In the contemporary era of increased destigmatization, perhaps more of these females are self-identifying as transgender or some other gender-variant self-identity and, as a result, more are presenting at specialized gender identity clinics.

There is a third and fourth possibility Zucker did not mention in this paragraph (although ROGD is mentioned later). The third is there are more females identifying as trans because of social contagion. There is historical evidence young females are prone to social contagions and body dysmorphia. The fourth is that same-sex attracted females and other “tomboys” in general are more prone to internalized homophobia or general insecurity about their gender. This is the opposite possibility Zucker mentions. It is that it is not socially acceptable to be a gender non-conforming girl or woman and this drives the transition, rather the social acceptability of being a trans-identified female. Some female desisters and detransitioners have cited anti-homosexual attitudes or fears around the treatment of females as part of the issues they had around their gender. This section reviews some of those statements, as well as a study that shows homophobic bullying increases trans identification.

Zucker discusses the sensitive topic of suicide risk in trans youth. Suicide risk is heavily promoted to enforce a view the affirmative model is the best mode of treatment. He has found that the suicide risk in gender dysphoric youth is about the same as the risk for any youth with any other mental health problem presenting for treatment:

Based on a variety of measurement approaches (e.g., standard- ized parent or self-report questionnaires, structured psychiatric diagnostic interview schedules, etc.), it has been found that adolescents referred for gender dysphoria have, on average, more behavioral and emotional problems than non-referred adolescents, but are more similar than different when compared to adolescents referred for other mental health concerns

He addresses the various explanations for the increased risk of suicidality:

There are several ways to conceptualize the elevated rate of co-occurring mental health issues among adolescents with gender dysphoria. In some instances, it may be that the gen- der dysphoria has emerged as secondary to another, more “primary” mental health diagnosis, such as autism spectrum disorder or borderline personality disorder, or as a result of a severe trauma (e.g., sexual abuse). Another explanation is that gender dysphoria is inherently distressing, i.e., the marked incongruence between one’s felt gender and somatic sex—even within psychosocial milieus that are largely “affirming/support- ive”—which leads to clinically significant symptoms such as anxiety or depression. A more common explanation (and one that is often favored by “gender-affirming” clinicians and theo- rists) is that the co-occurring mental health issues are simply secondary to factors such as family rejection or social ostracism within the peer group vis-à-vis the gender dysphoria (see, e.g., Grossman, Park, & Russell, 2016; Janssen & Leibowitz, 2018; McDermott, Hughes, & Rawlings, 2017).

In this section GHQ discusses the use of suicide terror in promotion of the affirmative model and how this discourse actually violates every suicide prevention groups policies on how suicide (which is socially contagious) should be discussed.

In this broader context of co-occurring mental health issues, concern about suicide risk has become a topic of intense focus in recent years (see, e.g., Tanis, 2016). On the Internet, for example, one might come across the comment made by some parents “I would rather have a trans kid than a dead kid” (see, e.g., Biggs, 2018; Digitale, 2017; “I’d Rather Have a Living Son Than a Dead Daughter,” 2016) and instances of completed suicide receive intense media scrutiny (e.g., Bever, 2016; Savva & Small, 2019). Indeed, Karasic and Ehrensaft (2015) asserted that completed suicides are “alarmingly high”—a statement which, in my view, has no formal and systematic empirical basis. In fact, I would argue that the statement itself is alarming.

He cites some studies that show support for the youth’s transition reduces suicide risk. GHQ also covers some of this information here.

From a treatment perspective, therefore, one can consider both non-specific and specific factors that might reduce the risk of suicidality. Regarding the latter, for example, it has been argued that (perceived) social support of an adolescent’s transgender identity reduces the risk of suicidality (Bauer, Scheim, Pyne, Travers, & Hammond, 2015). In another com- munity-based study, it was found that the number of social settings in which adolescents felt comfortable in using their preferred name was associated with less suicidal ideation and behavior (Russell, Pollitt, Li, & Grossman, 2018). Lastly, in a clinic-based study, Allen, Watson, Egan, and Moser (2019) reported that commencement of “gender-affirming” hormonal treatment was related to a decrease in self-reported suicidal feelings.

He discusses the issue of rapid onset gender dysphoria and the resistance to discourse around what could be causing it, sometimes by mental health and medical professionals even.

It is not entirely clear to me why some clinician and “armchair” critics have been so skeptical about the possible veridicality of ROGD. Perhaps because Littman (2018) advanced a set of hypotheses about predisposing psychosocial factors in its genesis, the objection is that this disrupts an essentialist model of gender dysphoria and, therefore, has therapeutic implications.

He also addresses the reality that some of the increasing numbers of young people coming out as trans are also desisting or detransitioning:

Because ROGD appears to be a new clinical phenome- non, we know very little about its subsequent developmental course, i.e., its “natural history.” For example, we know very little about rates of persistence versus desistance, which, in my view, is a critical issue in thinking about the applicabil- ity of the Dutch model with regard to the therapeutic care of these youth. At present, there are some compelling examples of desistance or even “detransition,” but right now this is largely in the form of individual testimony and parent’s report (see, e.g., “It’s not conversion therapy to learn to love your body: A teen desister tells her story,” 2017; Pique Resilience Project at https://www.piqueresproject.com/; Rae, 2017; Wil- liams, 2019). Thus, we urgently need systematic data on this point in order to inform best practice clinical care.

Since control groups are considered unethical he has some ideas about how to determine desistance overtime before the initiation of medical treatment:

Suppose, for example, an adolescent had to wait for a year, if not longer, to be seen for a baseline assessment. (Thus, they already have had time and space to continue to think about their gender identity, albeit without hormonal suppression and probably without ongoing psychosocial therapeutic support.) If one collected baseline data at the time of referral, and not the time of assessment, one could argue that if the adolescent continued to experi- ence gender dysphoria after sitting on a waiting list for a long time, this would, perhaps, be an argument for the institution of hormonal suppression. For those adolescents who, while on a wait-list, remitted with regard to their gender dysphoria, it is likely that they would not choose to even be seen for an assessment. Thus, one could use long wait-list times as a type of control as a partial way to evaluate the stability of the gender dysphoria.

Lastly, one could consider recommending exploratory psychosocial treatment without social transition and hormo- nal suppression, particularly if the case formulation is that the gender dysphoria has emerged in the context of other psy- chosocial factors or as a result of other mental health issues. Given the substantial uncertainties about best practice care for these youth, the frontline clinician will have to weigh carefully the benefits and risks of various treatment options and proceed with caution.

References:

Allen, L. R., Watson, L. B., Egan, A. M., & Moser, C. N. (2019). Suicidality and well-being among transgender youth after gender- affirming medical interventions. Clinical Practice in Pediatric Psychology. doi.org/10.1037/cpp0000288

Bauer, G. R., Scheim, A. I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: A respondent driven sampling study in Ontario, Canada. BMC Public Health, 15(525). doi. org/10.1186/s12889-015-1867-2.

Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE, 13(8). doi:10.1371/journal.pone.0202330

Russell, S. T., & Fish, J. N. (2016). Mental health in lesbian, gay, bisex- ual, and transgender (LGBT) youth. Annual Review of Clinical Psychology,12, 465–487. doi: 10.1146/annurev-clinpsy-021815-093153

Zucker, K. (2019). Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues. Archives of Sexual Behavior doi.org/10.1007/s10508-019-01518-8

We do not have open comments on the Gender Health Query website. But that doesn’t mean we aren’t interested in what you have to say. If you have a comment, blog post idea, or any other feedback, we would be interested if the information can be supported by science research, an informed opinion, real-world observations, or personal experiences. Please contact us.

Italian Politicians Seek to Ban the Use of Puberty Blockers for Childhood/Teen Gender Dysphoria

News

Voice of Europe has published an article stating that Italian politicians are seeking to ban the use of puberty blockers for the treatment of trans-identified, gender dysphoric minors.

The regional council of Friuli Venezia Giulia in northern Italy has approved a motion which calls on the national government to prohibit the use of hormone-blocking prescription drugs used in so-called ‘gender reassignment treatment’ for gender-confused children…

Bordin argued that the motion is not an “ideological position but a proposal of common sense in the exclusive interest of the health of children throughout Italy.”

A recent negative report has come out of the U.K. about the safety and efficacy of hormone blockers. The health consequences of medical transition are serious and can be found on our website here.

References:

Lyons, A. (2019, July 28). Italian council to ban gender-altering drugs for kids. Voice of Europe. Retrieved from https://voiceofeurope.com/2019/07/italian-council-to-ban-gender-altering-drugs-for-kids/

We do not have open comments on the Gender Health Query website. But that doesn’t mean we aren’t interested in what you have to say. If you have a comment, blog post idea, or any other feedback, we would be interested if the information can be supported by science research, an informed opinion, real-world observations, or personal experiences. Please contact us.

New Study on LGBT Youth & Mental Health released by the Trevor Project

News Commentary

 A new study on LGBT youth and mental health has been released by the Trevor Project, a U.S. based LGBT youth advocacy group. 

In this survey there are as many trans-identified youth as gay and lesbian youth or bisexual youth. This is unprecedented in earlier suites on the LGBT population.

This study shows that both trans youth and LGB youth report high rates of suicide ideation and attempts, as well as discrimination. The rates are higher for trans youth.

Youth who report having people try to change their sexual orientation or gender identity report worse mental health. GHQ does not support rejecting trans youth or diminishing their gender dysphoria issues. We support a mental health model and worldview that doesn’t consider inappropriately transitioned minors and young adults as morally acceptable collateral damage.

It is very important to protect LGBT youth from bullying and physical violence. This is not the only study that shows an association with poorer mental health and suicide risk and bullying.

There are some aspects of this study that have a negative impact on the quality of it:

 1) It is gathered on social media websites so it is a survey study, not population based. These may yield questionable results.

 2) This study as published online has a major shortcoming in that it does not break down biological sex, not by gay or lesbian, and not by trans-identified biological females relative to males.

2 studies reveal that having a biological sex of female verses male may be what is actually driving the highest suicide risk rates rather than “cis” versus trans. The recent Toomey 2018 study in the US and a Stonewall UK study are reviewed here pointing out that reality.

Recent data is showing large increases in numbers of females who identify as trans, as well as large increases in females with serious mental health problems. Biological sex is a very relevant factor in this research. Scientists should display this information clearly in studies and take it into consideration when analyzing data. It is actually an odd oversite that it is not included in the Trevor Project Study and other recent LGBT studies.

3) The study does not break down the mental health of gay, lesbian, and bisexual youth or of trans versus non-binary-identified youth. These are different populations. For example, many studies show bisexuals have worse mental health problems than gays or lesbians. They may have as many mental health problems as trans people do. Not isolating this population was a missed opportunity to communicate with the public what these young people are experiencing. It’s one of several negative side effects arising from constantly lumping all “LGBT” people together. These populations all show differing profile averages in mental health, physical health, and income. 

4) There are multiple questionable identities like “demi-boy” and “ace-spectrum” lumped in with LGBT youth which appear to reflect online Tumblr youth culture rather than clear data collection.

A previous blog post about two females who obtained nippleless double mastectomies raises the topic about whether or not minors will receive sugeries for non-traditional medical transitions. These are for identities such as agender, nullo, or neutrois, which are identities where the person wishes to be no gender or sexless and may remove nipples, the whole penis, or have the vagina sewn up and clitoris removed. These identities technically fall under non-binary identities which are being medicalized in children under the age of eighteen. Here in the list of the Trevor Project identities is “Neutrois.

Update 06/24/19: A recent news article “Almost 2 percent of high schoolers say they are transgender” about a CDC study shows it has similar results to the Trevor Project survey. It demonstrates drastic increases in numbers of trans-identified teens, and that they have much higher suicide risks rates

We do not have open comments on the Gender Health Query website. But that doesn’t mean we aren’t interested in what you have to say. If you have a comment, blog post idea, or any other feedback, we would be interested if the information can be supported by science research, an informed opinion, real-world observations, or personal experiences. Please contact us.

British Doctors' Editorial Raises All of the Same Concerns Present on the GHQ Site

News

British doctors have submitted an editorial to a UK medical journal that reflects the same concerns raised on the GHQ website.

From the abstract of “Gender incongruence in children, adolescents, and adults” by Bewley et al., 2019:

We do not have open comments on the Gender Health Query website. But that doesn’t mean we aren’t interested in what you have to say. If you have a comment, blog post idea, or any other feedback, we would be interested if the information can be supported by science research, an informed opinion, real-world observations, or personal experiences. Please contact us.

A Psychology Professor Believes Children Are Susceptible to Being Influenced by Gender Ideology

News Commentary

A recent College Fix article discusses the issue of nature versus nurture in gender identity and children.

In a recent talk and subsequent Internet post, a professor of psychology disputed the idea that children can honestly determine their “gender identity”—whether or not they are a boy or a girl—at their earliest ages.

Professor Katie Alcock’s original post on Medium is called “Young children, reality, sex and gender.”

The current popular narrative about childhood and teen gender identity is that dysphoric children are “trapped in the wrong body.” Gender dysphoria is due to a body defect, not a mental health issue. This is the viewpoint behind the recent move to add the term “gender incongruence” to the forthcoming edition of ICD (ICD-11) into a new chapter termed “Conditions Related to Sexual Health.” In this way, a trans child (and adult) will be viewed as simply having a physical birth defect that needs medical correction.

But there is evidence of environment influences on how children see other’s gender and their own gender beyond the “pink brain/blue brain” narrative. Topic 10 reviews “nature versus nurture” research on gender dysphoria and homosexuality. Factors such as family situation, homophobia, and mental health issues influence gender dysphoria. And Dr. Alcock believes that children’s perceptions of their own gender may be influenced by the gender expectations around them:

So researchers are clear that we are talking about children’s knowledge of sex, and that this can’t change. A nice quote from a 2003 paper:

“Categorical sex is an essential, immutable attribute of people that is maintained (by self and others) independent of changes in physical appearance (e.g., in hairstyle, clothes, or make-up) and of changes in behaviour (e.g., cross-sex play behaviour or homosexuality).” (from Trautner et al., 2003, in the International Journal of Behavioral Development)

Nevertheless, it takes children some time to work out both whether they themselves are a girl or a boy, and that both they and others cannot change sex. Working out which they are themselves happens earlier, and is based in all the studies that have been done on physical appearance and stereotypes. 

She then proceeds to show several examples of this. Children see gender in terms of stereotypical haircuts and dress. This information explains the reasons why people are concerned, including LGB people, parents, and even gender dysphoria professionals, that grey area youth, more likely to be LGB when they get older, may be harmed by having their gender confusion validated.

The reasons for stereotyping are rooted in the need for humans, including children, to be able to make generalizations at times in life (even if they are problematic sometimes):

Making generalisations is a very useful skill for a baby or child — if they couldn’t make generalisations, they would never be able to work out that a new cat they saw was in fact a cat, or a new apple was just as good to eat as the last one, or a new car is likely also to go places. Children can work out at a very young age that there are men and women, boys and girls, in the world — it’s probably quite useful for them to work this out in the general scheme of things².
So when they see all the girls at nursery wearing pink and having long hair, well, that’s what girls do! And they also realise, from what people are saying, and from how their parents dress them, what toys they are given, and what toys other children who look like them (same clothes, same hair) what they are supposed to like and do based on what sex they are.³

And:

Children know what they like. When society and the world tells them that the things they like are those that boys like — but they have been told in words that they are a girl — well, that’s easy. They already know that having short hair makes you into a boy. They know that playing with cars makes you into a boy. So it’s easy! Boy all the way. And their version of the world, at their age, means that changing sex is totally possible.

Dr. Alcock’s comments emphasis nurture. In contrast, the narrative promoted by the Trans Youth Project is generally “innate gender identity.” The Trans Youth Project studies are being used to validate early social transitions of thousands of children, to put thousands more on hormone blockers, and to support arguments for earlier and earlier medical interventions (whether this is the researchers’ intentions or not). In this article, head psychologist Kristina Olson doesn’t mention the possibility of desistance or its association with adult LGB identity. In this article, she calls concerns about the psychological impact of social transition “alarmist.” And here, the Trans Youth Project promotes the view that trans children “know who they are” when they both say they are trans and match cross-sex interests of controls. Olson’s view is that desistance was over stated in previous research. Her cohort’s declarations of “I am a girl” (versus wanting to be a girl), as well as a match in cross-sex interests, indicates a testable, innate trans identity.

Alcock indicates children may be influenced to understand their gender due to being drawn to cross-sex interests and style and opposite sex playmates. This is precisely Debra Soh’s criticism of the gender dysphoria affirmative model as stated in “The Unspoken Homophobia Propelling the Transgender Movement in Children” and elsewhere. It’s also getting difficult to argue that culture doesn’t affect gender dysphoria in youth as the demographics between younger and older people are so different, with now an increase in females transitioning.

A review of the trans child narrative and how it is heavily promoted through gender stereotypes can be found here and here. All of the educational graphics involve short hair versus long hair and GI Joe and Barbie type of imagery.

Children who will grow up to be trans adults are drawn to stereotypical cross-sex interests. But so are pre-gay/lesbian/bi children.

Autism spectrum individuals may also be susceptible to seeing their cross-sex interests as being indicative of their “innate” gender identity, as rigid and obsessive thinking may be part of the symptoms (here and here).

These are issues as medical transition starts as young as nine years old now in the United States.

GHQ seeks to learn the influence of gender ideology on pre-same-sex attracted and other gender nonconforming youth to ensure those youth are not over-medicalized as minors. Since detransitioned young people are often LGB, this is a population that deserves study and protection, as do trans youth. Determining all of these influences is necessary in determining best pathways to support dysphoric youth.

References

Alcock, K. (2019, May 29). Young children, reality, sex and gender. Medium. Retrieved from https://medium.com/@katieja/young-children-reality-sex-and-gender-3421f4f165f1

We do not have open comments on the Gender Health Query website. But that doesn’t mean we aren’t interested in what you have to say. If you have a comment, blog post idea, or any other feedback, we would be interested if the information can be supported by science research, an informed opinion, real-world observations, or personal experiences. Please contact us.