American Journal of Psychiatry Study Purported to Show Benefits of Transgender Medical Transition Made False Claims

The American Journal of Psychiatry published a study from Yale School of Public Health and the Karolinska Institute in Sweden touting the benefits of surgeries for gender dysphoria:

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

Gender identity surgeries include double mastectomy and phalloplasty for FtMs, and vaginoplasty and facial feminization for MtFs. They have now had to issue corrections indicating the study was flawed and shows no benefit.

The study, as others, indicates overall worse mental health and suicide risk for transgender people compared to the general population:

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). 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).

They found no evidence of benefits of hormones alone. They did report a “longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment.” The positive message about “gender-affirming surgeries” was widely cited by the media. Current media appears eager to promote pro-medical transition stories, even when it involves minors, as any critical commentary about these protocal is lacking in US media. Dr. Pachankis himself claimed in an interview:

No longer can we say that we lack high-quality evidence of the benefits of providing gender-affirming surgeries to transgender individuals who seek them.

However, the study is flawed and the data shows no benefits from these expensive surgeries that may have negative side-effects such as infection, loss of sexual function, and need for repeat vaginiplasty surgeries. After several letters to the editor criticized it, the journal redid the study’s statistical analysis and found the conclusions are wrong.

While the positive claims were reported in the media, some retractions have not been. Gender Health Query is sending out a request to media outlets who repeated the positive claims of this poorly done study whose authors may have been suffering from confirmation bias to correct the record. We are also asking the American Journal of Psychiatry why they continue to display this title prominently. It’s misleading. Notice the positive sounding title remains intact, but there is only a small link at the top mentioning that there are corrections to the article. Sometimes corrections are minor. That is not the case with this study. Does the AJP want to mislead the public? Because that will be the result based on this title. What are the reasons they did not retract the study altogether?

This study had a high quality, very large data set (2,600 transgender individuals diagnosed with gender incongruence between 2005 and 2015 versus all the rest of the Swedish population). It is one of the better data sets used in a study, with many studies on transgenderism being poor quality (ex- survey studies, convenience sampling, lost to follow-ups). It contricits the finding of the Cornell review And this analysis fails to show improvements in the mental health with hormone use and surgeries. That is significant given the huge increase in medicalized minors.

Most studies on outcomes for trans individuals are of poor quality in terms of research standards. Many studies indicate trans people have improved quality of life post-transition. Others indicate that long-term mental health outcomes are not good, calling into question the effectiveness in reducing suicide risk and improving mental health.

A list of “Letters to the Editor” and their response is listed under the published article:

35 Anckarsäter H, Gillberg C: Methodological shortcomings undercut statement in support of gender-affirming surgery. Am J Psychiatry 2020; 177:764–765Abstract, Google Scholar

36 Van Mol A, Laidlaw M, Grossman M, et al.: Gender affirmation surgery conclusion lacks evidence. Am J Psychiatry 2020; 177:765–766Abstract, Google Scholar

37 Curtis D: Study of transgender patients: conclusions are not supported by findings. Am J Psychiatry 2020; 177:766Abstract, Google Scholar

38 Malone W, Roman S: Calling into question whether gender affirming surgery relieves psychological distress. Am J Psychiatry2020; 177:766–767Abstract, Google Scholar

39 Landén M: The effect of gender-affirming treatment on psychiatric morbidity is still undecided. Am J Psychiatry 2020; 177:767–768Abstract, Google Scholar

40 Wold A: Gender corrective surgery promoting mental health in persons with gender dysphoria not supported by data presented in paper. Am J Psychiatry 2020; 177:768Abstract, Google Scholar

41 Ring A, Malone M: Confounding effects on mental health observations after sex reassignment surgery. Am J Psychiatry 2020; 177:768–769Abstract, Google Scholar

42 Bränström R, Pachankis JE: Toward rigorous methodologies for strengthening causal inference in the association between gender-affirming care and transgender individuals’ mental health. Am J Psychiatry 2020; 177:769–772Abstract, Google Scholar

Here is a list of URLs citing this study that now need correction:

https://www.bustle.com/p/affirming-peoples-gender-improves-trans-mental-health-a-study-says-19345160

https://www.madinamerica.com/2019/11/gender-affirming-interventions-reduce-mental-health-issues-study-suggests/

https://www.jwatch.org/na50059/2019/10/11/gender-affirming-surgery-durably-improves-mental-health

https://www.medpagetoday.com/psychiatry/generalpsychiatry/82642

https://www.nydailynews.com/news/national/ny-transgender-gender-affirming-surgery-mental-health-study-20191004-bxvqkg4gj5budinawa3bogp5oa-story.html

Here is a list of journal articles that referenced this study and quotes used:

Sevelius J.M., Gutierrez-Mock L., Zamudio-Haas S., et al. (2020). Research with Marginalized Communities: Challenges to Continuity During the COVID‑19 Pandemic, AIDS and Behavior, Volume 24, 2009–2012. https://doi.org/10.1007/s10461-020-02920-3

> Among our transgender and gender diverse staff and participants, delays in gender-affirming treatment, such as hormone injections and surgeries, due to the shutdown of clinics and delays in "elective" surgeries, can cause serious mental health issues, including depression, anxiety, and suicidality [16].

Wang Y., Pan B., Liu Y., et al. (2020). Health care and mental health challenges for transgender individuals during the COVID-19 pandemic, Lancet Diabetes Endocrinology, Volume 8, Issue 7, 565-565. https://doi.org/10.1016/S2213-8587(20)30182-0

> Besides access to health care, it is also important to highlight mental health issues of transgender individuals. Previous studies showed that gender-affirming surgery was associated with reduced mental health problems.4

Roque R.A. (2020). Transgender pediatric surgical patients—Important perioperative considerations, Pediatric Anesthesia, Volume 30, Issue 5, 520-528. https://doi.org/10.1111/pan.13845

> "Importantly, surgeries for transgender individuals are medically necessary procedures, proven to improve dysphoria, mental health, and quality of life,26, [29]-33 and should not be viewed as elective.14, 15"

Konrad, M., & Kostev, K. (2020). Increased prevalence of depression, anxiety, and adjustment and somatoform disorders in transsexual individuals, Journal of Affective Disorders, Volume 274, 482-485, https://doi.org/10.1016/j.jad.2020.05.074

Aldridge Z., Patel S., Guo B., et al. (2020). Long term effect of gender affirming hormone treatment on depression and anxiety symptoms in transgender people: A prospective cohort study, Andrology, published online 10 August. https://doi.org/10.1111/andr.12884

> "In contrast, Bränström and Pachankis [40] using the Swedish population register showed no significantassociation between the likelihood of accessing mental health treatment and time since initiation of GAHT.

"Flaherty, A.J., Sharma, A., Crosby, D. (2020). Should Gender-Affirming Surgery Be Prioritized During the COVID-19 Pandemic?,  Otolaryngology–Head and Neck Surgery, Published June 30, https://doi.org/10.1177/0194599820939072

> A recent study found significantly reduced risk of mental health treatment in TGNC patients after receiving GAS but not HRT alone.13

Schvey, N.A., Klein, D.A., Pearlman, A.T., Riggs, D.S. (2020), A Descriptive Study of Transgender Active Duty Service Members in the U.S. Military, Transgender Health, first published 19 May 2020, https://doi.org/10.1089/trgh.2019.0044

> The finding that transmales, who were significantly more likely to have taken steps toward gender affirmation, presented with better mental health may provide further evidence supporting the effectiveness of gender-affirming treatments in ameliorating distress and improving quality of life.69,[70]

Surmaitis, R.M., Greenberg, M.R., Ebeling-Koning N.E., et al. (2020). Characteristics of Transgender Patient Cases Managed by a Toxicologist: an Analysis of the Toxicology Investigator's Consortium (ToxIC) Registry: January 2017–June 2019, J Med Tox, Published: 17 June 2020 

> It would be helpful for further study to gather more information on whether patients have undergone surgical procedures or hormonal therapy because it has been shown that rates of suicidality and utilization of mental health services may differ based on transition-related medical interventions [20, 21].

Giraldi A. (2020). Mental health and gender dysphoria – why does it matter? Acta Psychiatrica Scandinavica, Volume 141, Issue 6, 483-485, https://doi.org/10.1111/acps.13182

> Though, some studies indicate that some of the increased risk of mental health problems persist, which may in part be related to internal and external factors (17-19).

References

Bränström, R., Pachankis, J. (2019). Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. American Journal of Psychiatry, 77(8):727-734. doi.org/10.1176/appi.ajp.2019.19010080

Cornell University. (2018, March 26). What does the scholarly research say about the effect of gender transition on transgender well-being? Retrieved from https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/

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

New Study Linking Conversion Therapy to Depression in Trans Adults & Criticism

News

Affirmative model advocate Jack Turban released a study linking suicide risk to childhood conversion therapy.

“Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults:”

Findings In a cross-sectional study of 27 715 US transgender adults, recalled exposure to gender identity conversion efforts was significantly associated with increased odds of severe psychological distress during the previous month and lifetime suicide attempts compared with transgender adults who had discussed gender identity with a professional but who were not exposed to conversion efforts. For transgender adults who recalled gender identity conversion efforts before age 10 years, exposure was significantly associated with an increase in the lifetime odds of suicide attempts.

The study was also criticized for having poor methodology by health professionals/scientists:

Misinterpretation of the findings of this study may limit safe, ethical treatment options for gender-questioning and gender-diverse people:

Prof Richard Byng, PhD, University of Plymouth, UK
William J Malone, MD St. Luke’s Endocrinology and Diabetes Clinic, Twin Falls, ID.
Prof David Curtis, PhD, Queen Mary University of London, UK

The study by Turban and colleagues reports that previous exposure to “gender identity conversion efforts (GICE)” is associated with suicidality among transgender-identifying adults. While the large sample size is a strength, the authors underplay the serious methodological weaknesses, particularly the likely confounding effects of co-existing mental health problems. They then take this association and in the abstract and conclusion seek to imply causation. Hence, the findings could mislead frontline clinicians and public policymakers alike.

The key limitation is that the study did not control for comorbid psychiatric illness, the greatest single predictor of suicidality. While mental health conditions are acknowledged as confounders, they are declared unlikely based on the spurious idea that this would require internalized transphobia. Rather, it seems likely that professionals encountering persons with gender dysphoria (GD) and significant mental health problems were more likely to engage in conversations about the merits of transition, which may later be recalled as a conversion effort. Thus, the association found is arguably more likely due to reverse causation.

Another limitation is that the study data are from a convenience sample of current transgender-identifying individuals, rather than all persons with a history of GD. The sample is highly unlikely to have captured individuals exposed to GICE who subsequently adopted a gender identity concordant with their biological sex. Thus, these data cannot be generalized to individuals as they present with GD.

Prepubertal-onset GD has a high rate of remission, while desistance of GD among those in adolescence with recent onset GD, the increasingly dominant presentation, is as yet unknown. We oppose coercive or unwanted deliberate attempts to change an individual’s gender identity and propose that a range of neutrally framed, supportive therapies and consultative approaches, which are neither affirmation nor conversion, be evaluated in randomized controlled trials. Outcomes of noninvasive treatments should be compared to those of “gender-affirmative models of care,” entailing hormonal and surgical interventions which are associated with increased heart disease, impairments in bone density, infertility, and high rates of suicide over the long term.

References
1. Turban J, et al. Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults. JAMA Psychiatry. 2019:1. doi:10.1001/jamapsychiatry.2019.2285
2. Franklin J, et al. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol Bull. 2017;143(2):187-232. doi:10.1037/bul0000084
3. Steensma T, et al. Factors Associated With Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study. Journal of the American Academy of Child & Adolescent Psychiatry. 2013;52(6):582-590. doi:10.1016/j.jaac.2013.03.016
4. Dhejne C, et al. Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLoS ONE. 2011;6(2):e16885. doi:10.1371/journal.pone.0016885”

References:

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

A Review Study Shows Higher Rates of Child Abuse Among Gender Nonconforming Children

News

A study that reviewed other studies regarding trans and gender nonconforming individuals reveals a pattern that they have higher rates of being child abuse victims. The abuse is also associated with other negative mental health outcomes in adulthood.

RESULTS

All studies were cross sectional, exploratory/descriptive. Rates of child abuse were high, with up to 100% of transgender males reporting childhood sexual abuse in one study. In four studies that measured childhood gender nonconformity (CGNC), children who exhibited CGNC were more likely to be abused. In the eight studies that investigated the association of childhood abuse among transgender and gender nonconforming people, it was associated with negative adult outcomes, such as sex without a condom, self‐harm, past year drug use, post‐traumatic stress disorder (PTSD) symptoms, and suicide attempts.

References:

Tobin, V., Demaney, K.R. (2019.) Child abuse victimization among transgender and gender nonconforming people: A systematic review. Perspectives in Psychiatric Care. DOI: 10.1111/ppc.12398

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.

Non-Binary Identity, A Familiar Story in the New Yorker

News Commentary

An article in The New Yorker called “A Year without a Name” about a female with a non-binary identity follows a pattern of other non-binary identity stories. The writer struggles with self-hatred, identity instability, body dissociation, and confusion.

Twenty years later, my girlhood was dissolving, with no clear alternative in place. I felt less embodied than ever, less able to gather myself into one person. And yet the idea of “transitioning”—changing my name, starting hormones, getting surgery—sucked me into a thought circuit with no end and no exit.

The concerning issue here is that some of these descriptions may indicate other mental health problems than gender dysphoria alone. These issues could also be related to body dysmorphic disorder and borderline personality disorder (known for identity instability). Plastic surgery does not help body dysmorphic disorder in the long run. Other examples showing a similar pattern in non-binary-identified people of depression, anxiety, identity instability, and an unhealthy need for validation can be found on GHQ here.

More examples of identity instability in The New Yorker article:

I taped the name to the wall inside my closet, so I’d have to look at it whenever I changed clothes. Sometimes I admired the shapes of the letters; sometimes I averted my eyes. Cyrus remained a stranger whose ways I was trying to understand. How would he wear his hair? Would he be on time? Would he be a vegetarian? Would he buy steak at the grocery store and cook it alone? Would he meditate? Would he have sex with strangers and tell no one it had happened? Would he have sex with men? Would he wear sneakers? Would he value success? Would he keep his word? Would he lift weights? Would he go running whenever he wanted, even in the dark, even when it was raining? What truth did the name contain? Was Cyrus inside of me already, or had I invented him?

There are a few studies that show those with non-binary identities have worse mental health than binary trans people. From the APA website (emphasis ours):

The lack of cultural visibility of non-binary identities may make the identity development process more difficult for non-binary individuals. Further, even after coming to terms with their own identity, they may face additional stress from having to frequently “come out” as non-binary, even in LGBTQ contexts, and from being mis-gendered or misunderstood.

Research on the mental health of people with non-binary gender identities is limited and generally includes only those who also identify as transgender. From this research, it appears overall, non-binary people may face both greater levels of minority stress and unique forms of minority stress, in comparison to binary transgender peers, a factor which has been (associated with higher levels of suicidality (Tebbe & Moradi, 2016). it appears that non-binary transgender people experience greater risk for negative mental health outcomes than their binary transgender peers (James, Herman, Rankin et al, 2016). For example, in one study, over half of the respondents reported clinical levels of depression and over one third of the respondents reported clinical levels of anxiety (Budge, Rossman, & Howard, 2014).

Researches tend to blame “minority stress” for an increase in problems among non-binary-identified people rather than consider there are serious mental health issues the person and therapist needs to explore internally. This puts the blame on the many people in society who do not believe there are “dozens of genders,” who don’t want to be forced to use the multiple pronouns that go along with these identities. And it calls into question the right they have to hold these views.

References:

Dunham, C.G. (2019, August 12). A Year without a Name. The New Yorker. https://www.newyorker.com/magazine/2019/08/19/a-year-without-a-name

Webb, A., Matsuno, Budge, S., Krishnan, M., Balsam, K., & American Psychological Association (2015). Non-Binary Gender Identities: Fact Sheet. Retrieved from https://www.apadivisions.org/division-44/resources/advocacy/non-binary-facts.pdf

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.

Mental Health Problems are Significantly Higher in Trans People in a Study of College Students

News

A new study called “Gender Minority Mental Health in the U.S.: Results of a National Survey on College Campuses” reviews data that shows much higher rates of mental health problems in college students with gender dysphoria.

Here is the overall comparison:

Graph circulated by a researcher on SM regarding Lipson (2019)

This chart is broken down by sex and shows FtMs have the most mental health issues of all categories:

Graph circulated by a researcher on SM regarding Lipson (2019)

The story is covered on a Boston University website which described the study this way:

The largest and most comprehensive mental health survey of college students in the US reveals that students who identify as transgender, gender nonconforming, genderqueer, and nonbinary face enormous mental health disparities relative to their peers. In a first-of-its-kind study published on Friday, August 16, in the American Journal of Preventive Medicine, Boston University researchers and collaborators found that gender minority students, whose gender identity differs from the sex assigned them at birth, are between two and four times more likely to experience mental health problems than the rest of their peers.

2.10% of the survey was categorized as “gender minority,” a very high percent of the population based on any research that occurred until recently. But this sample includes “genderqueer” individuals who may not be transitioning medically.

In a trend found elsewhere, more biological females identified as trans/non-binary. They weighted this data so some of the numbers they arrived at appear to be affected by that. From the study itself:

The sample included 65,213 students at 71 colleges and universities across the U.S. Overall, 98% identified as cisgender (n=63,994) and 2% as GM (n=1,237); 1.3% identified as trans masculine and 0.8% as trans feminine. The sample was roughly two-thirds white, and most were undergraduate students. Additional characteristics are presented in Table 1.

More females appear to be attracted to non-binary identities. To understand where this falls in terms of biological sex it is important to note more females attend college than males. In this survey the ratio of females and males who are not trans is 43,388: 20,606 or 43:20, about 2:1. A larger percent of the females were genderqueer-identified.

F=female:

Genderqueer FAB (n=460)
Genderqueer MAB (n=138)

References:

Colarossi, J. (2019, August 16). Transgender College Students Are Up to Four Times as Likely to Experience Mental Health Problems. The Brink. Retrieved from https://www.bu.edu/articles/2019/transgender-college-students-mental-health-problems/

Lipson, S.K, Raifman, J., Abelson, S., Reisner, S.L. Gender Minority Mental Health in the U.S.: Results of a National Survey on College Campuses. American Journal of Preventative Medicine 53(3), 293–301. doi.org/10.1016/j.amepre.2019.04.025

Post By a Detransitioned Female About Youth, Mental Illness, & the Internet That Mental Health Professionals Should Read

News Commentary

A young, detransitioned woman has written two articles about how trans identification, eating disorders, and mental illness in general, are justified and fueled by Internet culture and by Tumblr (a blogging platform many young people use) in particular. Some of these subjects are covered on sections on social influences on the GHQ website (here and here and here).

GHQ covers in the linked sections the data that shows an increase in mental illnesses in young females, including increases in self-harming, suicide attempts, and hospital admittance. Mental health professionals and parents should be aware of what is happening with mental health and the influences of the internet. Many metal health issues, including suicide risk and eating disorders, are known to work as social contagions. Helena, the author, writes very perceptively and eloquently and has put her discussion in the context of other research on these issues.

“Tumblr — A Call-Out Post”

“How Mental Illness Becomes Identity: Tumblr, a Callout Post, Part 2”

References:

Tumblr — A Call-Out Post. (2019, March 20). Retrieved from https://4thwavenow.com/2019/03/20/tumblr-a-call-out-post/

How Mental Illness Becomes Identity: Tumblr, a Callout Post, Part 2. (2019, August 13). Retrieved from https://4thwavenow.com/2019/08/13/how-mental-illnesses-become-identities-tumblr-a-callout-post-part-2/

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.

A New Brain Imaging Study Comparing Trans Women and Cross-Sex Controls Show Differences Based on Biological Sex

News

A new study called “Sex Matters: A Multivariate Pattern Analysis of Sex- and Gender-Related Neuroanatomical Differences in Cis- and Transgender Individuals Using Structural Magnetic Resonance Imaging” has been published in the journal Cerebral Cortex.

There are some relevant quotes about possible biological reasons for trans identity. Trans peoples brains may share some similarities to cross-sex controls:

A better understanding of neurobiological sex differences in terms of prevalence discrepancies, differing disease trajectories and outcomes in diverse psychiatric conditions is indispensable (Cahill 2006). Research dealing with gender issues in neuroscience claims that our brains are individual mosaics of female and male characteristics, thereby rejecting the simplistic idea of a “female” or “male” brain (Maney 2014; Joel et al. 2015). In light of this general rethinking, our findings support previously published evidence demonstrating that the brain structure of transgender people partially converges on an assumed sex continuum, although we cannot conclude from our findings that it resembles the morphology of the respective gender identity (Swaab 2007; Savic et al. 2010).

This study, as well as other brain imaging studies, still shows that there are differences between trans peoples’ brains and cross-sex controls:

Generally, we can conclude from our analysis that sex has a major effect on GM irrespective of the self-perception of being a woman or a man.

GHQ covers most of the research around the biological causes of both transgenderism and homo/bisexuality and possible environmental influences. Our position is that brain imaging studies should also use gender nonconforming homosexual controls, as well as heterosexual cross-sex controls, to better understand the differences between trans and gay/lesbian people, as this is the main contention in the issue of transitioning children. Some children grow out of gender dysphoria and are more likely to be LGB adults.

References:

Baldinger-Melich, P., Castro, M., Seiger, R., Ruef, A., Dwyer, D., Kranz, G., Manfred, K., Kambeitz, J., Kaufmann, U., Windischberger, C., Kasper, S., Falkai, P., Lanzenberger, R., Koutsouleris, N. (2019). Sex Matters: A Multivariate Pattern Analysis of Sex- and Gender-Related Neuroanatomical Differences in Cis- and Transgender Individuals Using Structural Magnetic Resonance Imaging, Cerebral Cortex, , bhz170. doi.org/10.1093/cercor/bhz170

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.

Puberty Blockers, Studies on Trans-Identified Youth, & Ethical Dilemmas

News

Commentary by bioethics professionals, who will be publishing in Pediatrics, appeared in The Conversation regarding the recent criticisms of a study of hormone blockers used to treat gender dysphoric children. The article is called “Puberty-blocking drugs: the difficulties of conducting ethical research” and it addresses the ethical dilemmas around randomized trials and treating people with gender dysphoria.

Some commentators on the UK trial have claimed that the study was flawed because it lacked a control group. But would it have been ethical to perform a controlled trial? To our knowledge, all of the previous studies of puberty blocking in adolescents have had a similar observational design (that is, no comparison group that is not treated). Potentially, this is based on either ethical or practical grounds. The ethical argument is that it would be wrong to withhold treatment from distressed adolescents who may benefit from delaying or halting the physical changes of puberty.

These ethical concerns about control groups was expressed by Kristina Olson, head psychologist researcher on the Trans Youth Project. She repeated an opinion many affirmative model advocates (and others) have about using control groups for gender dysphoria treatment. There are ethical concerns in using control groups on human subjects in general.

Some scientific caveats, none of these involve random assignment. I think every single person involved in this debate agrees that the scientific claim that we really want to randomly assign people would be the most unethical behavior ever. So, we are not going to say you get hormones and you don’t. No one’s ever going to do that.

Due to the possible dangers of hormone blockers, and that the psychological impacts can’t be determined without a control group, they lay out a case for more accurate studies.

In a forthcoming commentary in the journal Pediatrics, we also set out an ethical argument in favour of controlled trials of puberty suppression. We argue that one of the goals of medical ethics is to promote well-being. But in gender dysphoria it is uncertain whether puberty suppression achieves this goal. The drugs have potentially serious physical side effects. The nature and extent of the psychological benefits are unclear and may differ from person to person. It remains uncertain whether they are in the overall best interests of the adolescent.

They address the fact that a strict randomized trial may not be the best option as it forecloses treatment options for a youth who may be very distressed.

If puberty suppression is to be used with uncertain consequences, it is imperative that we study the effects as systematically as possible. Where a controlled trial is impractical, this might be through an observational design.

They discuss the difference between adults and cognitively immature minors who can’t truly consent to the harsh realities of what medical treatment does to the body.

Medical professionals also have an ethical obligation to promote the well-being of patients, and they also have an obligation to promote their autonomy. In the case of adult patients (with capacity), the right thing to do, in the face of uncertainty about the patient’s best interests, is usually to respect their wishes.

But autonomy is more complicated in the case of young adolescents. Adolescents have varying degrees of cognitive development, which is relevant to their capacity to make decisions. Autonomy is not merely desiring something, it is genuinely and accurately understanding oneself and the options available, and vividly imagining the consequences of all feasible courses of action. How much does an adolescent understand themselves, and how well have they understood and reflected on the consequences of their choices? Clearly, there are some situations where it would be a mistake to automatically comply with an adolescent’s expressed wishes.

Topic 17: Moral Dilemmas, on the GHQ site, has a table that contains the pro and con arguments for socially and medically transitioning minors.

References:

Wilkinson, D., Savulescu, J. (2019, July 25). Puberty-blocking drugs: the difficulties of conducting ethical research. The Conversation. Retrieved from https://theconversation.com/puberty-blocking-drugs-the-difficulties-of-conducting-ethical-research-120906?utm_source=twitter&utm_medium=twitterbutton

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.

Sociologist Investigates the Use of Hormone Blockers in Children in the U.K.

News

Micheal Biggs is a sociologist at Oxford who has been investigating the Nation Health Service (U.K.) and their policy to give children hormone blockers for the treatment of gender dysphoria due to questions about safety. His recent commentary can be found on Transgendertrend.

Calling this “an experiment,” Dr. Biggs says that in reviewing the data about these practices he:

…discovered unpublished evidence that initial results, after the drugs had been administered for one year, were predominantly negative.

He has asked the clinicians why they haven’t published the results yet of this experiment:

Following my original investigation, I wrote to Professor Russell Viner at University College London (UCL), the experiment’s principal investigator, and Dr Polly Carmichael, Director of the Tavistock’s Gender Identity Development Service (GIDS), asking why they failed to publish results. I also contacted the Research Ethics Committee which originally granted permission, pointing out that the researchers consistently failed to provide annual progress reports.

He mentions a controversial trans support group, Mermaids, helped the push for administering blockers at younger ages (under 16):

First, in the years before 2011, families and transgendering organizations like Mermaids lobbied vigorously to lower the age at which GnRHa drugs were administered to children, and the Tavistock could not resist this pressure. Second, the researchers could not employ the standard randomized trial to assess the effects of blocking puberty.

With a randomized trial, one can’t know the true effects of social transitions or hormone blockers.

Some of the commentary from Tavistock staff appears contradictory:

Five years ago, in 2014, Carmichael told the Mail on Sunday that the study demonstrated favourable outcomes: ‘Now we’ve done the study and the results thus far have been positive we’ve decided to continue with it’ (italics added). She even appeared in a BBC television programme – ‘I Am Leo’, aimed at audiences aged 6 to 12 – to promote the benefits of GnRHa drugs…

The Tavistock’s statement says remarkably little about the experiment’s outcomes. It cites Carmichael and Viner’s presentation to the 2014 World Professional Association for Transgender Health (WPATH) conference showing ‘there was no overall improvement in mood or psychological wellbeing using standardized psychological measures’ (italics added). This finding was presented in February 2014, but just four months later Carmichael claimed ‘the results thus far have been positive’. I cannot find slides from this 2014 presentation, but Carmichael’s presentation to the 2016 WPATH conference apparently recycles the same finding. It also acknowledges that ‘Natal girls showed an increase in internalising problems from t0 to t1 [after 12 months on GnRHa] as reported by their parents’ (italics added). This negative outcome is omitted from the Tavistock’s statement.

There is allegedly some negative data Tavistock has not communicated:

I cannot find slides from this 2014 presentation, but Carmichael’s presentation to the 2016 WPATH conference apparently recycles the same finding. It also acknowledges that ‘Natal girls showed an increase in internalising problems from t0 to t1 [after 12 months on GnRHa] as reported by their parents’ (italics added). This negative outcome is omitted from the Tavistock’s statement.

On the GHQ site, there are many examples of how the identity politics of this complicated subject may be affecting researchers behavior and willingness to admit there may be dangers in child/teen transition protocols.

Other inconsistencies and issues he believes are problems are listed in the article.

Update 07/30/19: TransgenderTrend published another post regarding the Guardian’s total lack of interest in reporting on concerns of clinicians in the GIDS.

It has been a great disappointment to many on the Left that the Guardian has been largely silent on this issue. But two former GIDS clinicians sent a letter to the Guardian back in 2017 to alert them to serious concerns about what was going on within GIDS. One of the authors of the submission to the Guardian commented to us “we really really tried.” However, rather than jumping to publish such a devastating testimony – the kind of exclusive most journalists would give their right arm for – the Guardian chose to ignore it.

The post goes on with the letter the clinicians sent the Guardian in 2017 who had to remain anonymous for fear of their jobs:

At the end of our tethers, in the summer of 2017, we wrote this letter and sent it to the ‘Do you know what I’m really thinking?’ column at the Guardian. Although only a couple of years ago, this was a different time. Gender critical therapists did not yet exist, publicly at least. We thought we would lose our careers if anyone traced it back to us. In fact, we were so paranoid that we posted the letter so it would never be traced. One of us then called the Guardian news desk.

The letter titled “Do you REALLY want to know ‘WHAT I AM REALLY THINKING’?” reflects all of the concerns raised on the GHQ website::

What I am really thinking is that mostly you are caught in a terrible moment of social contagion. You and your children are swirling in a toxic storm of psychological and emotional distress meeting homophobia, sexism, misogyny against the back drop of the most appalling ‘bad science’. There is no such thing as a male or female brain and you cannot be ‘born into the wrong body’. The sloppiness of the language of both the internet and the politicians does you no favours with their conflation of sex and gender. This chimes so well in the era of post Truth anti expert hatred.

The fact these clinicians were afraid to speak out using their names fits a pattern that can be found on our website covering a long history of abusive activist tactics.

References:

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/

TransgenderTrend. (2019, July 28). “We Really Really Tried.” A 2017 Letter from GIDS Clinicians Ignored by The Guardian. Retrieved from https://www.transgendertrend.com/2017-letter-gids-clinicians-ignored-guardian/?fbclid=IwAR3g8_Z4fEISWtP9oWqLP8uzYIh5wJ-gjWljzbmM1BhWrE_EK7lKeb12KHA

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.

Another Study Confirms a Link Between Autism & Gender Dysphoria

News

Studies and gender clinic observations have noted that autism spectrum individuals are greatly over represented in youth seeking treatment for gender dysphoria. More research is needed in this area. GHQ covers the GD/autism link here and here and here.

EurekaAlert has reported on a new study from Anglia Ruskin University, (Stagg, 2019), that confirms this pattern:

It found that 14% of the transgender and non-binary group had a diagnosis of autism, while a further 28% of this group reached the cut off point for an autism diagnosis, suggesting a high number of potentially undiagnosed individuals.

There is an increase of trans-identified females and many are on the autism spectrum:

These figures were primarily driven by high scoring amongst those whose assigned gender was female at birth, supporting recent evidence that there is a large population of undiagnosed women with an autism spectrum disorder.

The study highlights some personality traits of autism spectrum individuals that may influence how they relate to their gender:

The authors also found higher levels of systematising (a tendency to analyse, control and use rule-based systems) and lower levels of empathy amongst the transgender and non-binary group, characteristics often found in individuals with an autism spectrum disorder.

And:

"People with autism are also more likely to seek unequivocal answers to the complex issues surrounding gender identity. Our study suggests it is important that gender identity clinics screen patients for autism spectrum disorders and adapt their consultation process and therapy accordingly."

References:

Study finds transgender, non-binary autism link. (2019, July 16). EurekaAlert. Retrieved from https://eurekalert.org/pub_releases/2019-07/aru-sft071619.php

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.

3 Articles, 3 Takes on Breast Binding

News

Recently there has been several articles on breast binding, as more young females are binding and seeking double mastectomies than a decade ago.

New York Times article “Chest Binding Helps Smooth the Way for Transgender Teens, but There May Be Risks” talks about the health consequences, such as crushed ribs and breathing problems.

An article by feminist Libby Emmons describes it as destructive self-harm by females who may not be trans, but dissociating with their womanhood:

“Just Like Female Genital Mutilation, Transgender Chest-Binding Is Barbaric”

The New York Times printed another pro-binding article that features narratives that these dysphoric females will kill themselves if they aren’t able to bind:

“‘It’s Binding or Suicide’: Transgender and Non-Binary Readers Share Their Experiences With Chest Binders”

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.

The Struggles to See Quality Mental Health Support in the NYT

Opinion

By Justine Kreher

The New York Times published an article about non-binary-identified individuals called, “The Struggles of Rejecting the Gender Binary.”

Some observations:

Not everyone identifies as male or female.

One can’t identify as male or female. A person is male or female based on their chromosomes, regardless of how feminized or masculinized they my be and wether or not these traits contribute to a person having gender dysphoria.

In the New York Times article Salem is a troubled 20-year-old biological male. Many “non-binary” people rely on cloths and makeup to express what gender they are or what gender they feel like they are on that day (more on gender stereotypes in gender ideology here). Sam is no different:

'Why didn’t you wear makeup today?’

Jan Tate asked her client during a therapy session in May of last year.

“I didn’t feel the need to.”

“Would today be the day to begin using Salem instead of Hannah?”

There was a long pause and a hushed reply: “Yeah. But it would hurt a lot worse to start asking people to call me Salem and have them not do it than not to ask them.”

Another quote that demonstrates the centrality of hair and make up in current youth trans/genderqueer culture and to the journalists who report on it:

Their brown hair fell with a loose curl just past their slim shoulders. Unlike two days before, when Salem arrived for therapy with their full lips in dark red lipstick and a dash of blush across each cheekbone, and with their long fingernails painted a bright lavender, this afternoon there was only the nail polish.

Salem, like many non-binary-identified teens and young adults, is being given hormones despite lack of clarity about what s/he want to achieve with them:

Tate switched the subject to the hormones Salem had been taking for two months: a low dose of spironolactone, a testosterone blocker, and estradiol, a type of estrogen. Salem felt driven to feminize their body, to lessen their constant alienation from their own anatomy — and their self-revulsion — but wasn’t at all sure what the right combination of feminine and masculine would be. Different days brought different answers. From the hormones, their breasts were buds. “I could foresee breasts bothering me,” Salem told Tate, though they believed they wanted them. “I just have to hope the hormones don’t make too big of a problem.”

It’s good to remember hormones have health consequences.

An observation from the therapist:

Even so, Tate commented tentatively that Salem seemed more confident since starting the hormones, that Salem seemed to be making progress in accepting themself.

I am skeptical of the therapist’s observation that this person is truly getting better. “Seemed” is a week word. I have witnessed seemingly very nice mental health professionals at gender conferences who sincerely want to do some good by supporting social / medical transition in cases that involved very troubled people. It’s an environment ripe for confirmation bias.

“While I’m presenting myself as more comfortable,” Salem mumbled, head bowed, “the feeling I have is that I hate myself.” They sometimes called themself a monster. Tate has another nonbinary client who cut themself relentlessly across their shoulders, leaving “scars on scars on scars” that the client asked Tate to touch. Weeks before this session, Salem stripped naked in their bedroom and, with a marker, scrawled “tranny” and “faggot” all over their body, slurs that were inaccurate but screamed their self-disgust.

This is the background of the MSW, LCSWA, MED, CSOTP, therapist. It is a common profile for therapists who work with non-binary identified individuals. It is a profile of a therapist who specializes in supporting and validating what I would call “outlier” identities and behavior.

Jan Tate, MSW, LCSWA, MEd, CSOTP is a psychotherapist with a dual background in clinical sexology and clinical social work. Jan Tate earned her MEd in Human Sexuality alongside her Master’s in Social Work at Widener University in Chester, PA. Her areas of expertise include working with adults in the kink, poly, trans, GNC/NB, and LGBTQ communities, along with sexual disorders and general sex therapy. She encourages sex positivity for people across the spectrum of power role identification, sexual orientation, gender expression, as well as those who are unsure of, questioning, or evolving through identifications. e had no

All people should be supported in what is healthiest for them in their lives and sexuality as long as they are not impacting other people negatively. Of all of the identities and behaviors listed above, it is the validation of gender expression that requires the participation of the outside world. And this is something that concerns me greatly, that psychologists and social workers are enthusiastically validating this without considering externalities or that there may be downsides to the youths themselves. I believe young people are being trained to believe their value and happiness relies on other people and that they are entitled to force other’s to view gender they way they do. This is what a 3rd gender pronoun requires of society. We are already seeing examples of high school teachers and University professors claiming young people are manipulating adults with “queer youth” pronoun culture, where a pronoun can be changed day to day, and anyone not going along with current gender ideology may be severely socially punished.

In a few studies non-binary-identifed youth have more problems than trans youth. It may be a manifestation of other mental health issues related to the gender dysphoria or something masking as gender dysphoria. There isn’t enough research to say for sure. But other examples in the media paint pictures of youth with shifting identities, body hatred issues, and a strong need for validation from others.

nonbinary mental illness cited by the APA

Effeminate males and masculine females have almost no acknowledgement in society, except often to say something mean. Even butch lesbians and effeminate gay males have been looked down on within their own communities by more mainstream acting gay men and lesbians. This happens generally for two reasons. Because they aren’t attracted to that (“no fats, no fems”) or they want the community to appear more “normal.” I think recognizing this is an important part of understanding why so many same-sex attracted young people are adopting trans identities. Gender “outliers,” for the most part, haven’t been celebrated in popular culture. They aren’t always even universally accepted within the gay or lesbian community. Now that the media is celebrating trans issues, a non-binary identity, from a youth who isn’t undergoing full medical transition even, makes them special. They become worthy of newspaper articles and magazine covers. They aren’t awkward boys or girls or young men and women any more. They have power to demand acknowledgment through a 3rd gender pronoun request. They are unique. Their style is unique. Their pain is unique.

But it’s not unique anymore. It’s trendy. And these youths aren’t like David Bowie or Boy Goerge who’s genius needs no special pronoun. They are just citizens. And the public will get board of this the way they got board of “lesbian chic’ in the nineties and move on. And do you know what “lesbian chic” brought lesbians and bisexual women like me who take their relationships with women seriously? We got chewed up and spit out by women who wanted to look edgy. The media isn’t interested in lesbians at all anymore.

And when society moves on from their current gender fixation we will be left with a generation of gender nonconforming youth who have been raised by media, LGBT organizations, university campuses, validating parents, therapists, and teachers, to believe that for them to be accepted, for them to be valuable, for them to be loved, the entire society must have mandatory pronoun email signatures and pronoun acknowledgment moments before all social interactions. Then, what will make them worthy?

Tate said to me that “I often find myself gut-knotted after sessions with Salem, because of the things they don’t say” — because of the feelings Salem kept locked away, even from her, for fear that their experience was inexpressible, incomprehensible. She imagined Salem in an “abyss,” undergoing a torture that was the emotional equivalent of “taking a saw blade and cutting into the skin of an arm.”

I’m sad and feel for Salem as someone who struggled with serious generalized anxiety disorder that manifested itself as intense body dysmorphia when I was 20. I do not know what Salem needs. But I question if a they/them pronoun is it. And I question why psychologists and social workers aren’t asking the same thing.

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.

Swedish Documentary Highlights Mental Health Issues & Transgender Transition Regret

NEWS COMMENTARY

Recently a Swedish documentary called Uppdrag granskning (translated as “The Trans Train”) was released about the increasing numbers of youths medically transitioning to live as the opposite sex or as a non-binary identity.

A description on a Swedish website reads as follows:

The increase of teenage girls with gender dysphoria worry parents and health care staff in several countries - because of the lack of research on the new group of patients. What if the irreversible decision to undergo a gender correction is a mistake?

The increase in young trans-identified female is the current trend in many western countries, where generally about 2/3 of the youths seeking gender clinic services are females.

Here is a chart from Sweden demonstrating the increases of referrals (both sexes). This pattern is seen in the Netherlands, the United States, Britain, Canada, New Zealand, Finland, Germany and elsewhere.

Louise Frisén, Astrid Lindgren Children’s Hospital, Stockholm Swede, increase in gender dysphoria patients

We explore the topic “Why are so many females coming out as trans/non-binary” and possible reasons why this is happening, such as mental health issues, social contagion, and internalized homo/bisexual guilt. The Swedish health professionals are observing the pattern with these females that many of them have serious co-morbid conditions. The relationship between mental health and gender dysphoria is complicated. In some cases the mental health issues arise because the dysphoria isn’t treated or the person is treated poorly for being trans. However, it also appears that mental health problems may contribute to causing the gender dysphoria, is masked by trans-identification, or at least has a complicated integral relationship with the gender dysphoria.

There were some interviews with people who regret having transitioned. They believe they were affirmed too easily and did not receive proper care from doctors or mental health professionals, who claimed transition was the only way to cure gender dysphoria.

This documentary confirms, like in the United States, that they are operating on minors in Sweden (they state at fourteen years old). Mastectomies are being performed on females as young as 13 and vaginoplasty on minors under the age of 18 in the United States.

A clinician sums up the moral dilemma they feel they are in when the interviewers asks, “Can a 14-year-old really understand the consequences of such a decision?”

If it is a very young person, then we make a particularly careful assessment.

But you’re quite right that there is a dual ethical problem. The unethicalness of not helping to ease their suffering, and also there’s the unethicalness in that the patient may change their mind 15 years down the line.

The Swedish Pediatric Society indicates it does not support the “let the child lead” approach of affirmative model mental health professionals and doctors. Their position is the child can’t alone give consent to life-long body alterations.

A letter they submitted to the Swedish government reads (translated):

The physical and psychological maturation process of children and adolescents is individual, but for most people, it involves searching for and experimenting with their identities; this is natural and needs to be done with nuanced support by the child's relatives. Society's rules need to balance children´s own rights against the necessity to protect them. Giving children the right to independently make life-changing decisions at an age when they cannot be expected to understand the consequences of those decisions, lacks scientific evidence and is contrary to established medical practice.

Update 02/13/20: A part 2 of this documentary has been released:

Uppdrag granskning: The Trans train: part 2:

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.