TOPICS

For those new to this issue it’s best to know these terms before reading.

Tan et al. 2018, has found that non-right-handedness is more common in bisexuals and homosexuals and states that this may be related to androgen exposure. In utero hormone exposure is proposed as a possible reason in multiple studies.

The article “Is There Something Unique about the Transgender Brain” points to potential biological effects on trans identity, but like the older brother effect, studies on “pheromone-like” chemical response have also shown similar results when homosexuals are compared to heterosexual controls of the opposite sex.

In a study published in 2014, psychologist Sarah M. Burke of VU University Medical Center in Amsterdam and biologist Julie Bakker of the Netherlands Institute for Neuroscience used functional MRI to examine how 39 prepubertal and 41 adolescent boys and girls with gender dysphoria responded to androstadienone, an odorous steroid with pheromonelike properties that is known to cause a different response in the hypothalamus of men versus women. They found that the adolescent boys and girls with gender dysphoria responded much like peers of their experienced gender. The results were less clear with the prepubertal children.

And below is a quote showing homosexuals also share some ways of processing these chemicals:

In previous positron emission tomography studies, we found that smelling AND and EST activated regions primarily incorporating the sexually dimorphic nuclei of the anterior hypothalamus, that this activation was differentiated with respect to sex and compound, and that homosexual men processed AND congruently with heterosexual women rather than heterosexual men. These observations indicate involvement of the anterior hypothalamus in physiological processes related to sexual orientation in humans. We expand the information on this issue in the present study by performing identical positron emission tomography experiments on 12 lesbian women. In contrast to heterosexual women, lesbian women processed AND stimuli by the olfactory networks and not the anterior hypothalamus. Furthermore, when smelling EST, they partly shared activation of the anterior hypothalamus with heterosexual men. These data support our previous results about differentiated processing of pheromone-like stimuli in humans and further strengthen the notion of a coupling between hypothalamic neuronal circuits and sexual preferences.

Another study supporting biological causes of trans identity is referenced below, though again, this study did not controlled for sexual orientation:

Antonio Guillamon of the National Distance Education University in Madrid and neuropsychologist Carme Junqu Plaja of the University of Barcelona—used MRI to examine the brains of 24 female-to-males and 18 male-to-females—both before and after treatment with cross-sex hormones. Their results, published in 2013, showed that even before treatment the brain structures of the trans people were more similar in some respects to the brains of their experienced gender than those of their natal gender. For example, the female-to-male subjects had relatively thin subcortical areas (these areas tend to be thinner in men than in women). Male-to-female subjects tended to have thinner cortical regions in the right hemisphere, which is characteristic of a female brain. (Such differences became more pronounced after treatment.)

Research has also examined olfactory response and have found results suggesting that a trans identity may be innate for many male individuals:

They measured the responses of boys and girls with gender dysphoria to echolike sounds produced by the inner ear in response to a clicking noise. Boys with gender dysphoria responded more like typical females, who have a stronger response to these sounds. But girls with gender dysphoria also responded like typical females.

Researchers in the same article feel it is important to distinguish that a trans person’s brain is not exactly the same as the brain of a person of the opposite sex. Their statement points to a belief in brain anatomy, but also recognizes environment may shape the brain.

Trans people have brains that are different from males and females, a unique kind of brain,” Guillamon says. “It is simplistic to say that a female-to-male transgender person is a female trapped in a male body. It's not because they have a male brain but a transsexual brain.” Of course, behavior and experience shape brain anatomy, so it is impossible to say if these subtle differences are inborn.

Other studies done have confirmed MtF transsexuals do not have brains and behaviors that mimic women. For example, even after castrastion and vaginoplasty, they retain male-pattern sexual responses. The sexual responses of men and women differ. Male sexual response coincides with their stated sexual orientation. Women will have physical responses to images of sex outside their sexual orientation (vaginal arousal study here, and brain scan study here). This is relevant to the political discussion and slogan the “trans women are women” (more about political ramifications of trans activism here).

Ray Blanchard states about measuring the sexual responses of males  (47:30-48:18): 

…this has been carried out on post-operative male to female transsexuals, using the same apparatus that you use on biological females…And when you look at the results, they still look like males…There is something profound about the way that females and males respond differently.

There have been studies that link FtM transsexualism with polycystic ovary syndrome (PCOS), a condition caused by high levels of androgens. It can cause reproductive issues and insulin resistance. One study (Baba 2006) discovered PCOS in 58% percent of FtMs, as well as non-PCOS insulin resistance before they had any hormonal treatment. Given that these females have higher than normal levels of “male” hormones, it is reasonable to consider that androgen levels may also have a cognitive effect. Unfortunately, testosterone therapy makes this worse. 

This article criticizing some of the medical procedures being practiced on minors asks an interesting question in regards to PCOS and FtM dysphoria:

Why not treat the PCOS first, rather than making it worse with a hormone therapy that increases insulin resistance? Could gender dysphoria in these patients simply be a psychological result from PCOS? Why treat the GD instead of the PCOS? If you treated the PCOS, would the GD resolve?

The trans youth project researchers have used psychological testing results that show trans identified youth have similar profiles to youth who aren’t trans, and have framed this as an argument for biologically driven innate gender identity. They’ve used these results despite the fact that it is not a biological test and long-term outcomes are unknown. Also, these studies only used gender typical controls (and excluded gender nonconforming controls).

Furthermore, when predicting their identities in the future, trans girls see themselves becoming women and trans boys feel that they will be men, just as other girls and boys do. Even when we present children with more indirect or implicit measures of gender identity—the measures that assess reaction times rather than children's more explicit words and actions—we have found that trans girls see themselves as girls and trans boys see themselves as boys, suggesting that these identities are held at lower levels of conscious awareness. All this research combines to show that transgender identities in even very young children are surprisingly solid and consistent across measures, contradicting popular beliefs that such feelings are fleeting or that children are simply pretending to be the opposite gender. 

A comprehensive review paper, Sexual Orientation, Controversy, and Science, by J. Michael Bailey, Paul L. Vasey, Lisa M. Diamond, S. Marc Breedlove, Eric Vilain, and Marc Epprecht covers much of the research around both nature and nurture arguments about transgenderism and sexual orientation.

A study that may help distinguish trans brains from homosexual brains

One of the main goals of Gender Health Query is to ensure borderline dysphoric LGB and autistic youth are not given life altering, excessive, risky, and expensive medical treatments when they could be helped in other ways. Therefore, any information that could distinguish the trans population from gender nonconforming gay and lesbian children and adolescents is very relevant. The below study (Burke 2017) on adults indicates there may be some identifiable differences in these populations. Trans brains and homosexual brains may be similar, but trans people may have some sex differentiation differences and self-perception differences.

The present study searches to find neural correlates for the respective conditions, using fractional anisotropy (FA) as a measure of white matter connections that has consistently shown sex differences. We compared FA in 40 transgender men (female birth-assigned sex) and 27 transgender women (male birth-assigned sex), with both homosexual (29 male, 30 female) and heterosexual (40 male, 40 female) cisgender controls. Previously reported sex differences in FA were reproduced in cis-heterosexual groups, but were not found among the cis-homosexual groups. After controlling for sexual orientation, the transgender groups showed sex-typical FA-values. The only exception was the right inferior fronto-occipital tract, connecting parietal and frontal brain areas that mediate own body perception. Our findings suggest that the neuroanatomical signature of transgenderism is related to brain areas processing the perception of self and body ownership, whereas homosexuality seems to be associated with less cerebral sexual differentiation.

However, it is possible that social reinforcement (and hormone use if post transition) may affect both behavior and brain restructuring due to plasticity. Olfactory and auditory response may be more likely biologically determined, though these biological underpinnings are also found in homosexual individuals. Acknowledging this doesn’t mean that there are not borderline dysphoric individuals who could be affected by culture, as it does appear there may be a dosing effect involved in trans and homosexual identities. Another unknown: Even if an individual feels they are the opposite sex, why are they compelled to seek surgical body modification? The Scientific American author of  “Is There Something Unique about the Transgender Brain” supports the position that this is a complex issue.

Overall the weight of these studies and others points strongly toward a biological basis for gender dysphoria. But given the variety of transgender people and the variation in the brains of men and women generally, it will be a long time, if ever, before a doctor can do a brain scan on a child and say, “Yes, this child is trans.”

Is autogynephilia (AGP)an innate gender identity?

A controversial diagnosis but clearly observable phenomena

The above section reviewed some of the data regarding the biological basis of both trans and homosexual identities. This data, as well as what is intuitively known to many people who socialize in “LGBT” circles, shows that trans and GNC gay people can have some similarities. This is why many gay men, lesbians, parents and some doctors and mental health professionals have concerns over socially and medically transitioning minors. No one has demonstrated there is a reliable way to differentiate these two populations, especially in young people.

There are two broad categories of MtF transexuals, “homosexual transsexuals” (HSTS) and “non-homosexual male transsexuals” who are heterosexual (sometimes bisexual). These non-homosexual MtF individuals often come from very masculine professions before they transition, such as military (Rachel Levine), technology and sports (Caitlyn Jenner). Most have been married and fathered children. This well-known presentation of transgenderism in biological males is known as “autogynephilia”. It is highly likely that these individuals have a completely different pathway to their identity than the effeminate homosexual transexual males. Effeminate same-sex attracted males often present at very young ages. Autogynephilic males tend to start cross-dressing after puberty and come out later in life. The terminology was developed by Ray Blanchard. The theory is also supported by psychologist Michael Bailey, who has personally interacted with these individuals. Micheal Bailey’s book “The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism” discusses the differences between the two types of MtF transexuals.

Motivations for this are explained by MtF researcher, Anne Lawrence, who identifies as autogynephilic: 

Autogynephilia is defined as a male's propensity to be sexually aroused by the thought of himself as a female. It is the paraphilia that is theorized to underlie transvestism and some forms of male-to-female (MtF) transsexualism. Autogynephilia encompasses sexual arousal with cross-dressing and cross-gender expression that does not involve women's clothing per se. The concept of autogynephilia defines a typology of MtF transsexualism and offers a theory of motivation for one type of MtF transsexualism. Autogynephilia resembles a sexual orientation in that it involves elements of idealization and attachment as well as erotic desire. Nearly 3% of men in Western countries may experience autogynephilia; its most severe manifestation, MtF transsexualism, is rare but increasing in prevalence. Some theorists and clinicians reject the transsexual typology and theory of motivation derived from autogynephilia; their objections suggest a need for additional research. The concept of autogynephilia can assist clinicians in understanding some otherwise puzzling manifestations of nonhomosexual MtF transsexualism. Autogynephilia exemplifies an unusual paraphilic category called 'erotic target identity inversions', in which men desire to impersonate or turn their bodies into facsimiles of the persons or things to which they are sexually attracted.

The phenomena may range from erotic cross-dressing, to seriously dysphoric individuals who want bottom surgery. It may involve as high as 3% of the male population. Many MtFs are offended by this terminology and depiction because they feel it paints them as fetishists. There has been a huge effort to try to discredit this theory by some of the biggest MtF activist such as Julia Serano. Their concerns may be valid as some individuals from both the right-wing and radical feminist circles tend to paint all of these individuals with the same brush. However, given that some heterosexual males transition, even in old age, and that some asexuals with low sex drives transition (opting to drastically lower their libido through medical transition), it would be simplistic to characterize autogynephilia as just a sexual fuelled fetish for all MtFs. The paper by an MtF, “Becoming What We Love,” talks about the emotional component and complexity involved.

While many trans activists try to debunk autogynephilia and some psychologists have consciously worked to avoid the terminology (the term is not included in DSM-V as it is considered “stigmatizing”), examples that support the theory can be found everywhere. This is especially true in the age of the internet, where people’s personal behavior and inner thoughts are revealed online every day. Our position is generally the same as Alice Dreger’s (a bioethicist, free speech advocate, and intersex rights activist). Dreger herself was targeted with harassment for discussing the theory. She believes that autogynephilia exists, and that everyone has a right to their emotional and personal sexual expression, as long as no one else is being harmed.

So, is autogynephilia biologically innate? It likely is to at least some extent (as are many human personality characteristics being uncovered by research), but not in the same way that causes homosexuals to transition medically. It may be expressed through some other brain pathway not yet understood. This doesn’t mean it can’t also be influenced by cuture. James Cantor reviews this data in this paper:

Two independent empirical articles have recently appeared in the literature that, taken together, bear out an hypothesis Blanchard (2008) postulated in the Archives about brain development in transsexualism:

“[T]he brains of both homosexual and heterosexual male-to-female transsexuals probably differ from the brains of typical heterosexual men, but in different ways. In homosexual male-to-female transsexuals, the difference does involve sex-dimorphic structures, and the nature of the difference is a shift in the female-typical direction. If there is any neuroanatomic intersexuality, it is in the homosexual group. In heterosexual male-to-female transsexuals, the difference may not involve sex-dimorphic structures at all, and the nature of the structural difference is not necessarily along the male–female dimension. (p. 437”)

Blanchard’s prediction follows from studies that have repeatedly shown that the homosexual male-to-female transsexuals are “female-shifted” in multiple, sexually dimorphic characteristics, whereas the heterosexual male-to-female transsexuals are not (Blanchard, 1989a, 1989b). For example, homosexual male-to-female transsexuals are sexually attracted to natal males, express greater interest in female-typical activities (even in childhood), and are naturally effeminate in mannerism. In contrast, heterosexual male-to-female transsexuals are indistinguishable from nontranssexual natal males on these variables. The heterosexual transsexuals are still distinct from typical males in other ways, however, such as by manifesting “autogynephilia”—the erotic interest in or sexual arousal in response to being or seeming female. The consistent detection of cross-sex features among homosexual male-to-female transsexuals, but not among heterosexual male-to-female transsexuals, led Blanchard to predict that the cross-sex pattern would also emerge at the level of brain anatomy and be limited to the homosexual male-to-female transsexuals. That prediction now appears to be the case, with Rametti et al. (2010) supporting his prediction for the homosexual transsexuals, and Savic and Arver (2010), for the heterosexual transsexuals.

In this interview, James Cantor discusses that autogynephilia may involve mirror neurons. This could change patterns of attraction and self-perception in these individuals.

Since autogynephilia seems to appear on a spectrum with different variations, there is a concern that these individuals would be harmed by hasty medical transitions before they are fully mature (which happens past the early twenties). Even if they are not likely to be reinforced through “social transition” at an early age, they appear to be coming out young (see sexual orientation data in this post), and young adults may be harmed by the new “informed consent” libertarian model.

We are also concerned that research in this area, as well as research around detransition and desistance, is being stifled, as it’s considered “politically incorrect.” Some trans activist, for example, stifle research they do not like (see “Problems with a politicized climate” for harassment, censorship, etc). This has become a problem in general in science research and academia, not just around trans issues, but any identity politics issues.

Are non-binary identities, heterosexual female FtM identities, & autistic trans  identities biologically innate?

This is a quote from Transequality.org, and is fairly typical of the innate gender identity narrative promoted on “LGBT” websites (about not only trans identities, but non-binary identities):

Non-binary people are usually not intersex: they’re usually born with bodies that may fit typical definitions of male and female, but their innate gender identity is something other than male or female.

While androgyny is nothing new, what is new is people promoting 1) a culture heavily focused on the use of multiple pronouns and 2) medical techniques that may include breast amputation for a non-binary identity, varying doses of testosterone for females who want a more masculine look, or breast implants (even those with beards) or estrogen for non-binary males. Some non-binary males identities are likely just homosexuals or autogynephilia spectrum individuals, re-conceptualizing themselves in the current culture. In the above section we reviewed the science supporting biological underpinnings of trans identities. However, the exponential rise and demographics of those now identifying as transgender, seeking medical transition require careful consideration.

There are more females medically transitioning.There are also more people (particularly females) identifying as non-binary and seeking hormones and surgery. These homosexual, bisexual or heterosexual are seeking medical transition at higher and higher rates. Further many of these individuals also have co-occuring conditions such BPD. Additionally, while autism may have always played an unseen role, more and more individual on the autism spectrum are seeking transition. It’s unclear what’s actually causing all of these changes. Discussion on the varying (and sometimes confusing) presentations of gender dysphoria in the current culture can be found in the blog post “Gender dysphoria is not one thing,” written by Ray Blanchard and Michael Bailey. 

Clearly culture and media are relevant to the changes we’re seeing, as this number of individuals and identities were not presenting themselves 20 years ago. But there currently is not enough research to know how much of their identity is biologically innate. Even if their identities do have biological reasons, they may not be related to having physical similarities associated with the opposite sex. They may be due to other biological underpinnings involved in self-perception, mental health, rumination, and body dysmorphia. Autism has been shown to have biological components, but with so many more young people on the autism spectrum identifying as trans, we must consider how cultural environment affects them.

Some general quotes supporting the relevance of nurture in trans identity

The next sections of this “nature versus nurture” topic explore the effects, or possible effects, of the environment on trans identity in young people. Before we move on to in depth discussions, here are some quotes from individuals with direct experiences with dysphoric individuals. They acknowledge the relevance of factors beyond an innate sense of gender (at least for some individuals), or at least call for more research.

A quote from clinical psychologist and MtF Erica Anderson:

“I think a fair number of kids are getting into it because it’s trendy,” said Anderson, who was married for 30 years and fathered two children before transitioning seven years ago.

A quote from a parents’ petition regarding the AAPs statement in support of the affirmative model:

Summary: There are several factors and individual trajectories leading a youth to trans-identify with the most dominant factors being environmental. The “trans experts” have ignored all environmental factors, attempted to over-emphasize any biological components, failed to tease-apart GNC behaviors or homosexuality from any minor biological basis of transgender identification, and focused solely on the false position that the youth is infallible in their self-diagnosis despite conclusive clinical evidence that children diagnose themselves incorrectly 60-90% of the time.

A quote from a conservative and affirmative model medical skeptical doctor:

Diffusion-weighted MRI scans have demonstrated that the pubertal testosterone surge in boys increases white matter volume. A study by Rametti and colleagues found that the white matter microstructure of the brains of female-to-male (FtM) transsexual adults, who had not begun testosterone treatment, more closely resembled that of men than that of women.8 Other diffusion-weighted MRI studies have concluded that the white matter microstructure in both FtM and male- to-female (MtF) transsexuals falls halfway between that of genetic females and males.9 These studies, however, are of questionable clinical significance due to the small number of subjects and neuroplasticity. Neuroplasticity is the well- established phenomenon in which long-term behavior alters brain microstructure. There is no evidence that people are born with brain microstructures that are forever unalterable, but there is significant evidence that experience changes brain.

A quote from German gender dysphoria researchers:

The development and maintenance of gender identity disorders is held to be a multifactorial pathological process, in which individual psychological factors exert their effects in concert with biological, familiar, and sociocultural ones (e2). From the point of view of developmental psychology, it would be wrong to imagine that patients with GID constitute a homogeneous group was a uniform pathogenesis. Different theoretical conceptions imply different -complementary, not necessarily contradictory -notions of the possible causes of GID (e7). In view of the still unsatisfactory state of the data any generalizations should be made with caution. 

Anecdotal examples of the blurry line between gnc gay & trans, Marsha P. Johnson & Sylvia Rivera

 An interesting graphic by J. Morandini, encompasses 3 different simplified theories as to how trans and homosexual identities are formed in males. All three involve a biological component but two emphasize the environment and cultural influence.

The following sections will support that model 3 (innate trans brain) is not accurate for all, or even most cases of gender dysphoria, at this point in history. Parental upbringing, the child’s environment, the culture, and other mental health problems can influence gender dysphoria. This may not be true for all individuals as there have been trans people who existed in even the most oppressive environments.

A complicated real world example of how gender non-conforming gay/lesbian identities can overlap with trans identity (or be seen to be trans identities), can be found in the example of Marsha/Malcolm P. Johnson. Many trans people like to claim Marsha P. Johnson as one of their own. Marsha, often using a female name, also went by Malcolm, using both he/she pronouns. It was common to call drag queens and effeminate men “she/her.” He was very feminine at times and participated in activism, standing up for extremely feminine males. But Marsha would present on the streets “as a man” at times, and stated he identified as a gay man, drag queen, and transvestite (transvestite was synonymous with drag queen at the time). This has caused some gay men to resent the trans community for co-opting Johnson. A reader comment on this article claims Johnson lived “as a woman at times,” but viewed himself (apparently Silvia Rivera may have too) as both male and a gay man. 

Since you weren’t there, watch the documentaries OK, the interviews with Marsha and Sylvia. They are very clear. Marsha never called herself transgender. She said she lived as a woman at some points but said in interviews near the end: “I’m a man.” Near the end of her life Sylvia used the term “transgender” occasionally – as an -organizing strategy-, but she really didn’t like the label for herself. The only time she used it she called herself a “transgender person” = a gender variant person. This is very different from being a trans woman.

No one knows for sure how these individuals would identify as youth today, in a culture supportive of socially and medically transitioning children and teens. This is precisely the type of effeminate male many LBG people are concerned may be put on a medical pathway that may not have the best outcome. There are no studies with control groups to demonstrate clear diagnostics, nor to measure if outcomes would be better with or without medical transition in the long-run. It’s hard being an extremely effeminate gay man in a homophobic world and often masculinity worshiping gay dating scene. But being an MtF is also very difficult. You are often the target of exploitative “trans chasers”and rejection from straight men is common. Additionally, transition carries financial costs and medical risks.

Despite the continual, and often repeated, claims that trans identity is an intractable condition set in utero, and that drastic medical intervention is the only way to cure it, significant evidence exists to the contrary (that applies to at least some cases). That’s not to deny trans identities or discount trans people who feel medical transition is the best solution. It’s to point out that environment and comorbid conditions can have an effect on how some individuals view their gender nonconformity and/or their need to medically alter their bodies.

There are multiple factors that may influence gender dysphoria.

A. Anti-gay/lesbian/bisexual, tomboy, & female attitudes can fuel trans identification 

Homophobia & trans identity

One of the most concerning factors currently in the West relating to trans identification in young people, is the influence of anti-gay and anti-lesbian attitudes. These attitudes can be external and coming from anti-homosexuality straight people, but they can even come from within LGB, “queer-idenitifed,” and trans people. Researchers who published a study in The Journal of Youth Adolescence, found that gender nonconforming young people who are exposed to homophobic class mates and bullying are more likely to start seeing themselves as transgender. 

”The Influence of Peers During Adolescence: Does Homophobic Name Calling by Peers Change Gender Identity?” 

The chart below, from GLSEN (an “LGBT” youth organization), confirms that LGB students don’t just get bullied for their sexual orientation, but for their gender nonconformity as well. It also shows that the more gnc they are, the more often they get bullied for both their sexual orientation and gender expression. Anti-gender nonconformity sentiments affects trans and LGB youth. But the above study indicates that it also causes gnc youth to want to transition in order to mimic heterosexual norms, rather than be a boy or girl who doesn’t fit in. 

glsen.org

Teachers and mental health professionals are noticing anti-lesbian sentiments among the increasing numbers of trans identified females. 

Some families or peer groups have consistently derided gender non-conforming behavior and homosexuality. What messages has the client internalized about homosexuality and lesbianism? Internalized shame about same-sex attractions may lead to thinking the only acceptable explanation for their feelings is being transgender.

Clients with same sex attractions should absolutely be regarded as a potentially gay person in the earliest stages of sexual identity development, which is undoubtedly fraught with complicated feelings, confusion, shame, and gender issues.

This quote is from a piece in the London Times, in a country with soaring numbers of teenage females going to gender clinics as seen in the below graphic: 

They’d hold meet-ups in Hyde Park. “No one uses the word ‘lesbian’ any more,” she says. “It’s so uncool. It has really negative connotations.”Rather, these short-haired androgynous girls, many of whom had previously self-harmed, started to identify as boys. Some went by male names only online, others just among close friends. A few were “socially transitioned”: out as male to family and school. “It’s weird,” says Jessie. “It’s as if a switch is flicked and suddenly you feel different. I felt I will no longer be that weird girl who dresses like a boy. I will be a boy.

Here a doctor (remaining anonymous, due to fear of harassment or job loss) expresses concern for young lesbians growing up in the current environment: 

What we can’t underestimate, says Dr K, is the sheer homophobia outside middle-class liberal bubbles. “Lesbian” is at worst a grave insult, at best uncool. “The gay hierarchy is this,” she says. “At the top are gay men who can pass as straight, then camp gay men, then pretty, straight-passing lesbians. And right at the very bottom are butch lesbians. Masculine women have no cachet. But if you transition, you zoom right over the gay hierarchy to become a straight man. You can hold your girlfriend’s hand in public. As a butch woman you were unattractive, but lots of them become these cute little guys.”

An anecdotal example from the same article:

Growing up in a small Scottish town, Gill was bullied to the point of mental breakdown when she came out as a lesbian teenager. A doctor gave her a diagnosis as trans within ten minutes, but her mother refused treatment. Later she moved to London and encountered the newly emerging “queer” culture, where being trans was far more fashionable and edgy than being a lesbian. She took testosterone for several years, growing permanent facial hair, before desisting. Now 35, she says, “What I needed growing up was older lesbians to reassure me I’m fine as I am. And that’s what I think these girls need now: to meet women like me. But the LGBT movement wouldn’t allow us: they’d see this as transphobic.”

A teacher has noticed a similar dynamic:

I deal with incidents of bullying on a regular basis and I have noticed that there has been a significant increase in the use of sexist and homophobic language in school. Because of this, it has been a long me since a child came out to me in school that they are gay, lesbian or bisexual; these labels actually seem quite old- fashioned amongst the students now. Instead, children that I suspect might be LGB are most likely to come out as trans which is much more fashionable and means that they are far less likely to be victimized, as being trans carries so much power. Our transgender children are very confident when discussing issues related to their identity and challenging their peers and teachers. 

Here are other examples from parents and other adults observing trans identified homosexual females expressing a dislike of lesbians.

The author of the below quote can’t be verified, but the observation echoes comments made by other people involved in “LGBT” support groups, that most homosexual and bisexual females are trans identified now:

Another quote shared by a gender clinician in Canada in this letter can be found at Transresearchearch.info:

Another parameter that has struck us as clinically important is that a number of youth comment that, in some ways, it is easier to be trans than to be gay or lesbian. One adolescent girl, for example, remarked,“If I walk down the street with my girlfriend and I am perceived to be a girl, then people call us all kinds of names, like lezzies or faggots, but if I am perceived to be a guy, then they leave us alone.” To what extent societal and internalized homonegativity pushes such youth to adopt a transgendered identity remains unclear and requires further empirical study. Along similar lines, we have also wondered whether, in some ways, identifying as trans has come to occupy a more valued social status than identifying as gay or lesbian in some youth subcultures. Perhaps, for example, this social force explains the particularly dramatic increase in female adolescent cases in the 2008–2011 cohort.

A woman who took testosterone as an adult, but detransitioned and is now happy with her womanhood, wrote this of her experience as a young adult:

The problems I had as a teenager were never quite resolved, fear and shame around my sexuality turned inward which caused psychological and body problems. Although London was a great place, I had a few problems with homophobia, most small, yet every time it happened, it would build up a little bit of pressure that I couldn’t shake off.

These examples highlight that there may be an active support for trans men over a lesbian identity, both within the homosexual, bisexual, and trans populations and the society at large. Here is a statement from a woman who transitioned as a young adult.

On my own, I was considering that I could be trans but having many other people label me as such certainly reinforced that possibility and made it seem more likely.

Crucially, this socialization consisted of a lot of positive reinforcement. That is, when people decided I was trans and treated me accordingly they were often at the same time trying to show respect or be friendly. I didn’t receive the same sort of treatment as a butch dyke. When people accepted me as a trans dude they also integrated me into their social scene. People listened to me when I talked about being trans, gave me an opportunity to hold forth on my life. There’s this dynamic that can arise between trans people and trans allies where trans people get support and attention from allies and allies gain political/socially progressive cred for being friendly and cool with someone society thinks is a freak. Such a relationship typically contains some degree of objectification of the trans person, ranging from being slightly tinted by it to being totally pervaded… I don’t believe my experience of being socialized “trans” is totally unique.

This statement was said to an acquaintance of the lesbian woman who writes The Acknowledgement Chronicles. It reflects a common sentiment among same-sex attracted females and some of those around them.

“It’s better to be a cute boy than an ugly butch woman.” 

4thwavenow.com is a blog run by a mother whose daughter identified as transgender for several years, and then later stopped asking for top surgery and testosterone. There are multiple similar examples on this website demonstrating there’s more cultural support for a trans identity than a lesbian identity. Here are examples as described by young women themselves: 

Sarah R. is 19-year old lesbian from the US Midwest. She says: “From ages 14 to 16 I believed that because I was gender non-conforming, I was a transgender man. Gender critical theory saved me from potentially mutilating my body irrevocably. Today, I share my story in hopes that other young women can also overcome the hatred we are told to have towards our bodies, and to remain unapologetic about being gender nonconforming females.”

My own personal attraction to the booming trans trend is obvious in retrospect. Teen girls are taught to hate everything about themselves. None of us can win. Even the thinnest, most clear-skinned, prettiest of girls find an enemy in the mirror. Imagine my horror to look at my reflection and see a fat, short-haired, lesbian staring back. In a world where my style, my interests, and my attractions weren’t fit for a girl, transgenderism offered the perfect solution: Be a boy.

It wouldn’t work, of course. How could it, when all of my problems–the struggle to meet the expectations that society had for me, my depression, my anxiety, my dysphoria, and my dysmorphia, all of my unhappiness–had nothing to do with how I identified and everything to do with what I was: female. Of course, as a 14-year-old, this didn’t occur to me quickly. My transition to ‘boy’ was my ticket out of Self-hatred-Ville, and you’d better believe I was going to take it.

To exactly nobody’s surprise, Tumblr was ecstatic at my ‘realization’. A plethora of congratulations, encouragement, and support was sent my way–something that girl-me never got for being exactly the same as boy-me, save having a different name and pronouns. So of course my new identity felt right. How couldn’t it, when my mannerisms and appearance, which had previously othered me, were now suddenly in congruence with my gender, and my ‘bravery’ was being applauded by all the people I looked up to– both bloggers online and friends in real life.

Another young woman, Ash, has similar observations:

When female teens I know started identifying as trans, they instantly became more sexual. There are a number of reasons why: repressed emotions, “daddy issues,” negative body images, previous trauma, and some are also disabled. It’s completely unacceptable to be a fat horny girl, but it is more than acceptable to be a fat horny boy.

It’s safer and more socially acceptable in general to be a sexual boy than a sexual girl, especially a girl who is attracted to other girls.The word “lesbian” makes a woman sound gross for liking another woman but the word “gay” sounds completely fine and happy. When I was 12, I told some friends who are boys that I was attracted to girls. They basically said that’s not real, meaning it’s not possible for two girls to have a relationship. However, they also said it was hot, which made me see the label “lesbian” as a fetish term, unlike the label “gay” which is a legitimate form for a relationship.

Some have also pointed out that identifying as trans can increase popularity relative to being an average heterosexual, bisexual, or lesbian gender non-conforming youth (most youths in this study are female). And teachers are more concerned with transphobic bullying than anti-gay or lesbian bullying.

The following are quotes from parents about the perceived benefits of transgender-identification afforded to their child. One respondent said, “Great increase in popularity among the student body at large. Being trans is a gold star in the eyes of other teens.” Another respondent explained, “not so much ‘popularity’ increasing as ‘status’…also she became untouchable in terms of bullying in school as teachers who ignored homophobic bullying …are now all at pains to be hot on the heels of any trans bullying.”

Another example of anti-gay and lesbian attitudes emerging among trans-identified youth (ironic because many of these youths are same-sex attracted females, some who previously identified as gay):

Theme: groups targeted. The groups targeted for mocking by the friend groups are often heterosexual (straight) people and non-transgender people (called “cis” or “cisgender”). Sometimes animosity was also directed towards males, white people, gay and lesbian (non-transgender) people, aromantic and asexual people, and “terfs”. 

Here’s a therapist’s comment regarding the complicated issues that may be involved in same-sex attracted youth:

Hartke’s argument also implies that our fantasies, particularly – when they are incongruent with reality, have no nuance or symbolic value. What if a female client’s wish to be male is a subconscious attempt to find masculine energy and gain control over erratic aspects her life? What if a boy’s desire to be a girl is the manifestation of longing for intimate connections, belonging, or sisterhood? Perhaps affection is lacking in his too-macho male peer group at school. When a sudden shift in the “gender identity” of an autistic girl occurs right after seeing a “gender presentation” at school – could this actually reflect her tendency to think in absolutes about her own quirky interests and non-conforming gendered behavior? What if this young person is an effeminate gay man, or masculine lesbian woman, who sees no reflection of him/herself in the queer identity movement – or anywhere? Affirmative advocates would likely argue that those questions are “transphobic” and have no place in “supporting transgender children.”

For more on that topic in regards to females see here.

Anti-lesbian attitudes may make some parents more enthusiastic about medically transitioning masculine females over feminine males. In a USPATH presentation in 2017, Johanne Olson-Kennedy mentioned that there is more transphobia around MtFs, as parents are less reluctant to medically transition their dysphoric masculine daughters, than their effeminate sons. She doesn’t stop to consider that what may be going on may have more to do with anti-butch lesbian sentiment, not transphobia.

Jungian analyst Lisa Marchiano, who has been interacting with many parents of trans identified young people, worries the affirmative model cannot address issues of internal and external homophobia. 

An identity model does not allow us to examine the homophobia that drives some – possibly many — transitions. According to extensive research on desistance, a significant majority of children who identify as the opposite sex will not continue to do so into adulthood. The majority of those who desist will come to identify as lesbian or gay. “Feminine” boys are actually many times more likely to grow up to be gay men rather than transgender women. The same is true for “masculine” girl...To paraphrase psychiatrist Ray Blanchard, surely it’s preferable to have an outcome of a reasonably well adjusted lesbian woman, rather than someone who identifies as a trans man who has had many irreversible surgeries and a lifetime of drugs.

The above examples highlight the reason why there’s so much concern surrounding the social and medical transition of children and teens—Youths that are potentially gay, lesbian, or bisexual, as well as others who struggle with gender are at increased risk of being medicalized. Josh Slocum, a gay man, expresses his concern in a Facebook post . This post reflects the thoughts and concerns others as well, who are aware of the issue surrounding how gender nonconforming youth are currently being raised. He touches on the deleterious cultural aspects surrounding this debate as well. More on that can be found here. Anti-gay attitudes affect gay males when they are children/teens, as well as lesbians. 

Information on the association between childhood gender dysphoria and adult homosexuality can be found here. 

Here, in the “Myth of Persistence, ”Dr. Ken Zucker observes another incidence of internalized homophobia:

For example, one young birth-assigned male with whom I worked self-identified as trans at the age of 13 but by age 15 self-identified as gay, stating “I was having a hard time accepting myself as a gay boy...I wanted to be normal”

Below lesbian and a gay man, reflect on their concerns regarding the lack of safeguarding of minors. We prefer to document science journals or verified real world accounts, but sometimes anecdotal examples are necessary in absence of any scientifically valid study discerning the effects of culture and homophobia on desistance rates. Many gay and lesbian people report they were dysphoric as youth and are glad these options were not around to subvert their process to self-acceptance.

Examples of a female inferiority complex

Issues around female insecurity and trans identification may not only be due to same-sex attraction issues, but also reflect the position of women in society. This affects lesbian, bisexual, and heterosexual females. Transition mostly used to happen among same-sex attracted females who usually identified as lesbian prior to transition. In younger cohorts, more and more bisexual and heterosexual females are identifying as trans.

Below is an example of a girl being bullied for not looking like a pretty girl. This is one of many examples of therapists having no interest in exploring these factors:

The mother-of-three said the therapist refused to listen to her worries that her daughter had been ‘groomed’ by a gay, male friend. The schoolgirl had been bombarded with hundreds of Instagram messages from the boy accusing her of being ‘ugly’ as a girl, encouraging her to bind her breasts and to start taking testosterone. The therapist dismissed the messages as ‘jokes’ and continued to insist on the child being referred, the mother said.

Other observations reflect apparent female inferiority complexes, or self-consciousness around not fitting in:

Conversely, many female clients say that women are weak and transitioning will help them feel strong and confident. Normalizing the entire range of human emotions for either sex can be important to help the clients sort out false beliefs about what’s possible one’s own body – another example that calls for a completely apolitical approach to the discussion of gender.

 And:

Regarding aesthetics, I’ve found two general categories of trans-identified female adolescents. One group has a long history of preference for masculine aesthetic. A girl may describe her younger self as a tomboy who didn’t “know anything was wrong.” Around middle school, when all kids naturally start to segregate themselves by sex, these girls start becoming aware of their own divergence from other girls in appearance, mannerisms, sexuality, etc. Feeling terribly alone and different, they wonder if their aesthetic preferences indicate something is wrong. They search the internet for an explanation or begin identifying with other gender nonconforming peers or “trans” kids. The client may start taking online quizzes and “piecing things together.” Once they’ve adopted the trans explanation for their aesthetics and preferences, they push for an even more masculine presentation, and begin developing “gender dysphoria” that was previously absent.

Given the pressure on adult gender nonconforming gay & lesbian people to transition, it is reasonable to be concerned about the cultural effects on children & teens

Adult butch women also feel significant pressure to transition. And it’s not only due to anti-butch lesbian attitudes in the culture. Pressure to transition on gender nonconforming adults has not been studied scientifically. These anecdotal examples provide some insight into the the experiences of adult lesbians.

Some effeminate gay men are feeling this pressure, too, as we’ve emerged into a cultural reality where trans is the new “cool.” Here Trevor Moran, effeminate gay male and young musician, is brought to tears over his own gender identity crises—Others were cheerleading him on to transition and medically alter his body, due to his gender nonconformity. He planned to transition but changed his mind:

I had, like a huge identity crises, and I just want to talk about it... Yes you look also great as a girl, Oh my God, transition, transition, go transgender, you would f***ing kill it… but definately all the comments kept pushing it on me… I was so lost.

Some trans activists are aware of the homophobia in the general public & intentionally distance themselves from LGB rights activism, in order to access schools.

Given societal anxieties about sex, and particularly homosexuality, with regards to children and teenagers, some trans activists have realized it is in their best interests to distance themselves from gay people. The reason some LGB people find this offensive is that it is well established that many gender nonconforming children grow up to be LGB, not trans. While they would agree that talking about sexuality around children isn’t age appropriate, the idea that gender nonconformity should be reframed as trans identities in children, because they are “less offensive,” is something that is not supported universally in the LGB and T populations. 

Two of the most prominent trans activists, Joel Baum (US) and Fox Fisher (UK) have made statements that it’s in their best interest to distance themselves from the gay and lesbian community, as doing so can bring gender ideology they want to promote into schools. Fisher’s comments were in a video, but taken down after many LGB people from the UK and elsewhere said it was anti-gay. Joel Baum’s comments can be found in a previous section here.

Trans Youth Family Allies, Kim Pearson and Autumn Sandeen, also touch on the benefits of focusing on trans identified children in the cause of promoting trans rights because it doesn’t have to do with sex, unlike homosexuality, even though dysphoric children do grow up to be homosexuals. “Veterans and children” will be what will change legislation. 

You know I’ve always said there’s 2 groups that are going to make change in transgender legislation gender identity expression and language. It’s going to be trans youth because they take, you know they demystify it and take the sex right out of the trans experience. (Kim Pearson) They do, they do…and it’s hard to say no to kids and keeping kids safe. 

Trans activism has been wedded to the agenda of all organizations that used to advocate for homosexual rights, which is controversial among some homosexuals, bisexuals, and even some trans people (like Fox Fisher) who believe the needs of each community are different. However, trans activists distancing themselves from homosexuality with regards to school children is seen as a benefit for gaining access to young people, to teach not only anti-bullying programs (anti-bullying of gnc children is a goal we all support), but their ideological positions on gender. Some homosexuals observing this find this alarming and deeply homophobic, as young gender nonconforming children (including ones with gender dysphoria), often come to accept themselves as gay or bisexual people.

Since children are not old enough to understand their sexuality, and it isn’t appropriate to discuss these issues with young children, some see this as raising potentially LGB children to identity as trans from a young age. Books about trans girls in pink dresses are cute and sexless, talking about gender nonconformity as a part of homosexual attraction isn’t. It’s not that this is likely done by trans activists to be intentionally “homophobic,” but to achieve their strategy to teach about transgenderism (with less push back) to reach troubled trans kids. However, the effect of this on gender nonconforming gay and lesbian youth is not considered by advocates who push for this approach.

There’s a common counter concern to the previous discussion, around homophobia fueling gender transition in young people, that trans people will make. Many trans people feel it is transphobic to prefer an outcome where the child is LGB and not trans. It’s the foundation for their push to frame any attempts at helping a child align with their biological sex as “conversion therapy.” An FtM activist and social worker, Aydin Olson-Kennedy, exemplified this in a statement at a gender conference (Gender Odyssey Seattle, 2017) stating,“have you to ever been told by your parents they wish you were just gay.” Other trans people express this frustration. This is certainly a valid concern, as no human being or minority group wants to be devalued, nor should they be. Parents who are strongly against a transgender outcome may be conservatives, and/or religious. There are also conservative cultures and religions that prefer a transgender outcome over having a child who is homosexual—especially if that child is gender nonconforming (as the above examples show).

The parents who “wish their child was just gay” or who don’t want a rush to set their dysphoric nonconforming child on a path to medicalization, are often very liberal, accepting parents who simply do not want their child to undergo irreversible changes if it is too soon—To suffer unknown side-effects from puberty blockers, be sterilized, and undergo intense surgeries. One of the patients in the DeVries 2014 study, died from the vaginoplasty. A very popular FtM activist almost died after undergoing 30 surgeries to correct severe damage from an infection from a phalloplasty surgery that has left them with a permanent stoma and ileostomy bag. This FtM died from a hysterectomy at age twenty-five. There are over 20,000 bad outcomes reported from Lupron, a popular puberty blocker. It’s not the gender nonconformity or transness these parents worry about. It’s the surgery and hormones. In some cases, it’s the concern that gay and lesbian teenagers may be experiencing internalized homophobia. It should not be necessary to pit identities against each other in this debate, but unfortunately that’s what’s happening. 

Some cultures are more accepting of transgenderism than homosexuality

In many places around the world, all same-sex attracted and trans people are oppressed. In some places, homosexuality is more acceptable than transgenderism. In some, transgenderism is more acceptable than homosexuality. In some areas, particularly in Latin countries, men who have sex with effeminate males, consider themselves heterosexual. They don’t view it as a gay encounter, which, culturally, would make them appear weak (due to homophobia). In some areas of the Middle East, gender transition is legal, but homosexuality is punishable by death. In Iran, being transgender is acceptable and the government will even pay for sex change operations, but being homosexual is punishable by death. This puts LGB people in an unthinkable situation. A large percentage of transitioners are actually gay or lesbian. 

Some are fleeing to avoid gender reassignment surgery, but others have had treatment and find they still face prejudice. Parsi estimates that 45% of those who have had surgery are not transgender but gay.

Trans people in Pakistan can marry, but homosexuals can get the death penalty. These maps from Wikipedia show that homosexuality (blue) is less accepted than transgenderism in many places, at least from a legal standpoint.

In light of abuse of gay and lesbian people under these regimes, it’s not unreasonable to worry blockers and cross-sex hormones will be used on gender nonconforming children, in order to produce a more heteronormative appearing outcome, rather than a gay or lesbian one.

B. Evidence of parental influences on a child’s transgender identity

While there are trans individuals who have had trans identities since childhood and support the “innate childhood gender identity” model (such as Kristina Olson and other affirmative model advocates), there are several studies that indicate parental behavior or various circumstances may increase a child’s likelihood of having gender dysphoria, or persisting in that dysphoria. In the past, people (including mental health professionals) have tried to place blame on parents for innate characteristics, like homosexuality, in their children. And there are parents who are going to insist their child is the opposite sex. So, the purpose of this section is not to hold all parents responsible for varying levels of gender dysphoria in their children. And we should acknowledge here, that parental behavior may cause a child to hide the fact that they are dysphoric about their gender, as Diane Ehrensaft does in this quote—But interestingly (as an affirmative model advocate), Ehrensaft admits culture may be a factor in gender identity (what we are exploring in this whole “nature versus nurture” section):

The Gender Affirmative Model hypothesizes that gender identity is influenced by a number of factors, including socialization and culture (Hidalgo et al., 2013), yet these factors and their impacts are relatively unexplored in young children. Developmental influences that may inform the ways that prepubescent children of different ages cognitively understand and verbalize their gender identity also need more study. We know from other literature, such as suggestibility research (Ceci & Bruck, 1995) that children’s verbal statements, cognitions, and memories are influenced by what they are told by adults, who are often accepted by young children as the authority in all areas, including gender norms. When adult communications differ from a child’s reality, beliefs, or experiences, children will often defer to adults, even if that acquiescence leads to some confusion. These complicated dynamics have not been researched, but theoretically some gender-expansive children may struggle to comprehend and articulate ideas and experiences that emanate from within but conflict with the information they receive from others, a struggle that may persist until they approach puberty or even afterward. This factor, however, does not preclude young children from being transgender or gender expansive, but the assertion, and understanding of gender identity may be obscured or transformed by outside forces, often rendering parents stunned when their growing child first formulates and then articulates their transgender identity. 

On the other hand, there is also a fair amount of evidence that parental reinforcement and behavior has an impact on their child’s level of gender dysphoria. This isn’t completely surprising, due to the fact that dysphoria affects children in many ways, everything from how they see gender, to how resilient they are in handling negative emotions. Below are just a few in a very long list of examples, from the field of developmental psychology.

Parents clearly influence attitudes about gender roles:

However, the strongest influence on gender role development seems to occur within the family setting, with parents passing on, both overtly and covertly, their own beliefs about gender.

Here is another article on the power of parental reinforcement:

Developing Identity Through Mimicking Behavior-
Renowned Psychoanalyst Erik Erikson outlined an eight-stage theory of identity and psychosocial development. Erikson’s third stage is one in which children model their parents’ actions. This stage occurs between the ages of 3 and 5, according to Erikson. Parents need to pay close attention to behaviors modeled to children. For instance, a parent that ignores their child and spends a great deal of time on the phone may see them using a play phone incessantly. Children often play with dolls at this stage, and mimic parental nurturing and care. Erikson says children will not only mimic what they experience, but will also internalize these behaviors. The basic family unit is the greatest influence on a child’s identity at this stage in Erikson’s developmental theory.

This article discusses the effects of parental overprotectiveness:

Their intrusion into their child’s life typically came from a need to protect the child from painful feelings or to assure that the child’s behavior and choices were the “right” ones. As a consequence, these children grew up relying on their parents to define not only what they should feel or how they should behave, but ultimately their identity: who they are as individuals.

Here is an interesting study on reinforcement actually increasing, rather than decreasing, their children’s pain and their ability to cope with dysphoria:

Confirmatory factor analysis was used to establish a model that included the original 3 factors (Protect, Minimize, and Encourage/Monitor) and provided good fit to the data, with minor modifications to the original measure. As expected, parental protective behavior was associated with increased child disability. Parental protective behaviors also were linked to higher levels of child depressive symptoms and longer pain duration.

And another interesting study on identity development and parents:

Data show that identity status influences alcohol consumption. Low-profile identity and excessive maternal control affect the relational dependence and the tendency to perfectionism in adolescents. Among the predictors of alcohol use, there are socioeconomic status, parental control, and the presence of internalizing symptoms.

It is not unreasonable to be concerned that parental behavior may put a child on an unnecessary path of medicalization (despite solid cases of consistent dysphoria). There are multiple examples of patterns in parental behavior and trans identification in their children. There are also people who have witnessed anecdotal examples that have given them cause for concern.

 Some parents may prefer their child to medically transition, rather than be gay or lesbian as an adult

Petition to the American Academy of Pediatrics:

Most kids who desist grow up to be gay (Wallien et al., 2008). Are we converting “gays” to “straights”? Perhaps extremes on both sides of the political spectrum have motivations to accept, or even encourage, their child to trans-identify. Far-right parents may be embarrassed by GNC behavior and homosexuality, and far-left parents may be “eager to embrace the latest civil rights movement.”

Homophobia and transphobia are both issues in all societies. There are parents who have a dysphoric child and express hope that their children/teen/young adult will be gay and not trans. But for the most part, these gay-friendly parents are concerned about the medical effects of transition, rather than nonconformity itself. However, anti-gay/lesbian sentiment causes some parents to prefer a transgender outcome. In the recent BBC documentary “Transgender Children: Who Knows Best?” Dr. Ken Zucker shared that he had had families say of their trans kids, “Well, at least they’re not gay.”

More anti-gay sentiment can be found in this quote from a mother who has been telling her story in the media. This mother “punished” her effeminate son, but embraces her trans daughter. It is not known if these parental attitudes affect gender identity outcome. Given the study referenced above (homophobic bullying increases trans identification in tweens), it is reasonable to be concerned that it does.

I am a devout and conservative Christian and an ordained minister,” she said and explained that she tried to force Kai into being a boy when she was a toddler. “I knew my kid was different before the age of 2,” Shappley said. “My child was very feminine, flamboyant and dramatic. No matter how I tried to punish, reshape or discipline her, she continued being very feminine.

In this article she openly admits she was very dismayed her child may be gay. 

Another woman involved in “LGBT” support groups, expresses concern over parental homophobia:

Catherine Tuerk, who runs the support group for parents in Washington, D.C., started out as an advocate for gay rights after her son came out, in his 20s. She has a theory about why some parents have become so comfortable with the transgender label:“Parents have told me it’s almost easier to tell others, ‘My kid was born in the wrong body,’ rather than explaining that he might be gay, which is in the back of everyone’s mind. When people think about being gay, they think about sex—and thinking about sex and kids is taboo.”

Another doctor in Britain acknowledges that anti-gay and lesbian attitudes in parents contribute to enthusiasm when it comes to socially and medically transitioning their gender nonconforming dysphoric children:

Trans ideology is celebrated as progressive yet, says Dr K, it is deeply conservative, erasing homosexuality and enforcing gender stereotypes. Which is why, says another child clinician, Dr B, it has taken such a hold. “Parents, particularly those without much education, see it as the obvious solution. If your child had diabetes, you’d get him prescribed insulin. If your gay daughter is masculine and feels she’s a boy, you take her to the doctor for hormones. This is the narrative of trans activists groups such as Mermaids and it makes sense to a lot of people. It is far harder to challenge stereotypes, to be ‘gender critical’.”

This concern is warranted. In this article, “Staff at trans clinic fear damage to children as activists pile on pressure” gender clinicians worry about long-term damage they may be doing and inappropriate medical treatments on would be desisters.

This enthusiasm, to label gender nonconforming children “transgender” before they have had to the opportunity to reach sexual maturity and without considering desistance can be found in this example. This is alarming, even to the generally pro-medical transition staff at Tavistock in Britain:

A recent edition of the Radio 4 programme iPM featured a girl called Leo whose mother believed she was a boy because she liked Wolverine and wanted a pirate-themed birthday party, assumptions unchallenged by presenter Jennifer Tracey. Dr Wren says several Tavistock clinicians complained to the BBC: “There was concern about it.

Here is another observation in the context of a peer-reviewed study about parental homophobia from 4thwavenow:

I wrote about this topic in the post here, which contains a link to a 2000 study which discusses homophobia as being a causal factor in parents’ and clinicians’ choice to see GNC kids as “disordered” and in need of professional help. It also notes that homophobia amongst clinicians is a real thing.

“Regardless of the fact that homosexuality is not officially considered a disordered outcome, the prevention of homosexuality remains a significant reason for referral of children with GID. It would be naive to believe that prevention of homosexuality is not a motivating factor for at least some of the clinicians who work with children referred for gender-atypicality. Indeed, some researchers and clinicians in the area of GID in children are quite open about such a goal, writing books (e.g., Rekers, 1982, 1991) or belonging to organizations devoted to the prevention of homosexuality (e.g., L. Loeb: see http://www.narth.com/menus/advisors.html). Thus, although the issue of the risk associated with a homosexual outcome should be moot, it is not. It is crucial that researchers and clinicians in the area of GID in children recognize that the most likely outcome for children with GID, with or without treatment (Green, 1987), is homosexuality, and that homosexuality is a nondisordered outcome. Only a very few children with GID continue to have GID as adolescents or adults.”

Terry Paterson, who provides therapy to college students in Britain, worries about the connection between dysphoria and homosexuality, as well as the pressure being placed on counsellors to rush affirmation and approve irreversible medical changes in young people. Patterson expresses this concern in an article titled, “Unconscious homophobia and the rise of the transgender movement.”

On a personal note, I find this worrying and even slightly offensive. It might seem, on the surface that parents are being open-minded, even progressive about gender and sexuality, but what they are expressing is a terror that their child might turn out to be a ‘butch’ lesbian or a ‘camp’ gay man. If you are a girl who feels more masculine than average (and is attracted to the same sex), then you must become a boy, and if you are a boy who feels more feminine than most (and attracted to the same sex), you must become a girl. So, is this so-called progressive position masking a deep-rooted distaste for unconventional individuals who fall outside of heteronormative extremes? Is the unintended consequence of this push (for the rights of so-called trans children), actually driven by homophobia. Is it a move towards less diversity, less uncertainty and less tolerance? 

Parents are apparently more enthusiast about the social and medical transition of dysphoric masculine females, than dysphoric effeminate males. This could be interpreted as a concern that life will be more difficult for MTF individuals. On the other hand, the enthusiasm to transition females, could be interpreted as anti-lesbian bias. No studies have been done to discern the reason behind this, however the trend has been noted by several clinicians.

At a gender conference, Johanna Olson-Kennedy (USPATH, 2017) supports taking parents to court they aren’t on board with medical transition of their minor. According to her, parents are more enthusiastic about transitioning their female children. 

By the way I have never had to do this with a trans boy. It’s always trans girls.

This study of Californians, also supports the observation that parents are quicker to adopt the view that their child is transgender if they are masculine females. 

This may not be surprising in light of the fact that doctors are apparently willing to administer potentially dangerous drugs to mothers to prevent an increased likelihood of having a lesbian (or even just tomboyish) daughter, “The Anti-Lesbian Drug.”

Further disgust for homosexual males, particularly effeminate ones, are confirmed in this study: 

The gay target who displayed a feminine personality elicited more disgust and was perceived as lower in gender role conformity than a gay man who displayed a masculine personality.

Factors of parental influence may be positive reinforcement, psychological issues, an unwillingness to explore other issues with the child (other than transition), or just a genuine desperation to find an easier solution to their child’s distress. It is not known how these influences will affect the psychological development of a child as they grow up and enter puberty. Exploring this topic isn’t an attempt to put the blame on parents for the gender issues their child experiences—Transgenderism appears across cultures, and parents of trans identified young people often receive unjust criticism—it’s rather an opportunity to discuss and acknowledge that this is a complicated issue, and that not all gender dysphoria is the same.

Some clinicians have observed parental motivations which may have had an effect on a child’s trans identity, or have observed parents rushing to reinforce trans identity. Anti-homosexual attitudes influencing trans identification can be found here and here.

Parental support & even enthusiasm to transition their child

Ken Zucker, aprominent psychologist who specializes in this field,is controversial among trans activists for his cautious approach to the medical transitionofminors. He believes that helping a child develop acceptance of their body can be effective in reducing dysphoria later. Zucker’s watchful waiting approach is viewed as conversion therapy by affirmative model advocates.  Most people who currently support his cautious approach, don’t want any gender behavior policing, as it could be traumatizing to the child and acknowledge his caution was motivated by the reality of desistance and the harsh realities of medical treatment. The over-medicalization of children is a valid concern ast not only impacts a person’s youth, it impacts their entire life by creating a lifelong dependence on the medical industry.

In the “Myth of Persistence”:

I would argue that parents who support, implement, or encourage a gender social transition (and clinicians who recommend one) are implementing a psychosocial treatment that will increase the odds of long-term persistence.

Ken Zucker is far from the only psychologist or doctor who is concerned that early social transition increases persistence. Others include professionals who have worked with dysphoric people, such as psychiatrist Susan Bradley, Tavistock psychologists Bernadette Wren and Polly Carmichael, Thomas Steensma from the Dutch clinic, Sasha Ayad LPC, Jungian analyst Bob Withers among others. Other prominent researchers, doctors, and scientists from a spectrum of political beliefs ranging from the right to the left, such as Dr John Whitehall, Paul McHugh, James Cantor (sexologist), and Debra Soh (neuroscientist), also have these concerns.

Some parents are in such a rush to transition their children and put them on a medical path, to the point of worrying some doctors.

But the Tavistock’s caution can be unpopular with parents who crave a quick fix for a deeply troubled child. A new type of parent is emerging who, after some online research, is self-diagnosing their child as trans on superficial evidence.

Another gender dysphoria expert and clinician, worries about an emerging pro transition culture. He’s one of the world’s premier experts on gender reassignment surgery who is alarmed that a parent’s affirmation may drive unnecessary gender transition in childhood.

Around 40% of children who attend GIDS are prescribed puberty blocking drugs. But gender expert Professor Miroslav Djordjevic suggested the rise could be in part a fad among parents who indulge their children. 

Some mental health professionals and doctors believe parents supporting a social transition are setting their children up for gender reassignment and medical treatment. 

John Whitehall comments on the large increase of parents socially transitioning their children:

No studies are available on characteristics of parents despite numerous studies on their children. It is supposed that gender confusion in a child must deeply affect its parents, and the phrase common to those seen interviewed on television, “gut wrenching”, is easy to accept. Perhaps, therefore, it is despair that is driving an increasing number of parents to start “social transition” of their child to the opposite gender before seeking medical help, under the guidance of websites and support groups and the encouragement of an enthusiastic media. Toronto’s Dr Bonifacio says many have progressed far into transitioning before attending his clinic: parents are dressing and entertaining the child as the opposite sex, applying new pronouns and a new name. Such commitment, he explains, paves the way for further treatment.

A leading but nameless therapist agrees: about a third of children are already being “socialised”. This therapist worries that they are at risk of being “conditioned” by parents who have become “enmeshed” to the degree of being “cheer leaders”. This could lead to the child becoming “scripted” to repeat phrases that would convince therapists. One example is the declaration of a five-year-old that he was “transgender” when featuring with his mother in a recent documentary on childhood dysphoria by Louis Theroux shown on ABC television.

Margaret Nichols & Laura Jacobs, two therapists that support the affirmative consent model, admit in a trans conference brochure, that some parents are very enthusiastic about transitioning their children, despite high rates of desistance in the past, with a likely homosexual/bisexual outcome.

For even the most knowledgeable gender-affirmative therapist, work with transgender clients can sometimes be complex and difficult. There are parents who assume their gender-atypical child is transgender and prematurely insist on social transition…Assess when parental anxiety or problems are driving the referral and when gender dysphoria may be temporary.

Even Diane Ehrensaft, one of the strongest advocates of early social transition and puberty blockers admits that some parents are overly enthusiastic about transitioning their gender nonconforming children in an NPR interview:

(Interviewer)
Have you ever had an experience where you felt like a parent came to you and said, "My child is transgender" and you felt, after talking to the kid, that something else was going on that was producing this behavior and that it wasn't native to the child? 

(what)…I have had are experiences where parents may jump the gun and come to the conclusion that their kid is transgender rather than gender nonconforming or gender-fluid.

More examples of parental enthusiasm for putting their child on a medical pathway, even if it could be avoided:

But progressive-minded parents can sometimes be a problem for their kids as well. Several of the clinicians I spoke with, including Nate Sharon, Laura Edwards-Leeper, and Scott Leibowitz, recounted new patients’ arriving at their clinics, their parents having already developed detailed plans for them to transition. “I’ve actually had patients with parents pressuring me to recommend their kids start hormones,” Sharon said.

In these cases, the child might be capably navigating a liminal period of gender exploration; it’s the parents who are having trouble not knowing whether their kid is a boy or a girl. As Sharon put it: “Everything’s going great, but Mom’s like, ‘My transgender kid is going to commit suicide as soon as he starts puberty, and we need to start the hormones now.’ And I’m like, ‘Actually, your kid’s just fine right now. And we want to leave it open to him, for him to decide that.’ Don’t put that in stone for this kid, you know?”

 Here is an example of a case in Britain, where a mother allegedly groomed her child to be transgender (possible “Munchausen by proxy”). The child was removed from the mother’s home because, apparently, the boy was not actually transgender. Social workers were afraid to intervene due to transgender identity politics, fearing they’d be accused of bigotry. Apparently, that fear was warranted. Mermaids, a trans youth support group, as well as other members of the trans community, attacked the judge for transphobia and supported the mother in this case.

In a High Court case, reported last year, Mr Justice Hayden removed the child – known only as ‘J’ – from his mother after finding she had caused him ‘significant emotional harm’ and ‘pressed [him] into a gender identification that had far more to do with his mother’s needs and little, if anything, to do with his own’… J was being home-schooled and dressed in girls’ clothes, the court found. After being removed from his mother, the boy was sent to live with his father and was sent to school, and has since ‘asserted his own masculine gender’ by living life as a boy, the judgement said.

Transgender politics may have prevented necessary intervention. 

Moreover, as High Court judge Mr Justice Hayden said as he removed the seven-year-old from his mother, “an emerging orthodoxy” about trans identity had prevented social workers from intervening despite the mother’s aggression and evidence of neglect. Professionals fear not just being labelled bigots “on the wrong side of history” but of breaching the Equality Act, which enshrines trans rights.

Another story may or may not be painting a similar picture of Munchausen by proxy behavior. This story is in The Federalist, but more liberal leaning media generally refuse to publish anything that may paint early childhood gender transition in a negative light.

The transition therapist has observed that James is not consistent, insistent, or persistent in the desire to become “Luna.” For example, a dossier filed with the Dallas court says that, under the skilled eyes of the therapist, the child was presented two pieces of paper, one with the word “James” and one with the word “Luna,” and asked to pick the name he preferred. When the appointment only included his mother, James selected Luna, the name and gender he uses at his mother’s home and in his first-grade classroom. When the appointment was only with his father, however, James pointed to the boy name James, not the girl name.

A concerning observation about the therapist:

The glaring disparity between a child’s preferred identity when in the presence of one parent versus the other should cause a therapist to reassess, perhaps nullify the diagnosis of gender dysphoria, and terminate any steps toward transition. But in the case of James, this hasn’t happened.

One argument may be the boy is afraid to be “her true self” around his father. This does not seem to be the case:

When James is away from his mother, he consistently rejects the idea that he is “Luna girl” or that he wants to be a girl. Because the court prohibits dad from dressing James as a boy or from teaching him that he is a boy by sharing religious or science-based teachings on sexuality, dad presents James with male and female clothing options and James always chooses, even insists on, his boy clothes. Dad told me, “James violently refuses to wear girl’s clothes at my home.” This is not a sign of gender dysphoria.

Eyewitness accounts from friends corroborate dad’s observations of James preferring to be a boy.

In an interview on The Rubin Report, Blaire White, a conservative MtF Youtuber, recounts a story about another MTF who became dysphoric because of an abusive mother who would dress him up in female clothes:

Another interesting piece is that trauma, like emotional trauma, psychological trauma, or physical when you’re younger, if you are someone who went through a rape or was beaten can sometimes manifest that way. I read a story the other day of a kid who was raised by a really abusive mother… One of the ways she used to abuse him was to call him by a female name and make him wear dresses and stuff. And as he got older he had gender dysphoria. He thought he had gender dysphoria, what he thought was gender dysphoria, because he didn’t really know how to identify with his gender, because his abusive mother was like, confusing the hell out of him. And he went and transitioned and he did everything. Like, every surgery you could do, hormones, everything. And at the end was like oh wow this isn’t me, I’m not comfortable. So there’s a lot of gray areas with this people just don’t pay attention to. Which again is why it’s scary that kids are on the line for this.(29:10-30:02)

Adopted children, children in single-parent homes, & from certain socioeconomic backgrounds appear more likely to have gender dysphoria

There appears to be a higher rate of adopted children in gender clinics. This has been found in both Britain and the United States. This study finds a significantly higher rate of gender dysphoria in adopted British children:

This research investigated the prevalence of looked-after and adopted young people within a case file review of 185 young people referred to a UK gender identity development service over a 2-year period (1 April 2009 to 1 April 2011). Data were extracted from referral letters, clinical notes and clinician letters. Looked-after young people were found to represent 4.9% of referrals in this cohort, which is significantly higher than within the English general population (0.58%). Adopted young people represented 3.8% of referrals. In addition, the findings showed that looked-after young people were less likely to receive a diagnosis of gender dysphoria compared with young people living within their birth family. There were no statistically significant differences in the gender ratio or age of first gender dysphoric experience between groups. Looked-after and adopted young people were also not found to be experiencing greater impairment in overall functioning compared to other young people referred to the gender identity development service. In conclusion, there are a substantial proportion of referrals pertaining to looked-after or adopted young people, and it appears the referral route and process through the service may be distinct, particularly for looked-after young people. This may be understood by considering the possible complexities in the presentation of these groups, alongside the established higher levels of complexity generally for those experiencing feelings of gender dysphoria.

And here are similar results from a U.S. study:

Conclusion: Adopted children are referred to our gender program more than would be expected based on the percentage of adopted children in our state and the United States at large. This may be due to a true increased risk of gender dysphoria in adopted children, or could represent presentation bias. Gender programs should be prepared to provide assessments for adopted children. Further work is needed to understand the relationship between adopted status and gender development.

The reasons for this are unknown. Adoptive parents may be more likely to bring their child into a clinic, or to socially transition them. So, adopted children may have higher rates of dysphoria, or adoptive parents may be more likely to take them to gender clinics and/or affirm their gender dysphoria. The researchers presenting this data points out: 

Genetics have been implicated as a contributing factor in gender development. One twin study demonstrated increased concordance of gender dysphoria in monozygotic twins compared to dizygotic twins.15 Also, the prenatal hormonal milieu, more specifically the amount of androgen or estrogen exposure on the developing fetal brain, may also be influential on gender development in childhood.16,17 In addition, the postnatal environment appears to be important for gender development. Factors such as the social relationship between a young child and their caregiver,18 parental expectations, and societal norms 19 likely influence development of the child's gender identity. We must consider whether genetics, prenatal hormonal milieu, or the process of being adopted could result in higher degrees of gender dysphoria when considering this study's results.

They conclude post-natal environment is most likely a determining factor. This indicates culture does affect dysphoria and even the decision to medically transition.

Alternatively, postnatal factors could provide more plausible explanations. For example, adoptive parents may be more open to allowing their child to explore gender nonconforming behaviors than biological parents. Additionally, adopted children have a unique experience of identity formation, which differs from nonadopted children. Adoptive identity narratives have shown that adopted adolescents actively reflect on the meaning of adoption in creation of their self-theory.20 Perhaps adopted adolescents actively constructing their self-theories are more likely to critically assess other aspects of their identities, such as their gender identities, leading to increased presentation with gender dysphoria.

Multiple other gender dysphoria experts have noted higher rates of dysphoria in adopted children:

Zucker and Bradley 11 first noted overrepresentation of adopted patients in clinics serving transgender youth in 1998. They found 7.6% of their referred male population had been adopted or taken into permanent foster care before age 2 years, much lower than the Ontario early adoption rate of 1.49%.11 Spack et al. reported a prevalence of adopted children seen at the Gender Management Services clinic in Boston at 8.2% (8/97) using data from 1998 to 2009, however, this finding was not elaborated upon in that report.2 In a study of parental ratings of child mental health and gender, parent participants, all who were recruited from a single group therapy program for parents of gender nonconforming children and adolescents, reported a very high rate of adopted children (52%).12 A case study also described a child adopted at age 16 months with gender dysphoria and attachment disorder.13

There may be an association with gender dysphoria and a less stable household.

Furthermore, though detailing living arrangements of the children, the authors do not comment on their influence, though the effect of family chaos on the mood of offspring is well known. The study found only 36.7 per cent were living with both biological parents, and 58.3 per cent “had parents who had separated”. “Domestic violence was indicated” in 9.2 per cent…

 A clinic in Finland also found a significant association with single parent families and gender dysphoria:

It was also noticed that the clinically referred adolescents with GD less commonly lived with both their parents than the adolescents in the normal population (48% vs. 78%). (67)

In Australia, there is an association with gender dysphoria and a less stable household:

In the 56 children before the Family Court in Australia, discussed above, 25 of 39 cases in which family constellation could be discerned lived in single parent families or foster care, with only 14 from two parent families. 

This graphic is from a USPATH presentation showing a single parent and poverty connection:

Here is a quote from one of the original studies from Canada:

The bisexual/ homosexual persisters had a 13% increase in odds of coming from a lower social class background compared to the bisexual/homosexual desisters. 

Liberal parents, wanting to be supportive of their trans identified children, appear more supportive of transitioning their child in some cases.

One study from California showed that gay,lesbian, liberal, wealthy, and higher income mothers, are more likely to transition their children. This contradicts findings in older research, but the demographics, the numbers of children transitioning, and the affirmative model being painted as progressive, is changing things rapidly.

Psychological factors in parents may influence gender dysphoria in children

Korte et al. (2008), a German research paper, cites parental issues as factors in trans identification in children multiple times:

The parents' psychological abnormalities (20) and their effect on the child can promote the consolidation of GIS (21)

The authors have currently based their own approach on these considerations, working in a special interdisciplinary clinic for GID that was established in 2007 at the Charité Hospital in Berlin and that involves experts in adolescent psychiatry, sexual medicine, and pediatric endocrinology. All of the 21 patients who received a new diagnosis of GID in our clinic up to mid-2008 (aged 5 to 17; 12 boys, 9 girls) had psychopathological abnormalities that, in many cases, led to the diagnosis of additional psychiatric disorders. As a rule, there were also major psychopathological abnormalities in their parents.

Multiple references to negative parental behavior influencing trans identification in children can be found in this article:

Zucker and his colleagues argued that “co-occurring psychopathology” in the child and “psychodynamic mechanisms” in its family influenced gender identity, with the latter sometimes exerting an unrecognised “transfer of unresolved conflict and trauma-related experiences from parent to child”. Examples include “a girl observing her mother as bullied may self-identify as a male, while a boy observing his mother as depressed may self-identify as a female because subconsciously he wants to help his mother”. Conversely, “a mother with unresolved hostility toward men may encourage effeminacy in her son” [46].

There are a couple of pieces of data regarding the mental health state of the mother. One study seems to show a higher rate of depression (“maternal depression in 19.3 per cent”).

And here an association with depression, and a high association with maternal BPD:

This pilot study compared mothers of boys with gender identity disorder (GID) with mothers of normal boys to determine whether differences in psychopathology and child-rearing attitudes and practices could be identified. Results of the Diagnostic Interview for Borderlines and the Beck Depression Inventory revealed that mothers of boys with GID had more symptoms of depression and more often met the criteria for Borderline Personality Disorder than the controls. Fifty-three percent of the mothers of boys with GID compared with only 6% of controls met the diagnosis for Borderline Personality Disorder on the Diagnostic Interview for Borderlines or had symptoms of depression on the Beck Depression Inventory. Results of the Summers and Walsh Symbiosis Scale suggested that mothers of probands had child-rearing attitudes and practices that encouraged symbiosis and discouraged the development of autonomy.

The comment in the above study about “symbiosis” is interesting, in light of the results of this other study:

A new international study suggests that parents who employ challenging parent behavioural (CPB) methods – active physical and verbal behaviours that encourage children to push their limits – are likely protecting their children from developing childhood anxiety disorders.

Again, it is not known if these associations with childhood GD are due to the environment or genetics between the child and parents. More research is needed.

C. Psychological issues & environment influencing a trans identification in the present cultural context of trans affirmation.

1. Most studies on trans youth (and adults), show a high rate of comorbid psychological conditions (psychological issues that exist simultaneously with, and usually independently of, another medical condition). There’s debate about what causes this. Is it the body dysmorphia issues themselves? Is dysphoria caused by the other psychological problems in some cases? Is it all due to the stress of being a minority and resulting social stigma? Minority stress is certain to play somewhat of a role. For example, LGB youth and adults show high rates of mental health problems, even though they don’t have the same stresses as those who experience gender dysphoria. Gender dysphoric people have the added issues of body dysmorphia and dysphoria.

Here are just a few studies showing high rates of comorbidity with results that are representative of many others:

Korte et al. (2008)

All of the 21 patients who received a new diagnosis of GID in our clinic up to mid-2008 (aged 5 to 17; 12 boys, 9 girls) had psychopathological abnormalities that, in many cases, led to the diagnosis of additional psychiatric disorders.

Reisner et al. (2016)

Transgender youth, including adolescent and young adult transgender women assigned a male sex at birth who identify as girls, women, transgender women, transfemale, male-to-female, or another diverse transfeminine gender identity, represent a vulnerable population at risk for negative mental health and substance use outcomes.

 “Eating Disorders in Transgender Youth,”

There are two larger quantitative studies on eating disorders among transgender individuals. One study of 289,024 college students reveals that transgender students, compared to cisgender students, are almost five times as likely to report an eating disorder and two times as likely to use unhealthy compensatory methods (e.g., vomiting) for weight control.4 Another study of almost 2,500 teenagers shows that transgender individuals are almost three times as likely to restrict their eating, almost nine times as likely to take diet pills, and seven times as likely to take laxatives.5

“Psychosocial and Psychological Vulnerability in Adolescents with Gender Dysphoria: A ‘Proof of Principle’”

The findings supported the clinical impression that a large percentage of adolescents referred for gender dysphoria have a substantial co-occurring history of psychosocial and psychological vulnerability, thus supporting a “proof of principle” for the importance of a comprehensive psychologic/psychiatric assessment that goes beyond an evaluation of gender dysphoria per se.

Lisa Littman’s recent study, profiling the soaring numbers of rapid onset trans identified females, shows high rates of comorbid conditions: 

The AYAs who were the focus of this study had many comorbidities and vulnerabilities predating the onset of their gender dysphoria, including psychiatric disorders, neurodevelopmental disabilities, trauma, non-suicidal self-injury (NSSI), and difficulties coping with strong or negative emotions (Table 4). The majority (62.5%) of AYAs had one or more diagnoses of a psychiatric disorder or neurodevelopmental disability preceding the onset of gender dysphoria (range of the number of pre-existing diagnoses 0–7). Many (48.4%) had experienced a traumatic or stressful event prior to the onset of their gender dysphoria. Open text descriptions of trauma were categorized as “family” (including parental divorce, death of a parent, mental disorder in a sibling or parent), “sex or gender related” (such as rape, attempted rape, sexual harassment, abusive dating relationship, break-up), “social” (such as bullying, social isolation), “moving” (family relocation or change of schools); “psychiatric” (such as psychiatric hospitalization), and medical (such as serious illness or medical hospitalization). Almost half (45.0%) of AYAs were engaging in non-suicidal self-injury (NSSI) behavior before the onset of GD. Coping styles for these AYAs included having a poor or extremely poor ability to handle negative emotions productively (58.0%) and being overwhelmed by strong emotions and trying to avoid (or go to great lengths to avoid) experiencing them (61.4%) (Table 4). The majority of respondents (69.4%) answered that their child had social anxiety during adolescence; 44.3% that their child had difficulty interacting with their peers, and 43.1% that their child had a history of being isolated (not associating with their peers outside of school activities).

This discussion of cases in Australia demonstrate high rates of comorbid conditions:

In this same group of 56 children, 50% had a diagnosed psychological disorder, including six with Autism Spectrum Disorder (ASD), major depression, anxiety, oppositional defiance disorder, ADHD, and intellectual disability. 

In a sample of 105 gender dysphoric adolescents and using the Diagnostic Interview Schedule for Children (DISC), anxiety disorders were found in 21%, mood disorders in 12.4%, and disruptive disorders in 11.4% of the adolescents. Males had greater psychopathology compared with females, including comorbid diagnoses (de Vries et al. 2011).

A general comment from Kaltiala-Heino (2018):

Descriptive studies of adolescents referred to specialized gender identity services at different centers in Europe and North America have mainly suggested that ~40%–45% of these young people present with clinically significant psychopathology.(38,39,41–50) The lowest figures for psychiatric comorbidity (one-third of the presenting population) were reported in the Netherlands,41 and the highest (up to three quarters) was reported in Finland and Canada.(39,50)

Most studies show high rates of comorbid conditions in adulthood, even post medical transition:

“Psychiatric Axis I Comorbidities among Patients with Gender Dysphoria.”

“Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden.”

”The National Transgender Discrimination Survey Report.”

More studies on mental health data and suicide risk are referenced with regards to this topic.

Affirmative model advocates often argue mental health problems are due to oppression, rejection, and minority stress. Research shows high rates of discrimination towards trans people. LGB populations, including youth, also have higher rates of discrimination and mental health problems. 

There may be validity to the minority stress argument. The Trans Youth Project demonstrates that socially transitioned children, with support, have near normal mental health profiles. A review of a Dutch cohort, who had early intervention and social transition, had comparable mental health to their peers. These studies together indicate social acceptance and medical care can alleviate mental health problems. However, these studies are not without methodological issues and conclusions must be taken with caution.

At this point, it’s too early to draw broad conclusions from these two studies, about the benefits of early social and medical transition. The Dutch clinic claims to have had a thorough screening process for mental health conditions before providing hormones and surgery (many affirmation model advocates feel the Dutch model is too conservative). This is the type of gatekeeping being eliminated, especially in the United States see here and here). They did have other sets of youth, with high-rates of comorbid conditions, at their clinic. They did not medically transition those children. And one of the 55 children who was transitioned by a surgeon, died as a result of the vaginoplasty surgery performed.

The trans youth study is just a snapshot in time of a young population who have not dealt with all the realities of a full medical transition. It’s also a self-selected population of parents who may have high rates of good mental health. Olson admits this herself. Her results are an outlier. Clinics in Britain, Finland, Canada, and Germany all show high rates of comorbid conditions in the youth they treat. Lisa Littman’s ROGD study also shows high rates of comorbid conditions. The argument presented in Temple Newhook et al. (2018) (affirmative model advocates), is that the youths are distressed because of unsupportive parents, and early social and medical transition will solve these problems. But Steensma attempts to debunk that argument by claiming most of the parents who bring their children to gender clinics are loving parents who want to help their child. Littman’s study also demonstrates that high rates of parents support their children’s gender expression, name changes, and requests to see gender therapists. Why these results are so different from Olson’s results, is currently unknown.

Going into great detail about the extent social stigma has on mental illness in the trans community, versus other causes, is beyond the scope of this section. However, it’s arguably one cause of poor mental health. In addition, the intent is not to deny a biological basis for some individuals with persistent trans identities. Instead, we will focus on cases where psychological problems do seem directly related to a trans identification, in order to highlight the complexity of the issues surrounding diagnosis and determining which young people may be harmed by transitioning. 

Abuse & trauma appear to influence some individuals to identify as transgender

Numbers of trans identified youth, especially females, are increasing in Australia, as they are in other western countries. One gender clinician has noted an association with trans identification and sexual abuse:

Psychiatrist Dr Stephen Stathis, who runs a gender clinic, said he had seen girls who had been sexually abused and wanted to identify as transgender…The girls say, ‘If only I had been a male I wouldn’t have been abused’ Dr Stathis said.

The ROGD study also had high rates of trans identified females who had experienced trauma prior to their trans identification:

Many (48.4%) had experienced a traumatic or stressful event prior to the onset of their gender dysphoria. Open text descriptions of trauma were categorized as “family” (including parental divorce, death of a parent, mental disorder in a sibling or parent), “sex or gender related” (such as rape, attempted rape, sexual harassment, abusive dating relationship, break-up), “social” (such as bullying, social isolation), “moving” (family relocation or change of schools); “psychiatric” (such as psychiatric hospitalization), and medical (such as serious illness or medical hospitalization). 

The APA notes in its guidelines that later onset cases can be more complex and related to trauma:

The APA Task Force on the Treatment of Gender Identity Disorder notes that adolescents with gender dysphoria “should be screened carefully to detect the emergence of the desire for sex reassignment in the context of trauma as well as for any disorder (such as schizophrenia, mania, psychotic depression) that may produce gender confusion. When present, such psychopathology must be addressed and taken into account prior to assisting the adolescent’s decision as to whether or not to pursue sex reassignment or actually assisting the adolescent with the gender transition.”

This is from a Reddit social media post, where a person who wants to transition FtM worries trauma may be a contributing factor to dysphoria:

There are detransitioned women who say trauma was at least part of what fueled their transition. This is an account in The Stranger of a young woman who transitioned as a young adult, 

Three months before Cass started taking testosterone, her mom committed suicide. "Transitioning was kind of a survival strategy," Cass said. And that worked for a while, but over time, she started to sense that her dysphoria was rooted more in the trauma of her mother's death and her own internalized misogyny than in gender identity.

"Psychologically, it was harder to detransition," she said. She compares it to the process of working through her mom's suicide. "It involved a lot more dealing with my trauma and facing the self-destructive parts of myself. It's not fun, but it's worth it."

 Here is an account of a young desister who feels trans identification in young females can be related to abuse,

I’m glad she didn’t believe I was a boy trapped in a girl’s body. I’m glad she found a psychologist who saw how scared and angry and hurt I was and who wanted to help me with those things first instead of also helping me transition to be a boy.

“Trans” isn’t the right word. We’ve learned to know it as trans but really what I think some people feel is extreme, chronic dissociation, possibly from trauma and PTSD.”

Trauma can affect biological males as well.

A psychology student and former MtF (now a detransitioned man) from the blog Third Way Trans comments on his process of coming to accept himself as male. 

I then worked through a lot of trauma in therapy and discovered that I could be comfortable with presenting male after all, and that it was good to let go of the need of be seen as female. Much to my surprise it was possible to become okay with being seen as male, because it does not limit me from being who I am. I wish I could have saved myself all of this trouble and worked through these issues psychologically and I am concerned that the psychological community does not present this possibility. 

Here, he discusses trauma from abuse over being a soft male was at least partly instrumental in the dissociation that influenced his need to transition, 

Escaping from trauma is a moving away. Escaping from emotional pain is a moving away. The problem is that unlike with physical dangers, this doesn’t work with emotional dangers because you can not get away from yourself. This only allows for coping, which can be very important, but ultimately does not create healing, or a vital life.

WPATH doctors are apparently transitioning minors who have had severe trauma. This account is from a detransitioned female, skeptical of the safety of youth medical transition.

Other mental illnesses may blend with or fuel a trans identification in the current cultural climate

There may be cases where other psychiatric problems are expressing themselves in the context of increasing cultural focus on gender dysphoria. In these cases, these youths would likely not identify as trans even just twenty years ago. 

In Finland, their clinic has a much larger female to male ratio (41:6) and they have observed serious mental health problems in this population. Trans awareness combined with serious other mental health problems may be contributing to increasing gender dysphoria in some young people. 

In the majority of the applicants, gender dysphoria presented in the context of wider identity confusion, severe psychopathology and considerable challengesin the adolescent development. At this point it is not possible to predict how gender dysphoria in this group will develop:

The recorded comorbid disorders were thus severe and could seldom be considered secondary to gender dysphoria. This utterly contradicts the findings in the Dutch child and adolescent gender identity service, where two thirds of adolescent SR applicants did not have psychiatric comorbidity.

Of the applicants, 68% (32/47) had had their first contact with psychiatric services due to other reasons than gender identity issues. 

Here is an example where an obsession with gender identity may be the result of obsessive compulsive disorder,

To our knowledge, sexual obsessions concerning gender identity, including fears of being transgender, have not yet been reported in the literature. With the increasing media coverage and public awareness of transgender issues, this particular presentation of OCD is likely to become more common.

Distinguishing the distress due to OCD sexual obsessions about being transgender from gender dysphoria is a key step in developing an effective treatment plan. OCD obsessions would be treated with pharmacotherapy (e.g., selective serotonin re-uptake inhibitors) and/or an evidence-based psychotherapy (e.g., cognitive behavior therapy with exposure and response prevention) (21), whereas gender dysphoria would be treated with psychological support, cross-sex hormone therapy, and/or surgery (22,23). It is theoretically possible that a patient have both OCD and gender dysphoria. In such a case, it would be important to treat the OCD adequately before embarking on decisions surrounding transgender identity and treatment.

At the Gender Odyssey conference in Seattle in 2017, Aydin Olson-Kennedy states that many therapists are diagnosing these increasing numbers of females going to gender clinics with borderline personality disorder. Aydin Olson-Kennedy is a social worker counseling youth and one of the most enthusiastic supporters of the affirmative model. Olson-Kennedy attributes these youths BPD-like symptoms to frustration over their gender dysphoria.

I’m frustrated…BPD is the new bipolar

Given symptoms of BPD can include impulsiveness and self-image issues, it may be best not to write of the possibility that these individuals may be vulnerable to making poor decisions.

Borderline personality disorder is a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. It includes a pattern of unstable intense relationships, distorted self-image, extreme emotions and impulsiveness.

With borderline personality disorder, you have an intense fear of abandonment or instability, and you may have difficulty tolerating being alone. Yet inappropriate anger, impulsiveness and frequent mood swings may push others away, even though you want to have loving and lasting relationships.

Autism

It is now well established that there are higher rates of autism among gender dysphoric individuals and that these young people are turning up in higher numbers to gender clinics. The question we want to ultimately address here is if all dysphoric autism spectrum individuals really have an “innate gender” of the opposite sex or of a non-binary identity, or if there are characteristics of autism that are causing them to see themselves this way due to the current intense cultural fixation on gender and transgender identities (or both). Below are some comments supporting the observed higher rates of autism spectrum individuals with GD in autism/gender clinics.

This quote is a good summation of rates of presentation.

International Society for Autism Research:

The over-representation of ASD among individuals clinically referred for Gender Dysphoria (GD) has been observed across multiple sites internationally; up to 25% of youth gender referrals present with significant autism symptoms. There is also emerging evidence for an over-representation of gender identity differences among ASD-referred youth. The ASD/GD co-occurrence is conceptually and clinically complex, and a range of theories have been proposed to explain it. 

From Spectrum News:

Blakeley-Smith says one in four people who come to her autism clinic are young adults with gender dysphoria who say they are on the spectrum. She also sees young adults that she diagnosed with autism as children come to the clinic years later with concerns related to gender dysphoria. “I think this is a severely underserved population,” she says.

Forbes has a good comprehensive list of studies confirming a link with autism and GD,

Published Studies on the Gender Dysphoria – Autism Link:

1. A 2010 Dutch study of 204 gender dysphoric children and teens (average age = 11) who sought treatment at a gender identity clinic in Amsterdam found that 8% of fulfilled criteria for ASD (as measured by the Diagnostic Interview for Social and Communication Disorders). Broken down by gender, rates of ASD were 10% for those assigned male-at-birth and 4.5% for those assigned female-at-birth.

2. A 2014 UK study of 91 GD adults (63 assigned male-at-birth, mean age = 46; 28 assigned female-at-birth, mean age = 27) being treated in a private gender clinic in London found a prevalence of ASD traits (as measured by the self-report Autistic Spectrum Quotient) at 5.5% (7% among the assigned male-at-birth, 5% among the assigned female-at-birth).

3. Another 2012 UK study of 61 trans men (average age = 34) and 198 trans women (average age = 45) recruited through a London gender identity clinic and a university research website found significantly higher autism scores (as measured by the self-reported Autistic Spectrum Quotient questionnaire) among the trans men compared to both cisgender (i.e., non-trans) women and cisgender men. Trans women did not score higher in autism spectrum traits than the control groups of cisgender men or women; this is the only instance of a nonsignificant finding across all studies.

4. A 2014 U.S. study of 147 children (ages 6-18) diagnosed with ASD by a clinical pediatric neuropsychologist at a large U.S. hospital-based neuropsychology clinic in Washington, DC found that they were 7.6 times more likely than non-ASD children to be reported by their parents to sometimes or often “wish to be of the opposite gender.” Specifically, the rates of this type of “gender variance” was 5.4% among the children with ASD children compared to less than 1% among two separate general population samples, 1.7% among children with a medical neurodevelopmental disorder other than autism spectrum (including epilepsy and neurofibromatosis 1). However, rates of gender variance among children with ASD were only slightly higher than among children with attention deficit hyperactivity disorder (ADHD, 4.7%) whose rates were 6.6 times higher than the general population.

5. A 2015 Canadian study of 49 children with gender dysphoria (average age = 8) at a gender identity clinic in Toronto found that 45% of them were in the clinical range for autism (based on their mother’s report on the Social Responsiveness Scale), ranging from mild to severe. Furthermore, the more gender nonconforming the children were, the higher their autistic traits were.

6. A follow-up Canadian study also published in 2015 including 534 children (82% assigned male-at-birth; ages 3-12) referred to the Toronto gender identity clinic found significantly more obsessive thoughts and behaviors (as reported by their parents) in the boys and girls with gender dysphoria compared to their siblings as well as a separate group of children from the general population.

7. Another UK 2015 study with 166 parents of teens (63% assigned female-at-birth; average age = 14) with gender dysphoria presenting at a gender clinic in London found that 54% of them scored in the mild/moderate (27%) or severe (27%) clinical range for autism (based on their parents’ report on the Social Responsiveness Scale); additional 3% of those scoring in the normal range on the SRS had a prior autism spectrum diagnosis. No difference was found in autistic features between natal girls and boys.

8. A 2015 Finnish study with 47 teens under the care of a gender identity clinic in Tampere found that 26% of them had previously been diagnosed with ASD according to a psychiatric case note review.

9. Finally, a U.S. 2016 study of 39 children and youth (ages 8-20) presenting for evaluation at a multidisciplinary gender clinic based in a large pediatric hospital in Boston found that 23% of them scored in the “possible,” “likely,” or “very likely” on the parent-completed Asperger Syndrome Diagnostic Scale, with virtually identical percentages for children assigned male- or female-at-birth.

What are the theories as to why there is an association of autism with gender dysphoria? A quote by Naveed Saleh, MD, MS reviews some ideas:

Hypotheses Connecting Autism and Gender Dysphoria

Although several hypotheses have been proposed to causally link autism to gender dysphoria, there’s a lack of hard evidence supporting many of these guesses. Furthermore, the evidence that does support these “theories” (more accurately, hypotheses) is all over the place and often hard to piece together into cogent and coherent arguments. Nevertheless, let’s look at some of these hypotheses:

1. According to the extreme male brain theory, women are wired to think in more empathetic terms; whereas, men are more systematic in their thinking. Moreover, high levels of testosterone (a male hormone) in the womb results in an extreme male brain or male pattern of thought, which leads to both autism and gender dysphoria. Although there is limited evidence supporting some of the reasoning behind the extreme male brain theory, one glaring discrepancy is that increased levels of testosterone leading to a male brain don’t explain why gender-assigned boys, who already have a male brain, develop autism and gender dysphoria when exposed to higher levels of testosterone. Instead, these boys should be hypermasculinized and even more male in their thinking. Thus, this hypothesis explains only why girls may develop these conditions.

2. Difficulty with social interactions has also been used to explain the development of gender dysphoria in children with autism. For instance, a boy with autism who is bullied by other boys might come to dislike other boys and identify with girls.

3. People with autism have difficulty communicating with others. This deficit may contribute to others missing social cues about assigned gender which might increase the chance of developing gender dysphoria. In other words, because other people don’t pick up on cues of a child’s assigned gender, then the child isn’t treated in a fashion concordant with this assigned sex and may, therefore, be more likely to go on to develop gender dysphoria.

4. Gender dysphoria could be a manifestation of autism, and autistic-like traits could drive gender dysphoria. For instance, a child with the male-assigned gender and autism may become pre-occupied with female clothes, toys, and activities. In fact, this apparent gender dysphoria may not be gender dysphoria at all but rather OCD.

5. Children with autism can demonstrate rigidity with respect to gender differences. They may have a hard time reconciling the difference between their assigned and experienced or desired gender. This increase in distress could possibly exacerbate gender dysphoria and make it harder for them to manage these feelings.

6. Some research shows that unlike most adolescents with only gender dysphoria, adolescents with autism and gender dysphoria aren’t usually attracted to members of their birth-assigned gender (i.e., the non-homosexual subtype of gender dysphoria). This group of people may experience more severe autism symptoms and psychological problems.

7. In the past, some experts argued that people with autism were unable to form a gender identity—this was subsequently repudiated. However, either confusion in the development of gender identity or an altered pattern of gender identity development might contribute to gender dysphoria. Furthermore, deficits in imagination and empathy, which are common in people with autism, may make it hard for people with autism to recognize that they belong to a certain gender group

And Dr. Saleh adds another theory common among affirmation model advocates such as Natasha Kennedy and Diane Ehrensaft. That there really may be many more dysphoric and transgender people than we realize, it’s just societal expectations prevent them from recognizing their “true selves” in a similar way that anti-homosexual stigma does.

It’s plausible that gender dysphoria is just as common in children and adolescents both with and without autism. However, those with autism won’t suppress themselves in light of prevailing mores that perpetuate cisgenderism. By not hiding their preferences, children with autism are more likely to be identified as also having gender dysphoria.

In addition to cultural cisgenderism, Kennedy argues that clinicians and researchers also perpetuate cisgenderism by seeing gender as merely binary, unchangeable, and essential. According to the experts, it’s automatically pathological to identify in a gender nonconforming way. Experts fail to see that gender isn’t merely male or female but rather a spectrum.

Another informative review of theories can be found in the paper, “Gender dysphoria in adolescence: current perspectives.”

The excerpt below is a good general example of the increased acceptance, among autism/dysphoria mental health and medical professionals, in using the affirmative model to treat these young people.

And Children’s National:

Some young people have both autism spectrum characteristics (or related conditions) and gender non-conformity. They may express discomfort with aspects of their gender, or feel they are a different gender (transgender). We do not yet understand why autism and gender differences sometimes occur together, but we do know that this co-occurrence can be difficult to navigate for young people and their families. The Gender and Autism (and Related Conditions) Program is dedicated to helping youth and families through our clinical and research initiatives.

Supporting Children with Autism on their Gender Journey 

The Gender and Autism (and Related Conditions) Program at Children’s National Health System is dedicated to supporting youth with gender and autism (or related conditions) through evaluations, consultation and a specialized ongoing support program. We approach this work from the following perspectives:

●     Each young person’s gender journey is individual

●     There are many possible outcomes that can unfold over time

●     A young person’s neurodiversity is a key component in the gender discernment process 

 Our focus is on helping your child with their autism spectrum challenges, such as with flexible thinking, planning skills, future thinking and self-awareness, while at the same time supporting their need for gender exploration. 

Many affirmative model advocates believe autism just happens to coincide with gender dysphoria, and that autism personality traits (such as obsessiveness or social awkwardness) don’t need to be considered when affirming the child’s identity. Diane Ehrensaft calls autism spectrum children with gender dysphoria “double helix rainbow kids”:

Double Helix Rainbow Kids is a letter to the editor in conjunction with the forthcoming issue on autism and gender that discusses the intersection between autism and gender expansiveness, calling on extant research, clinical observations at the UCSF Benioff Children’s Hospital Child and Adolescent Gender Center and other clinics, as well as personal narratives. It alerts the reader to the importance of giving full attention to the gender stress or gender dysphoria that often accompanies autism spectrum in children, making constitutional-psychological-social links between neurodiversity and gender diversity.

Some mental health professionals and doctors do not agree with enthusiastic affirmation of an autism spectrum minor’s gender dysphoria. They feel the other personality issues specific to autism (such as rigid thinking and obsessiveness) may be worked through with therapy and maturation. They are concerned about the lack of research underlying the arguments to socially and medically transition minors, and even young adults, with autism.

Other experts say a fixed gender identity may take longer to develop for individuals with autism than it does for typically developing youth5. As a result, they say, many teenagers with autism who do not conform to gender expectations or who have a fluid gender identity may ultimately accept their birth gender.

“My concerns are less about the guidelines and more about the research used to substantiate the idea that gender dysphoria is more common in autism,” says Gerrit I. Van Schalkwyk, clinical fellow in child and adolescent psychiatry at the Yale Child Study Center. “My argument is you need to understand the normal course of gender development for people with autism first.”

Psychiatrist Susan Bradley is one of the more outspoken doctors disturbed by the high rates of autism youth that are medically transitioning. Her concerns are reviewed in the article, “How trans activists are unethically influencing autistic children to change genders.”

As a child psychiatrist with experience in both ASD and gender discomfort, I share Ehrhard’s concern and can substantiate her claim. In her account I see a familiar story of a youth with ASD who feels socially isolated, and confused about sexual feelings as she moves into adolescence. As I well know, involvement in internet chat sites offers adolescents with ASD a sense of belonging, but also can lead to foreclosure of reflective thinking about their own feelings and situation…

Activists would have the public believe that anyone who expresses a wish to be the other gender should be allowed and encouraged to do so. Credulous politicians have translated their demands into law. To date, however, there is no evidence that there is such a thing as a “true” trans, just as there is no marker that would identify a “false” trans. To accept the thinking and wishes of those with ASD at face value, without understanding why they feel the way they do, is not a kindness, and may in fact be extremely damaging.

Difficulties in sensory processing are common in autism spectrum youth. In this comment, Sasha Ayad states she has noticed issues of sensory overload in dysphoric youth (although doesn’t mention autism specifically here). 

Kids with deeply rooted body discomfort or dissociative tendencies are often afraid of their own sensory experiences.

Being dissociative and having sensory discomfort does seem to be directly related to gender dysphoria, and can be alleviated by transition. This FtM clearly says (comments section) that medical transition has felt like a great relief.

I also know there’s been some writing about autism on here, and would like to make it known, as someone who’s been diagnosed with aspergers, that that doesn’t mean for sure that your kid is just confused. I think it can, there are valid concerns… But I’m an autistic trans man who’s only been happy with his transition, has only been made able to thrive more in life. Suffice it to say, all kinds of people exist, and this is one of the distinctions I hesitate to encourage people do make (i.e., if you’re autistic, you can’t genuinely be trans). But “all kinds of people exists” also mean there WILL be autistic people who mistakenly think they’re trans…

What did happen was recognizing how bizarre and foreign having a female body felt. How proprioceptively disproportionate my body felt with female fat and muscle mass distribution, how my breasts, even 10 years after growing them, are something my brain refuses to incorporate into the map of how my body is supposed to be configured in physical space… To the touch, they feel foreign and make my skin crawl – My brain doesn’t know how to process the sensory information.

The point is not to deny these experiences. There are so many more cases of autism spectrum youth, and mostly female youth, going to gender clinics without a history of childhood GD. They are in the tumultuous time of puberty and they are making permanent decisions about their bodies as minors. Exploring all autism related issues, to ensure that these youths don’t also have body dysmorphic disorder, or some other sensory or rumination problems, seems responsible. This doctor has concerns:

Then, she says, there are the autistic girls, many undiagnosed. With a typically heightened sensory awareness, they find puberty particularly distressing, while a tendency to rigid categorical thinking means they see society’s pink and blue gender boxes and, if they like “male” clothes or pursuits, believe they must be physically reclassified.

In this section, CaseyJeanC, an autistic female and youtuber, confirms this was an issue for her (2:35-2:58):

As many of you probably know, a big part of autism for many people, even though it’s not considered diagnostically, is sensory sensitivity or sensory processing issues. And I think in many cases, and certainly my own, sensory issues can contribute to feelings that ultimately get interpreted or labeled as gender dysphoria.

Many educators are worried about very large increases of teenagers coming out as trans. These are not mental health professionals, but they do have the unique experience of witnessing child/teen behavior and trends over the span of many years. In this article, a teacher has observed huge increases in teens with gender dysphoria (mostly females and many autistic) and is alarmed.

An astonishing 17 pupils at a single British school are in the process of changing gender, The Mail on Sunday can reveal…

The whistleblower says few of the transgender children are suffering from gender dysphoria – the medical term for someone who feels they were born in the wrong body – but are just easily influenced, latching on to the mistaken belief they are the wrong sex as a way of coping with the problems caused by autism…

Over the next four years, Carol witnessed an astonishing explosion in the number of children claiming to be transgender.

In all but a very few cases, she says, the children were officially diagnosed as autistic by the local education authority. Those not formally diagnosed showed clear signs of being on the autistic spectrum, she says. 

According to Carol, nine of the 18 children she has seen identify as transgender have been diagnosed with autism while the rest had definite signs of the condition. ‘Typically, these children are bright outsiders,’ she says.

‘I don’t believe they are actually transgender. They are just young people with complex mental health issues who have found an identity and want to be part of a group of like-minded people.’

According to an internal report, a third of patients referred to the Tavistock Clinic, the UK’s only NHS service for young people confused about their gender, have strong autistic traits.

More research is needed on this population to determine how much effect cultural narratives about gender dysphoria (and gender in general) have, and how it influences these youths. It would be difficult to argue culture has zero effect, given the numbers of this cohort. It is also not known if there are ways to work with their autism symptoms, in a way that can help alleviate gender dysphoria, without medical treatment.

Plurals & other “dissociated” individuals

There apparently is a newly observed phenomenon of people with multiple personalities with trans identities. This is of interest because the theory of multiple personality disorder (now called dissociative identity disorder) is controversial, with some mental health professionals going so far as to call it a fraud diagnosis. It is often referred to as being more of a social contagion, even implanted by therapistsin the minds of vulnerable people. 

Having seen hundreds of patients who claimed to house multiple personalities, I have concluded that the diagnosis is always (or at least almost always) a fake, even though the patients claiming it are usually (but not always) sincere.

In every single instance, I discovered that the alternate personalities had been born under the tutelage of an enthusiastic and naive therapist, or in imitation of a friend, or after seeing a movie, or upon joining a multiples' chat group—or some combination. It was most commonly a case of a suggestible and gullible therapist and a suggestible and gullible patient influencing each other in the creation of new personalities. None of the purported cases had had a spontaneous onset and none was the least bit convincing.

This mental health professional has a differing opinion:

Dissociative identity disorder (DID), known previously as multiple personality disorder, is not a real disorder. At least, that’s what you might’ve heard in the media, and even from some mental health professionals. DID is arguably one of the most misunderstood and controversial diagnoses in the current Diagnostic and Statistical Manual of Mental Disorders (DSM). But it is a real and debilitating disorder that makes it difficult for people to function.

Transgender health professionals are indeed medically transitioning trans identified people who feel they have multiple personalities, sometimes called “plurals.” They not only claim to have multiple personalities, but some personalities may be male, some may be female, and some may be non-binary. This makes medical treatment more complicated. Given that these patients are not in touch with reality, it seems pertinent to ask the question, How much is the culture reinforcing these delusions that they have multiple personalities and different genders. Diagnosable mental illnesses exist in all cultures, but there are variations in how they manifest. Schizophrenia is one of many examples. They also occur at differing rates, and culture influences the way the therapists describe them. 

Karasic, a WPATH member, is not opposed to medically treating plurals. In this video, he explains that he is not “plural phobic” concerning medical transition. 

Here is a screen shot corroborating his medical transition of trans plurals.

Karasic medically transitions plurals, even if their multiple personalities are arguing over whether they want hormones or not, and even if they have life threatening substance abuse problems. This is on a continuum of a very pro medical treatment meme, held by many affirmative model advocates (see here and here).

Mental health and medical professionals also discussed transitioning people with DID in a seminar called “Complicated Cases,” a Gender Odyssey, in 2017. A therapist who works at a psychiatric hospital, worries that some don’t take dissociative people seriously if they want to transition. Angelo says she will emphasize the gender issues with gatekeepers in these cases. 

Here, a female with DID expresses the libertarian principles around medically transitioning often seriously mentally ill people:

I have sat witness to a many a conversation in which people —  even trans people — have said that the only reason to disallow someone’s transition is if they are “truly crazy — like schizophrenic or multiple personality disorders or something.” This notion derives from the false belief that disabilities or mental differences render you incapable of consent and making decisions about your own body. You are seen as a danger to yourself, in need of protection from your own desires. But we “crazy” people still have the same rights as everyone else to self-determination.

And the truth is that most trans people are struggling with mental health. We just have to hide it or risk having our healthcare and agency taken away from us. And risk community shunning.

“You can’t be a trans man and a drag queen,” a local transgender leader informed the support group she was facilitating. “That doesn’t exist.”

And yet, I have been both these things, sometimes at once, sometimes separately. It’s hard when your own community tells you that you don’t exist.

Apparently, there is a “trans plural” community large enough to justify this survey of hundreds of them working at Google. 

Not all dissociation is around identity or multiple personalities. It can take different forms, like feeling dissociated from body and/or mind. This study, “Dissociative symptoms in individuals with gender dysphoria: Is the elevated prevalence real?” found a high rate of “dissociative disorders” in people with GD:

This study evaluated dissociative symptomatology, childhood trauma and body uneasiness in 118 individuals with gender dysphoria, also evaluating dissociative symptoms in follow-up assessments after sex reassignment procedures were performed. We used both clinical interviews (Dissociative Disorders Interview Schedule) and self-reported scales (Dissociative Experiences Scale). A dissociative disorder of any kind seemed to be greatly prevalent (29.6%). Moreover, individuals with gender dysphoria had a high prevalence of lifetime major depressive episode (45.8%), suicide attempts (21.2%) and childhood trauma (45.8%), and all these conditions were more frequent in patients who fulfilled diagnostic criteria for any kind of dissociative disorder. Finally, when treated, patients reported lower dissociative symptoms. Results confirmed previous research about distress in gender dysphoria and improved mental health due to…

There is not a lot of research on trans plurals. But clearly both trans plurals and MPD, now DID, have had social contagion aspects fueling this type of presentation of mental illness, and/or the diagnosis of it. There was a flurry of diagnoses by therapists in the 1980’s, now viewed as a period involving a fad.

Conclusion, psychological issues

Reviewing these factors does not discount transgender individuals with good transition outcomes. And there are some individuals who maintain trans identities from early childhood. It is well established that there are higher rates of mental health issues in the trans population, but more research is needed to know exactly why that is. There also needs to be more research into how societal, cultural and familial factors affects both mental health and trans identity. Rising populations of teenage females have high rates of mental health problems, and links to autism are poorly understood. All of these complications make treatment more difficult.

These German clinicians recommend thorough screening and caution before transitioning young people.

All psychodynamically relevant conflicts and "transsexualogenic" factors that may be present should be thoroughly analyzed and worked through in psychotherapy or family therapy; indeed, when this is done, there is a real chance that the patient will, in the end, no longer a desire a sex change. If a purely biologistic approach is taken and a "rapid solution" with hormone therapy is initiated too early, these important aspects of the diagnostic and therapeutic process are likely to fall by the wayside.

© Gender Health Query, 6/1/2019

Continue (part 2)- Social Contagion

REFERENCES FOR TOPIC 10

Contents

10) Nature vs nurture (part 1)

-Innate nature: research supporting bio factors in trans & homosexual identities

-A study that may help distinguish trans brains from homosexual brains

-Is autogynephilia an innate gender identity? A controversial diagnosis

-Are non-binary identities, het female FtM identities, & autistic trans identities biologically innate?

-Some general quotes supporting the relevance of nurture in trans identity

-Anecdotal examples of the blurry line between gnc gay & trans, Marsha P. Johnson & Sylvia Rivera

A. Anti-gay/lesbian/bisexual, tomboy, & female attitudes can fuel trans identification

-Homophobia & trans identity
-Examples of a female inferiority complex

-Pressure on adult gender nonconforming gays & lesbians to transition, it is reasonable to be concerned about youth

-Some trans activists are aware of the homophobia in the general public & intentionally distance themselves from LGB rights

-Some cultures are more accepting of transgenderism than homosexuality

B. Evidence of parental influences on a child’s transgender identity

-Some parents may prefer their child medically transition than be a future gay or lesbian adult

-Parental support & even enthusiasm to transition their child

-Adopted children, children in single-parent homes, & from certain socioeconomic backgrounds more likely to have GD

-Psychological factors in parents may influence GD in children

C. Psychological issues and environment influencing a trans identification

-Other mental illnesses may blend with or fuel a trans identification in the current cultural climate

-Autism
-Plural & other disassociated individuals

-Conclusion, psychological issues

Continue (part 2)

Back to Outline

More

1. Do children outgrow gender dysphoria?

2. Permanent side effects

3. Are children & teens old enough to give consent?

4. Comments safety / desistance unknown

5. Gender dysphoria affirmative model

6. Minors transitioned without any psychological assessments

7. Conversion therapy laws

8. Regret rates & long term mental health

9. New World Order

11. Why are so many females coming out as trans/nonbinary?

12. Cultural ripple effects

13. Why is gender ideology being prioritized in educational settings?

14. Problems with a politicized climate (censorship, etc)

15. Suicide risk reviewed

16. Trans rights / risks of false positives on minors

17. Moral Dilemmas