TOPICS

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

Is it possible to implement protocols trans activists and affirmative model advocates want in treating gender dysphoric children, teens, and young adults and protect borderline youth, disproportionately likely to be gay, lesbian, bisexual, and those struggling with mental health issues, or on the autism spectrum from medical harm? The answer is NO. 

With the affirmative model, and the social and medical transition of children and young people, inappropriate medical transitions are an inevitability. It seems that society has made the decision that over-medicalized, mostly same-sex attracted youth, who in the past would have resolved their GD without medical treatment, are an acceptable price to pay for trans positive healthcare and supporting trans-identifying youth’s needs.

Youth gender transitions are reducing the diversity of expression of the gay and lesbian community and will continue to do so in the future. This is true of the non-trans bisexual community as more and more bisexual females are identifying as non-binary or FtM and are transitioning as minors. The question is not if this is going to happen, it already has. The question is, to what extent? These youths are in effect losing the right to grow up and mature without being permanently sterilized and medically defaced, due to a decision made before reaching full brain maturity.

The above graphics may be one-sided, coming from the gay/lesbian perspective, but they represent the very real fear many people have, LGB people (and some trans people) in particular, that the new cultural push to socially transition very young children, interfere with their puberty with puberty blockers, and immediately transitioning rapid onset teenagers and young adults (often with little or no psychological assessment) is a form of LGB eugenics/erasure. It is also literal eugenics of all LGB and T dysphoric young people, now sterilized, and not given the opportunity to transition with mature decision-making faculties, and fertility preservation.  There are serious implications for how trans people will be changed as people through medical manipulation at very young ages.

What is the evidence that a clean screening process between trans and gnc LGB oriented children, teens, & young adults is not possible?

1) False positives are already happening. So the fact that mistakes on immature people will be made is not debatable. It’s only a matter of what the percentages will be with so many young people transitioning. Anecdotally, it appears young detransitioners are disproportionately likely to be lesbian or bisexual females. There is already a growing population of young detransitioned women, many lesbian or bisexual, who transitioned too young to have fully understood themselves as adults. Their problems were not solved by medical transition. Regret rates will likely not be as low as adult transitioners of the past who received better assessment before the affirmation model took hold. Since the majority of young people identifying as transgender are females, there are likely be far more females detranstitioners.

2) Evidence from research, as well as observations from gender dysphoria professionals, personal accounts of LGB people and some GNC heterosexual people, demonstrates that children/teens with even serious GD align with their natal sex as they grow up. Access to gender clinics is subverting this process for children and teens who are socially and medically transitioned. There are no services for them and there is no “LGBT” organization to help them. These entities, liberal media, and some affirmative model advocates and their allies actively try to hide the fact that they exist. They do not want them to be a reason to exercise more caution with young people.

3) There are accounts of GNC female teenagers fully desisting, even after years of trans identification, in cases where they were fully affirmed as trans by therapists and medical doctors. Mental health and medical professionals will not be able to discern “true trans” teens from this cohort given current affirmation protocols. In Lisa Littman’s study on Rapid Onset Gender Dysphoria, more youth desisted given more time. Some of these youths are likely to be medially affirmed by therapists and doctors as minors, with at least some changes being irreversible.

4) Any parents who express caution, even with very disturbed minors, are being treated with hostility and some have lost their parental rights. They will not be able to prevent medical treatment on their children if current trends continue. 

5) There is historical precedence of harm arising from pro medical transition environments in Thailand and Britain. Thailand has raised the age of consent to 18 with parental permission and 21 without it due to reports of too many young “lady boys” having medical transition regret. A British doctor was admonished in Britain for poor gatekeeping in his practice. The process of transition, particularly in the US, is even looser with an intense effort to remove age barriers to breast and genital surgeries, with mastectomies now being performed on females as young as 13-years-old. There is no reason to believe the process in the United States is protecting the types of young people harmed in these other countries.

6) Data from Steensma (2013) shows socially transitioned children had significantly higher rates of persistence. Early social transition may in effect groom some youth for medical gender reassignment surgery by preventing an environment that supports their adjustment to their biological reality. We acknowledge socially transitioned youth are likely the most dysphoric cohort, explaining high persistence rate. But there is no proof of any clear line between a “true trans” and borderline effeminate gay male youth, and how social transition will affect the latter group. The argument that social transition will have no impact should be treated with skepticism given what is known about developmental psychology. Social transitions may be innocuous but should not be presented to the public as such until proven. It may be, but it may very well put a youth (who would have been more likely to grow up gay/lesbian) on a path of a medicalized body for the rest of their life. While the harm from a pro-youth medical transition culture is already clearly happening to lesbian young people (see here), the gay male community may not be immune from these mistakes. Males present as very dysphoric from younger ages. Many females are presenting more at puberty. Males may spend more time living in a full social transition. This will give them less opportunity and time to adapt to their natural bodies and biological reality. These false positives will be hidden by early treatment with puberty blockers that will disallow a testosterone exposure to a growing brain. It will stay feminized forever.

7) One research study, as well as many anecdotal accounts from LGB people indicate that internalized homophobia and externalized homophobia contributed to their gender dysphoria. Anti-lesbian attitudes have always existed outside of LGB and T populations but appear to be rising now within the “LGBT community” itself with other “queer” identified females and young same-sex attracted females themselves expressing open disdain for lesbians. 

8) In reality, gender dysphoria is often not an either-or situation but is a spectrum with differing variations, more like bisexuality. Many GNC people who have had times where they obsessed about their gender and where they fit in can attest to this. Diane Ehrensaft’s lengthy discussions of “fruit salads” are evidence of this reality observed by gender clinicians. Despite slogans in gender trainings about sexual orientation and gender identity being separate, there is a definite association between homosexuality and gender dysphoria, with at times a blurry line between trans and gay/bi gender nonconformity. There is some evidence the physical causes of homosexuality and transgenderism may be the same or similar with a dosing effect, where it is not possible to draw a clear line for proper screening of who should and who should not be socially transitioned and given hormone blockers. Under gender affirmative model, however, dysphoric youths will be socially transitioned and all will be given puberty blockers.  This study shows that both homosexuality and MtF transgenderism (same-sex attracted biological males) are associated wit birth order involving older brothers. A gradation of androgen exposure in females may also be associated with a range of cross-sex behavior to homosexuality to full blown gender dysphoria. These borderline youths are now cheered and encouraged to view themselves as trans, seek swift medical treatment and receive social capitol, coveted attention getting victim status and popularity among class mates. Several accounts recorded on this website can attest to this cultural dynamic (see here and here). In addition, autogynephilia also appears on a spectrum from cross-dressing to an intense desire for surgical alterations. Transition at younger ages may be harmful to some of these borderline young males as well. It is unlikely cultural cheerleading has no effect on the decisions these borderline youths will make to medically transition.

9) Many examples provided (topic nature v nurture) show that culture and other factors can influence gender dysphoria, the way people cope with gender dysphoria, or how much surgery trans people themselves feel they need to feel more comfortable. While cultural acceptance makes people feel able to transition, we may be currently reinforcing body dysmorphia and pro-medical transition by socio-cultural factors such as early introduction to these concepts in school, and social and mainstream media. The skyrocketing rates of trans identified youth, particularly females are the result. More time is needed to see if transition will be worth the costs but regret among youth seems to be going up.

10) Graphs of trans population demographics indicate gender dysphoria (GD) is a socially influenced mental health condition in young people. Older females are not transitioning in the numbers younger females are, even though the option is available. This demonstrates that in many cases GD resolves over time, particularly with biological females, without medical treatment. If this were not the case and transitioning was merely a matter of social acceptance and access, the female to male sex ratio would not be so intensely skewed towards the young female population. With the current social acceptance and informed consent model, the older FtM/MtF ratio should look a lot more similar to the younger ratio if life experience and culture did not have an influence. This challenges the immutable “innate gender” narrative promoted by activists and pro-affirmation clinicians. Some of the ratio difference may be attributed to autogynephilic (AGP) heterosexual males having a tendency to transition later as adults. However, this doesn’t likely explain all of the sex ratio difference given that AGPs seem to also be coming out at much younger ages with increased social acceptance. Why wouldn’t they? They make up the majority of MtFs in most studies. Culture appears to have a large effect on young masculine, androgynous, or even some feminine young females. Same-sex attracted, formerly lesbian-identified females, used to make up most of the FtMs. More and more young heterosexual and bisexual females are transitioning.

11) Autistic individuals (who may also be more likely to be homosexual/bisexual as many seem to be reporting same-sex attraction) who may never have considered transgenderism a decade ago will be exposed to the idea of transition as a solution to their social discomfort. Individuals on the Autism spectrum tend to have obsessive and rigid thinking. More research is needed to determine if transitioning will make them happier. Anecdotal evidence of detransitioners on the autism spectrum should give us pause.

12) Anti-gay and lesbian parents are going to be more enthusiastic about encouraging medical treatment of their pre-homosexual children. Many LGB people are concerned that is homophobia is fuelling transition in children. This article shows that they should be concerned. Dr. Zucker has also observed homophobic parents saying they prefer a trans child. More on homophobia influencing medical transition can be found here. Gays and lesbians are regularly beaten and have no support from the government in Russia. Homosexuality is not accepted in China, a culture that emphasizes conformity. Gender non-conforming children may be put at risk for these medical protocols in anti-LGB countries where the culture is not accepting of homosexuality, such as Pakistan, and thus, transitioning may be a way for homosexuals to cope in these societies. Iran already forces adult gay men and lesbians into sex reassignment surgery. 

B. Trans people have said gatekeeping has harmed them

The ability to socially transition and have access to medical techniques they want is considered a human rights issue in the trans community. Many trans people have said that gatekeeping is patronizing and that they know it’s the choice they want to make. For them, long wait times are a civil rights violation and emotionally abusive. Having this personal decision under the control of other people is feels oppressive.

These are valid, libertarian arguments supporting “my body my choice.” It is understandable that these individuals protest what they see as favoring possible desisters, regretters, and detransitioners over their own needs. Below is a comment from an article on trans youth.

While the claims in both comments are oversimplified, the general argument is a reasonable: “Why is it justified to hurt trans people in favor of protecting desisters?”

This sums up the perspective of many trans people. It speaks to the intense feelings of anger over denial of access to medical treatments that trans people see as harmful. It’s normal human behavior to center ones own needs and interests. Trans activists should not be dismissed or prevented from advocating for themselves. However, it is also important to consider that in the past (and potentially today), for the vast majority, their gender dysphoria resolved as they matured. Thus, adult transgender individuals represent only a small portion of those who experienced gender distress and therefore, their experience may not represent the experience of the majority of those who experienced or are currently experiencing gender distress. Also, the problems with trans activism have more to do with extremist behavior.

With understanding that trans people have a right to self-advocate, there are questions about the influence this should have on transitioning minors where it’s questionable whether or not their dysphoria will resolve naturally and whether or not they can give consent to treatment. Most of the activists who are pushing to socially and medically transition minors are autogynephilic heterosexual males, who have a completely different presentation of transgenderism than homosexual transsexuals and formerly lesbian identified women who transitioned in middle age, and all have survived puberty and made the decision to transition as mature adults. Is it appropriate for these individuals to control the entire narrative around the treatment of gender dysphoric children and young people, as they currently are, especially given the  limited data supporting early medical transition?

It is the job of mental health and medical professionals to consider the safety of all of their minor patients and balance the rights of those who will identify as transgender as adults with the rights of other gender nonconforming minors who will outgrow their gender dysphoria so that they are allowed to mature and receive proper mental health support. 

C. Trans youth matter: borderline youth?

An example of a confirmation bias for positive transition data in the affirmative model community:

Some of the critics of the paper talk about these methods as if they are strictly the province of pseudoscience, but that is simply not the case. I believe these critics are uninformed about the scientific process. In fact, I attended a panel discussion where speakers referred to my study as “methodologically atrocious” and another study—one supportive of social transition—as “phenomenal,” without recognizing the irony that both studies used the same methodology.

Some individuals & institutions appear to want to avoid discussion of risks to gnc youth in order to support the trans community

Because there are body autonomy arguments for medical transition and there is some positive data around early intervention for children and teens (de Vries (2014), Olson (2016), Norman Spack Ted Talk), a wave of pro-transition sentiment has taken over the therapeutic and medical communities (see here and here). The evidence is not concrete that they can isolate and transition would-be trans adults from minors who would outgrow GD.

Consequences of medical transition are life-long. The right for children and teens to mature without medical alteration based on an “at-war relationship to the natural body could also be framed as a human rights issue just as access to medical transition to support an innate gender identity can be.

It seems a thorough discussion about children who may be at risk because of the affirmative model is often lacking. There also may be an effort to cover up real world harm already being observed and this is occurring at the highest levels of the mental health and medical professions, in “LGBT” organizations, and in liberal media. Many concerned people have routinely had reasonable comments deleted off of social media and mainstream media articles leaving only positive, happy stories of transitioned youth. Most “LGBT” organizations have not acknowledged and make no comments on the increased risk of harm to bisexual and lesbian teenagers and prepubescent effeminate boys. Professional institutions, activists and their allies will actively dismiss or avoid discussion regarding concerning trends.

Why do some individuals and powerful people seem to have an aversion to addressing the rise of false-positive medical treatment on children, teenagers and young adults? Why does their seem to be a fear of any discussion of risks, real world harms already happening, or research into a better understanding of GD and why is there are large numbers of females suddenly identifying as trans when historically GD primarily presented in prepubescent boys and middle-aged men?

One explanation may be that some affirmative model advocates have simply made the decision that false positives on other gender nonconforming youth are morally acceptable and should not be a hinderance to trans children’s social and medical transition. Highlighting the risks (and in their minds over-emphasizing them) will do more harm than good by delaying the majority from social and medical transition (viewed as a human rights violation). A rational argument can be made for this, but it is far from clear if the costs out way the benefits given the current trends in trans identification and current research.

This may be leading affirmation model advocates to avoid properly informing parents (according to these now resigned gender clinicians) and the public about the research around GD, desistance, and side-effects that indicate there are risks to medical treatments on minors. This makes informed discussion more difficult. A culture of early social and medical transition may not be giving enough attention to the consequences to desisters and detransitioners in the interest of trans rights and trans affirmative medical care.

While suicidal ideation is a risk in teens with gender dysphoria, the suicide narrative (often discussed in a way that violates guidelines in reporting suicide in youth) is often promoted to compel the affirmative position and shut down any discussion about risks, possible alternative support, or the stories of lesbian teens and other young people being harmed by this. Worry this is happening is causing alarm with other members of the scientific community and members of the LGB community who view growing out of GD and without the harms medical transition and sterility to also be a human right.

Censoring risks in academia

Jeffrey S Flier MD and professor at Harvard:

In all my years in academia, I have never once seen a comparable reaction from a journal within days of publishing a paper that the journal already had subjected to peer review, accepted and published. One can only assume that the response was in large measure due to the intense lobbying the journal received, and the threat—whether stated or unstated—that more social-media backlash would rain down upon PLOS One if action were not taken. 

Academia is a place where research is done and discussed with the concept that scientific standards are being upheld. There have been several incidences that indicate many sections of academia seek to suppress any negative information coming to light about the youth social and medical transition movement.

When Lisa Littman presented a survey study indicating concerning patterns of females coming out as trans in statistically unheard-of clusters and obsessive social media use Brown university removed a link to the study from their website to prevent the information being disseminated to the public under trans activist pressure. It was peer reviewed properly and published on PLOS One, meeting all criteria many other studies are held to. It was upheld again after being subjected to an uncustomary second review based on activist pressure.

By doing this Dean Bess Marcus, from the public health department, appeared to fail to support the Brown University researcher. The dean’s actions also may have had negative effects on the reputation of the PLOS ONE Journal, and the people who did the peer review. This was despite the fact that there wasn’t any evidence they should be.

Dean Marcus admitted this was because trans students at the university didn’t like the study.

She added that people in the Brown community have raised concerns that the study’s conclusions “could be used to discredit efforts to support transgender youth and invalidate the perspectives of members of the transgender community.”

This blog post covers the incident.

The intense, swift reaction to the Littman matter–and ROGD–is stunning. Ironically, the pile-on intended to suppress Littman’s work may have had the opposite effect of that desired by activists. As of this writing, Littman’s study has been viewed on the PLOS ONE website nearly 59,000 times (this count would not include, of course, additional views of the paper via email shares of PDFs, etc).

A petition (over 5000 signed) was sent. There was no acknowledgment of the concerns raised within it or it’s receipt by Brown to our knowledge.

The petition was emailed to officials at Brown and PLoS ONE editors several days ago when it reached 2000 signatures, along with a personal letter requesting a response. As of this date, no reply email or even an acknowledgement of receipt has been received...

In addition to petition signatories, there have been many others who’ve stepped forward to express their concerns about this assault on academic freedom and the attempted muzzling of free and open discussion regarding the surge in new cases of gender dysphoria in youth and young adults. Press coverage of the exploding controversy is increasing.

Many people inside and outside of academia were very alarmed by Brown’s behavior due to concerns about academic freedom.

Jonathan Turley, professor of law:

The action of Brown is a chilling example of the increasing pressures felt by academics in limiting free speech, associational, and academic rights on campuses…

The relative silence of the Brown faculty is itself alarming and gives this chilling message a glacial meaning…

Marcus only recently started as dean after coming from the University of California (San Diego).  In my view, she should resign if she pushed for the censorship of this article. 

The Economist:

Squashing research risks injuring the health of an unknown number of troubled adolescent girls. Rachel, now 21, believes she latched on to a trans identity as a way of coping with on-off depression and being sexually abused as a child. After receiving therapy, her gender dysphoria disappeared. Had her mother affirmed her gender identity as a 16-year-old, as several gender therapists urged, Rachel would have embarked on a medical transition that she turned out not to want after all.

In order to paint the participants in the ROGD study (recruited from concerned parent sites 4thwavenow and Transgendertrend) negatively, affirmative model advocate Diane Ehrensaft made an analogy referencing the Ku Klux Klan. 

From The Economist:

Referring to these sites as “anti-trans”, Diane Ehrensaft, the director of mental health at a gender clinic in San Francisco, has written that “this would be like recruiting from Klan or alt-right sites to demonstrate that blacks really are an inferior race”. 

The statistics from the study do not paint a picture of abusive bigots to warrant such an inflammatory comparison. It should be noted that Littman’s survey was linked to at least one affirmative model site (by trans activist Jenn Burleton of Portland, OR) that wanted to give feedback from an affirmative perspective.

Ms Littman replies that 88% of the parents in her study said transgender people deserve the same rights as others, which is in line with national opinion. Similar methodology is frequently used in social research, particularly into children.

Some parents responded to these accusations on the petition protesting Brown’s censorship decision with more statistics that indicate supportive families.

Littman’s study offers, for the first time, a glimpse into families who hold space for their dysphoric children while also seeking out mental health care that focuses on underlying conditions. Consider some of her findings:

• 204 out of 256 youth reported on in the study claimed alternative sexualities to their parents prior to coming out as transgender

• Over 200 youth were supported in changing their presentation in terms of hairstyle and dress

• 188 had changed their names

• 175 had changed their pronouns

• 111 youth told their parents they wanted to see a gender therapist; 92 were taken to see one

Moreover, of Dr. Littman’s respondents, there were only eight cases of estrangement: six by the youths themselves and two “where the estrangement was initiated by the parent because the AYA’s outbursts were affecting younger siblings or there was a threat of violence made by the AYA to the parent.” [AYA = “adolescent or young adult.”]

These are clearly parents who supported their children in their distress and through exploration of identity. Littman’s study also found that 119 youth requested medical interventions at the same time they announced their new gender identity or within the first month of their announcement. Remember, 100% of the youth discussed in her survey did not qualify for a diagnosis of gender dysphoria at any point in their childhood or prior to coming out. Yet, 17 youth were offered an Rx on their first visit with a clinician. Perhaps even more concerning, “For parents who knew the content of their child’s evaluation, 71.6% reported that the clinician did not explore issues of mental health, previous trauma, or any alternative causes of gender dysphoria before proceeding and 70.0% report that the clinician did not request any medical records before proceeding.” This is in a cohort of young people of whom 62.5% had been diagnosed with at least one mental health or neurodevelopmental disability prior to the onset of gender dysphoria, which mirrors data from other affirmation-focused clinics.[2]

There were few cases of estrangement:

Should interviews with parents, who in 92 out of 111 (83%) cases honored their child’s request to see a gender therapist, be framed by Diane Ehrensaft as being the same as interviewing Klan members about black people? The Ku Klux Klan has terrorized black families by burning their homes down, has murdered scores of black people, and has strung black men up in trees to castrate them and/or murder them. Ehrensaft is the head clinician at a major US hospital, UCSF, and the top promoter of transitioning dysphoric children socially and medically at early ages. 

PLOS ONE decided not to defend this research on social media. Here is PLOS ONE responding to a trans activist on Twitter. 

This trans activist is not involved in any social science or medical science.

Some voices appear to be much more weighted than others. This is despite the fact that this person was never a teenage girl, the main topic covered in the study. PLOS ONE felt it needed to call for a special review of the study. The paper passed the muster of the second review.

On Monday, PLOS ONE announced it is conducting a postpublication investigation of the study’s methodology and analysis. “This is not about suppressing academic freedom or scientific research. This is about the scientific content itself—whether there is anything that needs to be looked into or corrected,” PLOS ONE Editor-in-Chief Joerg Heber in San Francisco, California, told ScienceInsider in an interview yesterday.

Bath Spa, a University in Britain, also does not want to address any possible negative outcomes from the increasing numbers of young people seeking hormones and sex reassignment surgery.This pattern of suppressing discourse is going on in Western countries in general. The full story of an incident where they blocked research on detransition can be found here:

 “A couple of years ago I realized there is a need to research people who reversed and regretted their gender reassignment because their numbers seemed to be rising. So, I took an MA program at Bath Spa University to do this research. In a nutshell, Bath Spa vetoed the research I had been studying for some time before we got to that point, refused to give me my fees back when I asked for them back. And the reason they gave for preventing my research was that it might attract criticism on social media. And criticism would be bad for the University. So, I was astonished by this decision. This is a suppression of free speech. And certainly, in the opinion of my lawyers it is in law. We are in a climate of growing suppression of free thinking and free speech, not just in academia but, our public institutions as well as society at large.” (:27-1:21)

Mental health and medical providers lack of expressed concern for risks

Detransitioned FtM and LMFT/LPC Carrey Callahan:

 “A note about therapists: There are some skilled, careful, ethical therapists out there. There are also lots of avenues by which therapists can get drawn into professional structures, like supervisory relationships and certificate programs, which if led by ideologues can force a shut-down of their critical thinking. If you ever feel that your therapist would feel disappointed or betrayed by your changing ideas about your identity or about the trans community, that is a big red flag that your therapist’s ideological loyalty is being prioritized over your autonomy and well-being. The most cult-like behavior I’ve seen in the trans community has been among the doctors and therapists. People in that crowd act like it’s normal to have “in-group” discussions that they don’t want the general public to catch wind of. That’s not a normal dynamic to encounter in medicine or mental health. I’ve received many personal messages from mental health providers and physicians saying they’re concerned about the potential outcomes of pediatric transition and informed consent care, but they can’t say it publicly. The trans health care scene is currently a wild situation, and I’m grateful I don’t have to be in it.

The above quote presents a picture that some mental health and medical professionals involved with treating children and adults are not just providers. They are also activists.

There often appears to be a positivity bias in the tone of some researchers. Here an Endocrinologist (Michael Laidlaw), exposes what he sees as a confirmation bias in the researchers involved in this study. They describe a lack of bone loss as a positive outcome, despite the negative of a lack of normal increase. The first graph shows just how much bone density changes in adolescents.

And here he explains the problems with the study and in his view, its apparent desire to minimize a negative narrative about bone health and medical treatment of minors.

WPATH

In WPATH SOC, the main organization setting the standards of care for transgender youth, there are no discussions of desistance or any risks of early social and medical transitions. At USPATH in Los Angeles in 2017 a prominent psychologist in gender dysphoria research, Dr. Ken Zucker, was going to give a presentation showing the below statistics, which are averages for four of the better studies on gender dysphoric youth. These statistics indicate GD is not permanently hardwired in many of these young people. For this research, he was driven out of the event by irate trans people.

This is the material that was presented.

Here is a statement he made based on looking at the data in these studies. He appears to disagree with Kristina Olson’s and Diane Ehrensaft’s emphasis of “I am a girl/boy” as diagnostic.

A video of this incident is here:

It is understandable trans people do not want any discussion about risks to desisters, and trans people should not be blamed for self-advocacy. But WPATH promotes itself is a professional body setting the standards of care for gender dysphoric minors. WPATH issued an apology for even inviting Dr. Ken Zucker in the first place. His treatment demonstrates that unbiased scientific inquiry may not be able to happen at WPATH, which questions the credibility of the organization. An account of the incident is here.

…some WPATH members advocate for changing WPATH’s upcoming Standards of Care 8 to ‘remove unsubstantiated and harmful statements on the statistical likelihood [sic]’ of transgender persistence or desistance among children.

The above quote mentions a goal to end discussion of the fact that a youth may align with their natal sex. This appears to be a push to stop professional discussion of risks to children disproportionately likely to be gay, lesbian and increasingly bisexual. This unfortunately would pit the mission of WPATH against the interests of protecting LGB, GNC heterosexual youth and other vulnerable youth from over-medicalization.

WPATH also turned off comments on the post below indicating gender therapists are seeing more regret.

Academy of Child and Adolescent Psychiatry

One example of the enthusiastic support for gender affirmation and medical treatments on minors can be found in the responses of the psychiatrists attending an American Academy of Child and Adolescent Psychiatry (AACAP) conference in Seattle. When Dr. Lisa Littman presented her paper (discussed above) at an academy event, audience members withheld applause after her presentation. It is not the norm to have a scientific audience treating a researcher this way. This was a peer-reviewed study, that met the standards of many other studies in psychology, sociology, public health, and in other subjects

I’ve attended several previous AACAP meetings, where educational sessions tend to have a staid consistency: An academic child psychiatrist or psychologist presents a topic related to their research or clinical area of expertise, there is polite applause at the end, followed by a fairly mundane Q&A in which audience members either praise the speaker and/or talk about how the presentation relates to their own clinical experiences. You may not be surprised to learn that what happened following Dr. Littman’s presentation was very different.

More accounts of the event:

Following Dr. Littman’s presentation, there was no applause before several audience members launched into questions. Some were more civil than others, but pretty much all were critical. One audience member pointedly asked Dr. Littman what she had previously studied in her research (OB-Gyn, public health issues), and whether she has worked with any transgender patients in the past (she has not), before concluding by telling Dr. Littman that she was not qualified to do this kind of research. Another questioner at the end repeatedly asked her “why did you do this study” and “what’s wrong with taking on a different gender identity,” to which she would only say that we should keep open the possibility that there may be social contagion occurring, as with her anorexia example earlier. The questioner then pointed out that unlike anorexia, a transgender identity is not by itself harmful.

She was also apparently admonished by another professional who said she wasn’t sensitive enough to the trans community. The organizers did not highlight the topic on social media, as the other topics had been. 

A comment from the person who observed all of this:

I hope that moderation can ultimately prevail, and I greatly appreciated Dr. Leibowitz’s approach. But I don’t think there was any applause at the end of Dr. Leibowitz’s summation. Was the audience fearful of showing where they stood? Also, Dr. Leibowitz did not tweet about this session afterwards, even though he tweeted about many other LGBTQ-related sessions at AACAP. I hope this wasn’t because he was wary of the immoderates of the Internet. In today’s political climate, I really wish the “silent majority” of those in the middle would not be so silent.

There were several youth who outgrew GD in Littman’s study and there are other examples of youth, who may be harmed by medical transition.

Also a comment on the quote above:

“what’s wrong with taking on a different gender identity?”

There are significant health problems associated with taking on a different gender identity. A recent study has come out of a Dutch gender clinic that shows significantly elevated risk of problems in heart and circulatory health in both MtFs and FtMs on a fairly young cohort. Medical transition is harmful to some. There are other issues such as extreme pain FtMs commonly experience during orgasm. Puberty blockers given early in puberty followed by cross sex hormones sterilizes young people. Young people have a difficult time truly weighing risks and benefits before the mid-twenties. Despite all this, minors are altering their bodies in unprecedented numbers.

American Academy of Pediatrics

The AAP has adopted the guidelines of the affirmative model. There is no mention of borderline children and how their new protocol may affect children diagnosed under a DSM in the past. The possibility they could grow up gay or lesbian is not even mentioned.

Here is their quote:

It should be noted the second quote is a deliberate attempt to focus on “methodological flaws” to deny desistance even though flaws in the studies don’t do this (see also here). There is evidence, real world examples, and gender professional observations that dysphoric youth may resolve GD and often grow up gay or lesbian. The denial seems inappropriate even for an “LGBT” activist website. This is a doctors’ organization website that treats children.

Another quote:

Social Affirmation: This is a reversible intervention in which children and adolescents express partially or completely in their asserted gender identity by adapting hairstyle, clothing, pronouns, name, etc. Children who identify as transgender and socially affirm and are supported in their asserted gender show no increase in depression and only minimal (clinically insignificant) increases in anxiety compared with age-matched averages. 48 

To truly know if social transitions are reversible and have no psychological effect on gender identity one would need a control group. Scientists don’t know if developmental psychology is irrelevant in a social transition.

Reporting on desistance and possible negative outcomes to the affirmative model in liberal media are almost nonexistent. Generally, only conservative media outlets are willing to highlight risks. Ironically, it is pre-gay/lesbian children that are at risk for being collateral damage. This article explains some problems with the AAP’s decision. 

I’m deeply concerned that AAP’s guidance has gotten so far ahead of the current knowledge base about gender dysphoric children, according to the best research we have that spans decades of clinical practice. We know from multiple studies that around 80 percent of gender dysphoric children will desist from their cross-sex identification in childhood to identify with their natal sex. Most of these will grow up to be gay or lesbian; a substantial minority have also been diagnosed with autism.

80% is likely too high but it appears to be significant under DSM prior to DSM-V and is likely significant even under DSM-V criteria.

Yet the AAP guidance incorrectly dismisses these studies as flawed and outdated. There is no professional consensus on medical treatment of gender-dysphoric children and young adolescents. While some preliminary studies of puberty suppression followed by cross-sex hormones and surgery have shown benefit to gender dysphoric youth, these have had small sample sizes and have only followed patients for a short period of time. 

This is an accurate observation. There isn’t consensus even among gender experts.

We do not know the long-term effects of medical transition in young people; these effects are mostly irreversible and include sterility and sometimes impaired sexual function. Watchful waiting, which was the treatment of choice for many years, has been dismissed as false and harmful with no evidence for this assertion.

The AAP appears to be on record as being hostile to “watchful waiting.” If the denial of proper mental health support for borderline youth results in medical treatment this could be considered child abuse and medical malpractice. There are also questions regarding whether a 10-year-old can consent to a decision that will:

• sterilize him/her, permanently destroy sexual function,

• effect cognition

• subject him/her later in life by puberty blocker side-effects

• take away choice about bottom surgery

There is not even one mention of desistance (except to discredit it), not one mention of the association of childhood GD and adult homosexuality, and not one mention of sexual dysfunction inducing protocols. It appears that they are saying that trans youth matter, but borderline youth do not. It’s ironic, however, because the issues with medical transition are real, even for those who continue to identify as transgender as adults.

American Psychological Association

The American Psychological Association also clearly supports the affirmative model. It seems in their materials they are discouraging a body acceptance or watchful waiting model model. What is lacking here is any discussion about the consequences of medical transition and false positives, youth who could have aligned naturally to their body as most have in the past. It is not even discussed.

A rational argument can be made that failing to support a gay boy to grow into adulthood as a gay man, who is now instead castrated, chemically feminized, and medically altered can be considered unethical. It’s just another example of how it seems gnc pre-LGB youth and their safety and long-term needs are not being given any consideration at all by the APA and other institutions  

4thwavenow.com, a site for parents questioning the affirmative model, has several valid observations regarding their policy. 

As it turns out, the American Psychological Association (APA) recommends the affirming and accepting approach that Jenn Burleton has put into action. (As an aside, it should be noted that five of the ten members of the Task Force responsible for the guidelines were transgender themselves.) The APA Guidelines mention two different approaches for working with gender dysphoric children, but only one of them is deemed ethical. As you read, please keep in mind that “TGNC” has been defined as Transgender and Gender Non-Conforming people, in effect, conflating these two groups of children:

One approach encourages an affirmation and acceptance of children’s expressed gender identity. This may include assisting children to socially transition and to begin medical transition when their bodies have physically developed, or allowing a child’s gender identity to unfold without expectation of a specific outcome (A. L. de Vries & Cohen-Kettenis, 2012; Edwards-Leeper & Spack, 2012; Ehrensaft, 2012; Hidalgo et al., 2013; Tishelman et al., 2015). Clinicians using this approach believe that an open exploration and affirmation will assist children to develop coping strategies and emotional tools to integrate a positive TGNC identity should gender questioning persist (Edwards-Leeper & Spack, 2012).

Notice how there isn’t any warning about possible negative consequences of the affirming and accepting approach? Just keep validating these kids and telling them it is possible to become the opposite sex. There seems to be no concern from the APA that all of this affirming will condition the child into believing they are transgender (when they may have desisted).

The APA guidelines do mention a second approach, though:

 In the second approach, children are encouraged to embrace their given bodies and to align with their assigned gender roles. This includes endorsing and supporting behaviors and attitudes that align with the child’s sex assigned at birth prior to the onset of puberty (Zucker, 2008a; Zucker, Wood, Singh, & Bradley, 2012). Clinicians using this approach believe that undergoing multiple medical interventions and living as a TGNC person in a world that stigmatizes gender nonconformity is a less desirable outcome than one in which children may be assisted to happily align with their sex assigned at birth (Zucker et al., 2012). Consensus does not exist regarding whether this approach may provide benefit (Zucker, 2008a; Zucker et al., 2012) or may cause harm or lead to psychosocial adversities (Hill et al., 2010; Pyne, 2014; Travers et al., 2012; Wallace & Russell, 2013). When addressing psychological interventions for children and adolescents, the World Professional Association for Transgender Health Standards of Care identify interventions “aimed at trying to change gender identity and expression to become more congruent with sex assigned at birth” as unethical (Coleman et al., 2012, p. 175). It is hoped that future research will offer improved guidance in this area of practice (Adelson & AACAP CQI, 2012; Malpas, 2011).

The APA felt the need to add on some warnings to the “embrace their given bodies” approach

Here is another relevant quote from the APA’s guidelines.

However, several research studies categorized 30% to 62% of youth who did not return to the clinic for medical intervention after initial assessment, and whose gender identity may be unknown, as “desisters” who no longer identified with a gender different than sex as- signed at birth (Steensma et al., 2013; Wallien & Cohen- Kettenis, 2008; Zucker, 2008a). As a result, this research runs a strong risk of inflating estimates of the number of youth who do not persist with a TGNC identity. 

Methodological flaws in studies do not disprove desistance; however, this is always the argument and it is never accompanied by any proof that the number children who do outgrow GD is so small that they don’t matter. This may be appropriate for a trans activist website, but this the American Psychology Associations website, who have a duty to protect all patients. 

Warning: profanity below

GDAWorkinggroup 

The GDAworkinggroup is a website for affirmative model advocate mental health professionals. They appear to have intentionally mimicked the name (plus one letter) of the GDworkinggroup, a group of mental health professionals who have a more cautious, but evidence-based discussion. That group was formed months earlier.

It also appears the GDAworkinggroup intentionally tailored their layout and verbiage to look the same.

The individuals involved include, Diane Ehrensaft, Margaret Nichols, Ph.D.Johanne Olson-Kennedy and her FtM partner Aydin Olson-Kennedy and some well know trans activists like Julia Serano and Brynn Tannehill. 

They were also involved in attacking Lisa Littman’s research on the rising number of female teens identifying (sometimes confused lesbian teens, trauma survivors, and child sexual assault victims) as trans at or post puberty, trying to discredit her. Her paper was a peer-reviewed survey study. Ironically, these professionals often use and cite survey studies when they support their arguments, even if they have the exact same limitations as Littman’s study. Below is their “call to action” to completely ignore some concerning findings in this study.

Call To Action

We hereby call on all medical and mental health organizations committed to the wellbeing of transgender individuals and the transgender community to formally reject "Rapid Onset Gender Dysphoria" as a notion harmful to vulnerable youth.

Modern research makes unequivocal that affirmative treatment philosophies – approaches in which the individual’s gender identity is supported through use of their chosen name and preferred pronouns, and in which there is a safe environment for the individual to explore and express their inner sense of self – yield positive outcomes.  The current literature also makes plain that the high rates of depression, anxiety, and suicidality often seen in the trans community are in large part due to a hostile society and family rejection.

Additionally, it comes as no surprise that those promoting ROGD have extensive histories of encouraging ‘reparative’ and ‘conversion’ therapy, methodologies seen as antithetical to mental health and formally outlawed in many localities.

As such, “Rapid Onset Gender Dysphoria” runs counter to evidence based treatment and should be officially repudiated by all major medical and mental health associations, as well as all organizations devoted to the wellbeing of transgender individuals and community.

It should be noted Littman’s study observed many notable issues such as large clusters of females coming out as trans, female teens seemingly identifying as trans due to trauma, and some teens desisting and more desisting given more time. Littman, who did the study has no history of being involved in conversion therapy. The parent websites where the survey was posted (4thwavenow and Transgendertrend) do not support “reparative therapy.” They express a desire to protect LGB and other GNC minors. Some of these parents had children who were put at risk for permanent medical alteration. A majority of the parents in the study were actually supportive of their children’s name choices, requests to see a gender therapist, etc. 

This GDA working group website also features a link to Zinnia Jones’ website. They link an article with the quote featured at the beginning of this section about people being more concerned about transition regret than the impacts of transition delays. While this is a reasonable point, it should be noted Zinnia Jones is a controversial figure within the LGB and T populations on social media, particular among gay men and lesbians. Many LG people have serious problems with elements of trans rights activism that Zinnia Jones represents. These issues include attitudes of entitlement to criticise people for not wanting to base their sexual orientation on gender identity rather than biological sex, aggressively promoting transitioning of children, and expressing violent fantasies towards those who disagree. Examples are below, 

The purposes for pointing this out is not an ad holmium attack on Jones. Jone’s has rights to free expression. It’s merely to highlight that the GDAworkinggroup and Jones are not representative of the “LGBT community” and many LGB and T people do not want it presented as so.  Further, by platforming Zinnia Jones, the GDAworkinggroup shows itself to be an activist group rather than a professional group, promoting concepts around gender (“my biological sex is what I say it is, gender is fluid, MtFs are lesbians) that are not universally accepted and actually cause conflict. 

They feature some of Zinnia Jones’ articles that deny desistance.

The below excerpt from an article by Julia Serano criticizing the ROGD study also has some questionable points:

1. Excerpts from:

Everything You Need to Know About Rapid Onset Gender Dysphoria
Published in: Meduim.com. August 22, 2018.  Author: Julia Serrano.

"Is this really a new phenomenon?  No, it is not.  Within trans health circles, it’s been well established that trans people may become gender dysphoric and/or come out about being transgender at any age."

"There is nothing inherently erroneous or illegitimate about a “rapid” onset of gender dysphoria — some trans people experience an epiphany during which all the clues and puzzle pieces suddenly come together, and they finally realize that they are transgender."

While there have always been trans people who come out later in life it is becoming impossible to say what is happening is not new. The below screen shots are from a study done with the “LGBT” organization, The Human Rights Commission and The University of Connecticut. It is a survey study and not a registry or randomized study, so it is not perfect. But this study shows over nine times more “trans boys” (biological females) than “trans girls” and very large number of those who identify as non-binary.

What is also new despite Julia Serano’s protests is that a very large percent of females who transitioned in the past were same-sex attracted, often identifying as lesbians before coming out as trans. Based on the second table, there are a large amounts of bisexual (pan and queer also essentially means bisexual) and heterosexual(by bio sex) females identifying as trans boys or non-binary/genderqueer. Thus, the huge shift in sex ratio and huge shift in orientation is in fact totally new.

Yet many adolescents and adults presenting with gender dysphoria do not report a history of childhood gender-nonconforming behaviors (Doctor, 1988; Landén, Wålinder, & Lundström, 1998). Therefore, it may come as a surprise to others (parents, other family members, friends, and community members) when a youth’s gender dysphoria first becomes evident in adolescence.

These studies Serano are citing are older and many of these later onset cases are AGP males attracted to women. The details of what these research studies actually say is very important. This is not the same cohort as these young females.

Here is another excerpt from a “late onset,” AGP MtF dismissing desistance and its association with adult homosexuality on the GDAworkinggroup website. Anyone has a right to present arguments, preferably fact-based ones, but AGP males are not the same cohort as young pre-homosexual effeminate males who show up in clinics as minors, or the increasing numbers of females coming out as trans.

Concerned people are defined as “trolls”:

1. Excerpted from:
The End of the Desistance Myth
Published in: The Huffington Post.  January, 2016.  Author: Brynn Tannehill

"Over the past few years, an endless parade of “concerned” people (trolls) have trotted out the same statistic over and over again: 84 percent of transgender kids stop being transgender on their own. They have used this to justify everything from reparative therapy, to denying medical care to transgender teens, to suggesting that reparative therapy on adults will work."

"The problem is that the desistance narrative is built upon bad statistics, bad science, homophobia and transphobia."

Desistance stats may have been inflated likely not insignificant.

More:

For starters, the most cited study (Steensma) which alleges a 84 percent desistance rate, did not actually differentiate between children with consistent, persistent and insistent gender dysphoria, kids who socially transitioned, and kids who just acted more masculine or feminine than their birth sex and culture allowed for. In other words, it treated gender non-conformance the same as gender dysphoria. Worse, the study could not locate 45.3 percent of the children for follow up, and made the assumption that all of them were desisters. 

This statement is actually untrue according to the link provided. For more information on how the Steensma study did track desisters with gender dysphoria see here. 

Another excerpt dismissing desistance statistics:

4. Excerpted from:

A Critical Commentary on Follow-Up Studies and "Desistance” Theories About Transgender and Gender Non-Conforming Children
Published in: International Journal of Transgenderism, April 26, 2018.  Authors: Julie Temple-Newhook, Jake Pyne, Kelley Winters, Stephen Feder, Cindy Holmes, Jemma Tosh, Mari-Lynne Sinnott, Ally Jamieson & Sarah Pickett

"It has been widely suggested that over 80% of transgender children will come to identify as cisgender (i.e. desist) as they mature, with the assumption that for this 80%, the trans identity was a temporary “phase.” This statistic is used as the scientific rationale for discouraging social transition for pre-pubertal children... The tethering of childhood gender diversity to the framework of “desistance” or “persistence” has stifled advancements in our understanding of children’s gender in all its complexity."

"We have identified the following methodological concerns in these four studies:

1. the potential misclassification of child research participants

2. the lack of acknowledgement of social context for research participants

3.the age of participants at follow-up, and

4. the potential misclassification of adolescent and young adult participants lost to follow- up.

Much of what is in this paper is presented in questionable ways or contains much pro transition bias according to other gender dysphoria experts. Counter arguments are presented in this paper, “The myth of persistence” by Ken Zucker and by commentary Steensma in this commentary.

We agree that the current persistence rates may go up if a different methodology would be used (see above), but the suggested reasons why non-responders may actually be persisters are unlikely and farfetched. For instance, the authors suggested that children were lost at follow-up because they moved out of the country, were being treated elsewhere in the Netherlands, or institutionalized. The chance that one of these situations occurred is, however, very low.  

A couple of excerpts on GDAworkinggroup include materials written by Jake Pyne, an FtM trans activist who apparently pushed a damaging lie about a very abusive comment attributed Ken Zucker that he never made. This contributed to his firing. This is relevant as it is paramount that the conversation about medical treatments on minors is nested in objective truth. The details of that incident can be found in this news story, “How the Fight Over Transgender Kids Got a Leading Sex Researcher Fired.”

Multiple other excepts exist on their website picking apart methodological flaws in desistance data despite the fact there are methodological flaws in all of the research they use to support their arguments and almost all trans research in general. It is incorrect to assert children (and even some of these female ROGD teens) do not desist from serious gender dysphoria. They do not provide evidence that the numbers of children who desisted in the past were too insignificant to consider.

There are also gender clinicians who acknowledge children outgrow GD from their own clinical observations (Tavistock researchers, Dr. Bradley, others). The GDAworkinggroup website advocates for social transition and access by minors to medical interventions. Instead of focusing on discrediting desistance statistics, they should be more explicit with their argument - that they believe that the risk to borderline children and other vulnerable children is preferable to denying gender dysphoric youth immediate social and medical transition. More research is needed to justify that position.

In summary, the GDAworkinggroup features quotes discrediting desistance, mimic the name of the GDworkinggroup site, include excepts from Jakes Pyne who pushed a damaging false rumor, and feature quotes from a trans activist who recommends children get hormones over the internet. The creators of this website include the prominent gender affirming doctor Johanne Olson-Kennedy and the prominent gender affirming psychologist Diane Ehrensaft promoting social and medical gender transition of minors as well as many people who have a lot of power in promoting certain narratives regarding medical treatments on minors.

A list of the individuals from this website are below.

Noah Adams, MSW is a social worker, MtF activist

Elsa Almås, PhD.

Erica E. Anderson, Ph.D. - BIO TO COME

Esben Esther Pirelli Benestad, MD, is a Norwegian physician, family therapist, specialist in clinical sexology NACS and a professor of sexology at the University of Norway.Goes  by hir

Ady Ben-Israel, PhD is a licensed clinical psychologist working in private practice in New York City. 

Peter Chirinos, MA brings over twenty years of varied professional experience working in as a sex therapist focusing on kink, fetishes and BDSM. Peter is an FtM

Damon Constantinides, PhD, LCSW provides individual, relationship, and sex therapy through his private practice and is a therapist and co-founder at Relationship and Sex Therapy Collective.

Diane Ehrensaft, Ph.D. is a developmental and clinical psychologist in the San Francisco Bay Area and the Director of Mental Health and founding member of the Child and Adolescent Gender Center, a partnership between the University of California San Francisco and community agencies to provide comprehensive interdisciplinary services and advocacy to gender nonconforming/ transgender children and youth and their families. 

Dr. Robert Garofalo is a Professor of Pediatrics and Preventive Medicine at Northwestern University’s Feinberg School of Medicine in Chicago, Illinois. 

Shawn V. Giammattei, Ph.D. is a clinical psychologist and the founder and director of Quest Family Therapyin the San Francisco Bay Area specializing in family therapy with couples, families, and individuals across the lifespan, with a particular focus on transgender and gender expansive youth and their families. 

Melanie A. Gold, DO, DMQ, FAAP, FACOP is a Professor in the Department of Pediatrics, Division of Child and Adolescent Health, Section of Adolescent Medicine at Columbia University Medical Center and in the Department of Population and Family Health at the Mailman School of Public Health.  

Linda A. Hawkins, PhD, MSEd, LPC Family Services Specialist, Social Work & Family Services Co-Director, Gender & Sexuality Development Clinic, The Children's Hospital of Philadelphia

Marco A. Hidalgo, PhD, is faculty clinical psychologist in the Center for Transyouth Health and Development at Children's Hospital Los Angeles and Assistant Professor of Clinical Pediatrics at USC's Keck School of Medicine. He joined the CHLA/KSOM faculty in 2018 and relocated to his native Southern California from Lurie Children's Hospital/Northwestern University Feinberg School of Medicine.

Laura A. Jacobs, LCSW-R (MtF) is a trans and genderqueer psychotherapist, activist, writer, and public speaker in the NYC area working with TGNC, LGBTQ+, and sexual/gender diversity communities. Laura currently serves as Chair of the Board for the Callen-Lorde Community Health Center, a multisite health center serving the LGBTQ+ community of New York City regardless of ability to pay and the largest single provider to transgender populations worldwide, and is the first trans and genderqueer-identified person to occupy the Chairperson position at a federally qualified health center. They are a firm believer in body autonomy as a fundamental human right and that gender and sexuality are arenas of the human experience through which we can explore identity, relationships, power, intimacy, cultural constructs, and even existential questions of meaning. (Goes by they/them pronouns)

Aron Janssen, MD is a clinical associate professor of child and adolescent psychiatry at the NYU School of Medicine, the founder and clinical director of the Gender and Sexuality Service at the Child Study Center and the Co-Director of the Pediatric Consultation-Liaison Service. Dr. Janssen's areas of expertise include LGBTQ mental health, gender identity and sexual orientation development, ADHD, anxiety and mood disorders, and psychopharmacology.Dr. Janssen is a member of the American Academy of Child and Adolescent Psychiatry, American Psychiatric Association, and World Professional Association for Transgender Health. 

Randi Kaufman, PsyD, (MtF)is a clinical psychologist who has been working with gender identity issues since 1998.  Currently the team psychologist at the Gender & Family Project of the Ackerman Institute for the Family in NYC, she previously worked at Boston Children’s Hospital/Harvard Medical School, where she provided psychological evaluations to assess readiness for TGNC youth seeking medical intervention. 

Colt Keo-Meier, PhD, (FtM) is a clinical psychologist whose expertise is in clinical work, research, and training in the health of transgender people of all ages.

S.J. Langer, LSCW-R,  (FtM) is a writer and psychotherapist in New York City, where he maintains a private practice.  He is on faculty at School of Visual Arts in both the MPS Art Therapy and Humanities & Sciences departments.  

Sean Lare, LCSW-C (FtM) is a licensed clinical social worker who is passionate about  serving transgender, non-binary, and gender diverse communities. In addition to providing psychotherapy for individuals in the transgender communities, Mr. Lare also works as an educator and advocate in the Baltimore, Washington, DC and surrounding areas to help increase awareness about the unique needs of transgender, non-binary and gender diverse individuals and their families. 

Arlene (Ari) Istar Lev LCSW-R, CASAC, CST is a social worker and family therapist who is the Founder and Clinical Director of Choices Counseling and Consulting (www.choicesconsulting.com) and TIGRIS: The Training Institute for Gender, Relationships, Identity, and Sexuality (www.tigrisinstitute.com) in Albany, New York. She is a part-time lecturer at the University at Albany, School of Social Welfare and is the Project Director of the Sexual Orientation and Gender Identity Project (SOGI).

M. Dru Levasseur is Senior Attorney and Transgender Rights Project Director for Lambda Legal, the oldest and largest national legal organization committed to achieving full recognition of the civil rights of lesbians, gay men, bisexuals, transgender people and people living with HIV. 

Jean Malpas, LMHC, LMFT, is the Founder and Director of the Gender & Family Project at the Ackerman Institute for the Family (ackerman.org/GFP), Director of International Training, and a psychotherapist in private practice in New York City. 

Zack Marshall, MSW PhD Assistant Professor School of Social Work McGill University. BIO TO COME

Denise Medico, Ph.D, is a Professor at Université du Québec à Montréal’s Department of Sexology (UQAM). She is a registered psychologist and sexologist in Canada and Switzerland, affiliated with the Meraki Health Center in Montreal. 

Christine Milrod, Ph.D., is a licensed psychotherapist, AASECT-certified sex therapist, and researcher at Southern California Transgender Counseling in Los Angeles, CA, specializing in human sexuality and transgender issues. 

Margaret Nichols, Ph.D. is a psychologist, AASECT Certified Sex Therapy Supervisor, and founder and first Executive Director of the Institute for Personal Growth, a psychotherapy organization in New Jersey specializing in sex therapy and other clinical work with the sex and gender diverse community.  

Johanna Olson-Kennedy, MD is an Adolescent Medicine physician specializing in the care of gender non-conforming children and transgender youth. Board certified in Pediatrics and Adolescent Medicine, Dr. Olson has been an Assistant Professor at Children's Hospital Los Angeles for the past nine years. 

Simon Pickstone-Taylor,  MBChB, is a General Adult Psychiatrist, and Child & Adolescent Psychiatrist who completed his undergraduate medical degree at Cambridge University, UK and finished medicine at University of Cape Town(UCT). Specialised in psychiatry in the USA and finished with a fellowship in Child & Adolescent psychiatry at the University of California San Francisco in 2003. He worked for the National Health Service in the UK for 7 years and then returned to the South Africa in 2011. 

 Jake Pyne 2018 Banting Postdoctoral Fellow, College of Social and Applied Human Sciences, Guelph University

 Stephen M. Rosenthal, M.D., Professor of Pediatrics, Division of Pediatric Endocrinology Medical Director, Child and Adolescent Gender Center

Cianán Russell, Ph.D.,(pronoun: they) coordinates UN advocacy for Transgender Europe (TGEU) and supports other projects within the Global Program, such as the TvT Project. Cianán received a Bachelor's degree in 2004 from the University of Iowa and a Doctorate in 2008 from Purdue University. 

Dr. Annie Pullen Sansfaçon, PhD Ethics, Social Work, De Montfort University, UK, is a Social Worker and a Full Professor of Social Work at the University of Montreal. Her work focuses on the development of anti-oppressive theories, approaches and methodologies to promote ethical and emancipatory practice in social work. Since 2010, she has focused much of her research time on various projects aimed at better understanding the experience of trans youth and their families. 

Herb Schreier M.D. Clinical professor University of California San Francisco-Benioff Children’s Hospital Oakland. He is a WPATH member.  

Judy Sennesh is the Chair of the Board of PFLAG NYC, a prolific speaker, the founder of the TransFamilies Project (previously the TransParents’ Project), and is a fierce advocate for transgender and gender nonconforming youth. 

Julia Serano, Ph.D. (MtF)is a biologist, author, and activist. She is best known for her 2007 book Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity(now in second edition)—The Advocateplaced the book on their list of “Best Non-Fiction Transgender Books,” and readers of Ms. Magazineranked it #16 on their list of the “100 Best Non-Fiction Books of All Time.” 

Caroline Shahbaz, BBSc(Hons), MPsych is an Australian trained clinical psychologist as well as a depth and liberation psychologist. She is co-author of Becoming a Kink Aware Therapist and the co-founder and CEO of Kink Knowledgeable, an AASECT and APA certified online academy aimed at developing kink knowledgeable mental health professionals.  

 John B. Steever, MD, graduated the George Washington University Medical School in Washington DC.  He completed an Internship, Residency and Fellowship in Pediatrics and Adolescent Medicine at Childrens Hospital Los Angeles in 1999.  His training has focused on providing medical services to “high risk” youth including LGBT clients and those affected by HIV/AIDS.   

Françoise Susset, Psy.D. is a clinical psychologist and couple and family therapist with over 30 years of experience working with LGBTQ populations. Her clinical work centers on trans adults and teens, during transition and beyond. She also focuses on supporting gender creative/gender expansive children, and helping families and schools challenge notions regarding sexuality, sexual orientation, gender identity and gender expression. Dr. Susset has trained and supervised hundreds of health professionals in transgender health across Canada. 

Brynn Tannehill, M.S., (MtF) graduated from the Naval Academy with a B.S. in computer science in 1997. 

Barbara E. Warren Psy.D., LMHC, is Director for LGBT Programs and Policies in the Office for Diversity and Inclusion, Mount Sinai Health System, where she leads Mount Sinai’s implementation of LGBT culturally and clinically competent health care. 

Linda Wesp, MSN, FNP-C, AAHIVS (MtF) is a board certified family nurse practitioner and HIV Specialist. She has provided primary and gender affirming care for transgender adolescents and young adults for over 12 years, and has also worked on a variety of research projects related to improving health and well-being of transgender youth.  Linda is a member of the UCSF Center of Excellence Medical Advisory Board. 

Johanne Olson-Kennedy is the recipient of a large NIH grant to study youth with GD. She also recently published a study following teen females as young as thirteen who have received double mastectomies. The below quote is of Johanne Olson-Kennedy from a Gender Odyssey conference (2017).

(audience member)

I find a lot of this stuff very confusing. But just trying to learn about it. But I’m curious like with kids, like young kids with an actual DSM diagnosis, is that the right term? DSM? Like how many of them wind up aligning with a cross-sex identification and how many wind up aligning with their assigned at birth sex? Like with just a DSM diagnosis?

This quote edited verbatim and may be a little confusing (Johanna Olson-Kennedy).

So, there hasn’t been in the past 30 or so years a study that has asked that exact question. But if you go back into the literature and you look at the older data it’s a little more difficult because the criteria were different and so the question would be slightly different. I think it’s, in my practice and I’m certainly going to caveat this by saying for sure I have a skewed population right because I’m a medical provider and I don’t know that people, that I am people’s first stop. You know so this is why I think this is really important for people to understand is um, that we focus a lot of, and I’ve been talking about this the whole weekend like, or the whole week that we focus a lot of our attention on sort of the landing spot. And not as much on meeting that kid where they are in the space that they’re at in the present. And so, I, I think while it, it might be interesting to ask the question how many kids who meet DSM diagnostic criteria go on to have trans identities, that might be an interesting or useful question but I think um, it sets up a false paradigm for a lot of reasons. The first is that you can’t have the diagnosis unless you have distress. So, that means that perhaps the first time you go into care with a professional at seven let’s say and you have a lot of distress because, because you haven’t socially transitioned yet, you’re going to meet diagnostic criteria. Because uh, in order to have that you have to have that category B of functional impairment related to distress. But what happens if you socially transition and two years later you come back in and you don’t have functional distress. You don’t you no longer have a diagnosis. So if you’re encountering somebody asking that research question, they’re not going to have the diagnosis. So, what used to happen when they looked at research is that people were categorized as sub threshold and threshold. So, you had enough of the criteria to get a diagnosis or you were sub threshold you had some of the criteria but not all of them. Right? And so, I think it’s just a really really problematic question. I think the questions that Kristina Olson is asking in her project are probably the more useful questions. What is the function and mental health of youth who are supported in a general role that matches for them? So, it’s a very difficult question. And nobody has ever asked that pure question that you’re, that you’re asking right there. Now certainly in the data kids who reach threshold for that diagnosis are far more likely to carry-on with a trans identity. So, there is something about those diagnostic criteria, as silly as some of them are, that are predictive of people um, having a trans identity in adolescence.

 Looking at the quote more closely (J. Olson-Kennedy):

So, there hasn't been in the past 30 or so years a study that has asked that exact question.

Multiple studies do have information on that children diagnosed with gender identity disorder went on to desist. These are under DSM-IV or earlier. Her statement appears to be incorrect unless she is adhering to a slightly stricter DSM-V or strictly “I am a” criteria. But some of the more recent studies do contain desisters from a DSM diagnosis. Here are some examples of such studies:

Drummond et al (2008)

Wallien and Cohen-Kettenis (2008)

Singh (2012)

Steensma et al (2013)

 But if you go back into the literature and you look at the older data it's a little more difficult because the criteria were different and so the question would be slightly different... 

And so I, I think while it, it might be interesting to ask the question how many kids who meet DSM diagnostic criteria go on to have trans identities, that might be an interesting or useful question but I think um, it sets up a false paradigm for a lot of reasons.

This data was presented by Dr. Ken Zucker at USPATH and the desistance rate was found to be 67%. It is true criteria was different. DSM-V (implemented in 2013) is slightly more stringent in diagnosis than DSM-IV. However, they have many similarities (including actual distress to be a factor).

The first is that you can't have the diagnosis unless you have distress. So, that means that perhaps the first time you go into care with a professional at seven let's say and you have a lot of distress because, because you haven't socially transitioned yet, you're going to meet diagnostic criteria. Because uh, in order to have that you have to have that category B of functional impairment related to distress. But what happens if you socially transition and two years later you come back in and you don't have functional distress. You don't you no longer have a diagnosis.

If they meet DSM-V criteria for dysphoria they may feel distressed and compelled to transition once their body starts changing. This framing is possibly to promote the idea GD is the result of not allowing a social transition. GD is actually a result of conflict with the biological reality of the body.

So if you're encountering somebody asking that research question, they're not going to have the diagnosis. So, what used to happen when they looked at research is that people were categorized as sub threshold and threshold. So, you had enough of the criteria to get a diagnosis or you were sub threshold you had some of the criteria but not all of them. Right? And so I think it's just a really really problematic question.

The above appears vague. 

I think the questions that Kristina Olsen is asking in her project are probably the more useful questions. What is the function and mental health of youth who are supported in a general role that matches for them? So, it's a very difficult question. 

Olson’s study shows children who were socially transitioned have normal levels of mental health. Immediately alleviated feelings should be taken into consideration. Should long-term consequences to a borderline child be considered and the influence of the surroundings on their developmental psychology? 

And nobody has ever asked that pure question that you're, that you're asking right there. 

There is data that is of high enough quality in Steensma worth mentioning that challenge this statement.

Aydin Olson-Kennedy also continues. A. Olson-Kennedy responds in a way that possibly indicates the viewpoint the question is transphobic & redirects the focus on the positives of social transition.

I think that there is a valuable, saying something about whether you’re asking the question as sort of a reflection of where you are in this process. Um, in relationship to your kid or whoever brings you here’s gender identity and gender journey. Is, is that thinking about, regardless of that answer, what does it mean to you. Right? If, if the answers like only 20% continue to have a trans identity is there some part of you that’s like, oh thank God? Right? Or is there some part of you like, like thinking about, like you don’t have to answer that because it’s a lot of pressure, but I think that it’s valuable… That I, that I think that it’s valuable, OK. I think it’s valuable for you to kind of check in a little bit about what’s happening. Because um I just, just for whatever it’s worth, that if your kid continues to move in a direction and they end up being trans, there are far worse outcomes. Right? That it is going to be a remarkable, difficult, but a remarkable journey that you are going to be on with your little human. And I promise you, and I’m biased, but I also promise you, that you will be better for it.

The above exchange is another example that does not really address the valid concerns people have about the individual child who may be sent down a medical path.

Diane Ehrensaft

Diane Ehrensaft is the most prominent psychologist promoting early social transitions and access to puberty blockers and surgery for “non-binary” youth. Diane Ehrensaft appears to downplay desistance statistics in previous gender dysphoria research. Her papers highlight methodological flaws in previous research studies, but do not provide data to argue desistance is irrelevant.

She has made a statement in this research paper  (Ehrensaft 2018) that seems to express the view that avoiding medical treatment isn’t a preferred outcome. The quote also appears to be framing that such a concern is inherently transphobic. Again, it’s largely pre-gay/lesbian youth that would be the subjects medical treatment because they weren’t given support and time to mature. One could argue it isn’t transphobic to want to give a gay child time to adjust, but it is homophobic.

Another concern that has been raised is that if a gender-expansive child is allowed to socially transition, then go on a GnRH agonist at Tanner Stage 2 of puberty, thereby never experiencing the puberty associated with their assigned sex, they will never have a full understanding and self-knowledge of their gender because they were denied the opportunity to experience the “correct” puberty. As stated previously, even if they appear happy and well-adjusted, from this transphobic perspective, being a transgender person is considered a poor outcome because of the discrimination they will face and the lifelong course of medical treatments they may require…

Furthermore, this is a value-laden statement suggesting that it is preferable for a child to avoid embracing a transgender or gender-expansive identity, and that diversity with regard to gender is inherently wrong and not as good as a cisgender identity. It also suggests that quality of life in childhood is negligible and can be sacrificed in the service of getting gender “right.” 

Many of the risks and benefits of social transition or the lack thereof have been alluded to in each of the previous sections, especially in the discussion about the controversies that are inherent in an approach that embodies both positive and potentially negative effects. What seems clear from the both the current research and clinical wisdom is that the benefits significantly outweigh the risks. 

The downplaying of desistance, and an apparent desire to sooth fears about medical false positives on minors, is concurrent with the fact she talks about borderline dysphoric children all the time, who may switch back and forth between gender identities. These are her “fruit salads.” If there are a lot of fruit salads, by definition these children have a fluid gender that may change or are simply working through identity development. The fruit salad may be dysphoric at age eleven when blockers are commenced. But the fruit salad may have become an “orange” at age fourteen in an orchard farm in the past without Lupron.

Dan Karasic

Dan Karasic is a psychiatrist and board member of WPATH. An incident that shows some ideological motivations and lack of willingness to be open to new information. Cari Stella, a detransitioner, created her own survey involving the growing online detransitioned community. It’s not a peer-reviewed study but a qualitative document involving many women who transitioned at very young ages and with no therapy in many cases. After she posted her results, Karaisc’s social media response appears to deny some of Stella’s information findings, stating that the women responders weren’t even trans.

The survey showed many of them identified as male. And one doesn’t have to be binary trans anymore to be considered trans. This appears to be intentional dismissiveness of a psychological condition whose epidemiology in young people has changed drastically. 

Cari Stella addresses another dismissive comment from this doctor highlighting that a large majority of follow up studies on trans patients are of very low quality form a perspective of trying to obtain the most accurate and nonbiased data.

Michelle Forcier

Michelle Forcier is a doctor and professor at Brown University’s Warren Alpert medical school who frames caution over giving children Lupron to allowing them to die from diabetes.

In an interview with NBC she said this:

“Kid’s rarely change their minds about their gender identity” (2:50)

This statement may have been true if Forcier were speaking about highly dysphoric children who remain dysphoric into the teenage years years ago (though we do not have data to support this), However, since the demographics of this condition have changed, with many more late onset teenage females coming out as trans, detransition and regret may be less rare in teenage and young adults, particularly same-sex attracted females in recent years. The fact is, there is no strong evidence to support Forcier’s claim.

Again, In these studies many children desist from gender dysphoria.

Drummond et al (2008)

Wallien and Cohen-Kettenis (2008)

Singh (2012)

Steensma et al (2013)

It is not surprising Forcier is doing this in light of what could be viewed as a very pro-hormones and surgery philosophy. She presented a case study where she blamed all of the problems of a highly mentally unstable patient (so unstable other professionals didn’t want to push medical transition) on the fact that the youth did not receive hormone blockers immediately, without any evidence to support this claim.

The inaugural conference of USPATH, the newly formed offshoot of WPATH, was held the first weekend of February in Los Angeles. At a session entitled “PUBERTY SUPPRESSION IN THE UNITED STATES; PRACTICE MODELS, LESSONS LEARNED, AND UNANSWERED QUESTIONS,” gender doctor Michelle Forcier presented a case study of a young teen “K.” who had been seen in Forcier’s gender clinic. K., born female, had been hospitalized multiple times for suicidality, cutting, an eating disorder and other self harm. K’s mother was reluctant to use male name and pronouns and was not initially willing to consent to Lupron.

During one of K’s month-long hospitalizations, Forcier pushed for the child to start blockers, despite the fact that the psychiatric team caring for K. was not in agreement, but was intent on medically stabilizing the child before contemplating other interventions.

After the child was released from hospital, the mother eventually consented to puberty blockers; the child was hospitalized again a few weeks after the Lupron injection. In her presentation, Forcier said that the time spent without blockers was one of many “missed opportunities;” she used the case as an example of how psychiatrists need to be better “educated.”

Blaming all of this child’s problems on not getting puberty blockers immediately may not be the whole story, especially since the youth was hospitalized after taking them.

Jack Turban

Jack Turban, a psychiatrist at University of California, San Fransisco, argues that even false positives don’t actually matter as regretters are likely a minority and may simply go back to living as their biological sex. Unfortunately, the effects of social and medical transitions on the gender identity of prepubertal children is unknown as there have been no studies with a comparable control group of those who were not transitioned. It’s worth asking what a false positive rate is considered acceptable. Certainly there are many detransitioners who have articulated that the permanent changes of medical transition make it impossible for them to simply going back to lives living as their biological sex.

It’s okay to let your transgender kid transition — even if they might change their mind in the future

De-transitioning is rare and not as bad as people think.

Many detransitioners have made statements (and there are numerous examples throughout this website) that detransition was traumatic and that they regret they have permanent scars and health problems. Provided below are some links to stories about desisters and detransitioners who have had even very bad experiences with their trans identification and detransition:

4thwavenow

B.C. Halliwell

Cari Stella

Carey Callahan

R/dtrans

Jamie Shupe

Pique Resilience Project

Turban asserts (an assertion that doesn’t seem to be supported by evidence) that young people don’t grow out of gender dysphoria and wind up being gay or lesbian. They just become closed trans people. In essence he being same-sex attracted is stigmatized by his claims that transphobia is causing trans people to identify as gay within the last twenty years is dubious.  

This was his response when challenged by a GHC member. There was no abusing language involved.

It’s not that these individuals don’t have a right to block who they want. But why block people asking challenging, but valid questions who aren’t being abusive. These discussions are being had nowhere among affirmative model advocate -not at gender conferences, not in most media, not in the government, not anywhere in these powerful individual’s environments who favor promoting a trans affirming protocol as safe for all children. These protocols have been demonstrated not to be safe for some teens and is unknown if they are safe for prepubescent children. These individuals are just talking about the potential positives of gender transition as though it is fact (as there are no sound long-term studies with the current cohort). They are refusing to discuss any negative.

Robyn Kanner

People just need to trust their gut that everything will work out fine. In what other area of medicine are treatments provided based on gut feelings?

I am reminded of what Robyn Kanner wrote in The Atlantic last year: “Society has done nothing for trans youth for so many years. People have to trust that the youth who sway in the breeze of gender will land on their feet when they’re ready. Wherever that is, it’ll be beautiful.”

Kristina Olson

Kristina Olson is the head o The Trans Youth Project, a longitudinal study of socially transitioned gender dysphoric children. Her research on gender dysphoric children shows socially transitioned young children have lower levels of distress (similar rates with controls) than in previous studies. These results are unsurprising and would be expected of a child with dysphoria, who feel they are the opposite sex. They have no concept of the social ramifications of transition or consequences of the medical techniques that will be performed on their bodies and they have not yet reached puberty to experience the changes to their bodies. Those ramifications may be worth it for trans youth, but may even be considered an “atrocity” in the cases of false positive. 

We provide information on gender dysphoria and desistance/persistence and the reality that dysphoria is a continuum, often not an either-or situation. Even though no gender clinician or researcher has actually proven they can tell which category a youth will fall into with certainty, many people are inferring from her research (based perhaps on the way she has presented it) that since these children match gender stereotypes of the opposite sex, and they feel they are the opposite sex, they are essentially the opposite sex. The inference is they won’t ever evolve out of their feelings if they demonstrate certain results on the tests she gives (see here and here), though these tests have not been assessed for reliability and validity. She is right that some or maybe most won’t. However, this won’t be true for all children according to past statistics on desistence. Further even if they persist in their trans-identity, social transition is a significant psycho-social intervention that may result in the child persisting in a trans identity, that without it, would have desisted.

There is evidence some youths do align with their natal sex. There are examples that demonstrate environmental factors and mental health factors influence gender dysphoria. And as she rightly acknowledges they may not always be able to tell who may outgrow GD. Regardless, her research is being used to eliminate mental health screening (see here and here) by promoting a “pink brain / blue brain” narrative, whether this is her intention or not.

1) She seems to display little interest in any discussion about how social transitions may push a child on a medical path or any engagement the theories and findings of developmental psychology in her papers “Mental Health of Transgender Children Who Are Supported in Their Identities”and “Predicting Early Children Gender Transition.”

In this LA Times article “How to raise happy, healthy transgender kids,” she doesn’t even mention the word desistance or the possibility of a youth outgrowing GD or how social transition could affect them. She doesn’t mention gay and lesbian adults are often very gender nonconforming as children and can have GD. This is odd due to the fact that her other research is on children and how the culture and environment influences them. But an environment of early social reinforcement, in an intensely pro-medical transition environment, reinforced by trans support groups where desistance appears to be an evil word, is not even considered. Should human rights and social comfort for trans youth be prioritized over preventing false positives? Affirmative model advocates can argue this but they should be transparent that is their position.

2) She promotes the argument based on flawed data, claiming prior data was inflated due to inclusion criteria. This, however, doesn’t prove the effects of social transition or puberty blocker protocols is irrelevant.

3) In articles for the general public she reiterates no one is performing surgery on prepubescent children  (Slate, U of WA). This argument is a red herring. Everyone knows there is no need for surgery before puberty. However, there have been surgeries done on youth as young as thirteen She is also likely aware that the real issue is some gender dysphoria experts believe social transitions will groom some youth for medical transition, as well as the hormone blockers in tweens the social transitions will lead to.

3) In her Slate article, she dismisses concerns about the affirmative model as “alarmist.’ Other skeptics that include LGB people, parents, doctors and mental heath professional are concerned about the powerful impacts of social reinforcement on children, brain altering effects of puberty halting hormone blockers, resulting sexual dysfunction, sterilization, possible loss of IQ points, and the influences of homophobic parents. Some gay men and lesbians in particular see any unnecessary castration or sterilization of a pre-LGB youth, as a serious human rights abuse.

4) There also is never any discussion of the risks to lesbians, bisexual, those mentally struggling, or are on autism spectrum and heterosexual gnc young people, despite more stories coming to light that they are indeed at risk. While she is aware of these stories only trans positive stories are circulated on her Twitter account.

The reason why all this is problematic is that this psychologist’s research is facilitating changes in the way gnc children are being raised with no control group or expressed concern for over-medicalizing dysphoric gay/lesbian/bi of heterosexual youth. The publicity of her study, whether her intention or not, has played a key role in mental health and medical professionals falling in line with the pink brain/blue brain - “if they say they are trans they are trans” attitude. This may be creating an environment where no one is bothering to do any mental health counseling with these youths. “Why would they need mental health counseling if they fall in line with gender stereotypes and say they are transgender?” 

The Federalist is not an LGB or T positive publication and should be treated with suspicion in reporting on such issues, but the observation below is correct regarding health care practitioners giving weight to her study, leading to the over-medicalizes of GNC youth.

Referring to Olson’s premature publication of her “conclusions,” NSF proclaims, “Although many of [Olson’s] findings have been made relatively recently, pediatricians are already using them to educate families and the public about social and health issues related to gender diversity.”

Her comments in this article in which she uses scare quotes around “guide” indicates her belief that any effort to promote body acceptance is problematic:

Yes, some clinics still counsel families to "guide" children to become satisfied as their biological sex. High rates of anxiety, depression and suicidal behavior persist among transgendered youth. Yet we see in our young research participants a clear sign that unhappiness and tragedy are not inevitable.

A youth may be better off experiencing childhood distress if they avoid brain altering chemicals, castration and a lifetime of medical industry dependence. Trans identifying youth are important and their concerns, ideas and health should be valued; however, so should that be for borderline pre-gay and lesbian youth. 

At the (Gender Odyssey conference in Seattle 2017), she also states she thinks a control group that would determine the impacts of the affirmative model protocol (early social transition, blockers at ten years old, etc.) would be unethical. Regulations around how medical research can be conducted on human subjects could apply to both deny care and over-medicalizing children. 

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

It should be noted blockers are hormones too. But why is a control group of children, who are loved and supported in their gender nonconformity, but raised in a body acceptance model with medical transition treated as a last resort “the most unethical behavior ever.” But instituting protocols that could prevent a natural process of children outgrowing GD, castrating and medically defacing scores of gnc people as minors morally acceptable? Pubertal discomfort lasts a few years. Living with permanent, ultimately unneeded medical scars, destroyed endocrine systems and sexual function, sterility is lifelong.

A comment about Jazz Jennings

There’s Jazz Jennings when she was little, as if she was in my study. (audience giggles). I like to think about her when I think of the conclusions of this study because I think for anyone who’s like seen her, or seen her show I think she kind of well demos demonstrates the basic findings that we have. That she seems by all accounts to be doing well, umm is a happy kid, uh she has a supportive family, ahh and she also, you know does things, like she, if you didn’t know she was trans, nothing she did or said would seem particularly striking to you. Um she would just seem like any other girl. And that is what we are finding so far.

She doesn’t mention some very relevant information to this case. 

1) Many argue the documenting of the child’s transition on television in front of the public to further the goals of trans activism is child abuse.

2) This youth was depressed and on antidepressant medication.

3) This youth had a crying breakdown during a hypnotism recounting memories of a passed life as a persecuted gay man. This is not “normal” for a teenage girl. 

4) This youth will likely never experience an orgasm in entire lifetime due to hormone blockers induced sexual dysfunction.

5) This youth has had a more difficult and extreme genital surgery also due to blockers to cross-sex hormone induced genital stunting.

6) This youth is sterilized.

7) This youth is afraid of dating and stated “my vagina is so effed up.”

Olson’s statement may be presenting medical transition positively by framing discomfort with ones genitals as “normal girlhood.” Discussion of any downsides to medical transition are highly discouraged and thoughts and language are heavily policed in these gender medical affirming conferences run by tans activists clinicians, but are serving to train mental health and medical staff.

In summary, one of the top researchers on gender dysphoria in children is downplaying desistance, believes worrying about the effects of socially transition on desistance as “alarmist,” thinks control groups are unethical but does not address the ethics of false positives, and seems to imply that therapeutic efforts that may, in fact, help a dysphoric child adapt to biological reality is problematic. There is no honest assessment to the potential damage this could do, even if it is to a small number of children?

4thwavenow has two blog posts on what the author sees as the confirmation bias of this researcher here and here.

Media hiding risks

The screenshots below are all negative articles in the Huffington Post on Ken Zucker who many trans activists despise for talking about desistance. The Huffington Post promotes pro-transition stories without balanced discussions.

Discussion of scientific research is “violence” towards the trans community according to leftist circles and should be banned. Here is a quote from a prominent trans activist Dana Beyer:

“After reading multiple Facebook threads, and speaking with some of the players and interacting on Facebook, I feel it comes down to one issue - not that Zucker’s words are hate speech, but that allowing him to speak is in and of itself an act of violence against certain members of the trans community.”

The Huffington Post also printed an article dissuading the reader to have concerns about effeminate gay boys in a pro medical transition environment because it will hurt trans identifying children.

If one follows the Hippocratic system and prioritizes doing no harm, the priority must be to transition the trans girls and not worry as much about the inadvertently transitioned gay boys.

ThinkProgress is another example of a liberal website that actually promotes misinformation (also here) to the public about statistics about youth who outgrow GD. All of their articles with titles such as “The Myth of Desistance” and others (written by Zach Ford) are focused on discrediting desistance. Zack Ford has had every opportunity to view statistical evidence of desistance.

Governments hiding risk

A government owned broadcasting station in Canada pulled a documentary about gender dysphoric children trans activists did not like because it contained statements that some children outgrow GD. Why would the Canadian government not want the Canadian public to know that some children may outgrow gender dysphoria and that some people are worried about how early transition will affect them? That story can be found in this article, “Why CBC cancelled a BBC documentary that activists claimed was ‘transphobic.”

Here is an example of Cheri DiNovo, a powerful Canadian politician, who likely has no thorough knowledge of research on gender dysphoric children, but nonetheless, supported the above documentary being censored in Canada.

It is a very common experience by those trying to raise concerns about the safety of gender medical treatments on children and teenagers to have comments deleted off of articles and to be blocked on social media. Trans youth matter and should be protected but the seriousness of mistakes should not be off the table. These are links to young people who have actually been harmed by medical transition.

“LGBT” organizations avoiding discussions of risks to LGB youth

All “LGBT” organizations currently support socially transitioning young children and commencing a hormone blocker protocol as tweens. Not one single statement exists about desistance statistics or how these protocols will affect mostly pre-gay and lesbian children who are too young to understand their sexuality. This includes the HRC, National Center for Lesbian Rights, PFLAG, GLSEN, The Trevor Project, Egale, Stonewall UK, likely all of the major LGBT organizatons in western countries. This is also true of “LGBT” media such as The Advocate, Out Magazine, and Pink News. It i is important that “LGBT” organization raises these necessary concerns.

“LGBT” organizations and media have attacked and demonized Dr. Zucker as homophobic and transphobic. Many people who are critical of the affirmative model disagree with some of Zucker’s alleged behavior modification attempts. But a difference between Dr. Ken Zucker (who is pro-gay rights and who did facilitate gender transition for trans youth) and many affirmative model advocates is that he did not believe it was ethical to medically transition immature, dysphoric and confused (many gay / lesbian) minors. Affirmative model advocates (WPATH, the APA, the AAP, Kristina Olson, Diane Ehrensaft, Johanna Olson-Kennedy, “LGBT” orgs) don’t express concern. It is ironic that organizations that contain LGB in their names, refuse to acknowledge any downsides of medical transition to LGB minors, despite that fact they are already starting to be observed.

D. Inappropriate medical transition of LGB & GNC heterosexual minors are acceptable collateral damage for trans positive healthcare

In summary, the most powerful people in trans research and healthcare, who have received the most funding for their work, appear to downplay the possible harms to LGB and heterosexual GNC youth. This is despite them having no clear data on the effects of early social transition and puberty blockers. They apply non-falsifiable arguments to discredit desistance and promote early social transitions and employ arguments about methodology when few studies are perfect. Real world observation of not only children, but of teens, and even adults supports the concept of desistance and the influence of environmental factors. 

These are the main reasons why Gender Health Query is a necessary organization. Interest in providing a clear screening process may not come from these individuals and entities without outside pressure, which is one of the goals of GHQ.

E. Only a control study could determine the effects of early social transitions, early puberty blocker use, & possible benefits of therapy for children and rapid onset female teens. That won’t be done. Supporting body acceptance is unethical, but false positives are not:

Again, Kristina Olson:

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

Sweeping changes to how gender dysphoric children, and now all children, are being raised have been made and will become the norm with current trends (see here and here). Social transition is being strongly encouraged in schools, even without parental knowledge. Children are encouraged to explore their gender fluidity at young ages, and puberty blockers are offered on a widespread basis to any youths with dysphoria regardless of the context in which the gender dysphoria developed.  A new goal is to eliminate age of consent for medical procedures already being performed on tweens (see here and here). This is all being supported by school systems, the mental health and medical professions, “LGBT” organizations and liberal media.

There are still questions about the ethics of medically transitioning, or even socially transitioning minors. No one has any idea about what the psychological effects will be on borderline dysphoric youth. Stress and depression in children with GD may be alleviated by social transition (Olson 2016) which is a good thing. If these practices facilitate children on a path to SRS, this is a major ethical problem (and possibly legal malpractice). It could be argued that this is as bad as denying trans youth immediate social and medical transition. The effects of raising children in a gender fluid environment are unknown but much evidence indicates some negative consequences. It is also in causing major conflict within the LGB and T populations. 

None of the advocates of the gender affirming model have a reliable and valid screening process or have data on the long-term effects on young people’s bodies. We have no knowledge of plans to accurately study the true effects of these monumental changes. 

There is considerable evidence that other factors besides an innate gender identity contribute to gender dysphoria such as external and internalized anti-gay and lesbian attitudes, comorbid mental health issues, trauma, sexual abuse, culture, and possibly parental influence on GD. The only way to truly measure the effects of early social transitions, puberty blockers on children and cross sex hormones on young people is with rigorous studies using control groups. 

The reasons this won’t be done are:

1) There are practical issues in getting parents to comply with guidelines of a study like this.

2) Denying trans affirmative care to children is considered unethical. False positives currently do not seem to be considered unethical, so studying the matter is irrelevant to a large part of the mental health and medical community. Some affirmative model advocate seem to believe this will be so rare it doesn’t matter.

3) Dissenting health professionals who do feel false positives are unethical will not have their research supported in this political climate, both in terms of funding and publishing.

Setting aside rules around ethical guidelines in research on human subjects, what is ultimately being argued is that a study with a control group, involving a relatively small group of youths (loved and supported but raised with a body acceptance and transition as last resort model), is considered unethical. A drastic changeover to a total affirmation protocol that could over-medicalized initially dozens, then hundreds, then 1000s, then 100,000s of GNC desisters, disproportionately likely to be gay/lesbian/bisexual seems to be accepted as a necessary cost to supporting trans youth. The same-sex attracted individuals who struggled but aligned with their natal sex without the medical industry in the past will cease to exist. 

Is this truly a balanced moral viewpoint?

The graphs presented in these sections (see here and here) are proof that this self-acceptance did occur in the past, otherwise the sheer numbers and sex ratios in young people and older people would look a lot more similar. They indicate a pattern of social contagion, facilitating a strong desire to medically transition, especially among young females. This has created a situation where offering young people medical transition creates more desire for it. This means the modern medical trans movement is iatrogenic. If transition outcomes were more positive and health problems less serious it would be easier to present this libertarian attitude towards medical treatment on tweens and teens in a more positive light. 

Even tough studies with a control group could be instituted theoretically, they won’t be. It may be possible to track different types of parenting styles in these studies and find back end ways to compare children socially and medically transitioned early to those whose parents prevented this. We already know youth transitions are a risk to teenage females.

Gleaning the effects of affirmative protocols on prepubescent children would be very beneficial to the trans community if the results are that the percentages who go on to get drastic medical treatment are not different. This contentious issue would be resolved. If the opposite is shown, there will be a human rights conflict, as this will be a form of eugenics, child abuse even, and a human rights violation of gay people and other GNC desisters. This will continue to be an argument (often an extremely angry ones) if this information isn't determined. 

We, and many others like us, disagree with Dianne Ehrensaft and Aydin Olson-Kennedy that desistance research is unimportant and transphobic. Over treatment on minor subjects is not an irrelevant irrelevant. Finding alternative ways to gleen cultural and parenting effects on childhood GD desistance / persistence could settle some of this conflict (or may make it worse). Trans activists do not want that. Negative effects on borderline children are viewed as worth the sacrifice regardless among many activists and those who support them.

This is causing conflict within the LGB and T populations now and will continue to do so in the future.

© Gender Health Query, 6/1/2019

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REFERENCES FOR TOPIC 16

CONTINUE TO TOPIC 17:

Contents

16) Trans rights / risks of false positives on minors

A. Fear of a gay eugenics planet
-No evidence a clean screening process between trans & gnc LGB youth is possible?

B. Trans people have said gatekeeping has harmed them

C. Trans youth matter: borderline youth?
-Some individuals and entities are motivated to suppress information highlighting risks

-Mental health and medical providers lack of expressed concern for risks

-Media hiding risk and harm

-LGBT” organizations hiding risks

-Governments hiding risk and harm

D. Even if some minors are medically transitioned inappropriately it’s worth trans positive healthcare

E. Only a control study could determine the effects of early social transitions, early Lupron use, and possible benefits of therapy for children and rapid onset female teens

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

10. Nature versus nurture

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

17. Moral Dilemmas