Implementation of the “gender affirmative model”

In the last five years or so, two major changes have happened around gender dysphoric minors and transgender activism. First, many mental health and medical professionals are adopting the “gender affirmative model,” despite the fact that it’s controversial. With the gender affirmative model, the gender dysphoria of the child or teen is affirmed. No attempt is made to help the child or teen align with his/her biological sex, as this is considered conversion therapy and harmful to their identity. Delaying access to medical transition (whose process begins at the onset of puberty), is viewed as an infringement on the youth’s human rights. There is a push to lower age of consent laws, to access cross-sex hormones and surgery. Double mastectomy and vaginoplasties are being performed on minors in the United States. Many activists want these “stage not age” policies everywhere.

This is being implemented mainly due to results from two studies that show early interventions have positive impacts on trans youth mental health [de Vries (2014) and Olson (2016)]. However, all studies on gender dysphoric minors indicate a significant number (over 50%) of children who had a gender identity disorder diagnosis, outgrew gender dysphoria in puberty. In addition, the type of mental health screening involved in the de Vries study, has been eradicated in many cases (see here and here). We seek to ensure that there’s evidence that these practices are safe for children and teens with gender dysphoria (who may or may not outgrow it).

The affirmative model is rapidly being adopted by parents with gender dysphoric children/teens, and is reinforced by many therapists and doctors, “LGBT” organizations, schools, and many in the culture at large. The image being promoted by these entities is that this is the fully accepted model in the scientific and therapy community. It’s not. It’s mainly promoted in the United States. Other gender clinicians in The Netherlands and Great Britain, for example, advocate for “watchful waiting” (“the Dutch model”), and express concern that the affirmative model may groom some children for medical transition they otherwise would have outgrown.

Huge increases in young people medically transitioning

The second issue that has arisen in the last several years, is a huge increase of young people, particularly teen females, identifying as transgender and medically transitioning. This process starts as young as nine (girls) or eleven (boys), with the administration of Lupron (hormone blockers). This increase is due to a rise in visibility and reporting on trans issues in the media as the new civil rights cause, interactions of young people on social media, and the implementation of gender identity trainings by trans or “LGBT” orgs in schools. This is all viewed positively by trans activists and “LGBT” organizations.

Some young people outgrow gender dysphoria if allowed to mature

In the past, there’s often been an unacceptable level of stress and difficulty in the lives of gender nonconforming children. This has to change. Life for gender nonconforming children can be very difficult, especially for children with dysphoria serious enough for a DSM diagnosis. Dysphoric children often experience persistent cross-sex identification and stress. Difficulties can include anxiety, depression, self-harming behavior, and suicide ideation.

If youths, who experience serious dysphoria, were all certain to eventually become transgender adults, this issue would be less controversial. If it were certain they would all want to permanently medically alter their bodies, in the way that affirmative protocols on minors do, this would be less controversial. Unfortunately, the reality is much more complicated, and this reality is often ignored in the way this issue is presented to the public (by media and entities that advocate for early social and medical transition of youth). Some children with gender dysphoria ultimately outgrow it. For this reason, many therapists, doctors, and LGB and trans people feel it’s unethical to enthusiastically support the social and medical transitioning of minors.

For those who want to understand both sides of the youth transition debate, here is an overview of the pros and cons.

False positives on LGB youth and drastic medical treatments on trans-identified youth

This issue is important to the LGB community because of the association of childhood gender nonconformity and gender dysphoria, with adult homosexuality and bisexuality. Minors, who will maintain a trans identity, need respect and support. Likewise, it’s important to respect and support minors who might not maintain a trans identity. That includes acknowledging that it’s unethical to permanently alter a minor’s body, through medical procedures, unnecessarily. We are beginning to see examples of the latter happening to teenagers and young adults who transitioned as teens. Inappropriate medical transitions of young people (disproportionately LGB) are an unfortunate inevitability. It’s only a matter of how many there will be.

Access to medical transition for minors is viewed as a human right by the trans community. Unnecessary medical procedures performed on minors, with questionable ability to give consent, is also considered a human rights violation and medical malpractice by many. Varying viewpoints need to be heard, and further research is needed.

Many affirmative model advocates appear to have already made the decision that false positives (mostly on gay and lesbian youth) are acceptable collateral damage for trans affirming healthcare and trans rights. There is scant data to back up this assertion, and little to no interest expressed in properly obtaining this data.

No accountability in proving safety of affirmative model protocols and medical treatments

Some youths “desist” (the term used for realigning with their natal sex) from gender dysphoria, usually into their teens—despite intense effort by activists, and some affirmative model health professionals, to downplay or deny this (see here and here). Currently there have been almost no plans communicated by gender clinicians and researchers, to determine the effects that social and medical transitions of young people have on desistance. If the affirmation model is going to be promoted and implemented by gender clinics, therapists, medical doctors, school systems, “LGBT” organizations, and media, then all entities promoting it have an obligation to provide evidence of their long-term safety and accurate screening processes. It is their responsibility to provide evidence that gender nonconforming youth won’t be over-medicalized as minors, and if this is happening, that the costs are worth the benefits. Additionally, the risks and harm, that are already resulting from these practices, must be disclosed and acknowledged to the public, in addition to the positive data currently being centered around these protocols.

There are trans people who bring perspectives from their life experiences, who feel caution is warranted. They think young people should not make hasty decisions because they have seen, first hand, sometimes serious health consequences from hormones and surgery. They know that transition is not always a panacea for psychological issues. There are no long-term studies on what will happen to the bodies of youths who are beginning medical transition in their tweens and teens. And there is alarming information around the use of Lupron, a chemical used to completely halt the normal pubertal development of a youth. Many former users (mostly for precocious puberty and as an anti-cancer drug) are complaining of serious and bizarre side effects from the drug, and are even bringing lawsuits.

Genderist/trans/genderqueer ideology, non-binary identities, and pronoun usage

We also want to closely examine the effect gender ideology (being promoted by media, “LGBT” organizations, and now schools) is having on gay, lesbian, bisexual, transgender, and heterosexual young people. Some of the effects appear to be negative rather than positive, and in the opinion of some LGB and T people themselves. We call for more research into why so many more female teenagers are identifying as trans or non-binary. 

Censorship

There are in fact some benefits to trans youth with the affirmative model; de Vries (2014), Olson (2016), Pulse (2012). However, the positive promotion of it by mental health and medical professionals, “LGBT” organizations, and by the media, often downplay or completely ignore risks to borderline dysphoric minors, as well as to children who will be trans adults, who are medicalizing their bodies at younger ages.

There’s a lack of balanced coverage of these issues, as well as active censorship of alternative viewpoints, not just by the media, but by organizations such as the World Professional Association of Transgender Health (WPATH)—an organization that sets the standard of care for treating gender dysphoric minors. We also want to address the climate of harassment and threats to people with valid concerns about the affirmative model. These include slandering people, trying to destroy their careers, and making physical threats.

We are pro-free speech for affirmative model trans activists and for people who have concerns. Even though information that could paint the social and medical transition of minors negatively is currently being censored, we do not seek to censor pro-early childhood transition data. Reporting all positive transition stories and data on this website is impossible due to time and space, but this information can currently be found on almost all other “LGBT” organization websites. We have highlighted the harms and potential harms on this website because they are currently being underrepresented. The voices of LGB and T and tolerant allies who are worried about much of what is happening, are numerous but underrepresented. We encourage people to do much research before forming opinions on this complicated topic.

Citations, evidence, and discussions to support our concerns

For more detailed information as to why this organization is necessary, please browse our “Topics” section, where we analyze the risks of socially/medically transitioning minors, the censorship around acknowledging potential and real-world harm, the influences of gender ideology on young people, and the reality that affirmation model advocates consider inappropriate medical transitions of minors to be a morally acceptable outcome of trans-affirmative healthcare.

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