One psychologist who gets it: “Trans” kids and their parents deserve better

What of the gender variant child whose social environment both accepts and encourages an early transition but may be unaware that the child, unwilling to disappoint, has had a change of heart ?Jack Drescher, MD, quoting Cohen-Kettenis, personal communication, in the introduction to this special issue

The Journal of Homosexuality published a 300-page special issue on childhood gender dysphoria in March 2012. It contains articles by several well known “gender specialists,” including Norman Spack, Kenneth Zucker, Jack Drescher, Diane Ehrensaft and others. These providers discuss their own clinical practice and experiences, informed by their viewpoints–and biases–about “trans” kids.

But of most interest to me is a piece by clinical psychologist David Schwartz, PhD., who is not a gender specialist himself, but knowledgeable about child psychology and the dynamics of family therapy. In his aptly named “Listening to Children Imagining Gender: Observing the Inflation of an Idea,” Schwartz critically and compassionately analyzes three of the other articles in the issue, focusing particularly on one written by Laura Edwards-Leeper, PhD., and Norman Spack, MD. Dr. Spack is a leading proponent of childhood medical transition, and heads up the Disorders of Sexual Development (DSD) and Gender Management Service (GeMs) at Boston Children’s Hospital, the first of its kind in the US.

Schwartz has two main points: First, he skillfully clarifies how most of the other clinicians writing in the issue operate from an idea–an inflated idea, unsupported by evidence–that gender is innate from birth. Schwartz terms this “gender essentialism.” And the concerned parents who bring their kids to these specialists imbibe the same biased idea.

Schwartz’s second key point is that the literal acceptance of a “trans” child’s demands and assertions, while completely ignoring underlying motivations typical of all kids, is something new under the clinical sun when it comes to treating children. It’s as if the insights of decades of child psychology are being thrown out in favor of automatically endorsing a narrative—a narrative driven by children, with their necessarily immature understandings and desires.  And Schwartz makes it clear that this clinical approach is doing no favors to dysphoric children–nor their parents.

We desperately need more outspoken therapists like Dr. Schwartz, clinicians who have deep clinical insight into developmental psychology and parent-child dynamics–not just “gender dysphoria.”

Because for most readers, the full article (and the rest of the journal issue) will be behind a paywall,  I am extensively quoting several of Dr. Schwartz’s key passages. The abstract is here. [Update:  “Awesome Cat,” in the comments section below, has a link to the full Schwartz article.]

The writing and language is that of a peer-reviewed journal article–formal and perhaps less accessible to some. But I am allowing Dr. Schwartz’s words to stand on their own merits. It is unusual to see this kind of gender criticism in a recent journal on the subject of gender dysphoria. Please note: The subheadings and boldface emphasis are mine, not Dr. Schwartz’s.

“Liberal psychiatric treatment”: the avoidance of ambiguity, p. 461

I am disquieted and stimulated by my mediated encounter with the children, parents, and clinicians represented in these clinical articles.

The children have a deeply felt complaint, expressed  explicitly or indirectly through the disruptions they inevitably provoke. They say they are unhappy with being named, classified, and treated in accord with the match between their visible genitalia and the prevalent set of conventions regarding those genitalia. For them, gender has become preoccupying …

…The parents seem to be trying to catch up with terribly surprising news, with varying degrees of success. They are frightened, frustrated, freaked out, and, finally, defeated, as they are forced to relinquish a cherished perception. Their particular defensive configurations vary (guilt, despair, anger, embrace), but all face extreme intrapsychic disruption and pain. The clinicians try to make this child/parent/symptom matrix fit into a model of liberal psychiatric treatment. As is common in the medical sciences, most push against ambiguity, preferring to emphasize speculative generalizations (“genetics is likely a factor”) instead of highlighting the lack of data from controlled studies.

Desistance: Most kids with gender dysphoria will change their minds, pp. 467, 470

With respect to the advocacy of intervention, Edwards-Leeper and Spack … say that they “have learned that delaying proper diagnosis can lead to significant psychological consequences”.  This warning implies that the reliability of diagnosis and associated prognosis in this area has been established, which is the case only for diagnosis, that is, we cannot say reliably what the course will be for a given child with GID or gender dysphoria. In particular, we cannot reliably say whether he or she will persist with an expressed need to be affirmed in his/her non-natal gender, or not. In fact, the majority do not sustain the diagnosis, that is, they desist.

[This] fact (supported by five research articles going back to 1987)…every clinician and parent of a child who is gender dysphoric needs to keep firmly in mind. …

Given this uncertainty of prognosis, it is significant that Edwards-Leeper and Spack’s presentation of the pros and cons of pubertal suppression, a primary intervention in their protocol and their frequent recommendation following diagnosis, is imbalanced.  They offer seven physiological benefits to pubertal suppression (for the most part just a list of the physical effects) and no disadvantages. Likewise they tout the psychological advantages, but note no potential disadvantages. Their conclusion is: “Therefore,
it is our clinical impression that preventing these unwanted secondary sex characteristics with puberty blocking medical intervention allows for better long-term quality of life for transgender youth than what they would experience without this intervention.”

Better quality of life? p. 467

The claim of offering “better long-term  quality of life” based on clinical impression only, and absent significant longitudinal experience or controlled data collection, is questionable. Considering that Edwards-Leeper and Spack are advocating a pharmacological intervention aimed at prepubertal children and adolescents, a number of whom are likely to desist, it is surprising and of interest that they so minimize the importance and value of alternative interventions, ones that might have fewer unknown consequences, both physiological and psychological. An alternative sort of intervention would of course be some variety of psychological therapy. Most typically this might include support, reality testing, empathic interpretation and psychoeducation offered to both parents and children.

On the psychology of “trans” kids, p. 468

The intransigent style (cognitive and behavioral) of trans children may deter some clinicians from considering that some of their suffering might be helped without rhetorically opposing their desires or trying to persuade them to relinquish their assertions.

… The goal of psychotherapy in this situation would be to help the child feel better and offer reality-based guidance for social situations, as well as the prevention of self-harm, in the rare cases where that is an issue. In general, psychotherapy should entail increasing (parents’ and children’s) self-understanding, not coaxing or pressuring them to change their minds. The disturbing demands and claims of trans children, as well as reports of self-harm (untabulated, to my knowledge) may shock and scare both parents and clinicians into expecting less frustration tolerance from them than is realistic. Such an underestimate of the trans family’s resilience may be abetted by the availability of puberty suppressing drugs. Frightened of the onset of puberty, and intimidated by the at times ominous articulations of the children, parents and clinicians are relieved to imagine even a temporary solution.

Anecdotes from adolescents are not data, p. 468

…Edwards-Leeper and Spack’s  usage of anecdotal data concerns me. To counter what they describe as the leeriness of parents with respect to the taking on of transgender identities on the part of adolescents with no prior history of gender dysphoria, they say: “However, many of these adolescents report that their friends are not surprised by their declaration of their affirmed gender, often responding that they had suspected it for some time.” We must assume that Edwards-Leeper and Spack are aware that an adolescent’s report of other adolescents’ validation of a gender identity claim is not credible evidence of more than the first adolescent’s desire to persuade. How then are we to understand their inclusion of this anecdotal information? It would seem that natural skepticism has been suspended in favor of literality. Are they trying to highlight the alleged power of essential gender by pointing to its observability by others even before the subject himself or herself has self-awareness? If so, the weakness of an anecdote such as this gives the appearance of a lack of appropriate scientific and psychological skepticism, and inattention to methodology.

Kids aren’t little adults, p. 470

With essential gender in mind [clinicians] are likely to be less psychologically minded and less thorough in their consideration of the cost–benefit ratio of invasive interventions and of research that might militate against their impulses to intervene. To be sure, they are trying to be respectful of and responsive to children’s stated wishes. But it seems that beyond that, when child patients talk about their gender, their belief in its reality seems to distract the clinician from the fact that we cannot listen to children in the same way that we listen to adults. Patients’ communications always need some degree of interpretation; that is especially true for children, who, necessitated by their cognitive limitations, speak more symbolically.

Is a 5-year-old boy “really” a girl–or trying to be like Mommy? p. 473

Ehrensaft tells us that throughout a session to which Brady/Sophie arrived fully dressed as a girl, “[she] kept sucking in her tummy, in an attempt to make herself more girl on top” (p. 351). This child is less than 5 years old. Sucking in her tummy will not make her more girl on top, since little boys and girls are the same on top, which Brady/Sophie surely knows: It will make her more woman, a very different thing. One possible interpretive direction in light of this slip would be that this child is more interested in a ticket to adulthood than a gender change, but for some reason sees being female as a necessary first step…

.  …At the conclusion of this patient’s treatment, parents and therapist decide that it is best to permit Brady/Sophie to present as a girl at all times.  Sophie (still not 5 years old) proclaims: “I’m the happiest I’ve ever felt in my life.” Ehrensaft furnishes a putative expert statement to the parents, which says in part: “To promote her wellbeing and emotional health, it is imperative that Sophie be seen and treated as a female by her parents, her educational settings, and the community surrounding her.” …Such certainty in matters so fraught with unforeseeable possibilities including the welfare of a child surprises me. The certainty of the child about her gender is matched by the clinician’s certainty about the outcome, both of whom, I suggest, are encouraged by the notion of a true gender found at last. Moreover, I wonder if Ehrensaft has not imagined the inner life of this child, who is rather adult-like in her speech (do 4 year olds commonly speak of “in my life?”), as more adult than it is. This could be for many reasons including, of course, the personality of the child. However, I believe it is easier to be distracted from the childishness of a patient’s claims when the terms they use conceptually match the clinician’s ideas. 

Gender is power, p. 474

 It seems to me that trans children, in response to great psychic pain (and adaptively or not) have engaged the rhetoric of gender and, thus, stumbled upon a communication of such potency that their parents and therapists are detoured from listening to them as children, instead crediting them with adult-like cognition. When we infer that the trans child has a disturbance in an unobservable gender system, based on a claim of gender transformation, we are granting the truth of a child’s self-analysis and proposed self-construction. I doubt that the receipt of such a gratifying abundance … of respect from the clinician is consciously intended by the child. It is more likely that the child longs inchoately for an emotional experience like respect and rapidly gains unconscious awareness of the power of gender complaints to bring such gratification. When the longing is unwittingly satisfied by the parent or clinician who, thinking they understand the child’s problem, validates the terms of the discussion as the child has set them, the child is likely to reiterate the complaint in those terms.

  For that child, a psychological structure, more or less transient, begins to develop. For the adult, the illusion of understanding begins to perpetuate itself. The most immediate lesson that the trans child has learned, and then enacts, encouraged by these interactions, is that the idea of gender is very powerful, and if you want to get a rise out of people, play with it daringly. The lesson for the parent or clinician should be: Stop talking about gender. 

Schwartz goes there: the child who threatens self harm, p. 475

The specter of harm to children—any harm to any children—is surely a powerful influence in all discussions about children, and no doubt it is playing a role, spoken or not, in this one…. I am aware of no controlled data to indicate that the incidence of self harm among trans children is any greater than somewhere between very infrequent and rare. I am aware of no data to suggest that pubertal suppression, cross-sex hormone administration, or genital surgery diminishes the probability of self-harm in trans children. Moreover, there is no reason to believe that the three above-mentioned physical interventions are any better for the welfare of trans children than supportive psychotherapy and psychoeducation for parents. There are anecdotal reports of threats by children and of children dramatizing the possibility of self-mutilation. There are psychiatric protocols for addressing the patient who seems to pose a risk of self-harm that are minimally intrusive and unquestionably reversible. The long-term psychological and physiological consequences of chemogenic pubertal suppression, cross-sex hormone administration, and genital surgery are unknown, and, as is the case with all self-selected populations, very difficult to assess owing to problems of control and limited sample numbers. The palpable misery of an articulate child may distract the empathic clinician or parent from the venerable admonition: First, do no harm.

Conflation of gender skepticism with historical homophobia, p. 470

 Edwards-Leeper and Spack take pride in what they see as their avoidance of the mistakes prior generations of mental health professionals made, in particular when the latter refused to accept gay and lesbian people at their word, sans diagnosis. Indeed, the analogy is tempting, but I would argue, deeply flawed, itself an aspect of the conflation of gender and sexual orientation. …

“An artificially vitalized concept”,  p. 476

I believe the disquiet and stimulation I initially experienced after reading these articles and watching some videos, was a reaction to my perception of children and adults struggling in the thrall of an artificially vitalized concept that subjugates and empowers each in complementary ways, a phenomenon both intriguing and worrisome. Most of these adults—parents and clinicians—have been persuaded that gender is biologically real, with specific rules for healthy functioning. The children, having unconsciously learned of the adults’ imbuing of gender with particular potencies, that is, with reification, medicalization, and transgressive possibility, try to put it to use in the course of their own self-development. It proves to be a high-risk and high-gain tool. It has the power to command adult attention, to affect adult emotions and thus to alter the position in the family of the child who chooses to deploy it. As well, in the unconsciously operating hands of the child it can also bring enormous pain, which in its compelling resemblance to physical pain further misleads the adults toward the reification of gender.  It is disquieting to observe clinicians unconsciously colluding with troubled parents in the inflation of concepts that are inherently psychologically constricting.

Teaching children to be homophobic? p. 476

… Just as racism requires belief in natural races, sexism and homophobia require belief in natural genders. If we organize our responses to children who play or become preoccupied with gendered behavior around the idea that there are natural genders from which they are deviating or toward which they can aspire with medical help (transitioning), then, however indirectly, we are buttressing the very structures upon which the hatred of gay men and lesbians stands. Or put differently: As clinicians responding to trans children, we are responding to a subjectivity, not to the results of a biopsy or blood test. We and parents must choose whether we respond to that subjectivity as the upshot of a hypothesized psychophysiological gender system, on the one hand, or choose to go no further than regarding it as a mutable psychological situation on the other. Choosing the former, the more elaborately and speculatively theorized framework of essential gender, accepts a theoretical structure that has been used to rationalize sexism and homophobia and, therefore, tends to promote them despite good intentions.

We owe more to kids than to take them literally, p. 478

There is much more to children than what they say. We owe to them a deeper listening than a literal one. We will then likely find that their engagement with gender, especially when it is transgressive or countercultural, may reveal a creativity and even a politics that can contribute to the erosion (if not destabilization) of the gender system as it presently operates. If we listen to them literally, interpret their communications and performances through the categories we adults have grown up with, and of course have ourselves failed to transcend, we will miss whatever new story they are telling or protest they are making. If we listen and respond to what they are saying in the mirror of the old system, they will seem to buy it, because it comes with the feeling, although not the reality, of being understood, which they no doubt crave. Thus, stasis is guaranteed for the child and for our culture. I am not naïve enough to imagine an intellectual transcendence of essential gender. But, in the name of equality—of gender and of sexuality—we must avoid promoting its continued entrenchment.

35 thoughts on “One psychologist who gets it: “Trans” kids and their parents deserve better

  1. Such good blogs, you’ve been providing for us. Thanks so much for your ongoing good work. I know it is time-consuming and no doubt emotionally draining at times as well.

    Schwartz correctly points out the imbalance of “pros” and “cons” in the pediatric transition kingpins’ narrative regarding this issue, and the paucity of actual scientific evidence that transing of minors is beneficial or even safe. This is my primary beef regarding nearly all media coverage, with the recent Frontline documentary being a notable and rare exception. The little stories in your local medium-sized market periodicals — the newspaper in someplace like Omaha — all find it novel and heartwarming. A hundred iterations of the same progressive feel-good story with the charming photos of the cute kids and the “brave” parent(s).

    These stories rarely mention that there could be any health risk related to blockers and long-term use of hormones, and even more rarely mention the sterility angle. They’re definitely not talking about the lack of science available. On the other hand, they invariably do mention risk of self-harm among kids who don’t get their way in this area. So the public gets a load of “benefit” talk and not much else. It’s as though the only reason anyone might object to early transing is phobia / prejudice, and enlightened people just ought to get past all that. (So pat yourself on the back if you are enlightened enough to be “supportive.” kwim?)

    Well, maybe the new NIH/WPATH database on trans people is going to yield some decent data. Eventually. But a lot of young lives are going to be messed up before that happens, if more parents do not start thinking more critically about what is actually going on here … and if more professionals like Schwartz don’t come forward with their concerns, despite the considerable professional risk.

    Liked by 4 people

    • Just briefly (ha) I also appreciate what Schwartz is saying regarding the emotional dynamic between the doctors and the parents and the kids here — the power relationships and the doctors’ and parents’ objectives in using the kids’ nonconformity as a tool in their own personal growth. Also his comments about people underestimating their kids’ ability to cope with any level of confusion/frustration, leading to the desire to provide a fix. You know? I think he is very perceptive about what’s driving this phenomenon.

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  2. Wow. You have done a great service by reproducing these insights. I can only hope the psychological community is paying attention. Most notable for me was the observation that these children” have engaged the rhetoric of gender and, thus, stumbled upon a communication of such potency that their parents and therapists are detoured from listening to them as children, instead crediting them with adult-like cognition.” The explanatory power of this perspective, considered in the light of child development, is remarkable and (bringing even a basic knowledge of child psychology to mind) so obvious that I find myself shocked not to have encountered it before.
    Thank you for sharing.

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  3. I read the full thing (thx to Awesome Cat) — boy, such good stuff. I appreciate that Schwartz mentions the maternal grief reaction which is NEVER allowed to be discussed in the media; you can only be 100% supportive, you can never be sad, alarmed, resistant, grieving. You can only be noble and loving; the “good mom” is always that. Yet I remember one story, I think it was the long New Yorker one on Isaac but maybe not, where the parents had acquiesced to transition. The mom, an artist, seemed fixated on creating art that seemed to refer to her psychic pain related to Isaac’s “top surgery.” (Or whichever FTM that was.) It was very sad.

    Schwartz also refers to families being stuck in terms of the kids demanding total flexibility and the families getting zero flexibility in methods of dealing with the situation, at least from the ‘experts’ who are advising them.

    And he says that of course kids who are deeply distressed/depressed need quick action, but that parents ought to be given the option of not centering gender. In fact, of distracting their kids with other activities/suggestions/techniques of improving their happiness and social functioning. Vs. trying to talk them out of nonconforming behavior or their idea that they are trans. This has been very beneficial in our household at least, in terms of our kid’s daily happiness.

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    • And parental grief isn’t some blind or bigoted catharsis; it’s informed by our deep knowledge of our children. It is scandalous that the media denies this intimate understanding in every account I’ve seen. It’s a form of thought control, this conspiracy of silence by journalists. I am also very grateful that Dr. Schwartz approaches the issue with respect for the family system, instead of exalting the supposedly objective viewpoints of the gender specialists. In fact, he does something I’ve never seen before: he turns the psychological spotlight back onto the specialists themselves, probing their own unexamined motives and vulnerabilities. A tour de force, for sure.

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      • I think the problem is that in some cases it parents ARE blindly bigoted, in others acting out of unconscious motives that are much more about the parent’s fears than the parent’s insights into their child… and some parents are the opposite. But we can never really know which is which. As a radical feminist I see the dangers in trusting or automatically defering to the family system. But I also think that there is room to respect a family and the insights of the people in it without blindly endorsing them. still, it isn’t as simple as “the parents are always right’ or “the parents are always good-intentioned.” I wish it was. But it definitely isn’t that the doctors are right, either. And between the docs and the parents I would tend to trust the parents more. But that’s a very low bar to set!


  4. “It is more likely that the child longs inchoately for an emotional experience like respect and rapidly gains unconscious awareness of the power of gender complaints to bring such gratification. When the longing is unwittingly satisfied by the parent or clinician who, thinking they understand the child’s problem, validates the terms of the discussion as the child has set them, the child is likely to reiterate the complaint in those terms.”

    Wow. Yes! This is a dynamic between parent and child which, once firmly established, is perpetuated at a wild pace with the help of doctors, counsellors, peers, etc. The child has unmet needs, and stumbles upon gender talk — which is everywhere; it’s practically in the air the kid breathes! — as a possible way to get those needs met. But the original need actually gets buried in an avalanche of inappropriate adult attention, and goes unmet.

    Dr. Schwartz gives the right advice: “stop talking about gender.” That’s excellent, but will it be enough? Even if an intuitive, intelligent and sensitive parent heeds this advice, there’s a whole world out there to deal with, right? A Brave New World with its “progressive” schools and its brand-new library books informing elementary school children that being a either a boy or a girl is complicated matter, one involving innate feelings and sex-role personality traits which might not match their little bodies, and which may require medical interventions. This is what families, who are in the throes of pain and confusion, who are under the watchful eye of authoritarian liberalism and its medical/human services systems, are up against.

    It’s big. These confused kids (and all kids) need protection from the ideology that gender/sex-roles are inborn. And their parents need intellectual defences against the insidious onslaught. That defence, of course, comes from feminism (proper). But since the media are not really listening to us, radical feminists — since we are maligned and misrepresented — I’m glad that Dr. Schwartz is using and promoting our long tradition of anti-gender work in this paper. I hope it gets a lot of attention, even if that attention is — at first — negative.


    • Inoculating one’s child against the trans narrative when the whole society seems to have bought into it sometimes seems an impossible task. Our kids remain at risk every moment they interact in real life, and online. I am hoping more brave therapists will come forward after reading Dr. Schwartz’s deeply insightful article. We need them as allies.

      Liked by 3 people

      • I love that he correctly points out that transitioning is a deeply conservative course of action, whereas kids who are gender nonconforming can actually be leaders in teaching society something about the mutable nature of gender. This is a very good point.


  5. I’ve been chewing on this for days. The “gender essentialism” narrative is so seductive in terms of offering an apparent fix for kids’ refusal to go into the gender box that matches the anatomy. Because it sidesteps any possibility that the kid has mental health issues and/or is caught in an unhealthy family dynamic, you know? “Born this way due to physiology” is so much easier to wrap your head around than “psychological disconnect with what society expects.” The general notion, promulgated by experts and especially by these kids’ peers and by anonymous internet cheerleaders, seems to be that transition’s more like a superficial choice such as body piercing or tats or breast augmentation, vs a highly risky level of messing around with basic physiological processes (not to mention cutting away healthy parts and attempting to substitute different ones). Or maybe something like “your kid has a permanent, incurable, life-threatening condition of unknown etiology, so do this thing, because even if it’s risky, it’s the only thing the ‘experts’ know do.”

    These kids and their parents get this carrot dangled in front of them: “Sign the consents, facilitate the body changes, change the name (and turn the prior one into a ‘dead name’), use the ‘correct’ pronouns, and then you can all go forward with your ‘normal life.'” Maybe for some families that even works well, for some amount of time.

    I can really see how that feels so appealing, vs “attempt some deep explorations of individual psychology and family dynamics, and maybe live with ambiguity, and society’s distaste for ambiguity, for a very long time.” Jeez, even as a parent of a nonconforming natal female, there are days when I think it would be so much easier to countenance and encourage the transition route. And If I have those feelings, knowing all I know? I am sure people who are not exploring the ramifications of it all have those feelings even more strongly. It takes a tough kid to put up with the lack of social affirmation of nonconformity, and a tough family to ride it out alongside for weeks and months and years, waiting for the damn frontal lobes to mature so the kids could actually do something more analogous to “informed consent.” Depending on what circles you run in, there can be WAY more social affirmation for a parent allowing and facilitating early transition than for a parent who’s letting it ride, encouraging caution, monitoring the kid’s health/safety but not trotting off to the gender clinic. (Caution, after all, is likely to get you labeled a TERF and accused of ‘misgendering’ your own kid and deliberately putting the kid at risk of suicide. Whereas fast action toward transition will get you patted on the back for your oh-so-progressive ‘bravery.’)

    So keep bringing us the good stuff, 4thwave. For me, at least, it helps me believe I’m not nuts.

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    • You’ve summed everything up so well here, Puzzled. You and I are looking into this stuff, but so many parents see nothing but the media stories celebrating transition as the only answer. The thought policing around dissent is very effective, especially when the 41% suicide attempt rate is trotted out (which it always is in the media). I was pretty shocked when I actually read the Williams Institute report (source of the 41% stat) to see how much mental illness is not addressed, nor controlled for in the data. And it’s politically incorrect to even suggest that addressing psychological issues might be a better avenue for treatment than lumping everything into “gender dysphoria.” I have my fingers crossed that some intrepid journalist is going to explore these issues more deeply–because after all, the way most people learn about things is through the media. Reporters have a duty to delve into what we’re talking about here. When will they?

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      • I’m afraid it’s not going to happen until the big lawsuit happens … class action by former ‘transkids’ with health troubles or big emotional blowback as adults, or just a particularly nasty single suit by a particularly loud former ‘transkid’ who’s pissed about what was done to him/her, accompanied by a particularly loud team of lawyers. I honestly think that’s what it’s going to take. There are so few publications that invest in investigative journalism now. People just expect to get their news from blogs and twitter. (Jeez, 4thwave, YOU and gendertrender are the investigative reporters now, unpaid and fueled by righteous anger. For which, thank you.)

        Alice Dreger’s experience in trying to move the medical community away from ill-considered surgeries on intersex kids is instructive here; I recommend ‘Galileo’s Middle Finger,’ her new book, regarding the difficulty of making these things change, even when there are strong voices from within the affected community finding allies in medicine and academia.

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      • I fear you may be right that it’s going to take a bunch of damaged people and a lawsuit, but I haven’t yet given up hope that there might be some reporters who will pick up the thread. Thank you for your kind words. It’s sad that true investigative digging is left to obscure bloggers in a corner of the Internet…

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    • “Depending on what circles you run in, there can be WAY more social affirmation for a parent allowing and facilitating early transition than for a parent who’s letting it ride, encouraging caution, monitoring the kid’s health/safety but not trotting off to the gender clinic. (Caution, after all, is likely to get you labeled a TERF and accused of ‘misgendering’ your own kid and deliberately putting the kid at risk of suicide. Whereas fast action toward transition will get you patted on the back for your oh-so-progressive ‘bravery.’)”

      Yes, Puzzled. Absolutely. That seems to me a very important observation. For parents to decide not to do anything, not to seek medical advice, but just to let things play themselves out, expecting the situation to resolve spontaneously (which it generally does), can — in certain circles — be perceived as negligent or worse. But playing a part, adopting an identity, sometimes for years, is very common in children. One of my sons spent his pre-school years “being mummy”, playing with his baby doll and his stroller. Didn’t even cross my mind to label this gender dysphoria. It wasn’t. He’s now a young adult. He still loves babies. A lot of teenage boys do.

      As for me, I spent several years being a pony. I trotted everywhere, tossing my mane and whinnying. What if my parents had been fashionably supportive to my species dysphoria? I might now be the first human/horse hybrid.

      Joking apart, the idea that a child enjoying activities that are identified in its family/community with the other gender means that they must wish to transition is not reasonable or thoughtful. To encourage transition with the use of heavy duty medication on the flimsy evidence described in this very interesting paper is just appalling.

      Does none of what we know about the evils of rigid gender roles and expectations filter through to these therapists? In some communities being a boy gives blatant advantages and, in such communities, there will be a lot of girls who long to be boys. Of course it’s not the penis they envy, it’s the freedom and the status. Now, if they’re very unlucky, they may find themselves being corralled into a role they never meant as more than child’s play. I cannot see the medicalisation of child GD as anything other than child abuse.

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      • The other crazy thing is, the gender specialists say 100% of the puberty-blocked kids choose to go on to cross-sex hormones. Assuming this is true, why the heck do you think that is? What kid (with an immature/prepubescent body AND brain–because their puberty was frozen, their BRAIN isn’t pubertal yet, either) is going to change their mind, when all the ADULTS are telling them they’re actually the opposite sex? The terrible risks (including sterility) don’t mean anything to that immature child. It’s utterly mind blowing, with what we know about executive function (specifically: awareness of future consequences and judgment) not being developed until at least the mid-20s. And the young people who will have that level of brain maturity at 25 didn’t have their puberty blocked. The whole thing is based on a flawed, circular argument.

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    • Puzzled, you wrote: “The general notion, promulgated by experts and especially by these kids’ peers and by anonymous internet cheerleaders, seems to be that transition is more like a superficial choice such as body piercing or tats or breast augmentation, vs a highly risky level of messing around with basic physiological processes” is so true. No big deal, accept it and let’s all be happy.

      My 19 year old daughter now tells me the trans party line: people can do with their bodies as they wish. Ugh, what if I don’t care to be witness to that, and neither do the other people who have known you for years. We don’t want to see it, unless we can be assured there is absolutely no other way for you to be happy with yourself. Can’t you find another way to be happy in your own skin…because we all love you as you are…the second you were born. Coveting the body of the other sex seems like a fool’s errand anyway.

      With the T lumped in with LGB, my daughter seemed to think that “coming out” as transgender was like “coming out” as it would be for LGB. Family should just accept it. She is who she is. She is who she says she is, a transgender person.

      But changing one’s gender identity is absolutely not the same as announcing one’s sexual identity. It isn’t about who you love, unless you consider it has everything to do with love for oneself. One’s gender identity becomes a part of others’ identities the second you are born and the announcement is made of your sex…based on REAL body parts. “It’s a girl/boy” becomes lodged in other people’s brains. To change your identity in OTHER people’s heads should not be considered a superficial choice. One’s decision to change gender identities could very well relieve their own anxiety, for whatever reason, but to do so without counsel regarding changes in interpersonal relationships is irresponsible on the part of the psychological community.

      It’s not superficial when it so powerfully affects how others view you and relate to you…unless of course one prefers to be a hermit. But then why would a hermit go through transition, right? A hermit transgender would be the true transgender, the transsexual who can’t live in the sexed body as it developed and so feels an overpowering need to change it.

      I am disturbed by how huge the Transgender Umbrella is. It used to be Transsexual. Now it is being overrun by those who simply wish to socially transition. This needs to be addressed. Social transition should not receive the same treatment as true bodily-based sex-based dysphoria. Different things, same treatment?


  6. Pingback: UK’s “Gendered Intelligence” has been indoctrinating students for the last 7 years, Daily Mail “can reveal” | 4thWaveNow

  7. Pingback: A commentary on the treatment of trans kids and the groundbreaking critical article by David Schwartz, PhD . . . | ThinkingAboutGender . . . Critically

  8. I just discovered your website via, and am extremely relieved and grateful for the information you provide. I’m sure I will comment more as I make my way through your blog. Right now I’m just digesting all the information. My 15 yo daughter, who previously had very little history of any gender-non-conforming behavior and no obvious other mental health issues, began talking about being a boy over a year ago. She had done thorough research on the internet, and introduced me to words like “dysphoria” and “pan-sexual”. Although we enjoy an excellent relationship and good communication, with time, we both agreed it would be best for her to see a therapist, so that she could freely talk to someone who was not emotionally invested in the outcome, as I was. We found a therapist a a women’s health center (something my daughter and I discussed, and she was OK with it). Although I like the therapist, and she has certainly not rushed us toward any medical/hormonal treatments, I am concerned that there’s too much focus on extablishing the “correct” gender identity, and not enough on what else may be going on that underlies what I perceive as an abrupt shift in my daughter’s relationship to her physical body. At the moment, I am curious if there are any resources for finding therapists/psycholanalysts who share Dr. Schwartz’s views.


    • Justyna, I wish we had a directory of therapists who didn’t immediately accept and affirm our children’s self-diagnosed trans identities, but there isn’t.

      4thwavenow, did have a therapist write in and recommend how to find one, though. Here is the link:

      Unfortunately, if you are in some areas (in the United States: California, New Jersey, Illinois, Oregon, the District of Columbia and the city of Cincinnati, Ohio; in Canada: Ontario; not sure about elsewhere), there are laws in place that restrict mental health professionals from questioning someone’s gender identity.

      I wish you luck in trying to reach your daughter.


  9. Pingback: International Psychoanalysis » Blog Archive » One psychologist who gets it

  10. I had occasion to recently meet a child psychologist and sit in her office. What a scam child psychology is. The main pretend clients are the children of parents who are getting divorced. But the kids are not the real clients. The real clients are the parents trying to assuage their guilt.


    • I see from your website, Colin, that you are a practicing neuropsychologist. Do you think all child psychologists are scammers? It seems to me that many were previously informed about developmental psychology, adolescence, and so forth. But with the rise of pediatric transition and “gender therapists,” so much of this knowledge appears to be being ignored by clinicians. However, you seem to be painting the whole profession of child psychology with a broader brush. Do any of your colleagues in the neuropsychology field take a similar view, as far as you know?

      Not sure if you’ve read it, but there have been two posts by psychologists on 4thWaveNow who are thinking critically about the current state of clinical psychology in light of the burgeoning number of trans kids/teens. One left her post because she felt her clinical judgment was no longer valued. The other, David Schwartz, wrote an excellent journal article critiquing the approach taken by many gender therapists.


  11. Pingback: The BBC controversy, clinicians and the politics of gender identity « freer lives

    • This comment actually contained reasonably-worded criticism, but because of the user name, we deleted all the content.

      Anyone watching: If you want your comment published and you object to something the author or other commenters have said, behave like an adult instead of a bratty kid.

      As our comment policy clearly says, comments are moderated and we make no guarantees that any comment will be posted. There are plenty of other places on the Internet where you can scream at anyone you disagree with.


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