Skeptical gender therapist: “A medical doctor is not a candy seller”

candy seller

In yesterday’s post, I focused on the situation in the United Kingdom, where the school system is deeply enmeshed with a trans activist organization which peddles its message to kids as young as 4 years old. And the majority of posts on this blog document the seemingly unstoppable trend to diagnose and treat children as “transgender.” With this overwhelming level of societal and medical support, the issue must be pretty much settled—right?

Not according to the gender specialists themselves, it isn’t.

Hot off the presses, in the October 2015 issue of the Journal of Adolescent Health, a team of Dutch researcher-clinicians report findings from a survey of gender clinics which serve dysphoric children around the world.

Although you’d never know it, judging by the accelerating trend to socially “transition” kids as young as 3, freeze adolescents’ natural puberty with GnRh agonists, and then move on to chemical sterilization via cross-sex hormones thereafter, there is no  consensus amongst gender specialists that this current treatment protocol is the way to go.

The qualitative survey, entitled “Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study” was conducted by a group of well-known Dutch researchers/gender specialists who are themselves actively involved in administering puberty blockers and other treatments to “transgender” children. The authors surveyed 17 treatment teams (endocrinologists, psychologists, MDs, psychiatrists, ethicists) regarding their views and experiences.

Many of the parents who contribute to and read this blog agonize about their difficulty finding therapists and doctors critical of the I’m-trans-if-I-say-I-am paradigm. I hope this post gives some measure of hope to those parents. While the skeptical specialists (nearly all of them psychologists or psychiatrists, with most endocrinologists and pediatricians apparently submitting pro-transition comments) are quoted anonymously, at least we know they’re out there. And enough of them exist to tell us that the runaway pediatric transition train may not have completely lost its brake pads—yet.

The journal article can be read in its entirety here, and the abstract summarizes the key findings:

The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no consensus exists whether to use these early medical interventions…

Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-)availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived…


As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment. Therefore, more systematic interdisciplinary and (worldwide) multicenter research is required.

Because my aim here is to show that gender specialists are not unanimously aboard the child transition bandwagon, this post will mostly highlight the comments from the more skeptical gender specialists surveyed. Amazingly (to me), the doubters seem to hit nearly all the same points I do in my blog posts.  [Note: Use of boldface to emphasize certain passages is my own, not that of the authors.]

So what is gender dysphoria?

Is GD a normal variation of gender expression, a social construct, a medical disease, or a mental illness? In the DSM-5 and the to-be-released ICD-11, the main challenge in classifying GD has been to find a balance between concerns related to the stigmatization of mental disorders and the need for diagnostic categories that facilitate access to health care, payment by insurance companies, and the communication between diverse professions.

I spend a fair amount of time reading articles and social media posts authored by gender specialists. It’s quite evident that there is currently pressure to completely de-stigmatize the transgender diagnosis…yet still find a way to get the “treatment” paid for by private insurance companies (or the taxpayer via public insurance such as Medicare or Medicaid). This thread from the WPATH public Facebook page [commenter names redacted] is illustrative of the dilemma the survey authors point to in the passage above.

wpath gender incongruence

So, this thread seems to indicate that providers are moving away from gender dysphoria as a disorder; even as an experience which causes distress. But why then would there be a need for medical treatment? This conundrum is addressed by the 17-clinic survey authors:

The interviews and questionnaires show that most informants find it difficult to articulate their thoughts about this aspect. Most see GD as neither a disease nor a social construct, but as a normal, but less frequent variation of gender expression. However, some note that you would not need medical procedures to make the lives of people with GD more satisfying if it were merely a normal variation.

Another thread from the WPATH public Facebook page seems to justify transition services for someone who just wants a “joyful and loving life.”

wpath joyful life

But when it comes to young people, at least one psychiatrist in the survey study gives us a less sanguine view of such quality-of-life justifications for medical transition:

“I find it extremely dangerous to let an adolescent undergo a medical treatment without the existence of a pathophysiology and I consider it just a medical experimentation that does not justify the risk to which adolescents are exposed. Gender dysphoria is the only situation in which medical intervention does not cure a sick body, but healthy organs are mutilated in the process of adapting physical and congruent psychological identity.” –Psychiatrist

I feel certain at least a few of the parents who frequent this blog wish they had the office phone number for this reasonable clinician. Amirite?

On the wisdom of puberty blockers

How many of us have asked, “but what if puberty blockers also inhibit the psychological/neurological maturation that comes with puberty–and beyond?” And, because many kids actually outgrow their gender dysphoria, interrupting puberty would deny them the opportunity to become comfortable in their bodies and avoid a life as a permanent medical patient.

It’s a pleasant surprise to see an acknowledgement of some of these concerns here:

In the literature, the concern is raised that interrupting the development of secondary sex characteristics may disrupt the development of a gender identity during puberty that is congruent with the assigned gender. The interviews and questionnaires show that some treatment teams share this view.

One clinician even talks about lesbian women who would have been misdiagnosed as “trans” children in an earlier time.

I have met gay women who identify as women who would certainly have been diagnosed gender dysphoric as children but who, throughout adolescence, came to accept themselves. This might not have happened on puberty blockers.”–Psychologist

So at least one psychologist who works on a pediatric transition team acknowledges what many, formerly gender dysphoric women, say: that if there had been “gender clinics” for kids in the 1950s, 60s, 70s, or 80s, they would not be happy lesbian adults today, but sterilized “trans men.”

Speaking more broadly, another therapist has this to say:

“I believe that, in adolescence, hypothalamic inhibitors should never be given, because they interfere not only with emotional development, but [also] with the integration process among the various internal and external aspects characterizing the transition to adulthood.” –Psychiatrist

On co-occurring psychological/psychiatric issues

If you read through the part of this blog where most parents congregate and introduce themselves for the first time, some common themes emerge. One is the observation by many parents that their kids have other mental health issues, nearly always predating the (sometimes sudden) announcement that they are transgender.  While most activists insist that transition is the cure for what ails a dysphoric child or teen, the clinicians working in the trenches aren’t so sure.

The risk of co-occurring psychiatric problems in children and adolescents with GD is high. The percentage of children referred for GD who fulfilled DSM criteria of at least one diagnosis other than GD is 52%. The psychiatric comorbidity in adolescents with GD is 32%. Another study shows that 43% of the children and adolescents seen in a gender identity clinic suffer from major psychopathology. To date, the precise mechanisms that link GD and coexisting psychopathology are unknown.

Miscellaneous physical and psychological risks of medical transition

The surveyed clinicians acknowledge many of the concerns discussed regularly on this blog.

The possible consequences of suppressing puberty for cognitive and brain development are unclear and debated at this moment. The normal pubertal increase in bone mineral density may be attenuated by puberty suppression, and it is uncertain if there is complete catch-up after treatment with cross-sex hormones.

While it only merits one sentence (and no direct quotes), the surveyed clinicians appear to view sterilization as an important concern:

In the interviews and questionnaires, the loss of fertility was often mentioned as a major consequence of treatment.

And here’s an additional worry I haven’t seen in writing before: the potential negative impact of puberty blockers on future SRS surgery.

In addition, various informants stressed the importance of the fact that the penis and scrotum should be developed enough to be able to use this tissue to create a vagina later in life. Very early use of puberty suppression impairs penile growth and consequently makes certain surgical techniques impossible.

Will we see this rather thorny issue discussed on an episode of the Jazz Jennings reality show? Will the Tumblr trans activists screaming “now or never” take heed?

On whether kids are mature enough to make these decisions

One informant stated that the decision whether to start with hormones should only be made during adulthood: “We should facilitate his or her process of integration in the society and if he or she would undergo hormone- and surgical treatments he or she could decide [on this] during adulthood.” —Psychiatrist

Influence of the Internet and social media

You know how trans activists scoff at our observations that our kids only started talking about “transition” after binging on YouTube and Reddit?

They speculated that television shows and information on the Internet may have a negative effect and, for example, lead to medicalization of gender-variant behavior.

They [adolescents] are living in their rooms, on the Internet during night-time, and thinking about this [gender dysphoria]. Then they come to the clinic and they are convinced that this [gender dysphoria] explains all their problems and now they have to be made a boy. I think these kinds of adolescents also take the idea from the media. But of course you cannot prevent this in the current area of free information spreading.” –Psychiatrist

Hello? The Advocate? The Boston Globe? The Washington Post? Anybody?

Furthermore, interviews and questionnaires show that treatment teams feel pressure from parents and adolescents to start with treatment at earlier ages.

Puberty suppression has been adopted as part of the treatment protocol by increasing numbers of originally reluctant treatment teams. More and more treatment teams embrace the Dutch protocol but with a feeling of unease…these professionals also have doubts because of the lack of long-term physical and psychological outcomes.

Hey, journalists. Obscure blogger over here quoting actual gender specialists, so you can’t say it’s just a bunch of nervous Nellie-moms making shit up. Need the link again? Oh, that’s just the abstract, here’s the pre-publication full-text, right here.

Self-harm/suicidal ideation

For several informants, a reason to use puberty suppression was the fear of increased suicidality in untreated adolescents with GD. Research shows that transgender youth are at higher risk of suicidal ideation and suicidal attempts. Nevertheless, caution is needed when interpreting these data because they do not show causality or directionality.

The meaning of that last sentence is crystal clear, and entirely in accord with what I, and other critics of the harmful “transition or suicide” meme that adult trans activists continually propagate, have tried to point out. While no one disputes that there is a higher self-harm and suicidality rate amongst trans-identified young people, there is no evidence that such self-harming behaviors and thoughts are ultimately alleviated by “transition.” Further, as this sentence implies, the “directionality” could be the reverse of what trans activists promote. Having a trans identity and/or facing the monumental prospect of medical transition could be a cause of self harming (in addition to the preexisting or comorbid mental health issues so many of these young people seem to have).

This is not the moment for another flippant call for journalists to take heed. This is deadly serious business: the terrible toll of self harm and suicide among trans-identified youth.  I have not seen a single news treatment of suicide or suicide risk that has even hinted at what these clinicians are stating baldly. Isn’t it time for a more nuanced discussion?

And finally: Leave it to a medical ethicist to point out the huge logical fallacy in the “informed consent” model of treatment now running rampant:

“The fact that somebody wants something badly, does not mean that a health care provider should do it for that reason; a medical doctor is not a candy seller.”— Professor of health care ethics and health law

Imminently sensible. So how is it that “informed consent” and the demonization of “gatekeepers” is more and more the norm? How is it that self identification as trans, even for young children, is fast becoming the only requirement for obtaining treatment? There is something strange going on here. If even some experienced gender specialists  are expressing doubts, why does the media behave as if the issue has been settled?

The positive attitude of many health care providers in giving hypothalamic blockers…is based on the need to conform to international standards, even if they are conscious of a lack of information about medium and long term side effects.” –Psychiatrist

But how can there be “standards” (they are talking about WPATH here) that these providers feel pressure to conform to, if the standards are not based on solid information about risks and benefits? Exactly which cart is pulling this runaway horse?

As still little is known about the etiology of GD and long-term treatment consequences in children and adolescents, there is great need for more systematic interdisciplinary and (worldwide) multicenter research and debate.

Reason for hope?

The article concludes in a way that makes me feel a whisper of hope for the future.

Several professionals mentioned that participation in the study made them think more explicitly about the various themes, and it encouraged them to discuss the issues in their teams. In the Dutch teams, we therefore introduced moral deliberation sessions to talk about these ethical topics. The first reactions of the professionals were positive; the sessions made them rethink essential aspects of the protocol.

Will this “moral deliberation” and “rethinking” result in more caution, or even a desire to put a halt to the pediatric transition train? Time will tell, but it is encouraging that at least the Dutch researchers may be losing some sleep in pondering the incredible power they wield over the lives of children and their families.

At least we know there is controversy. At least we know they are not all marching in lockstep.

And that is something.

35 thoughts on “Skeptical gender therapist: “A medical doctor is not a candy seller”

  1. Nice post! The phrase inthe beginning is what I always think. I m surprised(but no so much) that there are trans-sketcipal for children. But I am just wondering if they are also sketpic for transition in adulthood, because there are some points in common… for example that there is not a model for GD.

    Liked by 1 person

  2. This is a great post. I wish that there was time to put this before the UK Parliamentary Enquiry . In all the televised debate that I watched the chair kept coming back to issues such as waiting times and referral procedures from children’s to adult health services. NO questions were asked about
    the actual scientific validity and long term outcomes of medical intervention at ever earlier ages.

    In the meantime the advocate groups with their government funding, the sensation seeking media and a naive public just let that trans train keep on running.

    Liked by 3 people

  3. It is encouraging that they’re either beginning to question or merely beginning to express these concerns. But it’s disheartening that they have to remain mostly anonymous to do so.

    And, to put it layman’s terms, they need to go further and admit that the entire concept of an innate “gender identity” is a social construct They talk about the assumption that there must be a “congruence” between one’s so-called “gender identity” and their body. In other words, a person has to “match”. But what is called gender identity are really just normal variations of personality, interests, and personal style They need to come right out and say that there’s no need to “match”, that it’s OK to be “mismatching”, and, indeed, that there’s nothing TO match because the above-mentioned traits are not innately linked to a person’s sex.

    Secondly, they need to come to the logical conclusion of their admitting the presence of co-morbidity of GD with other disorders and admit that medical transition is nothing more than enabling the symptoms and leaving untreated the underlying issues that make the patient GD in the first place. With this in mind, it’s no wonder that transition really doesn’t help those are suicidal. They need to see that medical transition for those with GD is really little different from treating anorexia with liposuction.

    And concerning ethical issues, they need to strongly emphasize that children cannot give informed consent because of uncompleted cognitive development. NO child should be transitioned, ever. Childhood medical transition needs to be completely banned.

    Liked by 6 people

    • I would ban childhood social transition as well. This does NOT mean children should be forced into gender boxes that feel unnatural to them. If Josh wants to wear pink and play with Barbie, by all means let him! The same goes for Emma, who hates dresses and loves Ninja turtles. But Josh should still be Josh and not Joslynn, and Emma should still be Emma and not Emmett. If they want to transition socially, I’d say the minimum age should be high school. Even that would depend on the maturity of the individual. The kid would have to show that he/she is capable of abstract thinking (a la Piaget’s formal operational stage, not concrete operational and absolutely NOT pre-operational).

      Liked by 6 people

      • Funny how decades of knowledge about child development seem to have been jettisoned in favor of accepting at face value a child’s declaration that they are transgender. No matter how old the child, no matter what stage of brain and psychological development they are in. I really wonder how child psychologists have been convinced to go along with this. Why aren’t more of them speaking up? It’s a serious question.

        Liked by 3 people

  4. This is tremendously reassuring (though I share the previous commenter’s concern about the fact that so many people felt the need to remain anonymous while expressing skepticism). I wish we could see a discussion like this in the U.S. and other parts of Europe. We need more balanced, scientifically based decision making around these life-changing issues. In the mean time, despite my daughter’s continued insistence on using a male name and pronouns, I keep repeating the mantra, “no hormones, no surgery” in the hope that she’ll be able to better understand the implications of those things. If only I could find a doctor I trust to explain that to her!

    Liked by 1 person

    • I couldn’t help making the connection between them and us parents in this need to remain anonymous. Our reason is obviously that we need to protect the privacy of our children (unlike, apparently, all of these parents who are parading their “trans kids” in media stories). It would be wonderful if the skeptical clinicians would come forward, have the courage to express their unvarnished doubts to the public. Maybe then the media would start paying more attention instead of simply behaving as lapdogs to trans activists. I see this study, and if it is to be believed, the clinicians’ intention to start thinking about the ethics of what they’re doing and discussing it amongst themselves, as a step in the right direction. I think I might contact the study authors to see if I can get more information.

      Liked by 4 people

      • It is very unfortunate that these doctors cannot be “out” about their views, especially when they are basing their views on actual science. These doctors are the ones who could really help the children of the parents who post here. But how are the parents supposed to find them?

        Liked by 2 people

      • Hi. Mom of a lesbian who wants to tranition here. Your blog has brought my sanity back. Thank you for all the work you do. I found you 4 months ago and was so happy there were critical questions being raised about this movement. I could not understand why through my internet searches, I could only find “glowy” stories about how great life is on the other side. I thought there was some conspiracy…who could be controlling the net and media to the point of not 1 person providing a critical look at this movement (cult). I was so happy when I found you. The reason I am writing a reply here is that you mentioned the media. By reading comments and experiences of other parents, I realize that our kids’ experiences are not very unique. In fact, they are very cookie cutter. Internet binges, sudden disclosure, histories of cutting or self harm, depression, anxiety, self-loathing, suicidal ideation…then the emotional blackmail, the playing of “the suicide card.” Dissociation. It’s all there. The belief their problems will magically go away … I want to add 2 things I haven’t read from other parents yet. I wonder if others kids are doing this. First, bullying. I ha e read that many of these kids have been bullied, but I cannot tell you how fed up I am watching as my daughter attempts to force herself onto members of society. Imagine a teenager who hates a particular teacher. Now the gender thing comes up, and daughter is demanding the proper use of pronouns and a new name. All but 1 teacher go along with it. My daughter is having a great time “telling on” the despised teacher…reporting her to the counselor and principal. What a privilege to be able to get your least favorite teacher “in trouble.” I am disgusted with her attitude at the moment. Also, she is seeking celebrity. Jazz has his show, and site and celebrity…and my daughter had to hurry up and tell our extended family asap so she could start posting on YouTube *as if people care!* So I ask, are these kids looking for celebrity? They are sooooo misguided and have no clue about how the world works. Once ahe is out of this safe, very liberal, school as the token trans kid and out in the world, this bullying won’t fly. “Stop misgendering me!” Huh? Someone calls her “her” because that is reality, but society is supposed to bod and agree that the sky is purple? I don’t think so. So many of these kids don’t realize they have walked into a very volatile social, political movement and will be pawns. The thought they can just bully and harass people into agreeing with their dilusions is disturbing.


      • Glad you found us, eyeswideopen. You’re very welcome here–please stick around and keep us updated on how you and your family are doing.

        Have you seen the latest post for parents of kids like yours (you mentioned Internet binges and sudden disclosure)? Please consider participating in the survey. The researcher is the first to actually systematically investigate the phenomenon so many of us parents are experiencing. See here:


  5. Part of me wants to congratulate those Dutch folks for looking at this.

    But a way bigger part of me is simply ENRAGED that they have waited until NOW to look seriously at the ethics of the protocol they have developed and promulgated. Just NOW they are discussing the morality of it? Seriously? Just NOW they are taking the time to collect some honest opinions from among the ranks of the folks who are out there treating kids and adolescents with the protocol?

    Why were they not discussing the morality of this back in the early days when they were messing about with it (and of course the endocrinologists are some of the big boosters)? Why were they not asking these questions about effectiveness and sterility and health and self-harm back before Dr. Norman “It’s So Cool What Hormones Can Do To Tadpoles” Spack came around to investigate and walked away “salivating” to give it a shot in the U.S.? Why were they not asking before Dr. Rob Garofalo of Chicago, he of the “major self-doubt but we gotta hop on or be left behind” quotes, used Jennifer Pritzker’s big bucks to found his gender clinic at the most respected Children’s Hospital in the city? Why were they not asking before Dr. Johanna Olson in LA started pushing against even the weak cautions in the protocol and talking about skipping the blockers altogether and just going straight to the hormones for her insistent/consistent/persistent gender nonconforming pediatric patients?

    Now there are clinics popping up like weeds; there are lawmakers lining up to sign legislation based on principles regarding gay conversion therapy that have trans lumped into the language (so a lot of us can’t find treatment for comorbid issues in our kids because of the psychs’ assumptions that the kids are simply trans); there are groups quietly pushing this agenda into the primary schools; there are people who’d like to help your ‘unsupported’ daughter by sending a binder in a plain wrapper; and there are school districts spending time and money trying to figure out how the hell to respect the rights of all their teen students … yeah, I’ll set the whole locker room/bathroom discussion aside for another time.

    So, erm … thanks a lot, ya Dutch “pathfinders,” for what you’re doing now to actually think about the human cost of your ill-considered protocol, largely created through your “need to conform” to the ideas of the WPATH folks. At this late date. Good luck slowing down the train you engineered and sent out into the world. As for media attention to the doubt within the ranks? Not very sexy, doubt. And the inability to quote doubting professional sources because they are terrified of career blowback … that’s a problem, too, media-wise.

    Holy shit, there is so much wrong with this situation. Seriously, I firmly believe that only sp,e scandalous lawsuits, some sad future crash-and-burn tales, are going to be considered interesting enough for media to pay attention at this point. At the moment, they are all blinded by the mermaid glitter and the warm progressive feels. The beneficial evolution of the human race. The presumed march against bias and prejudice and bigotry. Ya know?

    Ai yai yai. As always, 4thwave … you da bomb. Every post affirms the decisions spouse and I are making with regard to our kid.

    Liked by 7 people

    • Righteous rant and spot on. When I read the last bit about the “moral deliberation” sessions they’ve started that are causing them to “rethink” the protocol, it seems the only reasonable outcome should be calling for a HALT to kid transition since (by their own admission) so much is unknown. It’s hard to understand how they can call for more research and data, when, to get the data, they have to keep experimenting on kids. (At least one of the skeptical clinicians actually called it experimentation, thankfully.)

      Maybe I’m reading between the lines, but I have to wonder if these people are maybe having some regrets about what they started when they opened Pandora’s box. Thank you for giving eloquent voice in this comment to the profound frustration I experience with every post I write. I do feel it’s up to the media to start paying attention to the doubts expressed by the researchers who let the horse out of the barn in the first place. I am going to be thinking about how to attract the attention of more reporters, and anyone reading this–please do the same.


  6. Interestingly enough, the titular phrase is close in spirit to what my family doctor said when I went to him at 15/16 asking about transition. He basically said that little could be done for me unless I was already living as male, and suggested they put me on the waiting list for counselling. Bear in mind this was 10 years ago when there was far less in the media about trans people and especially children (I knew of the singer Kim Petras who transitioned early, but in everything I had read about her, it stated that she was exceptional to do this at such a young age.) It’s probably very different now, at least in the UK where I live; but I imagine that if you have a very busy doctor and/or a surgery where waiting lists are long, the outcome might be similar. (Recently I had to wait three weeks to see a doctor about an eye infection with obvious symptoms, and still couldn’t get a prescription for it!) Although I don’t advocate making a child feel that his or her concerns are being dismissed, part of the reason I did not end up transitioning was that I felt I wouldn’t be taken seriously when I tried to ask about it …


    • “Gatekeeping” has become a dirty word but that’s exactly what is needed. Did you read the section where the authors say the gender specialists are feeling pressured by parents to transition their kids early? Of course they shouldn’t succumb to the pressure. But it was an interesting comment. The idea of “patient driven” healthcare has been taken to the point of insanity in this area.

      Liked by 2 people

      • Yes, you’re quite right, overworked doctors will now just sign off the patient for surgery/hormones as they have to move onto the next one quickly and are basically under orders that what the patient says on this one should go. (Interestingly some of my family is from Japan where trans people aren’t too visible in society or the press, but even though there is not much published about hormones/surgery, several doctors will still prescribe it believing it to be the best thing to do in the absence of more data about it)


      • “In the absence of more data”! It’s a worldwide experiment and all the providers know that. Yet the activists and the media never even hint that there might be adverse consequences down the road…


  7. That’s just it though, there are no major long term studies about the effects of cross sex hormones etc. It’s like where smoking was in the 1960s – everyone knew it caused cancer but with no one willing to hold up the proof, you were “only” allowed to publicly say it led to heart disease

    Liked by 3 people

  8. Pingback: Skeptical gender therapist: “A medical doctor is not a candy seller” | 4thWaveNow | Stop Trans Chauvinism

  9. Pingback: UK pediatric transition referrals DOUBLE in SIX months, girls far outnumber boys, most under 10 years old | 4thWaveNow

  10. It is good to see this article, I really think that if there is any hope of more critical research around these issues it will come from Europe and not the US. I find the whole thing maddening, I mean it seems like even if you are an enthusiastic supporter of gender transition, you should at least acknowledge that gravity and severity of what hormones/transition/surgery are, and use some caution with it. Instead it has become typical in many cities in the US to do even less screening than you would do for simple depression or anxiety.

    What is worse is the intense political pressure for clinicians to not express other opinions, and the idea that to question this makes you a bigot. Like you have pointed out on your blog, there are clinicians who do have different views, but they feel driven into silence out of fear of losing their jobs, or just being “uncool” and being ostracized. I am really interested in changing this, but I feel lost in how to go about it. When I talk to people about it in the field, they often agree with me and are concerned but also feel like they can’t say or do anything. I know that even within the WPATH itself there are people (particularly more senior people who have been around this for a long time) that are also concerned about how things are changing, but they don’t feel they can do anything about it either. The clinical community around these issues is completely overrun by ideologues, and the younger generation just thinks the people who express caution are out of touch and not with the times. A couple of people have said we just need to wait for there to be more regrets before the conversation can be opened, I reluctantly think they may be right, but that seems like a wholly unsatisfactory solution.

    Have you seen this article? I think it really captures the mentality of much of the clinical community on this issue. Can you imagine excitedly describing a gender-questioning client as a “slam dunk”? It is madness. Also, although the author is critiquing this idea, she is mostly critiquing from the point of view that not enough people are getting this treatment. I’m not sure who I am more angry at, her or the people she is critiquing.

    Incidently, the author of that piece was also on the committee to create the APA guidelines for gender dysphoria. I saw a presentation of hers presenting an earlier draft of these guidelines. It was clear she thought of this a social justice crusade, her powerpoint had pictures of various trans people that committed suicide, and she apologized for the part of the guidelines that said “there is no scientific consensus for working with gender dysphoric children” which an outside reviewer made them put in. She reassured us that “the committee had five out of ten trans and gender non-conforming people on it”. How could such a committee be unbiased? Someone else said we need to have new research to refute that earlier research. It is almost like the goal is to transition people.

    Thanks for your blog, it seems like in particular you do a really great job of organizing people and creating a platform for people who have various critical views to gather, and I appreciate reading it.

    Liked by 2 people

    • Wow, thank you so much for your comment. I think it’s clear that there are clinicians trying to put the brakes on this, but they all say the same thing, that they feel like they can’t. But don’t you think there is power in numbers? Why can’t some of these people start communicating with each other, maybe even form an organization (even if some of the members have to remain anonymous), issue press releases, etc.? It’s like anything else, I guess. Change will never happen unless people **join together** to do something. I love your blog and I hope you’ll continue to comment here. In fact, if you could introduce yourself and your work to readers here who aren’t already familiar, I think that would be great (links welcome!).

      And thanks for the insight about the APA process of formulating those awful “guidelines.” Are clinicians bound by them in an official sense? And I can hardly face the possibility that nothing will change until a bunch of sterilized adults file a class action suit in 20 years. It would really help if regular reporters would decide to write an article on the skeptical clinicians–instead of leaving it to bloggers like us to elucidate.

      Thank you very much for your support.


      • Also, there is so much important information in your comment (including the link to the “slam dunk” article and insight into the APA committee). I would like to elevate the comment in a post, if that’s ok, for greater visibility. Further, if you want to add or expand, a longer guest post would also be welcome.

        ALSO. This is a very interesting post. A psych student talks about the syllabus for a master’s level class on counseling transgender clients. Worrisome–and typical?

        And the syllabus here:

        Liked by 1 person

      • Yes, I can introduce myself. I am thirdwaytrans, the author of the blog The short version of my story is that I transitioned MTF at age 19, and then detransitioned at age 39 around 2 1/2 years ago. My returning to my birth gender was partially a result of my studies in a Master’s program in counseling psychology, and partially the result of a lot of therapy that included work on childhood trauma which directly related to my gender issues. I also have worked with trans and gender-variant clients as a clinician during my two internships, one during my master’s program at our in-school clinic and another at a queer counseling center. I was moving towards licensure as a marriage and family therapist, but then decided to go back to a PhD program in clinical psychology in part to do research around these issues, but I am finding it is actually taking me away from working on these issues rather than toward them, as the beginning of the program is very heavy coursework and I no longer have much time to write or do things outside of school. You can hear more about my story on my blog.

        I agree with you the joining together is important, and I am thinking of ways to do that, and would certainly join other people’s efforts. It is really a problem that people write to me asking for referrals to clinicians and I usually have nowhere to send them.

        Any statement from the APA about clinical work only effects clinical psychologists and not other mental health professionals like psychiatrists, counselors, MFTs or clinical social workers. Also, as the statements are “guidelines” and not “standards” they do not bind people. However, they still have a large effect as people look to them for guidance, they might be cited in court cases, and could be used as evidence in a malpractice suit for instance,


      • Also, to answer your other comment, which it won’t let me reply directly to for some reason.

        I did see that syllabus and article that you mentioned. I have attended four separate trainings for working with transgender clients and they all were more or less like that. They 100% focus on cultural competency and getting to know the population and how to support them and nothing else. These issues are very important and I agree with including them, but there is absolutely nothing about differential diagnosis, or red flags, or other issues to look at. It is just all about “affirming” the client, and nothing about how to explore with people, things that should be looked at before transitioning, or anything like that. There also is a lot of social justice ideology mixed in, so people come out of these trainings believing that all of the problems trans folk face are due to minority stress and stigma and not being able to be themselves and nothing else. I don’t deny minority stress and stigma are real problems, they just aren’t the only problems.

        You can definitely elevate my comment to a post, Thanks for your offer of writing a guest post. I might be interested in doing a guest post at some point, but not until December or later as school is taking up all my time.


  11. Pingback: 7 Signs You’re Transgendered, Plus HERO | Mancheeze

  12. Pingback: 6-year-old “trans girl” reality show star is mentored by 15-year-old “trans teen” patient of Dr. Johanna Olson of LA Children’s Hospital | 4thWaveNow

  13. Thank you so much for putting this blog together. My 15yo daughter is having body issues now, possibly related to sexual abuse or an emerging Borderline Personality Disorder. She has come in contact with other trans and gender-neutral teens in residential treatment, and now is convinced that her body shame is because of gender identity. We live in Oregon, so if she finds out about the laws here, all she has to do is find the resources to make “treatment” happen. The hard part, is I identify as lesbian, as does my WIFE, so we feel more pressure to just cave in to her cries of “I’m gender-queer” “I want to bind my breasts” because how dare we of all people not be supportive?!?! This post in particular has given me some great relief and support in continuing my skeptical stance towards my daughter’s sudden shift.


    • Yes. The cooptation of LGB by trans activists has been crazy making. I’m so sorry to hear your daughter has been swept into this. Please know we’re here for you and let us know how things go. As to Oregon, i’m sure you’re not the only parents who feel this way. I’ve wondered many times whether skeptical parents might find a way to connect in that state. Have you met anyone else who questions what’s going on there?


  14. Pingback: Social Justice and Gender Therapy | Third Way Trans

  15. With reference to request for contact at 2:34 pm on 15 March, from a reporter at LifeSiteNews: this is a conservative Catholic news site. Its ethos is expressly right-wing, anti-abortion and anti-gay.

    From the site’s About page:

    “3.’s writers and its founders, have come to understand that respect for life and family are endangered by an international conflict. That conflict is between radically opposed views of the worth and dignity of every human life and of family life and community. It has been caused by secularists attempting to eliminate Christian morality and natural law principles which are seen as the primary obstacles to implementing their new world order.

    4. understands that abortion, euthanasia, cloning, homosexuality and all other moral, life and family issues are all interconnected in an international conflict affecting all nations, even at the most local levels. …”


  16. And a year and a half later nothing has really changed. Perhaps it is even worse. We are going through it right now with our 14 year old son. Its a mess out there.


  17. “In addition, various informants stressed the importance of the fact that the penis and scrotum should be developed enough to be able to use this tissue to create a vagina later in life. Very early use of puberty suppression impairs penile growth and consequently makes certain surgical techniques impossible.

    Will we see this rather thorny issue discussed on an episode of the Jazz Jennings reality show?”

    I just wanted to add the information that yes, in the third season of I Am Jazz she is looking into bottom surgery and this exact problem has come up. I still haven’t watched the last episode but so far they have been to three different doctors and have gotten three different solutions/suggestions, but all three are saying that there is no way they can do a traditional vaginoplasty.

    From what is seen in the show this comes as a surprise to both Jazz and her parents, they seem not to have been aware of this complication at all.


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