Yes, let’s remember we’re talking about OUR kids

by Nervous Wreck, SunMum, BornSkeptical, Snowyball, & FightingToGetHerBack

Nervous Wreck (Twitter: @nervouswreckmom) is the mother of a rapid-onset transgender gifted female who “came out” after turning 18, was promptly affirmed on her college campus, and who sought treatment at an off-campus Informed Consent clinic.

 SunMum (Twitter: @Mum3Sun) is a UK academic and mother of a son who experienced sudden onset gender dysphoria.

BornSkeptical is the mother of  a 15-year-old girl who suddenly began to question her gender at the age of 13, now identifies as a gay boy, and plans to take testosterone and get top surgery when she turns 18. BornSkeptical wants to help her explore other options first.

 Snowyball (Twitter: @snowyball2) is trying to make sense of why her otherwise bright and happy teenage daughter is all of a sudden depressed and anxious following the unexpected realization that she is a boy born in the wrong body.

FightingToGetHerBack (Twitter: @FightingToGetHerBack) is the mother of a 16-year-old girl with autism who unexpectedly identified as a boy at age 13. After nearly a year of following the harmful advice of gender specialists, she has realized her daughter’s trans identity is the product of social contagion and autistic thinking. She is seeking therapeutic guidance to help her daughter, and pleading with journalists to expose what she considers the dangerous practices of gender therapists.

The following post is in response to a recent article and online chat in the Washington Post about transgender kids and teens; several 4thWaveNow parents participated in the chat.

On February 24, 2017, Steven Petrow, in his Washington Post “Civilities” column, used an email from a “worried mom” to kick off an article about transgender bathroom use in schools. He called it “Let’s remember, when we talk transgender law, we’re talking about our kids.

petrow original headline.jpg

Mr. Petrow describes receiving an email from a “worried mom” of a transgender teen. He assumes before he reads it what it is going to say:  “I figured that the mom was about to voice her anxiety about what rolling back the school protections could mean for her child.” But because Worried Mom doesn’t respond as Petrow thinks parents should, her email is used as a public example of how not to parent a transgender child.

Petrow forwarded the letter to “several parents of trans and gender-nonconforming kids and teens to get their read” and quotes their exemplary responses. Debi Jackson, mother of 9-year-old Avery, the transgender cover star of National Geographic’s gender issue understands Worried Mom’s concern, but explains that “Showing your child that you’re not going to judge as they go through this process is so important.” (Whether putting your young child on the cover of a magazine is necessarily beneficial to mental health is another question).

Another parent (who requests anonymity to protect her child) is more openly critical: “Every day I try to figure out where the line is supposed to be between supporting a child and encouraging a transition…. It sure sounds as if this particular mom is not trying to figure that out, that she’s decided what ‘side’ she’s on about an issue where there needn’t be sides at all.” Her advice is simple: “Just love your child.” (Worried Mom presumably needs reminding of that.)

For an “expert” perspective, Mr. Petrow reaches out to Diane Ehrensaft, Ph.D., a developmental and clinical psychologist at the University of California at San Francisco and author of “The Gender Creative Child.” Her advice? “We should always listen to parents.” Yet “the parent [should] also listen to their child, as at the end of the day, that child . . . will be the arbiter of their own gender identity.” (Translation, maybe?: we should listen to parents only if they say what we think they should say.)

Mr. Petrow makes it clear that parents should affirm their child’s decision to transition. He advises, “Use the name and pronouns that your kid (or another trans young person) relies on. If you’re not sure, ask — without judgment.” So how about we “listen to parents” without preconceptions, “without judgement”?  Mr. Petrow might have done this with the original email sent by Worried Mom, which we reproduce here in full:

Dear Mr. Petrow:    I have been reading your column for many years, have learned a lot from your perspectives, and in general, share your political views. I sense that your writing comes from a place of compassion and thoughtful consideration.    I am reaching out to you because there is an issue that you have been writing about lately that is of grave concern because it is very personal to me: that is, your reporting on the transgender issue.

The reason this is so personal is because my 16-year-old daughter told me she was transgender when she was 13. I was shocked. There had never been any signs of this. However, there were several kids at her school who identified as trans. She is also on the autism spectrum and very susceptible to mimicry and falsely identifying with groups in order to feel like she belongs.

What has happened is that therapists that I took her to for help did not question her beliefs but made her think she should transition and that I should blindly accept her assertion. They pushed me to accept hormone treatment, which I refused. As a compromise, I allowed her to wear a binder (which causes physical problems) and let her change her name and pronouns – and yet I know 100% in my heart that this is not real and I live in a constant state of anxiety about the psychological and physical damage this is causing. Mostly I worry about her future plans to fully medical transition as soon as she is legally able. I feel scared and powerless. The medical consequences are significant and irreversible.   It is impossible to convince a teenager – especially an autistic teen – of something that is a belief that can neither be proven or disproven. It is especially difficult when the media narrative seems to portray anyone who questions these beliefs as a bigot.

Following publication of Petrow’s article with the truncated version of the above email, many commenters wrote in to point out that he had failed to recognize the validity of Worried Mom’s concerns. And Worried Mom, the author of the email, also left this comment:

Mr. Petrow responded to my letter by stating that he would like to discuss this with me. I provided him with my contact information, but never heard back. It was only by accident that I learned that I had been selectively quoted pushing the very narrative that I had hoped I could get Mr. Petrow to question.  Such irony. The reason that I wrote to you, Mr. Petrow, was in the hope that you would see what is going on with our youth. The media seems very afraid to question the sudden increase in transgender identification in our youth. Common sense alone says that social contagion is a factor. And because of the politicization of this topic, parents like me are labeled bigots, told we don’t love our child…or as your “expert” stated, told that our child’s gender journey is “poetic.” I assure you that I am not a bigot, love my child unconditionally, and living with a teenage girl who thinks she is a boy is not a poetic experience.

Worried Mom also raised the issue with Mr. Petrow on Twitter. “I reached out because I trusted you would listen to me as the civil and respectful journalist that you describe yourself as,” she wrote.  (Mr. Petrow’s Washington Post column is entitled “Civilities.”)

Commenters on Petrow’s article were overwhelmingly critical of his stance. To his credit, on March 7, 2017, Mr. Petrow returned to the topic in his Civilities online chat. This could have been the perfect opportunity to present various perspectives on this complex and controversial issue, and to consider them in a balanced way.

Instead, Petrow invited only Dr. Michelle Forcier, Assistant Professor of Pediatrics and Adolescent Health at Hasbro Children’s Hospital to answer questions.  In 2016, Forcier had 400 patients on a transgender pathway. Rejecting “gate-keeping” or psychological evaluation as out of date, Forcier believes that “kids as young as two, three, four know what their gender is,” and compares gender identity to asthma: “You don’t have to prove to me you’re transgender, just like you don’t have to prove you have asthma.” (Unlike transgender identity, which is based on subjective feelings, there are objective tests of lung capacity in the case of asthma). Forcier, then, is no neutral “expert” but an evangelist for medical transition of kids. Perhaps Petrow’s plan was to allow Forcier to demolish the questions of “bigoted” parents. In any case, he did reach out in the hope of a lively confrontation, tweeting @4thwavenow and alerting his audience that “a sub-Reddit group of “gender critical folks” issued a “call to action” to get folks to join today’s discussion”.

You can find the complete chat via this link: Civilities: Taking all your questions about transgender teens with Brown U. expert Dr. Michelle Forcier and Steven Petrow.  In this post, we will highlight a few excerpts. In addition, some of the parents who sent in questions will explain in more detail what they made of Dr. Forcier’s answers.

petrow chat headline.jpg

The issues raised repeatedly in the chat revolved around some common themes: challenging the belief that there is a single “scientific” position on gender identity; asking why gender dysphoria increasingly appears out of the blue in troubled teens and why doctors do not look at existing mental health co-morbidities; and why the warning voices of detransitioners are not heard and not heeded. This question is emblematic:

My daughter certainly never seemed like a son to me, just a very creative intelligent girl who had trouble “fitting in” socially. But to so quickly get a prescription for testosterone for this out of the blue self-diagnosis feels very wrong. Dr. Forcier’s position is that parents of underage transgender kids who hesitate about medical transition could be charged with medical neglect with a report to child protective services. This goes against parental rights. […] Late teens/young adulthood is also the time when many mental health issues first show up…this is well known and documented. For instance, bipolar shows up at that time and it is known to distort the sense of self/identity. There are a growing number of detransitioners speaking up wishing they had been offered other treatment options, including mental health diagnostic testing with time for mental health treatment first. What do you suggest these detransitioners do to help the psychiatric community adjust their “one size fits all” treatment for gender identity issues in teens and young adults?

There are clearly many points to deal with here, but Forcier chose to first focus on the allegation that herposition is that parents of underage transgender kids who hesitate about medical transition could be charged with neglect and be reported to child protective services.” Forcier seemed worried that “the writer seems to know my position and I am trying to figure out how they actually ‘know this.’”

We know Forcier’s position on calling the authorities on some parents via a session on puberty suppression that she co-led at the February 2017 USPATH conference.  During the Q&A part of the session, Drs. Johanna Olson-Kennedy and Michelle Forcier explained that they are not afraid to involve the courts when they must to “bring along” “recalcitrant” parents.  A psychologist who runs a gender clinic asked whether there is a way to legally “force parents” to go along with the recommendations of a gender therapist to administer puberty blockers. Forcier explained that her team has been busy training family court judges in her region:

FORCIER: Yeah, there’s no precedent but you can again work with the child protection team for medical neglect. Work with one parent…at least to get things started. And again, you can do some education. We did education with judges in Rhode Island. We spent a half day with family court judges, telling them this is what gender and transgender is…

In the WaPo chat, Forcier seemed to deny that she advocated such an approach:

And I do NOT take the position that as the writer suggests ‘that parents with underage kids who suddenly insist they are transgender but as a parent have grave concerns about the only treatment option being medical transition could be charged with medical neglect with a report to child protective services’.

Forcier went on to claim that her approach is evidence-based: “There is reasonable science that supports listening to patients in regard to learning more about their gender identity. It does not mean, not asking questions or asking for more time to explore with a patient–but it is important with any medical issue or developmental concern to start with the patient.” Fair enough, although you hardly need “science” to remind a doctor to listen to their patient.  She reassured readers that she is flexible and responsive to individual patients:

We do espouse a very individualized, patient-centered approach to gender as with other types of youth care we provide. There is no one size fits all for gender. So first–it worries me that there is misinformation and mischaracterization of care and our practice. What is the harm of seeing how a child who is “different” explore their gender? Again, there just seems to be interesting bias against gender diversity and helping kids figure out who they are– a generally accepted part of adolescent development. So first and foremost–we want to get to know our kids well and there is not one size fits all…. second, accurate information is helpful for all parties!

But the parent who sent in the question was not reassured. She writes that her “big concern is with informed consent clinics, and the impact on young adults, newly on their own and full of youthful, optimistic self-assurance about their decision to live a transgender life”:

My perspective is as the parent of a transgender college student female who sought treatment after age 18, fulfilling her six months “real life” experience as a transman on a college campus…not exactly a real life experience. My child’s decision to identify as transgender was rapid onset after learning the concept only a year earlier at most, while attending a small high school where she felt a misfit, comparing herself to the other girls, as teen girls do. My child, the extremely smart yet highly anxious misfit who had a very stressful last two years of high school, picked up on the transgender option through online sites, a child who only the previous summer was happily frolicking in her swimsuit on a trip to the beach, not showing any signs of gender dysphoria, at least not beyond any other girl in puberty.

However, my child was able, at age 18, to go to an informed consent clinic only two times to get a prescription to start medical transition with testosterone. Two times. This has now become the norm. Teenagers are known for impulsive behaviors, and my child’s behavior is poster-child teen impulsive behavior. But apparently, no “asking for more time to explore with a patient” because this might be considered conversion therapy…simply exploring with a patient about gender expression. Hence, informed consent clinics in at least some states are indeed one size treatment fits all.

Another question took up the frequently reported link between autism and transgender identity: “Dr. Forcier, what is your explanation as to why kids on the autism spectrum are seven times more likely to have gender identity issues (and those at gender clinics 6-15 times more likely to have autism)? Do you believe that an autism diagnosis should be considered before a therapist tries to convince parents to support their child’s transition?”

The gaps in knowledge about autism and gender dysphoria did not translate to Dr. Forcier counseling caution in recommending irreversible treatment:

 FORCIER: We don’t know for sure. What we do know there seems to an association … We do know that with other neurologic conditions- there are menstrual and other reproductive health associations (epilepsy for instance). We do also know there is an association for gender and autism as well. For autism spectrum youth- maybe it is that not being as clued into or bound by social messages and constructs allows them a more fluid approach to gender and a greater willingness to express that more openly. For autism spectrum we know there are some differences in brain and neuro function… for persons whose assigned gender and anatomy/physiology is different than their identified gender (brain heart soul personhood gender) … this might be another way or manifestation of different ways brains are built or function in different ways.

This is curiously unscientific: Forcier glosses “identified gender” as “brain heart soul personhood gender.” For the more scientifically minded, there is a growing body of work on the link between transgender and autism. This 2014 paper co-authored by John F. Strang (a pediatric neuropsychologist with the Center for Autism Spectrum Disorders and the Gender and Sexuality Development Program at Children’s National Health System in Washington, D.C.), reports that participants in a study with ASD were 7.59 times more likely to express gender variance. Initial clinical guidelines were published in 2016 by Strang, et al, in an attempt to provide consensus guidelines for the assessment and care of adolescents with co-occurring autism spectrum disorder (ASD) and gender dysphoria (GD). But “why” there is an overrepresentation of youth with co-occurring autism spectrum disorders (ASD) and gender dysphoria (GD) is not yet known. Noticeably absent from the list of participants of these “consensus” guidelines is Tania Marshall, a specialist in the diagnosis of ASD in females. She states that the “majority of females do not receive a formal diagnosis until well into their adult years,” largely due to their very different coping mechanisms (as compared to males). As reported in this article by Aitken, et al, there has been a significant change in the sex ratio of adolescents referred to gender clinics: natal males outnumbered natal females up till 2006 when the ratio changed. How many of these young females fall within ASD but have fallen through current diagnostic tests that are based primarily on males? Please see this post. 4thWaveNow has previously published several other articles about the issue of ASD and transgenderism; see this and this.

Another parent asked what happens when transition makes a young person feel worse and actually intensifies dysphoria:

 Q: Gender clinicians claim that transition dramatically improves the mental health of gender dysphoric teens. If this improvement does not take place, is it right to reconsider either the diagnosis or the treatment? In the case of my child, who experienced sudden onset gender dysphoria aged 20 after a series of traumatic events, without any signs or expressions of gender dysphoria earlier in his life, transition followed by hormone therapy has been followed by a descent into social isolation, altered sleep patterns, anger problems and other symptoms of depression. We live in a socially liberal trans affirmative cultural setting and he attends a trans support group. I suspect other mental health problems and his family and general practitioner suspect that the problem is not gender. But gender clinicians refuse to consider any other diagnosis. In these circumstances, surely, a rush to accept the patient’s self-diagnosis is dangerous. Your thoughts?

Forcier conceded that “yes, many gender patients have other mental health comorbidities…” (thereby tacitly acknowledging that gender dysphoria can be seen as a “morbidity”). But whatever the co-morbidity, gender reassignment can go ahead: “Not sure that depression, anger, sleep issues after trauma negates an exploration of gender,” says Forcier. As this parent told us, “she didn’t address my suggestion that the problem may not be gender at all, a view held by the family doctor and by those who knew my son before he became ill. The fact that other professionals disagree with the transgender diagnosis evidently interfered with her upbeat narrative of brave kids and bigoted parents.”

Another parent wanted Forcier to recognize and respond to the fact that a large majority of gender dysphoric children desist and reconcile with their biological sex:

 How is it ethical to put children on a journey of lifetime hormone medication plus to endure the health risks of surgery when if those children are left to work their own life out, 80% will come to accept their biological sex?

Forcier’s reply:

Ethical questions are great when it comes to gender care, as NOT providing care seems to be more unethical and have worse health outcomes than providing care in this population. For example: How ethical is it to negate a person’s identity–to tell them you know them better than they do? How ethical is it to deny a person access to medication that is very safe, effective and proven to help persons with gender nonforming[sic] /diverse brain/identity and body experiences? The bias inherent in the question is interesting and deserves a response!

No evidence is provided for Forcier’s belief that “NOT providing care seems to be more unethical and have worse health outcomes than providing care in this population.” The medications she prescribes are not “very safe, effective” as recent studies on the side effects of puberty blockers make clear. Nor did she explain why it is ethical to medicate non-conformity (what Forcier calls “gender nonconforming/diverse brain/identity and body experiences”). Why should being different require hormones and surgeries?

Forcier then used a comparison between physical and mental disease; a puzzling response, if gender dysphoria is a naturally occurring variation (an assertion frequently made by trans activists and gender clinicians) rather than a disease:

FORCIER: Another good medical example, in trying to help us deal with offering or refusing to offer known safe effective medical care might be to liken this experience to other health concerns. For example, would you also propose letting a diabetic slip into diabetic ketoacidosis and coma before offering them fluids and or insulin if you suspected a high likelihood of diabetes? Would you wait for an asthmatic to collapse unconscious before offering oxygen and albuterol? Gender care has many safe medical options that in many instances are safer than withholding care. Additionally, this question has some other interesting perspectives… Transgender persons are never forced into surgical care- that is something that they need true understanding and consent to be able to engage in….The 80% data is not representative or accurate for the bulk of children who move towards blockers or gender hormones–not sure where that number came from but it is not correct.

Both asthma and diabetes are organic diseases which can be fatal and objectively identified. Gender nonconformity is a rejection of socially defined conventions and is not fatal. It is in no way like “other health concerns.”

And no one claims that 80% of the children “who move towards blockers or gender hormones” desist. In fact, nearer 100% of children “who move towards blockers or gender hormones” persist because social transition (which nearly always precedes medical transition), and blockers themselves, likely make desistance highly unlikely. Indeed, most “affirmative” gender clinicians, including Johanna Olson-Kennedy, Norman Spack, and others report near 100% persistence rates.

Forcier says she doesn’t know where the statistic “came from” that 80 percent of children who wish to be the opposite sex go on to accept their natal sex. This widely cited statistic is based on a multitude of studies—including those with children with severe gender dysphoria, including :


  • “the majority of boys with GID showed desistence of their gender dysphoria when followed into adolescence and adulthood: 87.8% of the boys did not report any distress about their gender identity at follow-up and were happy living as males.” Devita Singh, “A FOLLOW-UP STUDY OF BOYS WITH GENDER IDENTITY DISORDER”, PhD, 2012.
  • “The exact number varies by study, but roughly 60–90% of trans- kids turn out no longer to be trans by adulthood.” James Cantor, “Do Trans Kids Stay Trans When They Grow Up?” January 2016.

Returning to the chat submissions, another parent who voiced genuine concern for her child was simply mocked as bigoted, and she asked Petrow to have a bit of empathy:

 What would you do if your child suddenly, out of the blue, announced they were transgender, wanted to change their name, pronoun, and buy a breast binder? What would you do if you suspected your child might have been influenced by the media? What would you do if you suspected your child had other mental health issues to deal with? Walk in my shoes for one moment. What would you really do if it was your child? What would you do if your gut feeling was that your child was making the biggest mistake of their life? What would you do if everyone around you was telling you to celebrate your child on their brave journey? Please, what would you do?

In reply, Petrow equated transgenderism with homosexuality:

PETROW: Honestly, your question reminds me of those from parents in earlier generations who learned their kids were gay or lesbian. So, here’s what I’d do: I would try to read materials from the most credible experts, speak with other parents of similar kids (which you can find at PFLAG), and, of course, talk with my child. In other words, I would try to keep an open mind and learn as much as I can. Many parents of gay kids caused great harm to their young ones by not accepting them and but not helping them to accept themselves. I hope we’ve learned since then…

To this parent, Petrow’s reply was seriously lacking. She comments: “Despite my obvious concern and anguish you replied with absolutely no compassion. You chose to accuse me of being a bigot and to liken me to ‘earlier generations who learned their kids were gay or lesbian’.” This comparison misses the point. She explains:

My child did indeed inform us she was a lesbian, a few weeks prior to announcing she was transgender. When she told us she was a lesbian, we were happy for her and readily accepted it.  I find it hard to believe that you cannot see the difference between a child who announces they are lesbian and a child who announces they are transgender.

Being lesbian does not require her to become a lifelong medical patient. Being lesbian doesn’t ask her to chop off her breasts. Being lesbian doesn’t ask her to spend her life in anxiety about whether she will or will not “pass” as a man. Anybody can see that the future for a gay or lesbian child is very different to the future of a transgender child and I think it is an extremely lazy tactic to label any parent who dares to question their child’s transgender declaration as like “earlier generations.

I have already read extensively from many credible experts; I have spoken to many other parents of similar kids and of course I have talked with my child. I am keeping an open mind and learning as much as I can. And it is with my mind fully wide open that I am helping my child to make the right choices in life.

Mr. Petrow advises this parent to “seek top notch treatment” for any “other mental health issues” her child might be experiencing. She respond: “You seem to have absolutely no understanding of mental health issues and how these could cloud a child’s judgement.” Oddly, given the comparison with homosexuality, Petrow also appearsto think that a transient transgender identity can be discarded without difficulty: “I’d also note that changing a name or pronouns, even wearing a breast binder, can easily be changed or reversed.” But this parent knows the lasting damage that binders can do:

 You mention that changing a name or pronouns or wearing a breast binder are ‘easily changed or reversed’ without any understanding of real life. To think that you have no awareness of the damage done by wearing a breast binder shows that you have done absolutely no research (back pain, chest pain, shortness of breath, bad posture, rib fractures, rib or spine changes, shoulder joint “popping”, muscle wasting, respiratory infections, abdominal pain, breast changes, breast tenderness, scarring, skin infections – in case you were wondering).

 Transition as gay conversion was the premise of another question:

 How do we encourage kids and adults that being a feminine boy or masculine girl is ok, when trans communities use these stereotypes to determine if a kid is trans? Most homosexual adults didn’t conform to their gender as kids, will this mean the number of homosexuals is going to decrease because of transitioning? Could this be seen as homophobic?

Forcier’s answer is that “We encourage kids to be AUTHENTIC!” But if being “authentic” leads to medication with off label prostate cancer medication and later perhaps to surgery, it is a dangerous course. To truly encourage kids ‘to be AUTHENTIC!’ would involve accepting gender nonconformity and allowing kids to live in their own bodies without medical intervention. In her view

The clinical and research data do not suggest there are overwhelming numbers of parents or providers pushing kids into the trans box as suggested in some of the comments. In fact, historically, it has been hard for folks to access providers who listen and take them seriously or offer to engage in plans that explore gender.

History apparently began around the turn of the 21st century, when the category of ‘transgender kids’ was invented. Before this, kids were rebellious, or unusual, or gender nonconforming. Even in the 20th century, when medical transition started to become available, no one suggested that minors ought to be considered transsexual or in need of medical services.

From the mid-16th  through the 19th century, boys were dressed indistinguishably from girls until between the ages of two and eight. ‘Breeching’ was the moment that a boy was put into trousers and had his hair cut. But Forcier asks us to accept current gender stereotypes as evidence of an innate identity. A body of research—including this 2017 longitudinal study of over 4000 young people—has repeatedly found that childhood gender non-conformity is strongly correlated with adult homosexuality.

GNC gay

 Transgender suicidality is frequently used to coerce parents into supporting transition, as another questioner suggests:

 Parents of transgender teens are often told about the high rates of attempted suicide among the transgender population. However, the studies from which these statistics are drawn do not indicate whether attempts occurred before or after transition. Given that several good quality studies indicate that suicidality continues to be high after transition (the Swedish study by Djhene et al. from 2011), what clinical evidence do we have that transition reduces suicidality?

 But Forcier, similar to many trans activists, has no problem leveraging suicide as an argument. This is agreat question!” and she goes on to claim that:

There is both research and anecdotal evidence that both disclosure and appropriate care can offer relief to gender nonconforming youth who are at risk for self-harm and suicide. Data include Amsterdam’s early studies (no suicides and no street drug use) as well as later studies such as:

de Vries AL, McGuire JK, Steensma TD, et al. Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment. Pediatrics 2014.

Spack NP, Edwards-Leeper L, Feldman HA, et al. Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics 2012; 129:418.

We have good data that disclosure AND LOVE & ACCEPTANCE by parents and families is protective. See Ryan, See Olson and other Family Acceptance Project studies. Also we would not expect all self-harm or suicidality to “disappear” or resolve completely even with good treatment options as there is still minority stress status effects and other ongoing macro and microaggressions that harm gender nonconforming persons on a daily basis.

Forcier’s answer is both manipulative and misleading. Parents are told that “disclosure AND LOVE & ACCEPTANCE by parents and families is protective.” This is manipulative because it assumes that to love is to uncritically accept whatever your child says. No responsible parent would accept this advice in relation to any other parenting issue.

It is also misleading because there is no reliable evidence that medical transition prevents self harm, which is readily acknowledged in the widely cited 2014 Williams Institute report about suicide in the US transgender population (also cited in Petrow’s original article).  According to psychotherapist Lisa Marchiano, “it may in fact be the case that suicidality is higher among those who have transitioned.” Studies such as this one found: “Those who have medically transitioned (45%) and surgically transitioned (43%) have higher rates of attempted suicide than those who have not (34% and 39% respectively).”

 Another parent expressed concern that teenage mastectomy is a drastic surgical intervention:

Trans teens in this country now receive drastic surgeries, e.g. mastectomy, as young as age 14. How can such young kids truly give informed consent for such radical measures? There’s a good reason we don’t trust young teens with huge decisions — they are immature, by definition. Their brains have not fully developed.

Forcier did not like this framing:

 This “drastic surgery” — again such biased language!–has really changed many trans boys and men’s lives- and has low risks and outcomes for complications and regret. Teens assent to surgery WITH parent consent… we are lucky that many parents understand waiting for arbitrary legal age of 18 for chest surgery for some young teens is cruel and harmful from a physical and psychiatric perspective.

“Drastic” is a term that has been used by more than one clinician who has worked with this population. James Barrett, lead clinician at the UK’s oldest Gender Identity Clinic, writes that “The treatment of disorders of gender identity is drastic and irreversible, so it should only be undertaken in a setting of diagnostic certainty.” By dismissing the parent’s concern about medical transition as “biased,” Forcier minimizes the serious and irreversible treatment she is dispensing. “Diagnostic certainty” cannot be possible in the case of teenage clients.  There is a reason why many psychiatric diagnoses (including personality disorders, schizophrenia, and others) are not made until adulthood because it is known that young people are not fully mature and can and do change dramatically. (For a recent article by a professional who does acknowledge the need for more “gatekeeping” for young trans-identified clients, see “Careful Assessment is Not Happening” on the First Do No Harm website.)

Speaking of diagnostic certainty, those who regret medical transition and decide to detransition– whatever their number — present a fundamental challenge to the notion of diagnostic certainty in teens. A parent asked

 Given the growing number of people, especially young women, who have detransitioned in recent years, don’t you think it does young women a grave disservice if we don’t help them explore why they might want to transition– especially those young women who never expressed gender dysphoria as a child? Many of the detransitioners have talked about the role that trauma played in their decision to transition. And even though my child experienced a traumatic event shortly before her announcement that she believed she was trans, the therapist was convinced not only that she was trans but that she might need to start testosterone even at the age of 14.

In response, Forcier brands parental worries about regret and detransition as the creation of “alternative facts”:

Forcier: I am unaware of your data–please provide. If you are a gender provider and doing research – please send – it would be important to look at this and incorporate into care. But for clarity’s sake- there is no large number of “detransitioning” kids… It is so important to stick to what is actually going on for the majority of gender care youth- not create “alternative facts” that support our opinions.

 “Gender providers” have shown scant interest in studying the population of detransitioners, so some of them have taken it upon themselves to gather data:

These informal surveys demonstrate the need for further research. The first formal survey study of detransitioners opened on March 17. It is being conducted by Lisa Littman, MD, MPH, Adjunct Assistant Professor, Icahn School of Medicine at Mount Sinai.

In addition to looking at these survey studies, Dr. Forcier could visit any of the multitude (and increasing number) of blogs set up by detransitioners such as

 The underreported experience of detransition is beginning to appear in the mainstream media: see Experience: I Regret Transitioning and the BBC documentary, Transgender Kids: Who Knows Best? which aired in January 2017 (archived version available to US viewers here). Forcier should also be aware that USPATH, the U.S. branch of the World Professional Association for Transgender Health hosted a panel of detransitioners at the same conference she presented at in February.

Some of the parents’ stories sent in to the chat are harrowing, revealing the frequent association of mental health issues with sudden transgender feelings:

 My female child turned 18 and only months after learning the concept transgender, was put on testosterone at an informed consent clinic in the LA area after only 2 visits to the clinic. We have a wealth of mental health issues in our families, including bipolar that is very genetic and shows up in older teens/young adults. My child is 19, technically an adult, now on T, but I very much see signs of bipolar. Do you think gender clinics should add controls back in to take longer time with young patients? brain science says the brain is still adolescent until at least age 25, not in any way an adult brain at age 18. My child never went thru any diagnostic testing for mental health issues or autism spectrum that could be clouding her/his judgement. I think only 2 visits to a clinic is way too fast to start any medical transition. Do you have some advice for what I might tell my child about getting this testing done now before getting too far with the HRT? treatment for bipolar could change how s/he thinks, and counsel for ASD would be needed first since ASD can also cloud judgement about social issues. And how can these gender clinics be made aware of the need for gatekeeping for young adults age 18-25 since they can definitely be impulsive and may be dealing with young adult mental health issues that need treatment first.

 “More questions than we can really address here,” says Forcier, but she says that “bipolar and gender are two very different things.” She rejects

some of the very biased terminology…. gatekeeping, as reparative therapy has led to significant harm in the trans community. And recommending “gatekeeping” for consent age adults has an interesting paternalistic, controlling twist. Docs who provide adolescent and young adult care are clear on the literature about the 18-25 years continued brain development. But just as we might listen to a 9 year tell us they have a sore throat, take a history, consider taking a throat swab. Or we might listen to a depressed 16-year-old tell us they are sexually active and need chlamydia testing… we need to listen and incorporate a holistic approach to these youths’ care.

The parent isn’t satisfied with this response, and persists:

 Actually there is documented overlap between bipolar and gender identity. There are some cases that have made it into the medical literature.  See here and here and here.

And you can easily search online and find conversations within the transgender and gender questioning population about how bipolar episodes affect how they feel regarding their gender identity. Indeed, here is an interesting article about how bipolar affects the development of self.

For lack of a better word, “gatekeeping” is the due diligence that used to happen to ensure a low probability of regret following medical transition. There are mental health issues that, once properly treated, can resolve the desire for a change of gender identity. It is the slower approach of “Gender Identity Disorder” that has been replaced with the affirming approach that most are now practicing. Yet, how can a young adult struggling with undiagnosed bipolar be expected to accurately know that a change of gender at age 18 won’t be regretted at a later age after they are actually diagnosed and treated? All for the lack of mental health due diligence.

This could indeed be the case for my child….mood disorders are prevalent in her father’s family and I’ve documented behaviors that look suspiciously like bipolar disorder. This makes it particularly distressing that you should find “gatekeeping” (again read this as simply “first do no harm” medical due diligence) as “paternalistic and controlling”. A feature of someone with bipolar disorder is that they are highly unlikely to see it in themselves. Diagnosis relies on the observations of family and friends. Helping them seek mental health assistance is certainly not paternalistic and controlling.

The association of gender dysphoria with other psychological problems has been well understood by clinicians and researchers for some time. In recent years, however, activists have worked diligently to prevent that information from being widely discussed. To take just one example, a 2003 survey of 186 Dutch psychiatrists reported on nearly 600 patients with “cross-gender identification” with these results.

dutch psychiatrists high comorbidity.jpg

In her final remarks, Dr. Forcier dismisses the parents who joined the chat thusly:

There seems to be lots of bias, misinformation, making statements about “data” that are not supported in the actual medical literature. I am also always struck by how many persons without gender expertise or significant experience with a cohort of gender patients have such strong, absolute opinions.

But these questions came from “persons” with first-hand knowledge of their own kids; parents who have read widely (including the “actual medical literature”); parents who care deeply and who view bland reassurances with due skepticism. For these parents, simply “affirming” their kids’ transgender identity is not just a matter of “etiquette” and appropriate language. The decisions made by doctors who prescribe hormones and surgeries have real life implications for the lives of those we love,  and it has become evident to many of us that transition is not the best solution for our kids. And as far as “gatekeeping” goes, it’s quite obvious that the easier it becomes to transition, the more transition regret we are going to see.

Speaking of “bias” (the word Forcier used repeatedly to denigrate the parents raising questions in the chat): If one were to go strictly by the comments of Steven Petrow and Michele Forcier, it seems to us that the professionals in the affirm-only gender field and their media handmaidens are the ones with the “strong, absolute opinions.”

And just a reminder: they are talking about our kids.

The Tortoise & the Hare: The differing trajectories of gay rights vs gender identity in US law

Worriedmom is the mother of four (allegedly) adult children. She lives in the Northeastern part of the United States.  Worriedmom practiced law for many years and now works in the non-profit ara. She is available to interact in the comments section of this post.

by Worriedmom

While writing a previous 4thWaveNow article about my experience as a PFLAG leader, I  thought back on my longstanding personal connections with gay, lesbian and transgender people.  I first became interested in this group of humans while in college in the late 1970s, on account of my then-best friend, a gay man.  I remember demonstrating against Anita Bryant’s mean-spirited Florida anti-gay activism, and being filmed by the local police department, which regarded gay people and their allies as dangerous subversives.  I recall that same police department barging into the local gay disco, lining up the women and men against separate walls, demanding identification and threatening to haul folks to jail and put their names in the paper.  My friend told me disturbing, haunting stories about the naked aggression and harsh daily bullying he faced in high school because he was a “feminine” gay man.

I knew these experiences were but the tiniest slice of the everyday discrimination, violence and prejudice faced by gay and lesbian people in those days.  For myself, even those few encounters with the unfairness and unkindness faced by gays and lesbians led me, first, to provide free estate planning for men with HIV, shortly after I got my law license; and, later, to advocate for civil union and then gay marriage in my home state.  Along the way, I also became a PFLAG chapter leader and spent countless hours devoted to the cause of equal rights for sexual and gender minorities.

As I thought about my own history of advocacy, one thing that struck me was how very long a road it had been, one that has lasted my entire adult life.  And what next occurred to me was that, by contrast, transgender rights, in both law and fact, have had an extraordinarily short history.  Compared to the length of time it took for gay and lesbian people, and more specifically same-sex marriage, to become mainstream, transgender rights have taken center stage in a virtual blink of the eye.  In both these cases, people have been asked to accept a new, expanded or different interpretation or meaning of something they’ve taken for granted: in the gay and lesbian rights area, marriage; and in the transgender rights area, gender or sexual identity.

This article briefly explores the evolution of the law and public policy in the United States as it relates to marriage, and the sexes.  (For space reasons, I will have to skim over and condense an incredibly rich, interesting and complex history. There is a great deal more to say and learn about every subject covered.)

Gay marriage: An idea long in coming

Although gay and lesbian subcultures certainly existed prior to the 1950s, particularly in larger cities and in areas impacted by the World Wars, the first organized groups in support of gay rights did not emerge until the early 1950s.  The Mattachine Society, for men, was founded in 1950, and the Daughters of Bilitis, for women, was founded in 1953.  The first public protests in favor of gay and lesbian rights occurred in 1963 at the White House, and in 1966 in New York City (a “sip-in” against anti-gay discrimination).

news clipping

Although the 1960s saw increasing efforts toward social visibility and against discrimination, the Stonewall Riots, in 1969, are largely regarded as the catalyst for the modern-day gay civil rights movement.  The energy and intensity produced from Stonewall led to the creation of the first “out” gay rights groups, and within two years, virtually every large city in the U.S. had its own gay and lesbian political action group.

Activism around gay and lesbian rights grew during the 1970s alongside other movements of personal liberation, such as the women’s movement, Black Power, Chicano Pride and others – although a serious backlash ensued as some religious conservatives began to mobilize in opposition.  The AIDS crisis of the 1980s, and the activism that it engendered, ensured the prominence of gay people in the public mind.

act up

The first hint in the United States that same-sex marriage might someday become a reality was in 1993, when Hawaii’s Supreme Court ruled that denying marriage to same-sex couples violated the Equal Protection Clause of that state’s constitution.  This ruling did not legalize gay marriage in Hawaii but did kick off an intensive round of anti-gay marriage lobbying and advocacy, which culminated in the 1996 federal Defense of Marriage Act (“DOMA”).  While it did not prohibit states from recognizing gay marriage, DOMA provided that for federal purposes marriage was to be defined as the union between one man and one woman only.  Under DOMA, states were permitted to refuse to recognize gay marriages performed in other states, which temporarily settled the issue in favor of the anti-gay marriage forces.  In 2004, President George W. Bush urged passage of a Federal Marriage Amendment to the United States Constitution, which would have further codified the definition of marriage as being between one man and one woman only.  The Federal Marriage Amendment was never adopted, although it became the subject of a raging debate.

2004 also saw tremendous activism around gay marriage in general, with anti-gay marriage amendments and statutes up for referendum in numerous state contests.  It later developed that the Republican Party had adopted the strategy of introducing gay marriage as a political “wedge” issue into as many state elections as possible, with the hope of bringing more conservative, motivated voters to the polls.

Although chastened by the crushing defeat of 2004, in which anti-gay-marriage initiatives won in every single state in which they were introduced, gay and lesbian activists persisted.  One bright spot was the Goodridge case in Massachusetts (2004), which legalized gay marriage for that state.  Connecticut became only the second state to recognize gay marriage, in 2008.  A dark spot was California’s infamous “Proposition 8,” also in 2008, when voters made same-sex marriage illegal in that state. A “middle ground” proposal to allow same-sex couples to enter into “civil unions” or “domestic partnerships” was often explored and adopted as an intermediate legal step.  Many states and groups saw tremendous debate and dispute over whether civil unions were an appropriate substitute for full civil marriage, should be sanctioned by the State, or whether the concept was the proverbial “camel’s nose under the tent.”

In 2009, a team of “super lawyers” attacked Prop. 8 in California on constitutional grounds, with the goal of creating a test case that could be ruled upon by the U.S. Supreme Court to establish gay marriage as the law of the land.  However, the Supreme Court declined to hear the California case in October of 2014, and as of that date just 19 states and the District of Columbia permitted same-sex marriage.  Thirty-one states had laws or statutes explicitly prohibiting it.  The period between October 2014 and June 2015 was one of a very rapidly evolving legal landscape, as state laws and constitutional amendments were successively ruled unconstitutional.  Finally, as of June 26, 2015, the date of the U.S. Supreme Court’s Obergefell decision legalizing gay marriage in all 50 states, gay marriage had been legalized in 37 states and the District of Columbia.  By then, every state in the union had had court cases bearing on the issue.

Although there was some resistance in a few quarters to the Supreme Court’s decision, most notably with the Kim Davis controversy in Kentucky, by and large negative public reaction to Obergefell was muted.  Whether or not people agreed that the Supreme Court had the right to alter the concept of marriage, and whether or not they agreed that the court’s application of the U.S. Constitution to the issue of same-sex marriage was correct, by the time the high court ruled in June of 2015, all sides to the conversation had had their say (and then some).  In fact, gay marriage attracted so much attention, analysis, fact-finding and commentary, that eventually people on all sides of the issue actually became weary of the discussion.

The key point is that, in ruling in Obergefell, the Supreme Court did, in fact, re-define marriage as that term had previously been used and understood in American society.  (To be clear, other societies in other eras have had other definitions of marriage.)  Many people objected to such a re-definition because they did not agree that it was appropriate, moral, legally justified, socially desirable or for other reasons.  Those arguments were heard and evaluated on their merits, and every party concerned had the full opportunity to make its case.  We had a robust national conversation about the definition of marriage which lasted, even dating strictly from the Hawaii decision, for some 22 years.

Re-defining “man” and “woman”: An idea not very long in coming

Although older readers may remember the well-publicized early cases of Renee Richards (in 1976) and of Christine Jorgensen (even further back, in 1952), until very recently, transgender people were primarily regarded by most Americans as exceptionally rare oddities.  Early political efforts around transgender rights and people only began to gather momentum in the late 1990s, with the first efforts to add “gender identity” to anti-discrimination laws in a few jurisdictions and the establishment of the “Transgender Day of Remembrance” in 1999 as the signal holiday of the movement.  It was not until 2014, when Time magazine declared that the United States had reached the “transgender tipping point,” that many Americans began to realize the significance of the transgender movement.  And most observers would agree that Bruce Jenner’s transformation into Caitlyn Jenner, in 2015, was probably the event that finally brought transgender people and their issues into wide public consciousness, if not acclaim.

Initially, the focus of the transgender movement appeared straightforward.  It seemed logical to include the “T” as part of the “LGB,” in that transgender people were also often viewed as sexual minorities.  Given that gay and lesbian people often were, and are, punished and discriminated against for being “gender non-conforming,” it appeared that including “gender expression” or “gender identity” as qualities to be protected under civil rights statutes was natural and appropriate.  For instance, in 2009, President Obama signed a law that added anti-transgender bias to the federal hate crimes law; President Obama also banned discrimination on the basis of gender identity among federal contractors via executive order in 2014; and in June of 2016, transgender people became eligible to serve in the United States military.  Efforts to enact a federal employment non-discrimination law covering transgender people (and gay and lesbian people, for that matter) have been unsuccessful to date.

In February of 2016 (just one short year before this writing, although it seems much longer), the North Carolina city of Charlotte passed an ordinance establishing certain civil rights protections for gay, lesbian and transgender people, including – most controversially – the requirement that transgender people be permitted to use the bathroom facility of the gender with which they identified.  In March of 2016, in a special session, the State of North Carolina passed a bill that voided the Charlotte ordinance and affirmatively required transgender people to use restrooms and locker rooms corresponding to their birth sex.  A firestorm of controversy, and needless to say litigation, followed.  Then, on May 13, 2016, the Civil Rights Division of the U.S. Department of Justice sent the now-(in)famous “Dear Colleague” letter to public school districts, informing them that under Title IX of the Civil Rights Act (which prohibits sex discrimination in education programs that receive federal financial assistance), as a condition of receiving federal funds, the districts would be required to make “sexed” school facilities, such as bathrooms and locker rooms, available to students based on the students’ “gender identity.”  Schools, including colleges and universities receiving federal funding, would no longer be permitted to require that transgender students use separate facilities.  According to the Dear Colleague letter, “[g]ender identity refers to an individual’s internal sense of gender” and “[a] person’s gender identity may be different from or the same as the person’s sex assigned at birth.”  While enforcement of the Dear Colleague letter had been stayed pending judicial resolution as to whether it is a valid interpretation of Title IX, it has now been revoked altogether by President Donald Trump.  Most observers agree, however, that the issue is far from settled.

As the “bathroom wars” illustrate, the current focus of the transgender rights movement appears, then, to have shifted, from the straightforward request that transgender (and “gender non-conforming”) people be protected against discrimination in areas such as employment, housing, and education, to a much broader proposition.  Specifically, many transgender advocates now posit that transgender people must be accepted, recognized and treated, for every purpose, as members of the sex with which they identify.  According to the Dear Colleague Letter, from henceforth, a person’s stated “gender identity” or internal sense of gender (gender previously thought of as the set of socially conditioned behaviors and personality traits commonly associated with a given sex) overrides or replaces that person’s biological or natal sex.  In fact, the very notion that there is something called “biological sex” is increasingly rejected in favor of the view that “sex” is “socially constructed.” The short-hand for this view is the oft-heard claim that “trans-women are women.”

Such a claim has profound implications for humans’ understanding of one of their most fundamental sources of identity: their sex.  The transgender claim that a person’s sex is not grounded in a set of objective, observable facts, and that it is bigoted and ignorant to believe that it is, represents a quantum shift in the way that most humans perceive reality and each other.

We cannot discuss the intellectual underpinnings of the modern transgender rights movement without a short detour into the critical theory known as post-modernism.  Post-modernism was originally formulated in the 1960’s  in opposition to the Enlightenment idea that:  “[t]here is an objective natural reality, a reality whose existence and properties are logically independent of human beings—of their minds, their societies, their social practices, or their investigative techniques. Postmodernists dismiss this idea as a kind of naive realism. Such reality as there is, according to postmodernists, is a conceptual construct, an artifact of scientific practice and language.  This point also applies to the investigation of past events by historians and to the description of social institutions, structures, or practices by social scientists.”  Post-modernism also rejects the idea that “[t]he descriptive and explanatory statements of scientists and historians can, in principle, be objectively true or false.” The postmodern denial of this viewpoint—which follows from the rejection of an objective natural reality—is sometimes expressed by saying that there is no such thing as “Truth.”  The transgender claim, that there is no objective category called “sex” for human beings, is thus a very post-modern way to view the world.

While post-modernism can provide an interesting and illuminating lens through which to “de-construct” theories, beliefs, and works of art, it seems to do a much poorer job at providing “words to live by.”  Human beings do need to act “as if” there is “such [a] thing as Truth,” if for no other reason that it is impossible for humans to live in community and interact with one another unless they share some consensus on what constitutes reality.

This is why, I believe, the core transgender concept, that “man” and “woman” do not exist as independent qualities, but are matters of subjective belief, is so immediately foreign, if not abhorrent, to most people.  A quick review of the comments on virtually every transgender-themed story on a mainstream platform, whether that is the New York Times or, will show that the vast majority of people reject the post-modern view of sex, and in fact feel great discomfort when faced with demands that they adopt it.

Just Passing Through 18 hours ago

From dictionary dot com: de·lu·sion, noun. An idiosyncratic belief or impression that is firmly maintained despite being contradicted by what is generally accepted as reality or rational argument, typically a symptom of mental disorder. I’m a middle age man. Say I go to the closest middle school in my area and announce that in my heart, I truly believe I’m a 12 year old girl. I want to be a cheerleader, braid other girl’s hair, watch Justin Bieber videos, giggle and talk about boys. Of course, the administration with call the police and they will haul me away to the closest mental hospital. Someone will cry out, “you’re a 61 year old man, for God’s sake!” I will say, “so is Bruce/Catlin Jenner!” If a delusion is a delusion, why is one delusion celebrated and the other condemned?

Not buying it, and he’s got a lot of company.

It hardly needs saying that when we consider any other human physical qualities, whether that person is old or young, tall or short, or light or dark-skinned, we rely on what we observe or can measure to tell us where that person “fits” into any of these groupings.  Modern gender theory, however, tells us that for the specific category of sex (and only for sex, so far as I can tell), we cannot and should not base our conclusions on what we see and that sex differences have no basis in what we consider to be objective reality.

boy parts

This is a pretty heavy lift for most people.

queers gender

So is this.

To put it mildly, this is a paradigm shift.  In fact, it is a paradigm shift that has substantially broader implications than does expanding “marriage” to include same-sex couples.  In the case of marriage, as the well-worn slogan had it, “if you don’t like gay marriage, don’t have one.”  In other words, at the end of the day, the fact that same-sex couples could now be married had few ramifications for anyone other than the people involved – and, at any rate, all of the arguments were hashed out over decades.  An ancillary point is that by the time the gay marriage decision came down, most straight people knew (and knew they knew) gay and lesbian people.  They could sympathize with the desire of gay and lesbian people to be included in the definition of marriage, based on their personal familiarity with their lives and struggles.  And, of course, including gay and lesbian people within marriage did nothing to detract from or change the experience of marriage for people who were not gay and lesbian.

Re-defining sex as a matter of subjective belief has implications for every human.  In most of our daily lives, a person’s sex is irrelevant; it does not matter whether the people with whom we work or play are male or female.  However, there are important legal categories, statutes, categories and activities as to which sexual differentiation remains relevant, and if we re-define sex generally, we are re-defining it for all of these purposes.  This is where so much of the conflict emerges.  If we have decided that “sex matters” for some purposes, such as privacy, safety, re-dressing historic wrongs or inequities, competition in sports, religious observance and reproduction (to name just a few), re-defining what we mean by “sex” will have a ripple effect that extends to each and every one of these areas.

The 2016 Dear Colleague letter, while superficially addressed solely to educational institutions receiving federal funds, and while superficially concerned only with Title IX, codified the post-modern view of sex difference into law and federal policy.  This represented an incredibly swift, forced acceptance of an entirely new view of sexual difference for most people outside of academic or theoretical circles.  There has been virtually no opportunity for the public to think carefully about the issue, to research, consider, discuss, listen, or debate.  Efforts to think critically about what adopting this view implies for men and women are shut down and shamed as transphobic and bigoted.  Contrast this stunningly rapid adoption of the post-modern view of sex difference, with the decades-long fight of gay and lesbian people to be provided with basic rights and the evolution of society’s understanding of gays and lesbians as it related to marriage.

A social consensus may yet emerge to the effect that sex, and perhaps other human characteristics, is “in the mind of the haver.”  Society may also figure out different ways of grouping people – distinctions between the sexes becoming less important as people feel more comfortable in mixed-sex groups (a current example would be naturism), or as people become increasingly distanced from their physical bodies, whether through virtual reality or radical advances in medical technology.  “Sex” may simply cease to be a relevant category.  But we’re certainly not there yet.  When we look at how incredibly rapidly the post-modern view of sex has been imposed on our culture, it is hardly surprising that we are in a time of serious discord and dissension about it.  This is, at least in part, because re-defining human institutions from the “top down” is not a healthy thing for a society.  Telling the public that it must accept and internalize the post-modern approach to sex difference, long before we have had the chance to reach consensus about it, is unfair, almost certainly doomed to failure, and will result in a host of unanticipated consequences that will extend far beyond the local bathroom.

Age is just a number when it comes to neovagina surgeries

Trans activists constantly tell us “no one operates on minors.”  After all, the WPATH Standards of Care itself officially recommends genital surgeries only for those over the age of 18.

Anyone who has read this blog for awhile knows that such surgeries are already being performed on minors, at least in the United States. But how many know that gender doctors are openly discussing the advantages of early genital surgeries in highly respected medical journals?

karasic jsm piece in press

This piece, brand-new in the Journal of Sexual Medicine, co-written by Dan Karasic of UCSF’s Center for Excellence in Transgender Health, and Christine Milrod, psychotherapist at LA’s Southern California Transgender Counseling Center, makes it clear that WPATH members have been doing plenty of underage surgeries. And most surgeons quoted in the article [currently behind a paywall], despite a few concerns, are moving full speed ahead.

Their main criterion for determining surgical candidacy for vaginoplasty seems to be whether a young person can adhere to the “dilation schedule” necessary to keep the surgical wound (aka neovagina) from closing up. Any worries about brain development? Executive function? Ability to understand the many social, medical, and psychological consequences of this irreversible decision? Evidently not.

Age is just a number.  The “dedication” to adhere to the “dilation schedule” is a marker of maturity!

karasic jsm adhere to dilationIs there any lower limit for these surgeries? One surgeon opines that there “might” be a minimum age, but “I don’t know what that should be.”

(Heck, there are probably 8-year-olds who could adhere to the dilation schedule, so let’s not hem ourselves in with some arbitrary number.)

karasic jsm 2

Besides, college students are far too busy in their freshman year to keep up with their dilation schedules. Lots of other extracurricular activities to distract them!

karasic jsm maturity

How do you operate on stunted genitalia, after all those years on puberty blockers? Micropenises can be a problem in terms of creating an adult neovagina, but donor tissue and “scrotal tissue expanders” can be successful in some cases. Better than the alternative which some surgeons use, given the “concomitant morbidities” of persistent odors, colitis, and leakage of stool.

karasic jsm micropenis

And worries about potential lawsuits? Pshaw. We can’t get actual informed consent, but we’ve got the parents on board, and after all those years of gender affirmation, who’ll let a few side effects or lingering regrets get in the way?

karasic jsm consent

It’s a crap shoot they’re willing to take–even if a few of these young trans women end up unhappy with what they’re left with, like the six trans men currently suing one of the top gender surgeons in the US right now. After all, that’s what medical malpractice insurance is for.

Renowned San Francisco phalloplasty surgeon hit with multiple lawsuits

Note: The administrators and contributors at 4thWaveNow do not take a position on the veracity of the allegations set forth in these lawsuits. We are reporting on public documents available on the Internet about these legal actions. Commenters’ opinions are their own.

In a previous 4thWaveNow post, we documented the proliferation of gender surgeons who perform mastectomies and “bottom surgeries.” Some of them, including San Francisco surgeon Curtis Crane,  have publicly indicated their willingness to operate on patients under the age of 18.

One of Crane’s former patients, a detransitioned woman who underwent a double mastectomy at age 17, wrote a guest post for 4thWaveNow.

It has come to our attention that Dr. Crane has been the defendant in no less than six lawsuits during the last year. The suits variously allege medical malpractice, medical negligence, and/or failure to obtain informed consent.

Some of the lawsuits are still active, and all court documents are available via a public search on the San Francisco County Superior Court website.

Obviously, the exact details of the lawsuits vary, but all are centered around serious complications from phalloplasty and other “bottom surgery” procedures.

The six cases are as follows. To see the Register of Action (list of documents with dates) for each case, and all associated documents, simply enter the case number in the search box at the above link. When clicking on a document, be sure your browser allows pop-up windows.

  • 554254
  • 550630
  • 556743
  • 556713
  • 557327
  • 557363

Screen captures are taken from the complaint documents in the referenced cases.


Lupron: What’s the harm?

Worried Mom and her son, Worried Brother, co-wrote this post.  Worried Mom is an attorney who currently works in the non-profit area, and Worried Brother is employed in the pharmaceutical industry, with a background in chemistry.  This piece is sourced in the scientific literature; click superscripted footnotes to follow links.

For recent mainstream coverage about the potential harms of pubertal suppression, see here and here.

by Worried Mom & Worried Brother

Before we can have a sensible discussion about Lupron and its hormone-suppressing effects, it is important to understand what normal hormonal balance means in a healthy teenager or adult.

Normal body functioning requires a certain latent amount of testosterone and estradiol (estradiol is the major estrogen in humans).  Men and women both have some of these hormones naturally present in their bodies, produced by testes in men and ovaries in women.  Testosterone is involved in the development of muscle bulk and strength, the maintenance of proper bone density, the creation of red blood cells, the sleep cycle, mood regulation, sex drive, hair growth, and cholesterol metabolism.1,2,3  Low testosterone levels can lead to deficiencies in any of these areas.  For example, lack of testosterone can cause fatigue, insomnia, and interference with mood and sleep, together with a host of other impacts on, for instance, a person’s sex drive.

Like testosterone, estradiol is involved in the maintenance of proper bone density, mood regulation, skin health, and reproductive health.4,5,6  Lack of estradiol can lead to adverse impacts in those areas.  Because estradiol is a crucial component in maintaining bone density, individuals who lack sufficient amounts of estradiol will fail to undergo proper bone development, because the growth plates on the ends of the bones will never close.7  This profoundly alters the physical structure of the body.

Lower levels of estrogen are also associated with significantly lower mood.  The primary regulators of mood in the brain, according to our current understanding of neurochemistry, are the systems relating to the neurotransmitter serotonin.  Estrogen receptors are prevalent along the mid-brain’s serotonin systems, and they are believed to play an important role in serotonin-mediated behaviors such as mood, eating, sleeping, temperature control, libido and cognition.  Mice that are bred missing this particular sub-type of estrogen receptor show enhanced anxiety and decreased levels of serotonin and dopamine.8

As noted, both men and women naturally produce testosterone and estradiol in their bodies.  The levels of these hormones fluctuate greatly depending on the person’s stage of life.  At the start of puberty, a child’s body will begin to produce either testosterone or estradiol in much greater quantities than it had previously.  This increased production leads to the development of secondary sexual characteristics.  As men and women age, their levels of testosterone and estradiol also decrease, leading to well-known age-related effects, such as thinning bones and hair in both men and women.

A current focus in the treatment of transgender children and teenagers is to arrest, or delay, the impact of testosterone and/or estradiol in adolescence.  Arresting the impact of these hormones will prevent the development of secondary sexual characteristics.  Moreover, many clinicians recommend–if a child or teen is unsure as to whether he or she wishes to become a transgender adult–that the administration of so-called “blockers” will “delay” puberty and “buy time” for the teen to make a more informed or mature decision.  Theoretically, a teen could always desist from taking blockers and then normal puberty would ensue, although there is very little data in this area.  It is also currently unknown whether, if a teen takes a puberty blocker during what would otherwise have been his or her normal puberty and then stops, whether puberty will proceed entirely as normal or whether there will be some other effects from having delayed it for a period of years.  The “puberty blocker” discussed in this article is leuprolide acetate, better known by its trade name Lupron.

What is Lupron?  Lupron is a gonadotropin-releasing hormone analog.  The primary pharmacological effect of Lupron administration is a decrease in the concentrations of testosterone and estradiol throughout the body.9,10  How does it achieve this decrease?  It does so by tinkering with a hormonal feedback loop between the hypothalamus and the pituitary gland, and interferes in the release of gonadotropins (“Gn”), which is a catchall term for 2 separate hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH).  Gn acts as the primary means by which the body controls the release of testosterone and estradiol.  Gn interacts with the tissues that are involved with the release of these two hormones.  It stimulates specialized tissues in the ovaries and the testes to produce testosterone and estradiol.  LH stimulates the Leydig cells in the testes and the theca cells in the ovaries to produce testosterone11.  FSH stimulates the spermatogenic cells in the testes and the granulosa cells in the ovarian follicles (the granulosa develop to produce a layered structure around the egg), as well as stimulating the production of estrogen by the ovaries12,13,14. There are Gn receptors embedded in the cell membranes of these tissues and binding with Gn results in those tissues producing the hormones.  The hormones are released into the bloodstream, and travel to specialized receptors that are located systemically, in most major tissue groups.  The systemic distribution of these receptors is responsible for Lupron’s effect on the entire body.

The hypothalamus releases GnRH (Gn-releasing hormone) which binds with GnRH receptors on the pituitary gland15.  The hypothalamus responds to the concentrations in the blood of testosterone and estrogen, as well as the presence of Gn16,17.  Since Lupron is chemically similar to GnRH, it is essentially repeatedly stimulating the GnRH receptors on the pituitary gland.  This artificially high activation of these receptors desensitizes the pituitary gland to the presence of GnRH18.  There is an initial flare-up of Gn release in response to the presence of the Lupron, but it eventually results in down-regulation or deactivation of these receptors19.  In physical terms, this means that the pituitary, in an effort to restore normal functioning, will cull the number of GnRH receptors.  This results in a significantly lowered response to a given concentration of GnRH in the blood. Why is this?

This is the key point, because the strength of an organ or tissue’s response to any drug is directly proportional to how many receptors are activated by the presence of the drug.  So, using this idea, lower the number of receptors, lower the response, and if there is an absolutely lower number of receptors present, there is an absolutely lower potential response20.  Once the drug is removed from the body, the pituitary is left in a desensitized state, rendering it unable to respond to ‘normal’ activation by GnRH.  This results in decreased production of Gn, which in turn means decreased production of both testosterone and estradiol in the tissues with which Gn would normally interact.

Lupron use in otherwise normal teenagers to delay puberty is both relatively new and off-label.  Lupron does have a history in treating a condition called ‘precocious puberty,’ which is what happens when a child’s body enters puberty too quickly for his or her age.  However, this is a clinical condition typified by concentrations of sex hormones deemed wildly abnormal in the course of normal development.  As such, the usage of this drug may be more appropriate in  these particular individuals, because the marginal benefit of leaving this condition untreated is higher than it would otherwise be. Any competent medical professional would not generalize from outcomes observed in a population of individuals affected by abnormal hormone levels, to individuals with normal hormone levels.

Industry standards21 judge the usage of Lupron in treating gender dysphoria as providing at best no proven benefit and hold that there is an insufficient quantity of published evidence to prove its safety for this purpose.  UnitedHealthcare, the nation’s largest insurer, makes its stance clear on Lupron for usage in treating gender dysphoria on their Drug Policy page:22

‘Hayes compiled a Medical Technology Directory on hormone therapy for the treatment of gender dysphoria dated May 19, 2014.  Hayes assigned a rating of D2, no proven benefit and/or not safe, for pubertal suppression therapy in adolescents. This rating was based upon insufficient published evidence to assess safety and/or impact on health outcomes or patient management.’

A D2 rating is the lowest rating possible on that particular institution’s scale of safety and efficacy.  The Hayes Technology Review is considered to be the industry standard in linking treatments with patient outcomes.

In Lupron’s case, the vast majority of clinical data is found in samples of middle-aged or older men with late-stage prostate cancer.  This means the aggregate of the medical community’s understanding of Lupron’s safety profile relates to its use in this context, in terms of both the condition it is meant to treat and the individuals for whom it is approved.  When using Lupron as a “blocker,” medical professionals are, in both senses, treading untested waters, for the dual reason that it is not approved or recommended to “treat” this particular condition, and clinical studies relating to its long-term or even short-term safety in treatment of gender dysphoria are vanishingly rare.  To further illustrate this second point, the population to whom Lupron is most commonly prescribed on-label, middle-aged and elderly men, has a much shorter life expectancy from the date of administration than do teenagers.  In other words, based on the current state of research, one would not expect to see data collected from groups who are 40, 50 or 60 years “out” from administration.

Putting together what we know about how the body normally reacts and develops during puberty with what we know about how Lupron works, we can conclude the following: administration of Lupron to young people for the purposes of blocking puberty is a disruption of a delicate hormonal balance that has the potential to cause adverse health effects.  The risk is further compounded by the off-label usage of the drug for this purpose, as well as the lack of long-term data related to safety.


Open letter to the American Psychological Association (APA) on the rise in trans youth diagnoses

Note: The APA Committee on Sexual Orientation and Gender Diversity meets in late March.  Anyone with concerns similar to those expressed by Justine Kreher in this post may want to address them to the committee. Lisa Marchiano, LCSW, a Jungian therapist who blogs at (Twitter: @LisaMarchiano), has also written a letter to the APA which was posted today at Youth Gender Professionals.

Justine Kreher blogs at and can be found on Twitter @thehomoarchy.

by Justine Kreher

I am a 48-year-old, married, average US citizen, who has been in a same-sex relationship with the same person for 18 years. I consider myself a centrist skeptic. I believe that all sides of every issue need to be heard in order to truly make informed and fair decisions.  I am very concerned about how valid criticism/discussion is now called “hate speech” in many arenas of identity politics and how this is being used to try to muzzle free speech. Curtailing discussion around something as serious as permanently altering minors (children and teens) is a very bad idea.

I became aware of youth transitions because I wanted to blog about lesbian relationship issues ( This led me to read more LGBT websites and message boards. That is when I first became aware that some gay men and lesbians are concerned about how gender dysphoric children are treated, and that most dysphoric children grow up to be LGB and not trans. I am a latecomer to this issue compared to some lesbians who have been talking and writing about the impacts of transitions on the lesbian community for years now.

I delved into most of the studies available to the public and gathered other information. A detailed list of the risks involved in youth transitions can be found in my blog post “Do Youth Transgender Diagnoses Put Would Be Gay, Lesbian, and Bisexual Adults at Risk for Unnecessary Medical Intervention?” [A summary of a few of the key points can be found at the bottom of the current post.∗]

I can only speak for myself and don’t necessarily endorse anyone else’s opinions. I am not opposed to treatment for transgender children if evidence shows it is safe for all gender nonconforming youth and I want the best care for everybody.

I wrote a letter outlining my concerns and emailed it to over 150 people in LGBT rights orgs and media, as well as to mental health organizations. The American Psychological Association (APA) was one of only two which even responded. Their response, written by Clinton W. Anderson, at that time the Director of the Office on Sexual Orientation and Gender Diversity at APA, was pretty generic and did not address my concerns.  It consisted mostly of a reiteration of the APA’s current policies, although Anderson did say he (?) would share my concerns at an upcoming meeting of the APA Committee on Sexual Orientation and Gender Diversity in late March.

I have just written the below reply, which I sent today. (Letter has been altered slightly for publication on 4thWaveNow).

To the Office on Sexual Orientation and Gender Diversity at the APA,

Thank you very much for your response to my letter.  I would like a chance to address some unresolved issues. I will be posting this letter publicly.

I began researching the sharp rise in children being diagnosed as transgender to diffuse what I then saw as increasing transphobia among some gays and lesbians who were extremely angry about the prospect of false positives in youth transitions, because of how it disproportionately affects their communities. I was certain that gender therapists, researchers, medical practitioners, and LGBT organizations would be taking great care to ensure the safety of all gender nonconforming children. Instead, what I found, were…

  • dishonest statements about the known safety of hormone blockers and early social transitions
  • numerous stories about negligent gender therapists
  • lesbian/bi minor females identifying as trans for long enough to have an official diagnosis and be endangered
  • a tone-deaf attitude among supporters of the 100% gender affirmation model towards gay men and lesbian adults who promise this could have been them as children
  • trans kid camp materials where no other coping skills or role models are provided other than transition
  • sex reassignment surgery on minors discussed as if it were no more harmless than a mani-pedi
  • public statements that the only option parents have with every single child who claims they are transgender is to transition them or they will commit suicide
  • parents of children who had desisted being ignored
  • detransitioners being treated badly
  • professionals insinuating/stating outright that transitioning a few kids inappropriately is worth it
  • a general failure to take seriously the damage false positives can do, and the horrible human rights abuse against the diversity of expression of the non-trans gay/bisexual community.

I acknowledge transgender people’s right to advocate for their own community and to advocate for what is best for trans young people. I also understand that they view any hindrance to transition as an affront to their humanity and their rights. And I truly want to believe the vast majority of the young people in these programs have intractable gender identity disorder/gender dysphoria. I respect that they have rights and society is morally obligated to provide them the best evidence-based mental health and medical care.

I’m also familiar with the positive research on transitions to treat gender dysphoria. Almost all of the studies on transgender adults show low regret rates. Many studies also show that transition relieves the dysphoria. I’m also aware of the research studies on trans youth that show positive psychological benefits associated with earlier transitions. The two most cited are the Dutch 2014 study where the youth were intensively screened (a type of gatekeeping rapidly going away in many cases), where five stopped communications and one died from complications of genital surgery, but the remaining 50 eligible for followup were doing very well. The other is the Trans Youth Project study that showed socially transitioned children at followup had almost normal levels of mental health. However, as this Yale medical student stated, “The authors compared their cohort of children to cohorts in studies that were conducted more than 10 years ago, during a time when society was even less accepting of transgender youth.” This study doesn’t compare them with kids in loving, supportive homes, who are not transitioned as children, but who will be accepted in their own decision-making process when they are adults.

Neither of these studies had control groups to compare desistance rates for early social transitions or for the effects of hormone blockers, because (according to the current narrative), using such control groups would be unethical.

You mentioned you want to provide “evidence based care.”  So when you have your meeting at the end of March 2017, these are the issues I hope you will be discussing:

 1)    As I asked in my previous email, why do almost no children desist once put on Lupron, and where is evidence it doesn’t interfere with the youth’s identity formation? There has also been a recent negative story about the safety of Lupron.

2)    Why are there twice as many female young people coming to some gender clinics than males in Canada, England, and the Netherlands? Why is this not a cause for concern, when in Oregon, a 15-year old can obtain a mastectomy without parental consent, and activists are pushing for this everywhere else? Any other time the epidemiology of a condition changes this much, researchers have taken notice. Why, on this issue, is it treated as nothing but social liberation that deserves nothing less than total affirmation by a large number of mental health professionals, especially when it is well known that female teens are prone to body hatred issues and social contagion? I’m not aware of any APA studies seeking answers.

3)    Why is a hypothetical study involving for example, 200 gender dysphoric youth who are…

  • loved/supported
  • not gender policed in anyway as far as clothing and behavior
  • placed in safe schools
  • provided adult role models who have coped with being gender nonconforming without surgery
  • lovingly told there is nothing wrong with them and they will be loved and supported in their transition when they are mature as possible
  • afforded exceptions if the child was self harming and transition viewed as the best option

…not morally acceptable, but what is morally acceptable is…. 

  • the APA and medical field instituting ill-defined protocols, which are loosening daily, with no control groups, in circumstances where most dysphoric kids are pre-gay/lesbian, /bi and not trans, when effects on desistance are unknown
  • uncertainty if these practices risk disfiguring healthy bodies
  • risking perpetrating violations of the Hippocratic oath to not over treat
  • potentially violating the future 60-70 years of a child’s life in the case of false positives, that violates his/her journey to come to accept him or herself as a gay man or lesbian, even one with a difficult childhood; which amounts to an abuse of his/her human right to fertility, and an abuse of his/her now drastically altered sexuality
  • unknowingly participating in a civil and human rights abuse of gender nonconforming people who turn out not to be trans but are more likely homosexual; something that could affect thousands of people in the future?

Is this happening to socially transitioned children and tweens on hormone blockers? I am not saying I know it is, but unfortunately, you can’t prove it is not.

The psych field (including APA members) has skipped an entire, more moderate approach to treatment as outlined in the first example and gone straight to a 100% affirmation model (no attempt is made to help the child find alternative ways to cope) with no control studies and no meaningful publicly expressed concern over effects on persistence.

Does the APA understand that even though there is no clear-cut data that the very high stakes are parents having their children ripped from them by trans activists and gender therapists working with the government? Parents who may be loving and supportive but don’t want to permanently, physically alter their minor child for the rest of their lives based on data that is not solid. Does the APA understand that these governmental policies activists are working to implement could result in children being removed from the care of parents who protected their gender confused teens from permanent disfigurement by keeping them away from the gender clinic and the 100% affirmation model?

 This is morally acceptable to the psychological and medical field?

4)    Since the APA is encouraging supporting nonbinary identities, what research does the APA have to justify these recommendations, since it is increasing numbers of 18/19-year-old females (younger now in some cases) adopting these identities, many of which are recent proliferations spread on social media; and many of these “nonbinary” females are seeking breast amputation? Since there are now up to 50 of these gender identities, does the APA support reinforcing all of them, and if so, based on what data? Does the APA have proof that the use of dozens of different pronouns associated with these identities is actually adaptive and healthy for these young people?  Has the APA considered what will happen to these young people, the vast majority of whom would have found a way to fit into the binary 15 years ago? When these young people leave the open minded, nurturing environments of the therapist’s office and academia, they may be faced with employers who have every motivation to not hire individuals who require them to force employees/customers to use self created language or risk lawsuits/fines.

The story below highlights the fact that the “infinite genders” (actual quote) approach of gender-affirming therapists is in fact contributing to gender and sexual confusion in teenage girls. There are many more examples and I hope APA members are watching genderqueer young people on social media, because it is not reflecting a culture of mental health.

Will the APA study the effects on 5th grade girls (known to have inferiority complexes in relation to their male peers) who are not encouraged to view their traits as an expression of personality or as an indication they may be lesbian or bisexual when they get older (because at 10 this isn’t appropriate), but to instead view themselves as trans by gender-activist trainings in schools? This is in fact happening (for just one example see this video at 3:07:00). And can the APA demonstrate why any of this is actually healthier for these individuals and society than normalizing female “masculinity” and male “femininity” and stressing the shared, diverse traits and humanity of the two sexes?

What culture are you helping to foster? Several parents of transgender children who have been featured in the media have made statements which appear homophobic (i.e. “trans isn’t like homosexuality, it’s ok to talk to kids about it” “I hope my little ‘girl’ stays exactly the same”). From observations by some who have attended support groups for gender nonconforming children (often not run by mental health professionals), they are very politicized environments, where even questioning any of these practices is met with extremely negative reactions. What will be the effect on borderline dysphoric children, when their social life revolves around support groups such as this one; whose members and leaders screamed “transphobia” when a judge removed a child from a home due to possible Munchausen-by-proxy child abuse? Since you and your colleagues are medicalizing gender nonconforming children; and since the APA considers helping a young person adjust to their natal sex as “conversion therapy,” shouldn’t it be a priority to ensure the “conversion therapy” is not ever happening the other way around?

5) In your meeting, please acknowledge that the collateral damage of youth transitions is going to be an untold number of irreversibly altered young people who are not happy. To take only a few recent examples, the detransitioners who have created the vlogs below (mastectomies at 17 and 18, social transitions years earlier) fit all of the criteria for medical transition. The APA should be honest with the public about the risk of regret and detransition. You should include this information on your website material concerning trans youth, even if these regretters are a small minority. Ask yourselves how the APA can support lesbian youth, because such females who don’t identify as trans under the age of 21 are becoming a lot rarer. The detransitioners in these videos cite lack of support for a lesbian identity and positive role models as factors in their decisions to transition.

No one knows the ultimate effects of early transitions on younger children and tweens. We have in fact seen that youth transitions are dangerous to some teenagers and young adults, particularly ones that are lesbian, autistic, or have mental health problems. Child/teen transitions may be wonderful for the trans community and supportive of trans rights and mental health. I am not denying that. But every false positive that happens to a minor, affecting the next 60 years of that person’s life, is a human rights abuse. A top priority of the APA should be to analyze whether or not your recommendations are increasing persistence rates for dysphoric children. Because if they are, you may be doing amazing things for trans health and trans rights but you are also participating in the most serious human rights violation of LGB people since they where given electroshock therapy in the 1950’s. This is not even treated as a passing afterthought by many in the medical and mental health field, including APA members, from my numerous observations. I find this highly unethical and I hope it changes soon.

Thank you for your time.

-Justine Kreher


∗ Some risks and uncertainties involved in youth transition:

·         Most children–even some who have serious gender dysphoria–desist (grow out of it) and are likely to be gay/lesbian adults, so it makes sense to be concerned about children who are socially transitioned at a young age.  Gender-affirming mental health professionals almost always tout the safety of social transitions in the public statements they make to the press and in seminars they give, even though they have no proof it is. One example is Kristina Olson, involved in the Trans Youth Project; her attitude is the norm.

·         Gender clinics report that either no or very few children desist when they are put on puberty blockers (GnRh agonists such as Lupron). These chemicals prevent the secretion of pubertal hormones, despite the fact that exposure to sex hormones may help the child become comfortable with their natal sex. This has been done with no control group of children not put on blockers. Gender-affirming mental and health care professionals all claim that these hormone blockers are fully reversible in their public statements, despite a lack of data.

·         There has been a huge increase in female teens seeking services in gender clinics. The numbers are almost 2 to 1 in some clinics. The overall numbers have gone up but why are more females relative to males coming to these clinics when the adult transgender population doesn’t reflect this? I have read many articles and watched hours of trans seminar footage from gender affirming professionals where this isn’t even discussed. The clinicians at Tavistock & Portman in Britain are the few who even bother to mention it or express any concern.

·         4thWaveNow and its followers/commenters have documented several cases where teens who desisted were initially affirmed as trans by professionals or identified as trans for over 6 months, yet grew out of it even though this would have given them an official transgender diagnosis.

·         I cite examples in this post over the seeming apathy about the safety of gender nonconforming youth who may be borderline by gender affirming professionals. This is another example.

·         Censorship around this topic is a major problem. I have encountered this apathy many times, from health care professionals, media, and even politicians. For example, Canadian politician Cheri DiNovo immediately blocked me on Twitter for trying to send her my post and for sending her links about young people who have been seriously harmed by transition in the real world. I’m shocked that any person with influence would refuse to consider information about something so important. Followers of 4thWaveNow are well aware that there is a refusal to gather all sides of this story by many people in health care, the media, and from LGBT organizations themselves. The threat of trans suicides is used to squelch anyone who asks even the most basic questions about these practices.

·         Homophobia from parents or even other societies may play a part. For example in Iran, homosexual adults are forced to transition because it is more acceptable to be transgender. A mother in a recent HBO special on trans youth admitted that, prior to identifying her young son as transgender, she would punish him for being “feminine, dramatic, and flamboyant.” A recent longitudinal study of nearly 5000 adolescents found a high correlation between “gender nonconforming” behavior at age 3 and later homosexuality.