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.

Guest post: Why do WPATH & the APA scorn desistance?

This post is written by overwhelmed, a 4thWaveNow community member and mother who recently wrote about her own daughter’s desistance from trans identification. Her personal experience inspired her to submit this piece about the current effort by some activists and gender specialists to discredit decades of peer-reviewed evidence that most children with gender dysphoria do indeed change their minds.

Stay tuned for an upcoming post by 4thWaveNow that will take a closer look at the anti-desistance meme being propagated by proponents of  pediatric “transition.”

 by overwhelmed

There should be regulations in place to protect our children from harmful medical interventions. I think most people would consider this statement a matter of plain common sense. But unfortunately, common sense seems to fly out the window when “trans kids” are involved. More and more gender dysphoric children are being treated with puberty blockers, cross-sex hormones and even surgeries at young ages.

Trans activism has been busily exerting political influence on the medical field.  Being closely tied to LGB has given the T legitimacy (even if the aims of T conflict with those of the LGB). Trans activists have helped convince the public that gender identity is comparable to sexual orientation. They insist that helping children become comfortable with their birth sex is as abominable as conversion therapy is to homosexuals; that it is bigoted to want a child to avoid being transgender, just as it is bigoted to not accept a person as gay. But, the thing is, unlike the T, the LGB doesn’t require all of these medical treatments. And, unlike the T, the LGB just want people to accept their sexual orientation. Besides political gain, there really is no good reason to conflate gender identity and sexual orientation.

Recently, trans activism forced the closure of the CAMH Gender Identity Clinic in Toronto. In response to this closure, sexology researcher Dr. James Cantor  posted a compilation of childhood gender dysphoria research going back many decades on his site Sexology Today:

Following the closure of the CAMH Gender Identity Clinic for children, I have been receiving requests for what the science says.  Do kids grow out of wanting to change sex, or does it continue when they are adults?

 In total, there have been three large scale follow-up studies and a handful of smaller ones. I have listed all of them below, together with their results. (In the table, “cis-” means non-transsexual.) Despite the differences in country, culture, decade, and follow-up length and method, all the studies have come to a remarkably similar conclusion: Only very few trans- kids still want to transition by the time they are adults. Instead, they generally turn out to be regular gay or lesbian folks. The exact number varies by study, but roughly 60–90% of trans- kids turn out no longer to be trans by adulthood.

Cantor shared his post on the the World Professional Association for Transgender Health (WPATH) Facebook page. Although WPATH supposedly promotes evidence-based care and research, the vast majority of WPATH Facebook commenters appear to have strongly held opinions that contradict WPATH’s professed mission. Many state that once someone identifies as transgender, they will be transgender for life (regardless of the age of realization). Some commenters say it is a right for anyone (gender dysphoric or not) who wants to have these medical interventions.

When confronted with Dr. Cantor’s research compilation, there were many attempts to discredit the information. Some commented that the studies were old, flawed, invalid, and called them “junk science.” But others were more confrontational:

kills people

fuel to fire

Another commenter, Colt Keo-Meier, trans activist academic and recent (2013) psychology graduate from the University of Houston, is currently the co-chair of the Committee for Transgender People and Gender Diversity, Division 44 of the American Psychological Association (APA). This committee issued guidelines a few months ago that effectively put a damper on the clinical judgment psychologists and social workers can use when treating their gender nonconforming and trans-identified clients (more on these APA guidelines shortly).  Keo-Meier apparently believes that a child’s persistence in a transgender identity is to be desired.

colt comment

The last commenter on Cantor’s thread I will mention is Jenn Burleton (of “In a Bind” fame), who here discounts the research compiled by Dr. Cantor (referred to by Burleton as “Mr. Candor”) as flawed, while bragging about the 0% desistance rate of the over 200 kids seen at Burleton’s TransActive Gender Center.


Jenn Burleton seems to celebrate the 0% desistance rate, but the fact that it contradicts decades of prior desistance research should raise alarms. What approach do they use at the TransActive Gender Center to obtain these “impressive” results?

Here are TransActive Gender Center’s “Best Practices” :

transactive best practices

So gender-confused children seen at TransActive are affirmed as the opposite sex, socially transitioned, and treated to the “empowerment” of pubertal suppression, cross-sex hormones and surgeries. Is it any wonder these kids don’t desist? They are literally being conditioned to keep believing something is wrong with their bodies. Additionally, these socially transitioned children, even if they did start to have doubts, will likely feel tremendous pressure not to go back to their birth sex. Adolescence is already challenging enough without these complications. Just imagine how difficult it would be for a child in public school to start out as Jennifer, but later change to John.

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

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

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

The APA guidelines do mention a second approach, though:

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

The APA felt the need to add on some warnings to the “embrace their given bodies” approach–just as WPATH members scolded Cantor that encouraging a child to align with their natal body is UNETHICAL. Seemingly defying common sense, we have literally come to the point that it is considered immoral (and in some areas illegal) to help a child feel comfortable with their body.

Yes, I said illegal. In more and more places, legislators are making the “embrace their given bodies” approach unlawful. Since 2012, the United States has banned gender identity “conversion therapy” in California, New Jersey, Illinois, Oregon, the District of Columbia and the city of Cincinnati, Ohio. And, in Canada, the practice has been banned in Ontario.

As parents who haven’t bought into the truth of our children’s sudden trans self-diagnosis, we have found ourselves in the position of going against the advice of WPATH and the APA. We want our children to realign with their bodies, to once again be whole, to be healthy. Desistance is our goal. We are not being transphobic, we sincerely care about the health of our children. We don’t want to “affirm” them as the opposite sex and validate that there is something so wrong with them that it leads to cross-sex hormones, surgeries and becoming lifelong medical patients. Transitioning should be a last-ditch effort, something to be used only when all other options have been thoroughly exhausted.

These guidelines and legislation, however, have made it difficult, and in some areas impossible, for parents to find mental health professionals willing to help their children (many of them with pre-existing mental health issues) feel comfortable in their bodies. Trans activists are using their influence to change medical guidelines and legislation to align with their strongly held beliefs, despite the scientific research that contradicts them. Instead of having desistance as a goal, they are working hard to make it a myth.