Blocking puberty–and the right to an identity crisis

I recently wrote about research findings that gay and lesbian youth are typically older than their heterosexual counterparts when they first act upon and realize their sexual orientation. While same-sex attracted girls, in particular, reach this milestone between 19-early 20s, the current trend is to “socially transition,” then puberty block, and finally move on to cross sex hormones at age 16.

It’s easy to see that many of these teens are being set up to short-circuit the natural discovery of their sexual orientation. But is that the only potential problem with social transition and puberty blocking—the preemptive conversion of likely gay and lesbian youth to transgender?

Not by a longshot. There are so many important things that happen at puberty which are critically important to the maturation necessary to make informed decisions about major life changes (you know–things like sterility, loss of breasts, and a permanently deepened voice) that a developmental psychologist or cognitive scientist could write a doctoral dissertation about the subject.

In fact, many have; the research and clinical literature going back to the mid-20th century is chock-a-block with replicated studies, clinical observations, and meta-analyses. More recently, we have MRI and fMRI studies corroborating earlier observations.

What we don’t have, at least not yet, are the PhD theses showing how the experimental “treatments” currently being implemented by pediatric endocrinologists and gender specialists—many of whom have no professional background in child or adolescent psychology—fly in the face of that large body of literature.

I have spent hundreds of hours poring over the literature on gender dysphoria and pediatric transition. But in all the studies and papers I’ve read, I have not seen mention of the vast body of extant knowledge about child and adolescent psychology. It’s as if these gender specialists just started from scratch.


Erik Erikson

What exactly are they ignoring? Well, for starters, there’s the work of Erik Erikson, a preeminent child and adolescent psychology expert of the 20th century. You can’t read the scholarly or clinical literature on pediatric psychology without finding a reference to Erikson’s work; in fact, much of the current knowledge in the field is built upon his fundamental insights. A blog post is not adequate to even summarize it, but his bedrock finding about the psychological journey of adolescence is this: Developing an identity takes place in stages, culminating in an integrated adult personality; and “identity work”—including an identity crisis—is critical to healthy adult psychological functioning.

erikson capAdolescent psychology expert James Marcia was another foundational thinker who built upon Erikson’s framework:

… two distinct parts form an adolescent’s identity: crisis (i.e., a time when one’s values and choices are being reevaluated) and commitment. He defined a crisis as a time of upheaval where old values or choices are being reexamined. The end outcome of a crisis leads to a commitment made to a certain role or value.

But we don’t need a study, a theory, or someone with a PhD after their name to prove this to us, do we? Any adult who has lived through that time of life called “adolescence” can attest to the fact that questioning, and trying on and discarding different ways of being, go with the territory. And it’s a rough time. How many adults would willingly relive the fraught and tumultuous days of middle and high school? Every psychologist (until the Age of the Trans Child) has agreed: it’s not supposed to be an easy ride. In fact, without the essential but painful work of adolescence, a person will not reach their adult potential: unable to achieve an integrated adult identity, either because they have failed to resolve the identity crisis or because they have experienced no crisis.

Contrast this long-accepted understanding of adolescence with the approach taken by today’s gender specialists. Instead of helping children weather the natural and not necessarily comfortable process of cognitive and emotional development, they concretize and freeze in place the certainties of childhood, in what should be a time for exploration, not stasis.

It would be one thing if these gender clinics were really in the business of helping a child expand or explore different gender identities, without medical interference. But we know that they support and encourage “transition” from one sex to the other, with all the permanent physical changes that entails. In terms of adolescent psychological development, once these kids have taken the irrevocable step of moving from blockers to cross sex hormones, they have been denied the opportunity to go through an identity crisis.  So, a 16-year-old girl who has lost her fertility and her breasts, and who has already committed to a permanent testosterone-deepened voice and increased body hair — how easy will it be for her to experience James Marcia’s “time of upheaval where old values or choices are being reexamined?” That adolescent girl has been cheated of that stage of life. And when did we, as a society, decide that was a good thing?

The media stories and anecdotes from gender clinics are all the same: The kids are uncomfortable, so they and their parents seek relief. Then, according to everyone, the treatment “works” because the kids are happy. For how long? No one knows.

Be that as it may, an identity crisis isn’t supposed to be resolved in preschool, or kindergarten, or even middle or high school: It is the work and the challenge of adolescence, not complete until late adolescence.

 Adolescence has long been characterized as a time when individuals begin to explore and examine psychological characteristics of the self in order to discover who they really are, and how they fit in the social world in which they live. Especially since Erikson’s (1968) theory of the adolescent identity crisis was introduced, scholars have viewed adolescence as a time of self-exploration. In general, research has supported Erikson’s model, with one important exception: the timetable. It now appears that, at least in contemporary society, the bulk of identity “work” occurs late in adolescence, and perhaps not even until young adulthood.

“Late in adolescence”—after the time when most “trans” youth have moved on from puberty blockers to cross-sex hormones, thus bypassing the period when they would have been able to explore possibilities in their original bodies—including, but not limited to, their sexual orientation and other essential aspects of their identities and personalities.

The insights of the earlier child development experts have been corroborated by advanced visualization technologies, such as MRI and fMRI, which have revolutionized our understanding of the human brain and psychological development. In recent years, we have come to understand that full maturation occurs much later than previously thought.

Recent research has shown that human brain circuitry is not mature until the early 20s (some would add, “if ever”). Among the last connections to be fully established are the links between the prefrontal cortex, seat of judgment and problem-solving, and the emotional centers in the limbic system, especially the amygdala. These links are critical for emotional learning and high-level self-regulation.

Beginning at puberty, the brain is reshaped. Neurons (gray matter) and synapses (junctions between neurons) proliferate in the cerebral cortex and are then gradually pruned throughout adolescence. Eventually, more than 40% of all synapses are eliminated, largely in the frontal lobes. Meanwhile, the white insulating coat of myelin on the axons that carry signals between nerve cells continues to accumulate, gradually improving the precision and efficiency of neuronal communication — a process not completed until the early 20s.

In addition to reading research studies, I spend a fair bit of time reading the blogs, tweets, and social media writings of trans-identified teens. While most teens are pretty self-absorbed, with these kids, I am always struck by the depth of self-involvement, the extreme obsession with looks and appearance, and the constant focus on getting what they want, when they want it.

What is conspicuously absent in the narratives of many of these teens is another key aspect of pubertal maturation: self reflection and awareness. Concrete, literalist thinking is a hallmark of childhood. So a preadolescent frozen at Tanner Stage 2 of pubertal development (when blockers normally begin to be administered) may still think literally and concretely: “I am a boy.” Instead of: “Maybe I think I’m a boy because I like trucks and hate girly clothes. Maybe there’s a reason I think I’m a boy, but I’m really not.” The name for such higher level reflection, or “thinking about thinking,” is metacognition.

So when these young people, frozen at an earlier stage of cognitive development, are asked at age 15 or 16, “Are you SURE you’re really a boy?” why would any of them say “no”? And in fact, in the small number of studies that have looked at kids who have been socially transitioned and puberty blocked, none of them have failed to move on to cross sex hormones. Is this because they are “truly trans” and their clinicians have godlike diagnostic skills, with zero—zero!—false positives? Or is it because the very act of endorsing and reifying their self-proclaimed concretized self-images has helped them persist in those self-perceptions?

 No adolescent withdrew from puberty suppression, and all started cross-sex hormone treatment, the first step of actual gender reassignment.

It’s not just metacognitive and abstract thinking that develops slowly, reaching fruition in late adolescence. As I wrote about in this post, executive function—the ability to make decisions, plan, and think of future consequences (like, “do I want to have children of my own, ever”?) doesn’t begin to consolidate until the mid-20s.

Then there’s social maturity and a more nuanced understanding of how to interact with one’s peers. Who doesn’t remember the awkwardness, the trying-to-fit-in, seasick self-consciousness of adolescence? Social development takes place in concert with one’s peers, along with the slow dawning of self-reflection. A socially transitioned, puberty-blocked 14-year-old who has avoided the rigors of hormone-fueled social issues won’t  understand any of this.  How will that lack of experience inform their decision to continue on to cross sex hormones?

 We previously investigated how the ability to understand social emotional scenarios using mixed emotions varied across puberty in girls aged 9–16 (Burnett et al., 2011). There was a change between early and late puberty in the number of emotional responses that participants gave in social emotion scenarios, with girls in late puberty attributing a wider combination of emotions in social scenarios than their peers in early puberty

… Our findings of puberty-related changes in neural activation, together with those shown in other recent fMRI studies using different ‘social’ tasks as described in the introduction, suggest that aspects of functional brain development in adolescence, like these behavioral changes, may be more closely linked to the physical and hormonal changes of puberty than chronological age.

 As the authors note, social intelligence—a more nuanced understanding of “social emotion” scenarios—develops as a result of the release of hormones, not chronological age. This is so obvious it hardly seems worth studying (or proving on a functional MRI study).  Yet gender specialists talk as if the brain develops separately from the body; as if hormones are only important for secondary sexual characteristics. They are constantly reassuring skeptics that blocking puberty gives these incredibly immature kids the time to figure out if this is really what they want—without the benefit of the cognitive, emotional, and social maturation processes that comes with the secretion of pubertal hormones.

I’ve touched upon only a few facets of adolescent cognitive-emotional development in this post. The literature in this area is vast, still accumulating, and spans decades and millions of pages of writing. Contemporary cognitive scientists like Russell Viner, Sarah-Jayne Blakemore and Jay Giedd are continuing to add to the body of knowledge. But their work on adolescent psychology and brain development is not referenced in the media or in the writings of trans activists or pediatric gender specialists. In point of fact, what little peer-reviewed research there is in the field of “gender identity” is going in the exact opposite direction of the rest of developmental psychology and cognitive science—towards a reification of rigid, unchanging identity and decision-making “agency” for younger and younger children; while the replicated research of developmental psychology and neuroscience is moving toward an understanding of neuroplasticity, the necessity of undergoing an identity crisis, and a later age for brain maturation than was previously thought.

Cognitive scientist Jay Giedd:

One of the most exciting discoveries from recent neuroscience research is how incredibly plastic the human brain is. For a long time, we used to think that the brain, because it’s already 95 percent of adult size by age six, things were largely set in place early in life. … [There was the] saying. “Give me your child, and by the age of five, I can make him a priest or a thief or a scholar.”

[There was] this notion that things were largely set at fairly early ages. And now we realize that isn’t true; that even throughout childhood and even the teen years, there’s enormous capacity for change. We think that this capacity for change is very empowering for teens. …

Instead of respecting this “enormous capacity for change,” gender specialists are tampering with the endocrine system, freezing gender dysphoric children in a state of suspended development—and then expecting these psychologically and emotionally immature children to make permanent decisions about their future as adults. It’s a huge clinical gamble. What it amounts to is hoping for the best.

But is anyone preparing for the worst?