Could social transition increase persistence rates in “trans” kids?

The trend of “socially transitioning” children as young as 2 or 3 years old to endorse the notion they are “born in the wrong body” is a very new phenomenon. But to read about it in the press, you’d think this was a settled area of clinical practice, with proven results and few doubts about its efficacy.

It is no such thing.

In a 2011 journal article,  Dutch clinician-researchers who first pioneered the use of puberty blockers cautioned that early social transitions can be difficult to reverse:

 As for the clinical management in children before the age of 10, we suggest a cautious attitude towards the moment of transitioning. Given our findings that some girls, who were almost (but not even entirely) living as boys in their childhood years, experienced great trouble when they wanted to return to the female gender role, we believe that parents and caregivers should fully realize the unpredictability of their child’s psychosexual outcome. They may help the child to handle their gender variance in a supportive way, but without taking social steps long before puberty, which are hard to reverse.

Even the Endocrine Society, which actively promotes puberty blockers and cross-sex hormones for pubescent children, counseled against social transition in its practice guideline:

endocrine-society

As recently as last year, a 17-clinic qualitative study reported on doubts some clinicans have about aspects of “affirmative” treatments for children:

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

But among many clinicians and activists, social transition (which usually leads to puberty blocking and then to cross sex hormones) is now being actively promoted as completely harmless and “fully reversible.” Not only that: it is being shamelessly peddled as the only way to prevent suicide amongst children and teenagers.

What evidence do we have for these assertions? There is no historical record of desperately dysphoric “trans children” who demanded sex change lest they commit suicide.  The constant media and activist drumbeat that very young children must be socially transitioned ASAP; must be called by the correct pronouns; must have their “wrong bodies” fixed prior to the “wrong puberty”– or they will kill themselves–is the most irresponsible thing the mass media and medical profession could possibly do. It is a form of emotional blackmail which has terrorized countless parents into handing their kids over to gender clinics and activist-run “charities” for transition to the opposite sex. And the media, by running breathless stories implying that the only way to support gender-defiant and gender dysphoric children is to  “transition” them, may be contributing to suicide contagion, a phenomenon that has been well known for decades.

As far as evidence that social transition is “reversible,” which of these children is actually “reversing”? Certainly, the ones who have continued on to puberty blockers are not:

spack-100-persist

Imagine the pressures on any of the myriad trans-kid YouTube stars, or the children who are the subjects of the too-many-to-count fawning media portrayals we see in every major newspaper and magazine. Can a Jazz Jennings really change course?

None of the children who have been identified as “truly transgender” by clinicians like Norman Spack and Johanna Olson are going to get the chance to find out if they would have been just as happy not being socially transitioned. We won’t learn in any systematic way whether social transition and media validation could be creating persistence in children who might otherwise have grown up without medical and psychiatric tampering.  We can’t know, because researchers aren’t studying them; they don’t have control groups of children who claim to be the opposite sex but who are not socially transitioned and subsequently puberty blocked.

What is a truly transgender child? According to activists and some clinicians, the key trait (along with being generally “gender nonconforming” and preferring the clothes, activities, and appearance more typical of the opposite sex) is that these children are more “persistent, consistent, and insistent” in saying they are the opposite sex (vs simply wanting to be, or wishing they were).

But what is the meaning of “persistent, consistent, and insistent” with children who have only been on the planet a short time, as are the many toddlers, preschoolers, and grade schoolers now being labeled as “trans kids”?  Especially when a rather large percentage of these children also exhibit traits of autism—a disorder known to be characterized by rigid thinking, gender nonconformity, and obsessive/restricted patterns of behaviors?

Activists don’t seem troubled by any of this, nor by the decades of research showing most dysphoric children desist and grow up to be lesbian or gay adults.

korte

The recent study most often cited by trans activists is one by Kristina Olson at the University of Washington, which essentially proved that children who preferred the activities and appearance of the opposite sex weren’t just pretending; they  really meant what they said! (Why would anyone question that?)

But even Dr. Olson, whose confirmation-bias-riddled study includes no control group of non-socially transitioned children, admits that no one can know the outcome for this new generation of experimental patients. kristina-olson-does-not-know

These kids are, by any measure, guinea pigs being subjected to social engineering and then (in most cases) experimental medical procedures, the results of which won’t be known for decades. Researchers like Kristina Olson are fully aware of this, but they think it’s worth the cost of some regrets, some detransitions. Because hey–it’s science.

kristina-olson-admits-kids-are-guinea-pigs

A commenter on the above article aptly points out the elephant in the room:

comment-on-olson-article-persistence-caused-by-social-transition

Fortunately, there is reliable data from other clinician-researchers which suggest a more cautious approach is still in order. We have a 2012 study by Devita Singh, which demonstrated that a very high proportion of kids—some 88%–happily desisted from a trans identification as adults.  It’s worth noting that several of these children were “persistent, insistent and consistent” in their formerly intense gender dysphoria.

Dr. Singh shared her views about early transition in a recent, unusually balanced article in The Walrus magazine:

Singh is frustrated that, despite the findings of her study and others like it, there’s now more pressure than ever for doctors and families to affirm a young child’s stated gender. She doesn’t recommend immediate affirmation and instead suggests an approach that involves neither affirming nor denying, but starting with an exploration of how very young children are feeling. Affirmation, she argues, should be a last resort.

These days there can be a high price to pay for treating gender affirmation as a last resort. Dr. Ken Zucker, a  renowned gender dysphoria expert, has approved puberty blockers and cross-sex hormones for many adolescents. Nevertheless, he recognizes that children often change their minds, and takes a careful approach in his clinical practice. For this heresy, he was hounded from his position at CAMH in Toronto by trans activists hellbent on preventing any kind of therapy for dysphoric kids besides “affirmation.”

But Dr. Zucker is still actively publishing,  having co-authored several scholarly journal articles in 2016 alone, and he continues to work with families and young people in his private practice.

In an age when too many believe that children, no matter how young, should be affirmed in their gender identities with no further investigation, clinicians like Zucker are very much needed. Desistance, despite trans activist protestations to the contrary, is a real thing. It’s just not as newsworthy as the latest trans kindergartener coming out story.

This places a heavy burden on parents who aren’t sure who their children are, or who don’t accept the notion that a 5-year-old, even an insistent and strong-willed one, has a set identity in the same way adults do. The current politics leave them behind, because their stories don’t fit neatly into the binary in which trans identities are either accepted or rejected, full stop. There’s no natural political grouping for parents of desisters, because desisting isn’t an identity-politics lodestone in the way persisting is. “We’re quieter,” said Amanda of parents of kids whose gender dysphoria desists. “There are a bunch of us scattered around, and we’re not acting collectively.” As Merry put it, “I feel like sometimes there’s no middle ground. You’re either trans or you’re not, and you can’t be this kid who is just kind of exploring.”

 

Groundbreaking study: Kids mean what they say

The clinic advised that Rudy should start to make his own choices and, specifically, recommended that he was allowed to pick an item of clothing. ‘He chose a Disney princess nightie and skipped around the house in it, laughing,’ recalls Kathryn. Towards the end of Year 1 at school, Rudy started wearing girls’ clothes at home. ‘Of course, he chose to dress as a girl. I watched him at the disco, chatting to girls, wearing a pink glittery dress. That was a turning point.’ Back home, Rudy chose a girl’s school uniform for the new term and asked to be called Ruby.

–Parenting a transgender child: The day my four-year-old son told me he was a girl

 


When Ana was five years old, her mother Cathy organised a birthday party with one rather unusual condition: No girly presents, please. ‘I felt awful doing it, but I knew Ana would be devastated if anything pink or fluffy turned up.’

‘I knew when I was growing up,’ says Alfie now, ‘that I didn’t want to do the things that girls did. I was the sort of kid who ran around and got dirty. … People thought me being a tomboy was a phase, but I knew I wouldn’t change. I didn’t want to wear girl clothes. I hated the way they fitted to me. … I was told I would change and get interested in make-up, but I could never see it happening.’ The paediatrician then brought up the topic of gender transition. So in the car on the way home, I said to mum: ‘I think I’m transgender.’

–My child had a boy’s brain in a girl’s body


Trans activists and gender specialists don’t have much in the way of well controlled, peer-reviewed research to support their core assumption that “gender identity” is innate and immutable. The latest brain science shows very little difference between male and female brains. If this is the case, what is the scientific basis for believing there is an innate “gender identity,” baked in at birth, that would be worth turning young people into sterilized, permanent medical patients as adults?

Recently,  in the activist blogosphere, the transgender press, and on the WPATH Facebook page, there have been excited proclamations that data to prove “true identity” has emerged in the form of a paper published a few months ago in the journal Psychological Science. The study of 32 “transgender” children and the same number of non-trans controls, entitled “Gender Cognition in Transgender Children,” [abstract; full study here] was conducted by University of Washington assistant professor of psychology and director of its TransYouth Project  Kristina Olson (not to be confused with LA Children’s Hospital gender specialist Johanna Olson), along with transgender activist Aidan Key and Stony Brook University assistant professor of psychology Nicholas Eaton.

I’m going to start with the punch line and work backwards from there: The study demonstrates only that 32 socially transitioned children (that is, kids who are being “supported” by their families and “gender specialists” in being referred to by an opposite sex name, pronouns, and assumedly, though the authors don’t tell us, sporting opposite-sex-stereotyped clothing and hairstyles), really, truly do prefer the playmates, hairstyles, and clothing more typical of the opposite sex. Further, these “transgender” children really and truly do prefer and “identify with” the same playmates and physical attributes as the control group of “cisgender” children (yes, the study authors use that term) of the opposite sex.

Who were the “transgender children” recruited for the study?

To be included in the current study, children had to be 5 to 12 years old and live in all contexts as the gender expression “opposite” of their natal sex. These requirements resulted in the exclusion of 4 additional gender-nonconforming participants

And the control group?

Thirty-two control participants (20 female, 12 male; mean age = 9 years) … matched to the transgender participants were recruited through the first author’s research lab from a database of families interested in participating in developmental psychology research studies. They were required to have no significant history of gender nonconformity.

[Note: A group of “cisgender” siblings of the “transgender” children were also part of the study, but time and space in this blog do not allow a full analysis of their responses, which were similar to but not the same as the non-familial “cisgender” control group.]

What do the authors mean by “gender nonconforming” or “no significant history of gender nonconformity”? This is never defined, although we can guess that the “transgender” children dress, play, and appear differently from generally recognized gender stereotypes. But the control group? Do the authors mean these children entirely conformed to stereotypes—i.e., the girls all wore dresses, played with dolls, and had long hair, while the boys played with trucks, had short hair and wore rough-and-tumble   trousers?

Olson et al don’t tell us. And what about the four excluded “gender nonconforming” subjects, who apparently did not “live in all contexts” as “opposite” to their natal sex? Did these children occasionally indulge in sex-stereotyped play and behaviors, so they weren’t “trans” enough?

The study stimuli consisted of questions coupled with pictures of boys and girls, “matched for approximate age and attractiveness.” (And what does “attractiveness” mean? There is an even bigger question vis-à-vis these pictures, which I will get to in a few moments).

Olson and colleagues tested the children in 3 areas:

  • Gender preference (for play/friendship)
  • Object preference (associating a nonsense word with a picture of a boy or girl,  saying this was the name of a toy or food that the pictured child was using)
  • Gender identity (whether the child feels they are a boy or girl)

Each of these three variables were addressed via explicit (i.e., responses to direct questions)  and implicit measures.

What’s the difference between explicit and implicit measures? In psychology research, it has been posited that “implicit” measures

 may resist self-presentational forces that can mask personally or socially undesirable evaluative associations

In other words, “implicit” measures are meant to get at how someone really thinks and feels, whereas a reliance strictly on explicit “self reporting” might be tainted by what a subject thinks someone wants to hear (or other motives).

So, for the “gender preference” part of the Olson et al study, the explicit measure was to ask the child, “who would you rather be friends with?” when shown a pair of pictures of a boy and girl. The implicit measure was to show the children pictures of a boy and girl and ask to label them “good” or “bad.”  (The underlying premise here is that most pre-pubescent kids prefer their own “gender” as playmates).

For gender identity, the implicit measure consisted of asking the research subjects to label pictures of boys and girls as “me” or “not me.” The explicit corollary was

telling them that people have outsides (their physical body) and insides (their feelings, thoughts, and mind). They were told that some people feel like they are boys on the outside, and some feel like they are girls  on the outside, and that those people might feel the same way or different on the inside. They were told some people feel, for example, like a boy on the outside and inside, and that others feel like a boy on the outside but a girl on the inside. Further, they were told that some people feel like both or neither, or that their feelings change over time.

Children were asked whether, on the inside, they felt like a boy, a girl, neither, or both; whether their gender identity changed over time; or whether they did not know.

For “object preferences” the authors didn’t assess preference for actual objects, but only whether the research subjects chose the same preferences as pictured  boys or girls. They were

shown pairs of photographs of children and told that each one had a preferred toy or food. The names of these items were in fact novel words (e.g., “This is Amanda and she likes to play flerp. This is Andrew and he likes to play babber.”). Our interest here was whether children would use the gender of the person endorsing the item to inform their own preferences.

It’s difficult to see how this adds any more information than asking kids what sex playmates they prefer. If a child who “identifies” as a boy sees a picture of a boy playing “babber,” that child would likely prefer to do what the pictured boy is doing.

Be that as it may, what exactly did Olson et al set out to prove with these probes?

… if these children are not confused, delayed, or pretending, and in fact their expressed gender represents their true identity, we would expect them to respond   similarly to gender-matched control participants not only on self-report measures, but also on implicit ones.

We reasoned that if children are confused by the particular questions posed to them….[or] if they are merely self-reporting the “wrong” gender identity… or even if they are just oppositionally reacting to the question of their gender identity— …these children should show one of two patterns of confusion. First, they could be truly confused, as indicated by random responding and no systematic  response across measures and participants. Alternatively, they could implicitly identify as their natal sex (because they actually understand gender and are merely self reporting this “incorrect” gender).

And the results of the study? Surprise—the socially transitioned “transgender” children did indeed respond similarly to the “cisgender” control group.

But what does this actually demonstrate?

First, let’s consider the stimuli, consisting of pictures of age-matched boys and girls. What would distinguish a picture of a prepubescent boy from a picture of a prepubescent girl,  apart from clothing and hair styles? Not much.

Prior to puberty and the influence of estrogen or testosterone, school-aged kids look much the same. So unless the pictured boys and girls had identical haircuts and clothing, the 32 “transgender” children labeling a boy or girl picture as “me” or “not me” would have been identifying with a boy or girl based on stereotyped dress and appearance—haircuts, clothing, and the like. How could it be otherwise?

Put another way, if the pictures of the boys and girls did all have the same haircut and clothes, irrespective of biological sex, would the research subjects have been able to identify the sex of the child they identified with? Likely not.

Now, to the question of whether these kids were confused, delayed, or pretending, the authors did show that these kids are not likely to be knowingly pretending to be the opposite sex, nor are they “confused” i.e., they just don’t know what they think or feel. But why is this of much significance?  What would be the motivation for these children to “merely” self report the “incorrect” gender, or to “oppositionally react”? The fact that these kids are sincere in their convictions is reported by Olson et al as an important finding, but does anyone, including critics of pediatric transition like me, doubt that dysphoric or trans-identified kids really mean their gender nonconformity?

Further,  deliberately “pretending” in order to deceive is not the same as conflating fantasy or desire with objective reality–an aspect of normal childhood development which activists, gender specialists, and researchers like these seem never to have heard of. Just because a child  sincerely sees him or herself as the opposite sex does not make it true.  Child psychologists have known for decades that children’s firmly held beliefs do not always comport with reality.

 Research indicates that children begin to learn the difference between fantasy and reality between the ages of 3 and 5 (University of Texas, 2006).  However, in various contexts, situations, or individual circumstances, children may still have difficulty discerning the difference between fantasy and reality as old as age 8 or 9, and even through age 11 or 12. For some children this tendency may be stronger than with others.

The authors seem not to have thought of the most obvious conclusion: That these kids DO believe they are the opposite sex but that doesn’t make it so—especially since even the implicit measures the authors seem to think are so meaningful are nothing more than identification with gender-stereotyped activities and appearances which they happen to prefer.

By demonstrating that the “transgender” children aren’t just being obstinate or dishonest, Olson et al seem to believe that their study indicates (in their words) “true identity” in the children they have labeled “transgender.”

But what is “true identity?” Is it the elusive Holy Grail of inborn, unchangeable gender, something no one has come remotely close to proving, yet is the unquestioned assumption from which all the current medical and psychological and legal decisions about “transgender children” have flowed in the last few years?

That the authors even use the term “true identity,” which they themselves admit is unproven, is all we need to show the study is fatally tainted by confirmation bias.

 Confirmation bias, as the term is typically used in the psychological literature, connotes the seeking or interpreting of evidence in ways that are partial to existing beliefs, expectations, or a hypothesis in hand.

–Confirmation Bias: A Ubiquitous Phenomenon in Many Guises, by Raymond S. Nickerson,  Tufts University

It’s quite clear that the authors’ “hypothesis in hand” is that there is such a thing as “true identity.” Further, they interpret the evidence that “transgender” children feel as strongly about their identity and gender nonconformity as “cisgender” children do as somehow confirming this hypothesis. Even though they themselves in their Notes section  of the study assert:

  1. We avoid using common colloquial phrases such as “born as a boy” because they suggest that transgender identities are not innate (an unresolved scientific question) and are thus offensive to some individuals.

 On the one hand, because they don’t want to be “offensive” to “some individuals” (and I think we can guess who they are), Olson et al don’t want to “suggest” that gender isn’t innate (and in fact present their study as evidence that their “transgender” research subjects have a “true identity,”). But at the same time, the authors explicitly acknowledge that the question of “innate” gender identity is an “unresolved scientific question.”

But while being careful not to offend “some” people, they don’t have any trouble splattering the term “cisgender” throughout this article,  despite the fact that some other individuals find “cis,” well—offensive. Certainly Olson et al aren’t living in such a bubble that they are unaware that the label “cisgender” is repugnant to many of us who the transgender community apply it to.

And in point 2 in the Notes, we have a further indication that the authors’ work is riddled with confirmation bias:

2. We use the term “opposite” for clarity but acknowledge that gender is not binary.

They “acknowledge” that gender is not binary. But as with “innate  gender identity,” who has proven that “gender is not binary?”  No one. This jargon comes straight from the trans activist lexicon.

In peer-reviewed research, investigators always indicate the limitations and possible flaws in their study.  The weaknesses I’ve pointed out in this post are not even marginally addressed by the authors. What limitations do Olson et al concede?

 All of the participants tested here identified and lived life as one gender at the time of assessment, choosing names consistent with that gender and preferring those pronouns as well. Future studies along the spectrum of childhood transgender experiences will be needed to clarify how generalizable these findings are to children who have different degrees of identified gender expression or to those with different life experiences.

Apparently what’s next is seeing whether their study measures can also be used to prove the “true” identities of “gender fluid,” “genderqueer,” and “nonbinary” children. I wonder what exclusion criteria they’ll have in future studies? Hopefully they will be more precise in their definitions of what constitutes  gender (non)conformity in their next paper.

In their summary, Olson et al reiterate their key finding that these kids really mean it when they say they prefer the lifestyle of the opposite sex:

In summary, our findings refute the assumption that transgender children are simply confused by the questions at hand, delayed, pretending, or being oppositional. Instead, transgender children show responses that look largely indistinguishable from those of cisgender children, who match transgender children’s gender expression on both more- and less-controllable measures. Further, and addressing the broader concern about transgender individuals’ mere existence raised at the outset of this article,the data reported here should serve as evidence that transgender children do indeed exist and that their identity is a deeply held one.

“Do indeed exist.” Of course children who believe they are, or want to be, the opposite sex “exist.” And of course such children are going to exhibit preferences for the appearances and activities of the opposite sex, in a “deeply held” way. But it doesn’t follow that those children are somehow innately the opposite sex.

All Olson and colleagues have demonstrated is that some children really, really, really want to be the opposite sex; even to the point of saying they are the opposite sex. They want to look and dress like the opposite sex—a girl, for instance, might want a short haircut and to wear comfortable boys’ clothes. They like playing with children of the opposite sex. And they like doing things that the opposite sex likes to do. In other words, these kids are don’t conform to the stereotypes of their birth gender. But does it then follow that they should be groomed and conditioned to believe they are the opposite sex, leading them in the near future to puberty blockers and on to sterilization and surgeries?

If the stakes were not so incredibly high, a study like this could simply be filed away under “strongly held beliefs and desires of gender nonconforming children.” But given the fact that so many activists and gender specialists are in the business of promoting medical transition, this study should instead be filed under “confirmation bias rationalizes non-evidence-based medical experimentation on vulnerable children.” What Olson et al have not proven is innate gender identity. All they have shown is that these kids really mean it when they say they are or want to be the opposite sex.

This study, instead of being promoted as a rationale for pediatric transition, should carry no more weight than any of the thousands of media articles trumpeting the unsubstantiated yet continuously promoted idea that children who refuse to conform to gender stereotypes—yes, who really mean it when they say they want to look and play and dress like the opposite sex—are “transgender.” Like the ones quoted at the beginning of this article. Or the thousands of others that have been published in the last few years. Like this one:

Tom charges about in a Batman costume, brandishing a sword. …Tom loves dressing up. “Normally as a superhero,” Cassie [his mom] says.

“Batman and Superman,” Tom adds. “And Wolverine!” He also likes to play cowboys or policemen with his best friend, Charlie. “Sometimes we arrest people. Remember when we did it yesterday to the dog?” He grins. “He wasn’t putting the ball down.” He shows me his bedroom. There’s his treasured Playmobil pirate ship, his Marvel poster featuring Ironman, Captain America and the Hulk, and his pencil case shaped like a football boot.

When Cassie took three-year-old Tom to the barber for the first time, she wept. “That was the final thing. If I let him get his hair cut short, that was me accepting he is a boy.” The hairdresser was bemused. “I was crying and I had this little boy with me who had hair down to his arse. She asked him: ‘Has your mummy never let you get your hair cut?’ And he loved it, because she thought he was a boy with long hair.” After that, Tom never got mistaken for a girl, and became much happier.

Transgender children: ‘This is who he is – I have to respect that’