James Cantor shreds American Academy of Peds gender-affirmative policy statement

Anyone who is paying attention knows the US holds the dubious distinction of being the world’s incubator for the “gender affirmative” approach. This treatment pathway–increasingly, the only pathway available in the United States–frequently consists of:

  • full social transition for children, starting as young as toddlerhood;
  • cross-sex hormones and even “top” and “bottom” surgeries for young teens, some of whom showed no childhood gender discomfort and only announced a trans identity in adolescence; and
  • affirmation of a child’s trans identity at any age, regardless of other possible causative/related factors (such as autism, social contagion, or same-sex attraction). Some of the more fervent US clinicians eschew careful psychological assessment before they prescribe full social and/or medical transition, asserting that such thorough evaluation is unnecessarily onerous or “triggering” to the young patient.

The American Academy of Pediatrics recently released a policy statement  which essentially rubber-stamps the affirmative approach. (While the Academy itself has tens of thousands of members, a recent article pointed out that the policy document was the work of a very small, activist-inspired subgroup). The AAP document creates the impression that affirmative treatment is a matter of settled clinical consensus.

Nothing could be further from the truth.

The AAP policy has a number of glaring flaws. To take just one example, it omits a significant body of research evidence that is inconvenient to the AAP’s affirmation-only doctrine. Worse: the research the AAP document does cite ironically substantiates the very “watchful waiting” approach dismissed by the AAP. The truth is, this more cautious approach is the most commonly used and evidence-based treatment for childhood gender dysphoria recognized by clinicians around the world.

There’s a lot more to pick apart in the AAP’s policy statement, and James Cantor, PhD., a Toronto-based sexologist, researcher, and clinical psychologist, did just that today. His long (but worth it) fact-checking article is required reading for anyone interested in the topic of pediatric transition.

Please read and share Dr. Cantor’s piece widely. You can read the whole thing here.

Cantor sex today lead aap

Has the UK become a police state? (And has Twitter become its informant?)

Inga Berenson is the mom of a teen girl who previously identified as transgender but has now desisted. She lives with her family in the United States.


By Inga Berenson

Freedom of speech took another big hit in the United Kingdom last month. In response to a complaint filed by Susie Green, CEO of Mermaids, the Yorkshire police interrogated Kellie-Jay Keen-Minshull because of some tweets she posted in 2016 and 2017. Known on Twitter as ThePosieParker, Ms. Keen-Minshull is a stay-at-home wife and mother of four.

Mermaids is a nonprofit organization based in the UK. According to its website, Mermaids “supports children and young people up to 20 years old who are gender diverse, and their families, and professionals involved in their care.”

The offending words

According to Ms. Keen-Minshull’s account, Ms. Green objected to a tweet stating that “the CEO of Mermaids took her 16-year-old to Thailand and got him castrated.”

For this tweet and others criticizing Mermaids for promoting pediatric transition, Ms. Keen-Minshull was “interviewed under caution” for 40 minutes on February 23, 2018. She now awaits the Crown Prosecution Service’s decision on whether she will be charged. According to Ms. Keen-Minshull, the potential charges against her are “nuisance, public order, malicious communications compounded with a potential hate crime.”

On the crowd-funder site she has set up to raise funds for her legal defense, Ms. Keen-Minshull writes, “This fight is not whether you agree with my views on [the] transgender issue as much as it is that you agree that I have a right to air my views, a right to voice an opinion, a right to free speech.”

Without question, Ms. Keen-Minshull’s tweets were strongly worded, but were they untrue?

Unmasking euphemisms

It is not disputed that eight years ago Ms. Green took her 16-year-old child to Thailand to receive gender reassignment surgery, which was and still is illegal for minors in the UK and is now illegal in Thailand. (In fact, the legal age for SRS was raised to 18 not long after the Greens went there for the surgery.)

In a 2012 BBC 3 documentary, Ms. Green confirmed that her child underwent full GRS in Thailand. The narrator [4:15] states that Ms. Green’s child was “the youngest person in the world to change gender through surgery.”

It must indeed have been painful for Ms. Green to see a tweet in which someone says she had her child castrated, but the statement is not untrue. In fact, this type of surgery involves far more than castration, which refers only to the removal of the testicles in natal males. But Ms. Keen-Minshull used the word “castrated” to make an important point: GRS is a euphemism that conceals the drastic nature of this medical intervention.

And if it seems unfair that Ms. Keen-Minshull singles out Ms. Green, we must remember that she is not merely a mother who did what she believed to be right for her child. As CEO of Mermaids, she is an advocate for the use of these interventions in other people’s children. Mermaids has provided training and education to various UK government agencies, including schools and (interestingly) the UK police force. Mermaids representatives regularly attend Pride parades and other events to reach out to gender-nonconforming children and teens to inform them about transition. Ms. Green cannot reasonably expect that others won’t point out the full reality of these interventions if she is promoting them for other children.

Ms. Keen-Minshull also came under fire for a tweet that said Mermaids “prey[s] on homosexual teens,” alluding to the organization’s efforts to reach out to gender nonconforming and gender dysphoric children, many of whom (many decades of research have shown) grow up to be gay or lesbian.

The 4thWaveNow website has previously featured articles about Mermaids and its influence on UK policymaking, as well as their efforts to circumvent parents and appeal directly to children and teens.

Although our website hosts authors from both North America and the UK,  4thWaveNow is based in the United States, which protects the freedom of speech via the 1st Amendment to the US Constitution. If that were not the case, we too might have been interrogated by the police, because Ms. Green’s complaint (which we have seen but are not at liberty to share at this time) also cited a tweet we issued in the summer of 2017:

mermaids candy and puppiesWe decided to raise this question in our tweet,  after seeing this one posted by Mermaids a few weeks earlier:

mermaids unsupportive parents

As parents of current or formerly trans-identified teens, we are concerned that Mermaids is trying to influence teens whose parents do not share the organization’s definition of “unsupportive.” (In fact, as parents who try to help our kids find ways to feel comfortable in their natural bodies – at least until they are adults, we are being supportive.) And the fact that Mermaids feels empowered to publicly state its intention to influence teens like ours is all the more troubling.

We and Ms. Keen-Minshull are far from alone in believing that Mermaids oversteps appropriate boundaries in advocating for transgender services for children. In October 2016, a court removed a seven-year-old child from his mother’s custody because she was found to have essentially groomed her child into a transgender identity. The mother had been receiving support from Mermaids. The court reportedly ordered the child should have no further contact with the charity. (See “The boy who ‘lived in stealth’: Judge challenges ‘emerging orthodoxy.’”)

Twitter’s role in the interrogation of Ms. Keen-Minshull

Although it’s troubling enough to think that a supposed democratic Western nation would interrogate someone for expressing her opinion, it’s even more troubling to hear that a US-based company revealed the person’s identity to the government. According to Ms. Keen-Minshull, the police informed her that they had obtained her contact information from Twitter.

This is not the first time that Twitter has shown its bias in the battle between adherents of gender ideology and those who see dangers in it. Gender-critical individuals have had their Twitter accounts suspended for merely stating that “transwomen are men” while adherents of gender ideology regularly direct misogynistic language like “cunt” or “Kill All TERFs” at people who disagree with them.

It turns out that individuals associated with Mermaids are also guilty of mud-slinging on Twitter. “Helen” (@Mimmymum), who has frequently stated she is a member of Mermaids, regularly brandishes the word “bigot” at those who don’t share her opinions. In a tweet referring to Dr. Ray Blanchard, an American-Canadian sexologist, best known for his research studies on transsexualism and sexual orientation, she writes:

mimmymum blanchardBoth sides of this debate are exercising their democratic right to express their opinions and their concerns about public policy, but it appears that both the UK police and Twitter have chosen to respect the rights of the one while disregarding the rights of the other.

Uncomfortable truths

Ms. Green and her organization suggest that those who oppose the transitioning of minors are motivated by bigotry and hate. They refuse to acknowledge that this opposition could stem from genuine concern for the welfare of children and outrage that organizations like hers promote transition so eagerly and misrepresent the realities of it.

In a segment on BBC Newsnight in November 2016, Stephanie Davies-Arai, founder of the organization Transgender Trend, said that “the treatment pathway [for treating trans-identified children is] … cross-sex hormones…. It leads to children being sterilized and on medication for life.” When the interviewer asked Ms. Green if this were correct, she answered, “Well, no,” then changed the subject. (See “Should Mermaids be permitted to influence UK public policy on ‘trans kids’?”)

Yet this statement is correct, and it’s acknowledged to be so by clinicians who promote and administer these treatments. While the word “castration” may be jarring, Ms. Keen-Minshull used it because it exposed the reality that activists like Ms. Green would evidently rather conceal.

Ms. Keen-Minshull believes strongly, as do we at 4thWaveNow, that drastic interventions like these deserve public scrutiny. To be able to express our concerns about these interventions, we must be able to name them. If people no longer have the right to speak uncomfortable truths because others may find them offensive, a democratic society is no longer possible.

Who’s gaslighting whom? Susan Bradley, youth gender dysphoria expert, weighs in

Child psychiatrist Susan Bradley, MD, FRCP(C), founded the Child and Adolescent Gender Identity clinic at the Toronto Center for Addiction and Mental Health (CAMH), originally the Clarke Institute of Psychiatry, in 1975. She continued to direct that clinic until 1982, when Dr. Kenneth Zucker took over as head of the clinic after joining as a student in 1977. Dr. Bradley was subsequently employed at Toronto Sick Kids Hospital, where she was chief of the department of child psychiatry. She was also head of child and adolescent psychiatry at the University  of Toronto from 1989 until 1999. She is currently professor emerita at University of Toronto, and is writing a book about supporting youth with high functioning Autism Spectrum Disorder.

Dr. Bradley recently wrote an article for the Post-Millennial about the current political and clinical climate surrounding issues of childhood and adolescent gender dysphoria; highly recommended.

We will be posting a lengthy 4thWaveNow interview with Dr. Bradley in the near future. Stay tuned.


Below, Dr. Bradley responds to a recent paper by Damien Riggs (associate professor of social work) and Clare Bartholomaeus (research associate) of Flinders University, Adelaide, Australia entitled “Gaslighting in the context of clinical interactions with parents of transgender children.”

gaslighting author screen cap

The piece is, in essence, an attack on skeptical parents of trans-identified children, in the form of three “fictionalized case studies.” Riggs and Bartholomaeus characterize parents who do not fully affirm their child as transgender as engaging in “identity-related abuse”; they use the term over 30 times in their paper. According to the authors, “abuse” and “gaslighting” include such transgressions as not using preferred pronouns; cancelling appointments; and not agreeing to medical transition on the timetable preferred by Riggs and other providers engaged in pediatric transition.

The authors counsel therapists to try to see a child privately when parents are not sufficiently obsequious. They even refer to non-compliant parents as abuse “perpetrators”:


gaslighting article 5

Authors suggest therapists should find “creative ways” to make private contact with the child


We have included more screen captures from the Riggs article in Dr. Bradley’s response below. However, we will not be deconstructing the entire paper in detail. We strongly encourage readers to examine it closely.

 


by Susan Bradley, MD, FRCP(C), Consultant Child Psychiatrist

 Where is Damien Riggs coming from?

That’s what I had to ask myself when I read his diatribe against parents of youth who have recently expressed their feelings of gender dysphoria. His position seems to be this: Parents who are reluctant to simply buy into his belief that anyone who expresses feelings of gender dysphoria must be “trans” and supported in their transition with no questions asked, are not being adequately supportive of their child; further, he terms this parental skepticism “identity-related abuse.” But it’s natural for any parent of a youth expressing such feelings, particularly if they are of recent onset, to wonder “why?” or “how come now?” Such sudden changes in identity would make anyone question what is really going on inside that person.


gaslighting article 1

Parents are “gaslighters” if they question hormone blockers or want to slow down medical intervention


To be a parent of a child undergoing such a radical change in identity is a very stressful experience, with conflicting feelings of wanting to support their child, but also wanting to be sure that what they want really makes sense. If this child has a previous history of feeling rejected by peers, many parents will be aware of the damage that has been done to their self-esteem, and rightly see them as vulnerable to those who offer acceptance, at whatever cost.

But Damien Riggs, the therapist advising us, seems to see things in black and white terms: if they voice any feelings of being “trans” they must be “trans”. What about those individuals who change their minds? Does the therapist know for sure that my daughter is not going to change her mind? How do we know that this sudden, intense interest is different from other intense interests the child may have had in the past? How do we know what impact interventions such as puberty blockers will have on her future, especially if she changes her mind?


gaslighting article 2

“Cisgenderist” parents who misgender their kids should not be allowed to apologize


These are just some of the questions that would go through the minds of any caring parent in that situation. If the therapist does not address these concerns in a straightforward manner, most parents would then begin to wonder if they are in the right place to help their child. Failing to engage wholeheartedly in the “therapy” would be one way of trying to deal with their uncertainty when they sense that the therapist is not open to a discussion about their concerns.

This hardly qualifies  as “gaslighting,” a term defined in the dictionary as “behavior intended to manipulate someone by psychological means into questioning their own sanity” or behavior that “seeks to sow seeds of doubt” about their reality or beliefs. To the contrary, those parents are behaving as most parents would in a situation where they do not feel heard.

From the description of the process of therapy engaged in by Damien Riggs, there appears to be no attempt to help parents be understood in terms of what most would regard as very normal worries about a process that seems to be moving forward with little thought for the persons involved. There is no evidence of intent to deceive by these parents; only a lack of faith in the person directing their child’s treatment, who after all, has very little prior knowledge of that child, their issues, their vulnerability, or their ability to make a competent decision about life-altering interventions.

I would argue that Damien Riggs’ accusations about the parents “gaslighting” is unethical and lacking in understanding of the relationship between child and parent. Amongst other things it is the parents’ job to protect the interests of their children until they reach an age when they are capable of doing so by themselves.  Riggs appears not to understand the importance of this relationship when he mislabels the rather normal reactions of parents with a rapid onset dysphoric child as “gaslighting”.


gaslighting article 4

Parents who ask for a diagnosis for their trans-identified children are gaslighters.


If Damien Riggs had done a careful assessment of the youth, particularly, the girls with rapid onset gender dysphoria (ROGD), he would have understood that most of these young women had begun to have homoerotic feelings as they moved into adolescence. Experiencing crushes on same-sex peers is not unusual both in individuals who later become lesbian, but also in heterosexual women.

However, if you are a teen who has had social difficulties, it is easy to feel that having these feelings will make you feel more “weird” than you may already feel. Homophobic slurs are common amongst teens, further increasing anxiety about acceptance in these young girls. The process is easy to uncover if you—as a therapist—ask the right questions, in that these young women desperately want friends and someone who accepts them. The internet sites for “trans” individuals are very welcoming of anyone who expresses interest. Because many of these young women are not really skilled at self-reflection, finding a simple solution (“I’m trans!”) that makes them feel accepted seems perfect. Unfortunately, as we all know, life is more complicated and what seems like a simple way of feeling good may not be a good long term solution.

Caring parents take time to understand and accept mental health issues even when they are more common than the belief that one is in the wrong body. Recent onset gender dysphoria is a rather sudden change in how the youth sees herself, and although some of these individuals may eventually decide that transitioning is best for them, many will realize that they are lesbian and can explore that and find acceptance in a same-sex relationship without having to change their bodies. They need time to understand their feelings and explore ways of finding the best solutions for them. Parents can usually participate in being supportive when they understand what their child is struggling with and how they can help.  For Riggs to blame parents for not accepting his approach wholeheartedly is not what those of us in mental health are trained to do.

No glitter life: Don’t be swayed by middle-aged transitioners–including me

by Helen Johnson

As time permits, Helen will be available to interact in the comments section of this post. As always on 4thWaveNow, comments that challenge the author will have a better chance of publication if they are delivered respectfully.


My name is Helen Johnson and I am a trans woman.

That’s partly true. I am trans, but I’m not telling you my real name. After you have read my piece, I hope you’ll understand why. Transgender activists reserve a special kind of treatment for apostates who speak out against their dogma. I have no wish to deal with their threats and intimidation, but neither can I remain silent when those transgender activists are driving a contagion that is consuming our young people.

Much has been written about the explosion in the number of children who have come to believe that they were born in the wrong body. I’ve said nothing because — like other trans women who transitioned as adults — I’ve nothing to offer. I’ve no childhood experience of living as the opposite sex and my own kids are thankfully unscathed by this epidemic. I can therefore only sympathize with other parents whose children are struggling with their gender. Some have asked me directly, but I have always suggested that they seek support from other parents in the same position. Certainly not from me.

Unfortunately, other trans women think differently and some of them seem to think they know best. Entire pieces have been written about trans activists like Rachel McKinnon,  who told trans kids to dump their moms on Mother’s day and join the “glitter-queer” family of adult trans activists. Worryingly, Dr McKinnon is far from alone. The message is pervasive, and it is sinister: transition your kids or lose them. Sometimes it is subtle.  For example, Julia Serano, a leading figure in the trans community, suggested that children will grow distant unless parents affirm the transgender behavior. Others are more blatant. Caitlyn Jenner is one of many who throw suicide statistics around like confetti.

None of them are experts. All they have to offer is their own experience of growing up. But if they can do that so can I and, unlike deluded fantasists like Zinnia Jones who thinks they actually were an adolescent girl, I am in touch with reality.

Gender dysphoria was present in my earliest memories; it persisted throughout my childhood and stayed with me in adulthood. It made me socially uncomfortable and I struggled to make friends. My dreams of becoming a girl were never fulfilled and I reluctantly accepted that there was no alternative to becoming a man. I’ll say no more about that. The trans narrative is repetitive and it is tedious. But just like McKinnon, Serano, Jenner, and Jones, I survived childhood and everything it threw at me. Yes I had difficulties, but lots of children have difficulties. Growing up is hard.

Today’s youngsters are being fed dangerous and fallacious nonsense. Society has been infected by post-modern, post-facts, post-truth ideas that spread unchecked on social media. Opinions and feelings are on the ascendancy, while facts and evidence are cast aside. For socially awkward children struggling to understand themselves, McKinnon’s “glitter-queer” family may look superficially attractive; an easy escape from reality. But it comes at huge cost.

I am glad that I did not succumb as a child.  Male puberty was a mixed blessing for me. It changed my body in ways that I did not like, but it enabled me to have my own children. Today they are my pride and joy: fine kids who are now making their own way in the world.  They would not be here had I been transitioned in childhood.

It’s now becoming all too clear that the first generation of child transitioners may have thrown away more than the chance to be parents.  Sex reassignment surgeons need material to work with. Only after male puberty did I have sufficient tissue for my vaginoplasty. Children who never experience natural puberty, like Jazz Jennings for example, are finding that they have a serious problem. To be blunt, there is no way that a functional vagina can be created from a penis only two inches long and an inch and a half in circumference. Sadly, Jazz may never be able to enjoy the sex that adult male-to-female transitioners take for granted.

Even transitioning later is a mixed blessing. I am in remission from the gender dysphoria but that is only half the story. My life is harder in other ways. Whenever I am clocked as trans I am treated differently, and not better. Mostly I deal with this by living in stealth. In my day-to-day life I just don’t mention it. People can’t discriminate if they don’t know. But that brings troubles of its own: when I’m asked about my childhood, I obfuscate; when asked about my children, I fudge; when asked about my private life, I create back stories. I hope they are consistent. When acquaintances become friends, I anguish over whether to come out to them, then when to do it and finally how to do it. Lying about your past is not great, but admitting it is harder especially in the early stages of a new friendship. Securing a life partner is something else. Trans people are seen as exotic curiosities rather than possible suitors. Rarely are we seen as human beings, usually as trans human beings. Not quite the same and not quite suitable.

But, people say, at least I have found my true self. Maybe, but I’ve always been my true self. I transitioned to escape the pressures that I faced but I will never really be a woman, I merely live as one, and I am always one step away from being outed. It works but it’s an expedient tactic rather than a fulfilling solution.

But you must be sure, they say. How can I be sure? All I have are circular arguments: because I needed to transition I must be a woman, and I must be a woman because I needed to transition. But I can never know what it is to be a woman. All I can know is what it is to be me. My experience will always be different from the women around me. It isn’t a glitter life, it’s a hard life. It works because I make it work, but it’s not great.

To kids contemplating transition I have no answers, only questions. Do you really need to transition? Give up the chance to grow up and form relationships as a human being rather than a trans human being? Have your own children? Have sex like other adults have sex, and live free from lifelong medication? If gender expression is the issue then be yourself and embrace your gender, but don’t try and change your sex in the process. One day, society may free itself from the shackles of gender norms, and feminine men, masculine women and gender-neutral members of both sexes will be able to take their rightful place in it. Make it your generation that does that, not the ones that follow you.

To your parents I would say, give your children a hug. Love them and nurture them. Let them be free to explore their gender and help them make that break from the crushing weight of society’s restrictions and expectations. But steer them away from transitioning from one gender prison into another, certainly before they can experience what it means to be an adult. If their gender dysphoria persists, as mine did, they can always transition in adulthood. That option will always be there. If it desists, then they will have avoided making a truly catastrophic mistake.

But above all, parents, don’t be swayed by middle-aged transitioners. That includes me, but it also includes McKinnon and the others. You know your children, we don’t; you brought them into the world, we didn’t; you love them and care for them, we don’t even know them.

Have confidence in yourselves because, when it comes to your children, you will always know better than people like me. Never forget that.

Gender-atypical toddler = transgender living doll: No future for gay & lesbian youth?

Melissa Hines is a researcher affiliated with Cambridge University. She has co-authored several important studies delving into the influence of prenatal testosterone on childhood behavior, as well as the relationship between gender nonconformity and sexual orientation.

In February, along with first and second authors Li and Kung,  Hines published a longitudinal study of nearly 5000 adolescents in Developmental Psychology, on the topic of gender nonconforming behavior in childhood and its correlation with adolescent homosexuality: Childhood Gender-Typed Behavior and Adolescent Sexual Orientation: A Longitudinal Population-Based Study.

hines abstract

It will come as no surprise to 4thWaveNow readers that the investigators found a consistent and strong relationship between gender nonconforming behaviors exhibited between ages 2.5 years – 4.75 years, and later homosexual orientation.

Of course, the link between a gender-atypical childhood and being gay or lesbian has been known for a very long time; this is not a new insight, neither in terms of published research, nor in the anecdotal but very common reports of gay and lesbian adults who reflect on their own childhoods.

hines conclusion.png

This study is important, though, because it may have the largest subject cohort to date (2169 boys and 2428 girls), and because of its thorough and systematic methodology. Please take the time to read it, along with previous works by Hines and her colleagues.

Although this post will not go into detail about the study, we will point out the obvious:

  1. It is impossible to find a media account of a young “trans” child that does not repeatedly mention the child’s gender-atypical behavior, expressed via toy choices, playmates, play behaviors, and hair and clothing preferences. These celebrity trans kid stories now routinely appear in print and broadcast media on a daily basis in the United States and the UK in particular.

While trans activists and gender doctors take pains to claim that the diagnosis of trangenderism in young children is “much more” than these gender-defiant behaviors, journalists (and the child’s parents), oddly enough, always and only focus on these behaviors as evidence that the child was “born in the wrong body.” Maybe that’s because they refuse to challenge the absurdity of a child claiming they “feel like” the opposite sex, for which there can be no actual evidence? How can one know what it “feels like” to be something they are not? But you won’t see a question like this posed by any of the “journalists” who create these puff pieces; “journalists,” after all, who have abdicated their duty of asking hard questions and actually informing the public so a nuanced debate can take place.

  1. With this large study pointing out that gay and lesbian people are much more likely to exhibit behaviors more typical of the opposite sex, it is painfully obvious that—even if embarked upon with the best of intentions—the contemporary practice of socially and medically transitioning young children leads inevitably and inexorably to the outcome of anti-gay eugenics.

It doesn’t ultimately matter if the practitioners of pediatric transition don’t intend to turn proto-gay children into sterilized facsimiles of the opposite sex;  the impact of the practice of early transition leads to exactly that outcome.

Once you have read the Li, Kung, and Hines study for yourself, take a look at the latest slick bit of propaganda about “trans kids” and see if you can avoid the obvious implications.

A group of Canadian trans activists are manufacturing a “nesting doll” set,  a “trans boy” named Sam. Sam, from toddlerhood, wants to play with trucks and have short hair, refusing the doll and pink dress Sam’s mom offers. The moments when Sam grabs the truck and gets a haircut are presented as obviously full of significance in the animated promo film (which was partially funded by the Quebec government).

sam kickstarter

With the daily onslaught of trans-kid propaganda, what chance will a girl who just happens to like trucks and short hair get to believe anything other than she is ‘really” a boy? This stuff is being actively and aggressively marketed to children and gullible parents.

With the financial supporter of the taxpayer.

 

The dollmakers want to “crush transphobia” before it starts. But what they are really crushing is the future of kids who once were allowed to grow up without tampering—many of them into healthy gay or lesbian adults. Now these kids are being transformed into sterilized, surgically and hormonally altered medical patients—living transgender dolls.

Gender dysphoria and gifted children

by Lisa Marchiano

Lisa Marchiano, LCSW, is a psychotherapist and certified Jungian analyst. She blogs on parenting at Big Picture Parenting, and on Jungian topics at www.theJungSoul.com. You can also find her at PSYCHED Magazine and @LisaMarchiano on Twitter. Lisa has contributed previously to 4thWaveNow (see “The Stories We Tell,”  “Layers of Meaning” and “Suicidality in trans-identified youth”).

Lisa is available to interact in the comments section of this post.


Rates of gender dysphoria in children and young people have increased dramatically in a short period of time. There is some evidence that significant numbers of those who experience dysphoria are gifted.

Since 2016, I have been consulting with families with teens or young adults who identify as transgender. Nearly all of these parents report that their child is bright or advanced, and a significant majority have shared that their transgender-identifying child was formally assessed as gifted. Four of these families report children who tested in the profoundly gifted range (verbal and/or full scale scores >150).

An investigator who presented as-yet unpublished research at the Society for Adolescent Health and Medicine conference this year described a population of adolescents and young adults presenting with a rapid onset of gender dysphoria (an abrupt onset of symptoms with no history of childhood gender dysphoria). Of the described population of 221 AYAs, nearly half (49.5%) had been formally diagnosed as academically gifted, 4.5% had a learning disability, 9.6% were both gifted and learning disabled, and 36.2% were neither.

This is a curious correlation. Could it be that gifted young people are more likely to experience dysphoria? Or is it rather that parents of gifted children are more likely to seek out my services or respond to surveys? My best guess is that it may be a little of both.

 

Possible Reasons for Increased Incidence of Gender Dysphoria Among the Gifted

  • Correlation with Autism Spectrum Disorders

Among those with Asperger’s, there is a higher proportion of giftedness than in the general population, and there are many overlapping traits between Asperger’s individuals and gifted individuals. This is especially true for the exceptionally or profoundly gifted. It has been suggested that as many as 7% of people with Asperger’s syndrome are gifted, compared with 2% of the general population who are gifted.

Those working with gender dysphoric youth have remarked on the significant proportion of those seeking treatment who carry a diagnosis of ASD. A 2010 Dutch study found that the incidence of ASD among children referred to a gender identity clinic was ten times higher than in the general population. At the UK’s only gender identity clinic for children, a full 50% of the children referred are on the autism spectrum.

A 2017 survey of 211 detransitioned women found that 15% were on the autism spectrum. This is 29 times higher than the rate of autism among females in the general population. Many of the survey responders felt that their autism contributed to their belief that they were transgender. For example:

I would absolutely not be trans if it were not for my autism spectrum features, which caused me to be grouped with boys in my youth because I was a “little professor” who lacked the ability to perform socially and emotionally in the way girls are supposed to.

And:

I think autism had something to do with my childhood difficulties relating to other girls and understanding/performing femininity. Traits like difficulty socialising, extreme focus on very specific interests etc seemed more acceptable once I framed myself as a boy.

  • Gender Atypical Preferences Among the Gifted

Research has shown that gifted children are more likely to exhibit gender atypical preferences. Gifted boys and girls may have wide and varying interests that do not conform to gender stereotypes. It is this author’s observation that most teens who self-diagnose as transgender do so on the basis of gender stereotypes. Liking video games rather than nail polish is interpreted as evidence that one is a boy, and so on.

  • Awareness of Difference; Bullying

Gifted children often have particular social needs and struggles. Even at a young age, gifted kids can have a sense of being different from everyone else without understanding the reasons for this difference. Feelings of isolation and loneliness can result. These feelings can be especially intense for profoundly gifted kids, or for kids who are both gifted and learning disabled (twice-exceptional). Because the experience of the gifted child can be so qualitatively different from those of his or her peers, gifted children may struggle with social isolation.

It seems plausible that some of the gifted transgender-identifying teens whose parents I have consulted with have come to understand themselves as trans, in part, as a way of explaining their pervasive sense of difference. “I was never like the other kids. I always knew I was different, I just didn’t know why.”

Being different can also bring with it negative social attention, including bullying. The blogger, detransitioner, and PhD psychology student ThirdWayTrans has shared his story on his blog. Diagnosed as profoundly gifted and radically accelerated in certain subjects, ThirdWayTrans found himself to be the victim of violent bullying throughout much of his childhood. He transitioned at 19 and lived as a woman for 20 years before coming to the realization that his gender dysphoria and desire to transition were linked to the traumatic bullying he experienced.

When I was a child I experienced trauma issues with bullying. When I was young I was physically the slowest boy but also very intellectually advanced like a child prodigy. By fourth grade I was going to the high school to take high school math, and on the other hand I was the weakest. So I was singled out for being a kind of super nerd. This didn’t make me popular at all. It made me popular with the adults actually but not my peers. So I suffered a lot of bullying and violence. It peaked in middle school where every day I would have some sort of violence directed at me.

When I was a child I started to have this fantasy of being a girl, because it meant I could be safe and not suffer from this violence due to being at the bottom of the male hierarchy. I could also be more soft. I used to cry a lot and that was also something that was not seen as good for a boy. I could be free of all of that and also still be intellectual because everyone was saying that girls can be smart too.

ThirdWayTrans notes that as an adult, he understood intellectually that it was okay for men to be vulnerable and “feminine,”  but that his internalized child perspective made it feel unsafe for him to let go of his trans identity.

  • Existential Questioning

Questioning one’s gender may go along with a predisposition to question one’s place in the world. Gifted children tend to question traditions critically, and to challenge things that others take for granted. Thinking about one’s identity may come more naturally to gifted kids.

  • Perfectionism and Anxiety

Gifted children may suffer from anxiety and perfectionism. Anxiety disorders were also well-represented among the comorbid issues reported in the detransitioners survey mentioned previously. It has been suggested by some that adopting a transgender identity may in some cases be an anxiety management strategy. I am familiar with one young man with dysphoria who is both gifted and learning disabled. His preoccupation with gender waxes and wanes, but is predictably worse during exam periods, when he tends to fall behind and become overwhelmed. The feelings of dysphoria seem to allow him to distract himself from his feelings of intense anxiety and insecurity, while alleviating some of the academic pressure. When he is suffering from increased distress over gender dysphoria, his teachers and parents are more focused on his mental well-being, and they place fewer demands on him.

Outcomes

Currently there is very little data on long-term outcomes for gender dysphoric youth. To date, there is only one study that examines outcomes for those who pursued medical transition as minors. The study followed 55 individuals who pursued medical transition as minors, and showed that at one year post operation, study subjects evidenced positive outcomes according to several measures of mental health. However, it is important to note that the individuals followed in this study were carefully chosen, screened, and followed according to a strict protocol. All of those in the study had histories of lifelong gender dysphoria. It is a big leap to generalize these findings to teens exhibiting sudden onset gender dysphoria, and who may receive minimal assessment and counseling before starting hormones or undertaking other interventions.

I am aware of young people transitioning whose families report a decrease in symptoms and an improvement in academic and vocational functioning post transition. However, in my experience, this is the exception rather than the rule. Of course, families seeking my assistance are doing so mostly because of poor outcomes, so I hardly see a representative sample. Nevertheless, certain patterns have emerged through my work with parents.

Most parents with whom I have consulted have teenage children with rapid onset gender dysphoria. (In other words, their child did not exhibit any dysphoria until adolescence.) Most parents supported a social transition, allowing their child to change names, pronouns, gender presentation, etc., but drew the line at medical intervention (hormones and surgery) until adulthood. Most of the parents I have worked with noted one or more of the following changes subsequent to their child’s social transition: worsening gender dysphoria as the child became increasingly preoccupied with passing; decreased academic or vocational functioning – declining grades, etc.; increased social isolation as child spent more time on transgender internet sites, or spent time exclusively with transgender friends; worsening overall mental health evidenced by increased anxiety, self-harming behaviors, and/or depression; constriction of interests as the young person ceased to pursue pastimes and activities that had once been important to him or her; and worsening family relationships, including increased tension and anger between parent and child.

I have also known of gifted young people who desisted from a transgender identity. These young people had parents who were loving, engaged, and supportive, but who assisted them in questioning their belief that they were the opposite sex. Though the sample size is small, those who desisted from identifying as trans appeared to benefit from improved family relationships, increased social and academic engagement, and overall better mental health than during the period of transgender identification.

Conclusion

Currently, there is very little research into long-term outcomes for gender dysphoric young people. My observations indicate that a disproportionate number of those families seeking consultation with me have a transgender-identifying teen who is also gifted. There are many possible reasons for this confluence. Assessment and treatment for gender dysphoria in teens should take into account the various motivations that might influence a young person to self-diagnose as transgender. Families should be encouraged to support their child in ways that feel most appropriate to them, taking into account that a one-size-fits-all treatment for gender dysphoria is likely not suitable at this time. Further research is needed into causes and treatments.

Becoming whole: Could integrative medicine heal the mind-body split in gender dysphoria?

by worriedmom

Worried mom lives in the Northeast, and is the mother of several children. She works in the nonprofit area, and is a voracious reader and writer in the area of gender identity politics. She is available to interact in the comments section of this post.


Imagine this world: A child is sad, depressed, and struggling with uncomfortable, odd, or scary feelings about his or her body. Maybe a little socially awkward, maybe a lot. Worried about the fact that his or her interests don’t seem to fit in well with peers’. Maybe being mocked or bullied, because s/he doesn’t “act like” the other kids. Perhaps that child is having trouble making friends, or is even having intrusive thoughts that make it challenging to succeed at school, athletics or social life. Maybe that child has started puberty, and is concerned or ashamed about the physical changes in his or her body, and the way other people are reacting to those changes. The changes might not feel so good, even be quite unwelcome. The child’s body is perfectly healthy; the mind–not so much.

In this world, our child can go someplace where people know that there’s a solid and extensively documented connection between the mind and the body. In this place, treating the child involves taking into account the physical, social, psychological, community, environmental, and spiritual realities of the child’s life. Here:

  • The patient and practitioner are partners in the healing process.
  • All factors that influence health, wellness and disease are taken into consideration, including body, mind, spirit and community.
  • Providers use all healing sciences to facilitate the body’s innate healing response.
  • Effective interventions that are natural and less invasive are used whenever possible.
  • Good medicine is based in good science. It is inquiry-driven and open to new paradigms.
  • Alongside the concept of treatment, the broader concepts of health promotion and the prevention of illness are paramount.
  • The care is personalized to best address the individual’s unique conditions, needs and circumstances. Practitioners of integrative medicine exemplify its principles and commit themselves to self-exploration and self-development.

integrative medicine circle

Our child receives sensitive, understanding care, to help navigate through a hard time in life. His or her feelings are taken seriously (which isn’t always the same thing as literally). S/he will learn techniques such as meditation, guided imagery, and deep breathing to help cope with discomfort. Our child may have the chance to learn yoga, or T’ai Chi, qi gong, healing touch, and other movement therapies such as the Alexander technique. S/he may try out massage, biofeedback, acupuncture, or hypnotherapy. Non-western therapies, such as Chinese medicine or Ayurveda, are a possibility.

The medical care our child receives is coordinated with other therapies to help him or her feel comfortable, accepted, and confident. Perhaps our child will receive social skills training, with peers, or have the chance to interact with a specially-trained service animal. Maybe someone at this special place will work with our child using art therapy, music therapy, dance therapy or even horticultural therapy.

When all is said and done, our child is healed, calm and well, without ever breaking the skin! S/he is prepared to face the challenges of teenage and adult life, understanding that “feelings aren’t facts,” and equipped with techniques, ideas and support to help manage those unpleasant or unhelpful thoughts should they recur.

What is this place you ask? Well, it’s only the hottest trend in medicine these days. Call it integrative medicine, holistic, alternative, or complementary… whatever you call it, this approach to healing has taken the Western medical world by storm. World-renowned treatment centers have formed integrative medicine units – Memorial Sloan-Kettering, the international cancer center, is one of them. The Mayo Clinic is another. Many integrative medicine centers are affiliated with major teaching hospitals or medical schools. Over 40% of U.S. hospitals now offer at least some integrative medicine techniques to their patients.

The foundation of integrative medicine is the recognition that there is a profound, and not yet completely understood, connection between the human mind and the human body. That this connection exists is no longer open to question – otherwise, no drug trial would control for the placebo effect! Beyond this, research has shown that humans can, indeed, use their minds to control or change the way their bodies feel. These techniques provide a powerful way for people to actively participate in their own health care, and to promote recovery and healing for themselves.

not just the disease

While the jury is still out on the efficacy of some “CAM” practices (CAM being the term of art for “complementary and alternative healthcare and medical practices”), what is not in dispute is CAM’s rising popularity and acceptance among the general population. Far from being a “fringe” or counter-culture phenomenon, in certain patient populations, CAM use has been as high as 90%, and has been estimated at 38% for the United States as a whole.

According to the Academy of Integrative Health and Medicine:

HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores are higher when patients receive integrative services. In one study, 76.2% of patients who received integrative services for pain in the hospital felt their pain was improved as a result of the integrative therapy. [Source] Health-related quality of life was significantly improved for patients who received integrative care. Treatments were also found to reduce blood pressure, decrease anxiety and pain, and increase patient satisfaction in thoracic surgery patients. Additional studies have corroborated the observation of reduced pain and anxiety in inpatients receiving integrative care.

In addition to its use in fields such as pre- and post-surgical and cancer care, integrative medicine is increasingly used to help patients manage or cope with such chronic medical conditions as diabetes, arthritis, Crohn’s disease (and other IBDs), asthma, allergies, hypertension, headache, insomnia, and back pain, as well as psychiatric maladies such as anxiety, depression, phobias and PTSD.

People who practice in this field do not argue that integrative medicine is the cure for all ills:

Using synthetic drugs and surgery to treat health conditions was known just a few decades ago as, simply, “medicine.” Today, this system is increasingly being termed “conventional medicine.” This is the kind of medicine most Americans still encounter in hospitals and clinics. Often both expensive and invasive, it is also very good at some things; for example, handling emergency conditions such as massive injury or a life-threatening stroke. Dr. [Andrew] Weil is unstinting in his appreciation for conventional medicine’s strengths. “If I were hit by a bus,” he says, “I’d want to be taken immediately to a high-tech emergency room.” Some conventional medicine is scientifically validated, some is not.

A 2010 review of the medical, corporate and payer literature showed that:

to start, immediate and significant health benefits and cost savings could be realized throughout our healthcare system by utilizing three integrative strategies: (1) integrative lifestyle change programs for those with chronic disease, (2) integrative interventions for people experiencing depression, and (3) integrative preventive strategies to support wellness in all populations.

boy trapped in girl bodyWe’ve certainly gone quite a while in this post without mentioning the word “transgender,” but the implications for the application of integrative medicine in this area should be crystal clear. If folks are literally or even metaphysically “born in the wrong body,” or if dysphoria is primarily caused by an incongruence between one’s physical sex and one’s gender (“what’s between the ears doesn’t match what’s between the legs”), then dysphoria would appear to be a mind/body problem of the first order.

In fact, it would seem that the transgender phenomenon is the prototypical example of a mind/body disconnect – because in the case of dysphoria, all involved acknowledge that the body in question is perfectly healthy. Something seems to be amiss in the way that the body and the mind are connected, or in the way the mind thinks of or perceives the body. So, what’s the application of integrative medicine principles to the problem of dysphoria? Wouldn’t it seem like the two are a natural fit, and that dysphoria would be the perfect arena in which to use these techniques, which are now in the medical mainstream?

You would think that, but you would be wrong.

Suppose, as is all too common nowadays, that our child’s feelings of distress and discomfort are interpreted by a parent, pediatrician, teacher, or other well-meaning professional, as the harbinger of an incongruence between the child’s sexed body and his or her brain. Let’s visit a few pediatric gender clinics (there are more than 40 such clinics in the United States alone) and see what’s on offer for our confused and hurting child.

At the Boston Children’s Hospital Gender Management Service clinic (GeMS), one of the oldest pediatric gender clinics in the U.S., the course is clear. The child meets with a clinical social worker whose job it is to “make sure that you fully understand our protocol.” The child is referred to a therapist who will need to work with the child for a minimum of three months (gosh, a whole three months to decide on something that will completely dominate the rest of your life!). Next is an appointment with a GeMS psychologist for a specialized “gender-related consultation” and then… it’s off to the races with the pediatric endocrinologist.

The Seattle Children’s Hospital Gender Clinic provides pubertal blockers, cross-sex hormones and “mental health support and readiness discussion.” The shiny new gender clinic at Yale New Haven Hospital offers “puberty blockers,” “cross-hormone therapies” and “mental health services” focusing on “readiness.” Not to worry, of course, since “male to female” surgery may be obtained for those over 18 through Yale Urology. Here’s another one: the Lurie Children’s Hospital of Chicago Gender Development Services department “provides medical consultation, medical intervention (e.g., cross sex and pubertal delaying hormones) and health research with gender non-conforming youth across the developmental spectrum of pediatrics and adolescence.” Oh, and here’s another one: Cincinnati Children’s Hospital’s Adolescent and Transition Medicine Department (note “Transition” is right there in the title of the department) provides “puberty blockers, gender-affirming hormones, menstrual suppression and referrals for therapy, psychiatry, psychology, pediatric endocrinology, pediatric gynecology, nutrition and other services as needed.” The University of Florida’s Youth Gender Program provides “consultation, psychotherapy, psychiatric medication management and assessment of medical readiness for cross-sex hormone therapy.”

Celeb ftmsA short note on the term “readiness.” It’s interesting and perhaps unintentionally revealing that this word shows up on so many pediatric gender clinics’ websites in connection with gender counseling, rather than other terms that could be used such as “suitability,” or even “screening.” “Readiness” connotes a certain inevitability about the transition process – for instance, an educational psychologist assesses a child’s “readiness” for school. The question is not if a child will go to school, of course, but when.

Although I’ll admit I haven’t reviewed the websites of every single one of the 40 U.S. pediatric gender clinics, so far I haven’t seen any that are incorporating integrative medicine techniques and principles. What seems clear is that pediatric gender clinics do not view their mission, in any sense, to include assisting their patients in resolving dysphoric feelings short of medical intervention, much less engaging in discernment or decision-making as to whether medical transition is appropriate in any given case. In fact, as we know, the primary approach to the treatment of dysphoria in the United States has shifted away from the much-maligned “gatekeeping” of the past, to an “affirmative” model. What this means in practice is that the patient (or the patient’s parents) dictate the terms of engagement; if you’re going to a “transition” clinic, guess what you’re going to get?

And although much lip service is given to the idea that a child is on a “gender journey,” it’s pretty clear from the gender clinics’ websites that this journey has only one expected destination. Most of the gender clinics’ websites contain cheerful, if not glowing, testimonials to the happiness that lies ahead for their successfully transitioned patients (“Never a Prince, Always a Princess” “Becoming Lucy,” and of course, “Born in the Wrong Body”).

The Gender and Sex Development Program, housed at the Lurie Children’s Hospital of Chicago, is especially upbeat about the amazing future in store for their pediatric transition patients, with links to a documentary entitled “Growing Up Trans,” testimonials from grateful parents and thankful teens, and multiple links to news stories with titles like “Trans Teen in Chicago: From Surviving to Thriving,” and “When Boys Wear Dresses: What Does it Mean?” (hint: the correct answer isn’t “nothing”).

gender spectrumIn fairness, it’s possible that the mental health assistance pediatric gender clinics promise their young patients could include helping children and families decide whether medical transition is the optimal outcome. It’s impossible to know whether psychiatric care given by a therapist who is professionally affiliated with a transition clinic would still be unbiased about the subject. But anecdotal evidence certainly suggests that “gender therapists” are personally and professionally invested in the transition narrative to the exclusion of all other therapeutic approaches.

Moreover, one of the primary activist goals of the transgender lobby is insuring that young patients do not have access to integrative medicine, CAMS, or to any other treatment modality, besides “gender affirmation” (i.e. medical transition for all who seek it). “Conversion therapy” bills, which prohibit therapists and other professionals from adopting any other treatment approach for pediatric gender dysphoria other than gender affirmation, have already been passed in seven states and many cities, and federal legislation that arguably would enshrine “gender affirmation” as the sole acceptable treatment has been proposed in the current Congress. (Even legislation which confuses the issue would also confuse would-be caregivers and create a chilling effect.) A new lobbying group, 50 Bills 50 States, has been formed to push for anti-conversion therapy laws to be passed in all states that do not currently have them.

One point on which all sides in this debate can agree is that gender dysphoria represents a radical “disconnect” between the mind and the body. But there is another, fundamental, “disconnect” at work here, too. We know, and have known for millennia, that there are many ways to address mind/body dysfunction that do not entail wholesale alteration of the body, which can succeed in healing and strengthening the mind. Integrative medicine blends the best of these techniques with Western medicine to obtain the healthiest outcome for the patient, yet those involved with pediatric transition appear resolutely blinded–if not hostile–to any potential application in their own field… willfully “disconnected” from current medical thinking and practice.

In fact, if the activists get their way, the “healing place” envisioned for our child at the beginning of this article will not only remain imaginary, but will be outlawed throughout the United States. Parents–indeed, all people who care about children–should be very, very worried.