Do No Harm: An interview with the founder of Youth Trans Critical Professionals

A new organization has formed for therapists, social workers, medical doctors, educators, and other professionals concerned about the rise in transgender diagnoses among children, adolescents, and young adults. Youth Trans Critical Professionals was founded by a psychotherapist and a university professor just a few short weeks ago. The organization has a website (already publishing thought-provoking pieces from professionals), a Facebook page, a Twitter account, and many followers. If you are a professional skeptical of the transgender youth trend, please visit the website and consider contributing to the effort. Your anonymity will be protected at your request.

4thWaveNow recently interviewed one of the founders of Youth Trans Critical Professionals. She is available to respond to your questions and remarks in the comments section below this post.

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Why did you start this organization for professionals skeptical of the trans-kid trend? What is your personal interest in this matter?

I’m going to start by saying something that I will probably say several times. Our main concern is with medical intervention in children and young people that leaves their bodies permanently altered and/or sterilized. We don’t have a moral issue with people identifying as transgender, and believe that those who do should be protected from discrimination like any other minority. However, the medical treatments for children who identify as transgender are risky, not approved by the FDA, and permanent. With any other condition, we would be bending over backwards to find other ways to support these children without resorting to major medical intervention, and would turn to puberty blockers, cross-sex hormones, and surgery in only the rarest and most extreme cases. It is very disturbing to the originators of youthtranscriticalprofessionals.org that these treatments, whose long term effects are not well-studied, are being offered very casually for a condition which isn’t even clearly defined.

I have a private practice where I work mostly with adults, although from time to time, I do see adolescents. I first became aware of this issue because parents were coming in describing kids struggling with gender identity. I started to notice a pattern: an anxious, depressed, or socially awkward kid who spent a lot of time on social media would announce that he or she was “trans,” often requesting access to cross-sex hormones shortly after this announcement. Every one of the mothers in my practice who reported this behavior was incredibly supportive of her child. These moms may have shared feelings of confusion or concern with me, but their initial reaction toward their child was always acceptance.

The first time I heard this story, I didn’t make much of it. It sounded like normal teenage experimentation to me, and I admired the mom’s openness to accepting her child. However, as I saw more of these cases – and I saw the cases progress to the point where the child was demanding medical intervention – I became concerned and wanted to learn more.

What I found once I started looking was that more and more young people are identifying as trans, often after bingeing on social media. For some reason that I can’t quite fathom, there is a tremendous feeling of excitement around this issue among many adults. I found out that administrators at private schools were boasting about “several kids transitioning” at their school. I heard this from more than one school while I was researching this. They shared this as evidence, I think, of how truly progressive and accepting their school is. However, I find it really odd that no one blinks an eye when four kids are transitioning in a grade of sixty kids. Given how rare transsexualism is believed to be, doesn’t that alone ring a warning bell?

The more I learned, the more disturbed I became. Where were the critical voices? Where were the adults familiar with child development speaking out for young people who are in danger of being swept along on a current that may carry them towards sterility before they have even finished high school?

I was shocked to realize that many of my fellow therapists appear to have uncritically bought into the narrative about trans children that goes something like this: 1.) gender identity is a legitimate thing. You cannot question it without being bigoted. 2.) Children know their own gender identity. 3.) If you do not immediately and uncritically affirm a child’s professed gender identity, you will be doing that child grave harm, and may even induce suicidal behavior, 4.)  The best and only treatment for a child who professes to have gender dysphoria or claims to have a gender identity other than that associated with his or her sexed body is transition – social, medical, or both. It doesn’t matter whether that child has comorbid mental health issues such as anxiety, depression, trauma, autism, substance abuse or bipolar disorder. 5.) Once a child has professed his or her gender identity, the adults around that child should follow his or her lead, providing whatever treatment and accommodations are requested by that child.

There is nothing about the narrative outlined above that is beyond controversy and shouldn’t be open to questioning. The construct of gender identity is poorly defined and lacks coherence. It surely shouldn’t be the basis for subjecting our kids to irrevocable body changes and sterilization. Assuming that children have some mysterious knowing about their gender identity seems like poor practice. Children are often very sure of things at one moment in time and believe something completely different a week, a month, or a year later. Child development is a fluid process. Refraining from immediately affirming a child’s gender identity brings with it no documented harm. The oft-quoted figure about suicide among transgender youth is a misuse of statistics. Many children (and adults, for that matter) feel significant distress about an aspect of their body or identity. Usually, therapists explore many ways to support a person facing this kind of discomfort. Sometimes medication can bring relief. Sometimes, exploration brings a new understanding. Sometimes, discomfort must be borne as we come to terms with a difficult or disappointing reality. Why the rush to change the body? Permanently?! Of course we as adults should be putting the brakes on a process that is leading toward permanent sterilization. Of course we should. Where were the other professionals who also believed this?

There is such a dearth of professional voices calling for restraint and caution in turning to medical intervention. Pediatricians, social workers, psychologists – most professional groups state that we must affirm a child’s gender identity. While we appreciate the intention here to be supportive of gender non-conforming kids, it seems the greater value ought to be protecting children from unnecessary medical procedures that often result in sterility; a central aim of youthtranscriticalprofessionals.org is to raise awareness of this.

Yes. Where are the child and developmental psychologists on all of this?  Much of what transgender activists promote seems to fly in the face of what we know about child and adolescent developmental psychology. It has been understood for decades that young children confuse fantasy with reality; that adolescents try on and shed different identities;  that children are conditioned by what they experience; that a child or adolescent’s sense of self is anything but rigid. Have you heard from any skeptical child psychs, and what will it take for some of them to start speaking out?

So far, I haven’t heard from any, but I imagine we will. You are right, and you phrase the issues very clearly. Kids do try on different identities. And we as adults don’t do them any service by privileging gender identity as some special, separate category. There is nothing innate or special or sacred about gender.

And kids have very strong feelings about what they want, and they often confuse things they want with things they need. It is so incredibly difficult to watch out child be in psychic pain. It can send us flying into action as we try to make their suffering stop. But part of our job as a parent is to use our discernment as the adult who knows them best to learn when to listen to the manifest story they are telling us about themselves, and when to listen to a deeper story underneath that.

I was talking recently with a friend who has a daughter in college. She was telling me about the awful, awful time she went through when he daughter was 13. The girl was obsessed with getting an iPhone. She cried nightly about how terrible it was for her not to have one, how it was damaging her social life and making her isolated and depressed. She was visibly distraught over this issue being any reasoning. She begged for it literally as if her life depended on it.

Thinking of this issue with trans kids, I said to her, “At least you knew that she wasn’t going to come to any grave harm if you didn’t give her an iPhone.”

My friend surprised me by saying that at the time, she felt confused about whether she was doing great harm to her daughter by not giving her a phone. “Between the peer pressure and the advertising, I was almost convinced that I was doing her grave psychological damage.” Imagine how hard it would be to stand up to a teen’s desperate demands for hormones if you had mental health professionals telling you that you were damaging your child by withholding them!

I suppose the point is that just because our kids want something very, very badly doesn’t mean that we have to capitulate or surrender our adult judgment. Teenagers don’t have a fully developed prefrontal cortex. We can’t abdicate our responsibility as their parent to say no when what they fervently desire may be harmful for them, or at least may have consequences they aren’t capable of fully appreciating.

Do you believe there are truly transgender children? Are they different from the teens who claim to be trans because of social contagion?

What a complicated question! Let me break it into a couple of parts.

First of all, there is no question that there has been a huge increase in kids identifying as trans. Much of this increase is certainly due to social contagion. Kids are getting exposed to this on social media, where they are taught that “if they are asking whether they are trans, they probably are.” Look, most teenagers go through a period of feeling intensely uncomfortable in their own bodies. I think that for many of these kids, this is an expression of that discomfort. Forty years ago, maybe more kids developed eating disorders. Twenty years ago, they were cutting. This is the current way to express that nearly universal adolescent discomfort. We all need to feel that we fit in, and that we stand out. Identifying as trans hits both of those criteria big time. You go to school and announce you are now Joe instead of Jo, and let people know you want to be referred to by a different pronoun, and in many schools, you are met with excited acclimation from peers. You are different in an exciting, trendy way. At the same time, you can feel a part of the other kids who are also embracing different gender identities. It must be very heady.

So I do believe that there is a huge social contagion piece, and this is one of the things that I don’t hear other people talking about much. This matters a great deal, because it has probably happened that some anxious, socially awkward kid has come out as trans as a way of gaining acceptance and belonging, and has gotten so much support and affirmation that she has continued down the road to take hormones. In short order, she had permanently altered her body – a deepened voice, facial hair, baldness, increased risk for certain diseases – and maybe this wasn’t for her, really? Or not for her forever? But now this person has to live with those consequences forever. Testosterone and other cross-sex hormones are not tattoos that carry trivial risks, or can at least be hidden easily. This ought not to be a life-style or fashion decision, and for some kids at least, I am convinced it is. I realize this is an incredibly unpopular stance, but this is what I am seeing from my little perch.

Of course, there are those who identified significant distress with the sex of their body before transgenderism became a cause celebre. I have read the stories about two-year-olds who ask why God made a mistake. Some of these stories are pretty compelling. I am not an expert in this area, and when I read these stories, my strongest reaction is that I am grateful I have never had to be the person responsible for making a decision about such a case. I’m not at all sure what the right thing to do is, but I will say that I could imagine that transitioning might be right in some cases.

There is an Atlantic article about this from 2008 that I found very interesting. It profiled several of these kids who are “persistent, insistent, and consistent” starting at an early age. Some of the Canadian kids were treated by Dr. Kenneth Zucker. The article describes some of the things involved in the treatment such as “taking all the girl toys away.” I admit that made me cringe. Really?! Who would want to do that to their child? However, at the time the article was written, Chris, the child in question, had grown up to be a gay, effeminate man who had a healthy, intervention-free body.

My understanding is that when Zucker’s team assessed a gender dysphoric child, they closely examined the family system, considering carefully different dynamics that were in play, and then crafting an individualized treatment plan that might involve several different kinds of interventions. I believe that enforcing gendered toys was something that was done in some cases, but was accompanied by other therapeutic interventions that took into account the whole family dynamic. The ultimate aim was to help the child feel comfortable identifying with his or her natal sex.

The article also followed an American child who had been affirmed early, and had begun to live as a girl. And it made reference to the social media star Jazz Jennings, who was profiled by Barbara Walters. I found the reaction of the Canadian parents to this practice of early affirmation very compelling, so let me quote from that part of the article. (The bolding is my own.)

The week before I arrived in Toronto, the Barbara Walters special about Jazz had been re-aired, and both sets of parents had seen it. “I was aghast,” said John’s mother. “It really affected us to see this poor little peanut, and her parents just going to the teacher and saying ‘He is a “she” now.’ Why would you assume a 4-year-old would understand the ramifications of that?”

“We were shocked,” Chris’s father said. “They gave up on their kid too early. Regardless of our beliefs and our values, you look at Chris, and you look at these kids, and they have to go through a sex-change operation and they’ll never look right and they’ll never have a normal life. Look at Chris’s chance for a happy, decent life, and look at theirs. Seeing those kids, it just broke our hearts.”

So I think, if I had a little boy who insisted he were a girl, and I could do this terrible thing of enforcing gendered play, or I could do this terrible thing of altering his body and destroying his ability to have his own children, which would I pick? If I knew I would have a healthy, happy, whole gay man at the end of it, if I had a reasonably good guarantee that would be the outcome, I would much rather pack away the Barbies. The personal and social difficulties of back-tracking on a childhood or adolescence spent transitioning will inevitably be immense. If a child has been transitioned from a young age how will they know, or be able to begin to articulate, that a mistake has been made? At a recent at Cambridge University seminar entitled ‘Gender Non-Conforming Children: Treatment Dilemmas In Puberty Suppression‘ it was stated that 100% of children on puberty blockers go on to transition; it’s clear there is absolutely no going back on medical intervention.

In any case, those of us who started youthtranscriticalprofessionals.org would argue that transition is always an option into adulthood. I am familiar with the view that when someone transitions as a child, they have a better chance of “passing” in adulthood, but given the very real risk of later regret, I think we might decide that medical transition is a choice to be made by full-fledged adults only.

How do you answer charges that you are promoting harmful reparative therapy on trans youth? How is this different from trying to turn gay kids straight?

Well, I’m not sure I believe that we should try to “talk kids out” of believing that they are trans, first of all. If a fourteen year old kid came into my office and said, “I’m pretty sure I’m gay,” or “I am gay,” I would say, “Tell me about that! What is that like for you? How long have you known? What lead you to first wonder about your sexual orientation? What is hard for you about knowing this? What kind of support do you need?”

If a fourteen year old kid came into my office and said, “I think I am trans,” or “I am trans,” I would ask similar questions: “Tell me more about that? What does that mean to you? Help me understand your internal experience that leads you to know yourself as trans? What kind of support would be helpful in addressing this? When did you first start to wonder?”

The purpose is both cases would be to do the thing that therapy is meant to do – to explore our experience so that we can understand it more deeply.

There are a couple of differences. First, while I would be interested in hearing from the gay child about his particular way of experiencing his gayness, we all have a pretty clear idea of what that means. A gay boy experiences sexual attraction to other boys, and not so much with girls.

The notion of gender identity, however, is much less clear. If a boy of fourteen were to tell me he is really a girl, I would want to know about that experience. What does that mean? In what way do you experience this inner sense of femaleness? How does this experience manifest for you? What are the different ways of understanding this experience? Is it a consistent experience, or is it subject to variation? How does this experience influence your understanding of yourself?

Sexual orientation and gender identity are actually quite different and these differences justify different approaches. Sexual orientation has shown itself to be quite stable. Most gays and lesbians knew from very early on that something was different. These feelings aren’t dysphoric, although they may cause distress because of homophobia. It isn’t dysphoria, it is just an awareness of who you are. It isn’t a sense of being wrong, or in the wrong body. And it doesn’t tend to change. These feelings are generally stable throughout the life span.

This isn’t the case for gender dysphoric kids. We know that a majority of them will naturally desist. Unlike sexual orientation, gender identification does tend to change for the large majority of dysphoric kids.

The other major difference – and this is the heart of the artichoke – is intervention. Gays and lesbians are not seeking intervention. They just want to love whom they love. My hypothetical gay boy client and I would be free to discuss and explore his experience of being gay and his coming out process without any high stakes medical decisions hanging over our heads. If I knew that my hypothetical trans patient would not have access to medical intervention until she was, say, 25 years old, she and I could spend our therapeutic hours exploring her experience as a trans woman, and I could offer support for the difficulties involved in being different in this way.

My goal for therapy with a trans kid would be to provide a warm, judgment free space in which they could explore their gender identity and what it means for them without a rush to medical intervention. I wouldn’t aim to convert. No. But I wouldn’t want to close in on this being the final answer, since I know that so many gender dysphoric kids will desist of their own accord.

I would hope that no one would ever be shamed or persecuted or made to feel unworthy or respect and love because of these feelings. I would argue that there is another approach in between rejection and affirmation, and possibly the word for that would be acceptance. I accept you as you are. I support you. I am curious about what you are going through. I want to hear more about your experience. And I accept that your sense of your own identity might change, and I will accept you then as well. But in any case, I would hope to delay medical intervention until the person was at least 25 years old.

Maybe the last thing to say about this is the most controversial. It isn’t really clear what exactly “gender identity” even means. It appears to refer to a subjective inner state, but when pressed, those who identify as trans will often resort to gender stereotypes in describing their discomfort. Forgive me, but I am not going to want to send any person down a conveyor belt toward permanent mutilation and sterilization over a self-diagnosis of an inner state.

Gender is a social construct. If gender is the problem, why on earth change the body? Is seems obvious that the right thing to do is to change or even abolish the construct altogether. Changing the body to fit the social constructs we have around gender only serves to further entrench the constructs we are trying to escape – and these are socially, not biologically constructed; there is no evidence that gender identity is innate.

What is your vision for Youth Trans Critical Professionals? What do you ultimately hope to achieve?

Initially, we are hoping to solicit posts from 100 professionals writing on the trans child trend from how they see it. By doing this we aim to assemble the first collection of voices of Youth Trans Critical Professionals to evidence our mutual concern. There is a meeting being planned, and we are also discussing the possibility of co-authoring a book. Ideally, we would like to help move the needle on this conversation, hopefully resulting in clearer standards of care that protect gender dysphoric and nonconforming young people from unnecessary medical intervention and permanent sterilization.

How can a group of anonymous professionals make a difference? Without a public face and voice, who will believe you are who you say you are?

Anonymity certainly limits our credibility at this point. Many of us are contending with constraints of professional institutions which broker no dissenting views. It is our hope to speak out publicly once there are more of us. In the meantime, I hope that we will be judged by how we write and think. I believe that people that read the site will know that we are striving to do this in order to protect children from unnecessary medical procedures and permanent sterilization, not out of hatred or bigotry. In addition, some professionals working with us are also friends and relations of children and young people identifying as trans and need to remain anonymous to protect their loved one’s privacy.

In the few weeks the site has been live, have you heard from other professionals who want to be on-board?

The site has been up for less than two weeks, and it has already been viewed over 2,000 times. The overwhelming majority of the comments have been positive. (I have not deleted any comments, if that tells you anything. One person wrote a critical comment, which I approved.) And yes, professionals are reaching out and asking how they can be involved not just from professions allied to medicine, but teachers, youth workers, practitioners of law, artists and writers and so on.

How can parents find therapists and other medical providers who will resist the current trend to diagnose kids as trans? There are no public directories, while there are tons of  published resource lists of “gender specialists.”

What a good idea! Perhaps we could gather the names of such providers and maintain a directory. This would be a great resource because families are telling us they reluctant to access services because they do not trust service providers to tread a sensitive line between gender confusion and medical intervention.

As a therapist, how would you suggest a parent deal with a child insisting they are trans? The current trend seems to be “affirming” the child’s identity, no matter how old the child is.

Well, this is another complicated question. Obviously, we always want to communicate love and acceptance of our children. We can accept and affirm our child and respect their struggles and personhood without necessarily affirming a professed identity.

Part of what makes this a thorny problem is that there is no neutral stance. If we affirm the kid’s gender identity, we likely tip the scales in favor of a trans identity. If we look for other ways to express our support and empathy for our child, we likely tip the scales the other way. Given that even doing nothing is not a neutral intervention, we have to ask a difficult question. Is desistance a better outcome? If we had to choose which way to tip things, what is the right way? For me, it is clear that, all things being equal, desistance is a better outcome because it avoids invasive medical procedures and sterilization. Whenever a young person is engaged in keeping the conversation about their trans identity open, they may feel comfortable deferring medical intervention which will have the side effects of irreversible sterilization – at least this puts growing maturity on their side.

There is also the very critical issue of social contagion. I believe that many kids identifying as trans for the first time as teens – and perhaps many younger kids as well – have “picked this up” from social media. Parents are not infallible, but we are likely the best judges of whether our kid is truly suffering from deep-seated gender dysphoria, of whether the gender issue is a way to express other issues.

If a parent has a teen who comes out as trans, I would be interested in knowing the following:

  • Has the child been anxious, depressed, or struggling socially?
  • Does the child have other mental health issues, such as PTSD, substance use, or bipolar disorder?
  • Has the child been spending a lot of time on social media? What sites? How much time?
  • Are the child’s peers (or desired peers) coming out as trans as well?
  • Did the announcement come “out of the blue,” without prior indication that the young person has ever struggled with their gender or identity before?

If the answers to these questions are pretty much “yes,” I would actually suggest that the parent state firmly and clearly that they do not support their child’s transition. I realize this is heresy. I would, as David Schwartz suggests, stop talking about gender. Anxious and depressed teenagers may learn that they can get a rise and a reaction out of adults when they mention gender. Addressing only the gender dysphoria instead of the underlying issues does these kids a huge disservice.

We know that social media sites like Tumblr and Reddit are fertile ground for social contagion and that many children start talking trans following immersion in these worlds. We know it’s easier said than done, but disconnecting them from the internet, especially social media, does give space for developing more self-reliant thinking. For some families it may be possible to remove a young person from their environment completely. Three months spent in nature away from screens, or overseas, or volunteering in a challenging environment may serve as a “hard reset,” allowing them to focus on something other than themselves. (After all, gender dysphoria is in essence very solipsistic.) Of course not all families have the networks or necessary resources to broker new horizons for their child in these ways. Parents are telling us it is extremely difficult to work out the best ways to support their child. But we are gaining increased confidence that saying ‘no’ to your child’s trans aspirations can inspire your child’s confidence for reflection. All parents try to keep their children away from dangerous trends sweeping youth culture and the trans trend requires the same vigilance.

I do believe that parents can have an impact. Letting a kid know that you don’t buy the gender identity drama, stating plainly that you love them as they are, but you don’t want to see them destroy their health and sterility can have an impact. They might roll their eyes, but I believe they hear you. At least if they ever look back in regret and despair they will know that you tried to protect them.

How can we support you?

If you know a lawyer, doctor, therapist, academic, nurse, teacher, guidance counselor or other professional who deals with young people and questions this trend and is thoughtful, please send them to our website! We are hoping to solicit 100 professionals to post on the site over the next few months. They can reach us from the site, and can send us material to post – anonymously if they wish.

Send parents, trans youth and their allies to the site too. Our aim is to cohere strength amongst and between us to bring serious, committed and critical attention to the dangers of trans orthodoxy.