Affirm and medicate: cookie-cutter gender clinics for troubled teens
We were confident they would not comply with a child’s demands for testosterone and breast removal without any exploration of what had happened to suddenly change her — we were wrong.
This is a world-first extract from the new book Inventing Transgender Children and Young People, edited by two British academics, disability researcher Michele Moore and social theorist and philosopher Heather Brunskell-Evans, with international contributors including Sydney psychologist Dianna Kenny.
The book was delayed by weeks of legal skirmishing with a gender clinic demanding to see a copy before publication. Its contents range from what’s going on in youth gender clinics through medical ethics and arguably flawed research studies to gender theory colonising the classroom and the glamorisation of trans identity on YouTube. There are family crisis stories of often troubled, soul-searching teenagers who suddenly seize on gender change as an identity-answer that seems to fit, as well as the testimonies of “detransitioners” who re-embrace their biological sex and go in search of a healthy path into the future.
What follows in this edited extract are first-person accounts from parents of trans-identifying children and “dissident” staffers at gender clinics in Scandinavia and Britain, interviewed by Moore and Brunskell-Evans, who have both faced harassment, abuse and intimidation because of their scrutiny of the trans project and determination to publish analysis that is searching — Bernard Lane
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‘It did not sound like her’
Anna’s parents
When she was eleven Anna got her own smartphone and stopped being sporty, stopped going out, stopped having friends on visits. When the smartphone came she spent more and more time in the room with the phone. She became in a way “not present”. We don’t know what happened but she went through a comprehensive change of behaviour in a short period of time. She began to be interested in Japanese comics, Cosplay, made new online friends.
Then soon after, one evening, she said “Mum, I’m a boy.” We did not know what to think. Was this just a phase? She is not a boy and she never showed any signs of being a boy. Then she sent us a text message: “Hello, there’s something I’ve been thinking about telling you, I feel like a boy. Therefore, I want everyone to use ‘he’ as my pronoun and use the name Jaakko. This is very important to me, and I know it can be difficult for you who are (non-trans) ‘cis’ people to understand, but I expect you to try, although it will certainly take some time to get used to it. Regards Jaakko”.
What struck us was that this message was so unnatural. It did not sound like Anna.
I logged in on her computer out of desperation to know what could be wrong. I learned that Anna has been part of a larger network of young girls who have been fascinated by popular YouTubers who say how nice it is to change sex and how wonderful it is to take testosterone and share advice on how to “pass” as a trans man. She was accessing a whole world of 24- hour online support, run by and for transgender people. They send out free breast “binders”. They sell “packers”, imitation male genitals of all sizes and colours for children from age three years. I discovered a dark and suggestive subculture of transgender activism in which children and young people who are unsure of themselves are being groomed in trans-ideology. Anna, in a very vulnerable situation and age, had been groomed on social media, to become a boy.
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Teenage ‘trans’ epidemic
Around the mid-2000s gender clinics in rich countries began to witness something new: teenagers, especially girls, suddenly declaring they were boys (See the video interview below with German clinician Alexander Korte). Unlike past patients with “gender dysphoria”, or severe distress about conflict between “inner” gender identity and biological sex, these teens had no childhood history of feeling “born in the wrong body”. What many did have was a host of pre-existing troubles, from poor mental health through autism and family problems to suppressed same-sex attraction. Now, as if reading from scripts, there were teens demanding that startled parents “affirm” their gender transition or take the blame for otherwise inevitable suicide attempts .
Many also wanted to avail themselves of new invasive medical treatments with unknown long-term effects: puberty blocker drugs to halt unwanted development, cross-sex hormones to mimic the opposite sex, even surgery to remove breasts. These were teenagers reared on Tumblr, Reddit and YouTube but activists for the dominant “affirmative” model of social and medical gender transition rejected any suggestion of a socially contagious trend; this was an affront to the dignity of inborn trans identity.
In 2016 Lisa Littman, an American physician and public health researcher at Brown University, broke a trans lobby taboo. Hearing stories of this new teenage trouble — given the tag “Rapid-Onset Gender Dysphoria” — Littman focused an exploratory study on parent groups, especially those with members alarmed by this out-of-character behaviour from their children. Her survey found some patterns: for example, a jump in social media use around the time gender dysphoria took hold, peer groups where non-LGBT teens were mocked, clusters of friends coming out as trans, and these announcements being rewarded with popularity. Littman suggested ROGD might be a new type of gender dysphoria, a hypothesis that warranted further research.
Even so, this modest claim was kryptonite to the pro-trans “affirmation model” of gender clinicians, and her study was misrepresented so it could be dismissed. Affirmation activists insisted a child’s “expert” discovery of gender identity’s “inner truth” could not be contaminated by social pressure or online influence. Positive stories of medicalised gender transition have dominated mainstream and social media — see the Alex Bertie video “One year on testosterone” at the bottom of the page — and the typical theme is the exhilarating uplift of the next item of self-liberation on the diversity agenda of identity politics.
But for the worried and isolated parents of these teens not persuaded by the trans narrative, ROGD was a label that captured the family crisis they were living through, and which the transgender system did not want to know about. It’s now common to see the tag “ROGD mum” on Twitter accounts — Bernard Lane
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Oscar’s parents
Suddenly, at 15, Oscar said he was a girl. We were shocked since this was not something we had ever seen any signs of when he was growing up. We tried thinking what made him think this. For a few years he had been involved in the student council. When we found out more, we discovered this organisation works to normalise the idea that people can change gender, sex and sexuality. The student council has embedded these ideas in his school. Oscar was searching for a way to belong and feel included and became active in internet transgender groups to do this.
Julia’s parents
At her eating disorders outpatients clinic she met two transgender female-to-male individuals and became close friends with both. A few months later she started identifying herself with them. We found their messages supporting her and encouraging to “keep going”. A couple of months later, she stated that she does not have any gender, and started asking for a short haircut. She even trimmed her eyelashes. I overheard her tell a transgender male-to-female classmate that she wanted to be a boy. That trans girl told her “after getting hormone treatment you will feel so much better”.
Anonymous gender clinician
Transgender identification in groups shows freedoms shutting down because actually society has become more gendered in many ways. And linked with that is the amount of normativity that we hear, incredibly regressive gender ideas which are used as the explanation about why a kid needs medical intervention, you know, “Why would a child need (puberty) blockers?” “Well, they need blockers because they’ve always liked pink and that means he can’t be a boy” or “She wears jeans and always plays football so is really a boy”.
Clinician
The doctrine is to treat gender dysphoria and mental health problems as two independent issues. This means we are endorsing intervention on children’s bodies without accounting for variability. A tolerance to self-identification is extended which is actually repressive.
You don’t just see one child and understand gender identity is not innate, but once you’ve seen a hundred you’ve seen “the Reddit kid”, you’ve seen “the teenager with autism”, “the one who might be gay”, you’ve seen “the girl who was sexually abused and hates her body” or whose mother has been sexually abused and hates her body and doesn’t want the same for her child. We know that by not examining what is behind the onset of dysphoria, and going straight for “self-affirmation” that the patient is transgender, we are subjugating children’s clinical needs to an ideological position.
Clinician
We hear all these stories of the internet and the influences that are out there and it’s very hard to know whether you think there is any innate gender (identity). But the questions aren’t allowed to be asked about that. Even going down this route of thinking is seen as being completely unacceptable. It’s true, the (transgender) lobby groups are creating an atmosphere of great difficulty. We have to “affirm” (a child’s gender declaration), no questions asked.
Anna’s parents
The school had major problems with bullying in the girl’s group and she was involved in this. She was so sensitive she would start crying in class. Her weight increased, she cut her hair and people said she looked like a boy. She became darker in mood. We begged gender clinicians to look at what Anna had been going through that might give insight about why she changed so rapidly and decided she was a boy. No-one had expected this; the girl, who loved dolls, dresses, glitters and ribbons, was no longer identified as “she”, but suddenly became a dark and gloomy “he” binding her chest with duct tape. We were not heard. Anna did not get the help she needed to process possible trauma.
Clinician
Once the child announces that gender is the problem, this masks all other issues. Referring clinicians assume that gender problems are too specialist for them to deal with, and that the children they refer to the gender identity development service will then be receiving psychotherapeutic care. But that’s not the case; once the child gets to the specialist service the clinical work is all about fast-tracking gender-affirmation and transition.
Julia’s parents
We went to the eating disorder clinic because she was already diagnosed with anorexia at 12 years old, just after the menarche (onset of menstruation), when she started spending a lot of time on (the) internet and started restricting food intake. She had been hospitalised before because of vital parameters and now she was not stable in weight. But our daughter said to the doctor “I am a healthy transgender, I don’t need eating disorder treatment, refer me to (the) gender identity centre. I am a boy”. She was immediately referred to the children’s gender identity clinic. The eating disorder clinic said they would not any longer treat her. I remember the psychologist told me that I have to accept she is a boy, saying “otherwise your child will relapse in anorexia or die”. We felt that the therapist was wrong.
Elsa’s parents
She had just ended her first long-term relationship with a boy, with a hard break-up, ending in threats from the boyfriend that he would commit suicide if they did not get back together. We asked the clinician why she was so disturbed. They said “because she is born in the wrong body of course”.
Tuomas’s parents
Tuomas became psychotic and received sex-reassignment surgery despite our warnings that he was obviously heading into schizophrenia when he began identifying as transgender. We sent letters to clinicians and attempted to intervene via the health supervising authorities. No proper assessment of his socio-economic or psychiatric status was done. After the sex-reassignment surgery was done, we pleaded with the hospital to give him proper treatment for his schizophrenia, this to no avail. He was treated solely for gender dysphoria.
Oscar’s parents
Growing up, he had a hard time understanding social codes which made him feel he wasn’t like everyone else. When he was about 10 or 11 years old, he received a diagnosis of ADHD with some autistic traits. At that time, he also had thoughts about his body and his appearance, he was dissatisfied with his body. As is typical for Oscar with his Asperger’s traits, now he has decided he is a girl, no one can change his mind. He will not listen to any other points of view. He has started to take SSRI (anti-depressant) medication but is not happier or released by his gender transition. I don’t think changing gender is solving any autistic spectrum problems for him.
Filip’s mother
I am concerned that research is needed to properly understand ROGD because taking a blanket approach to affirmation of transgender identification has meant that Filip’s autism has been completely overlooked to produce a clinical picture that sanctions sex-reassignment without any attention to his autism. For Filip, and other young people with similar social problems, autism or autistic traits, transgender identification seems to be an expression of other underlying problems.
Clinician
Cases that are worrying involve children whose family history is not explored, histories that include abuse, autism, clearly homophobic families, examples of survivor guilt where a child in the family had died and it seemed as if the cross-sex identification might be a response to the loss of the sibling. We see young girls internalising misogyny but attempts to hold a space open for reflection and exploration (are) seen as elitist and patriarchal.
Anna’s parents
We thought we would be in the safe hands of specialist gender clinicians who could explore the past, uncover trauma, and help 13-year-old Anna to process her confusion and distress. We were confident they would not automatically comply with a child’s demands for treatment with testosterone, for beard growth, a deeper voice and breast removal without any exploration of what had happened to suddenly change her. But we were wrong.
We were told we as parents needed help, not Anna. We were assigned our own family counsellor who guided us to come to terms with Anna’s sex change. Anna was assigned her own psychologist. According to the psychologist, what Anna has said is confidential. The outcome created by the gender clinic was that the distance between us and Anna was assured: the service had created a situation where we as parents were treated as adversaries to our own child.
We just want Anna to wait and see how she feels about her sex and gender as she grows up. At 13 she does not have the prerequisite experience to understanding the consequences of choices being made now. We think it is terrifying that the specialist clinicians assume the authority of confirming reassignment of sex and gender for children at such a young age without involving parents and with no acknowledgment of how much the internet affects the current cohort of children identifying as transgender in unprecedented numbers. Parents like us are marked out as conservative, evil, prejudiced and accused of destroying our children. We are not those things. We are an ordinary average family. We support our child and have a good relationship with her.
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LINKS
Sceptical of the “affirmation model”
* Australian Parents Questioning Gender
* 4thWaveNow: US-based community questioning medicalisation of gender-atypical youth
* Kelsey Coalition: US-based advocacy group with parents’ testimonials
* UK Legal Case to Protect Children from Experimental Medical Treatment: crowd-funded litigation to challenge legality of puberty blocker drugs for troubled teenagers
* Transgender Trend: UK-based parents questioning the trans narrative
* Gender Health Query: US-based LGBT group concerned about risky medicalisation of youth
* Rethink Identity Medicine Ethics: Clinicians and scholars with LGBT profile and focused on risk to young people
* Gender Identity Challenge: Scandinavian parents concerned about ROGD
“Affirmation” advocates
* Australian Parents of Gender Diverse Children
* Australian Professional Association for Trans Health
* Australian Psychological Society