From 2018, so today it's "transphobic", as are the parents at the start, who inflicted "conversion therapy" on their "son" and increased "his" risk of suicide.
So much for parental grooming, social contagion and surgery on minors all being myths.
When Children Say They’re Transgender - The Atlantic
"Claire is a 14-year-old girl with short auburn hair and a broad smile... until recently, she wasn’t certain she was a girl.
Sixth grade had been difficult for her. She’d struggled to make friends and experienced both anxiety and depression. “I didn’t have any self-confidence at all,” she told me. “I thought there was something wrong with me.” Claire, who was 12 at the time, also felt uncomfortable in her body in a way she couldn’t quite describe. She acknowledged that part of it had to do with puberty, but she felt it was more than the usual preteen woes...
Around this time, Claire started watching YouTube videos made by transgender young people. She was particularly fascinated by MilesChronicles, the channel of Miles McKenna, a charismatic 22-year-old. His 1 million subscribers have followed along as he came out as a trans boy, went on testosterone, got a double mastectomy, and transformed into a happy, healthy young man. Claire had discovered the videos by accident, or rather by algorithm: They’d showed up in her “recommended” stream. They gave a name to Claire’s discomfort. She began to wonder whether she was transgender...
Claire found in MilesChronicles and similar YouTube videos a clear solution to her unhappiness. “I just wanted to stop feeling bad, so I was like, I should just transition” ...
In Claire’s mind, the plan was concrete, though neither Heather nor her husband, Mike, knew about any of it. Claire initially kept her feelings from her parents, researching steps she could take toward transitioning that wouldn’t require medical interventions, or her parents’ approval. She looked into ways to make her voice sound deeper and into binders to hide her breasts. But one day in August 2016, Mike asked her why she’d seemed so sad lately. She explained to him that she thought she was a boy.
This began what Heather recalls as a complicated time in her and her husband’s relationship with their daughter...
To Claire’s parents, her anguish seemed to come out of nowhere. Her childhood had been free of gender dysphoria—the clinical term for experiencing a powerful sense of disconnection from your assigned sex. They were concerned that what their daughter had self-diagnosed as dysphoria was simply the travails of puberty.
As Claire passed into her teen years, she continued to struggle with mental-health problems...
Claire’s parents were wary of starting that process. Heather, who has a doctorate in pharmacology, had begun researching youth gender dysphoria for herself. She hoped to better understand why Claire was feeling this way and what she and Mike could do to help. Heather concluded that Claire met the clinical criteria for gender dysphoria in the DSM-5, the American Psychiatric Association’s diagnostic manual. Among other indications, her daughter clearly didn’t feel like a girl, clearly wanted a boy’s body, and was deeply distressed by these feelings. But Heather questioned whether these criteria, or much of the information she found online, told the whole story. “Psychologists know that adolescence is fraught with uncertainty and identity searching, and this isn’t even acknowledged” ...
Most of the resources she found for parents of a gender-dysphoric child told her that if her daughter said she was trans, she was trans. If her daughter said she needed hormones, Heather’s responsibility was to help her get on hormones. The most important thing she could do was affirm her daughter, which Heather and Mike interpreted as meaning they should agree with her declarations that she was transgender. Even if they weren’t so certain.
As Heather was searching for answers, Claire’s belief that she should transition was growing stronger. For months, she had been insistent that she wanted both testosterone and “top surgery”—a double mastectomy. She repeatedly asked her parents to find her doctors who could get her started on a path to physical transition. Heather and Mike bought time by telling her they were looking but hadn’t been able to find anyone yet... “We also took away her ability to search online but gave her Instagram as a consolation.”...
Claire humored her parents, even as her frustration with them mounted. Eventually, though, something shifted. In a journal entry Claire wrote last November, she traced her realization that she wasn’t a boy to one key moment. Looking in the mirror at a time when she was trying to present in a very male way—at “my baggy, uncomfortable clothes; my damaged, short hair; and my depressed-looking face”—she found that “it didn’t make me feel any better. I was still miserable, and I still hated myself.” From there, her distress gradually began to lift. “It was kind of sudden when I thought: You know, maybe this isn’t the right answer—maybe it’s something else,” Claire told me. “But it took a while to actually set in that yes, I was definitely a girl.”
Claire believes that her feeling that she was a boy stemmed from rigid views of gender roles that she had internalized... As she got a bit older, she found girls who shared her interests, and started to feel at home in her body.
Heather thinks that if she and Mike had heeded the information they found online, Claire would have started a physical transition and regretted it later. These days, Claire is a generally happy teenager whose mental-health issues have improved markedly...
The number of self-identifying trans people in the United States is on the rise. In June 2016, the Williams Institute at the UCLA School of Law estimated that 1.4 million adults in the U.S. identify as transgender, a near-doubling of an estimate from about a decade earlier... A major clinic in the United Kingdom saw a more than 300 percent increase in new referrals over the past three years...
If you read the bible of medical and psychiatric care for transgender people—the Standards of Care issued by the World Professional Association for Transgender Health (Wpath)—you’ll find an 11-page section called “Assessment and Treatment of Children and Adolescents With Gender Dysphoria.” It states that while some teenagers should go on hormones, that decision should be made with deliberation...
The leading professional organizations offer this guidance. But some clinicians are moving toward a faster process. And other resources, including those produced by major LGBTQ organizations, place the emphasis on acceptance rather than inquiry. The Human Rights Campaign’s “Transgender Children & Youth: Understanding the Basics” web page, for example, encourages parents to seek the guidance of a gender specialist. It also asserts that “being transgender is not a phase, and trying to dismiss it as such can be harmful during a time when your child most needs support and validation.” Similarly, parents who consult the pages tagged “transgender youth” on glaad’s site will find many articles about supporting young people who come out as trans but little about the complicated diagnostic and developmental questions faced by the parents of a gender-exploring child...
Until recently, hormones were typically not prescribed until age 16; it’s now more common for 15- and 14-year-olds, and sometimes even younger kids, to begin hormone therapy...
Early results, while promising, can tell us only so much. Olson’s findings come from a group of trans kids whose parents are relatively wealthy and are active in trans-support communities; they volunteered their children for the study. There are limits to how much we can extrapolate from the Dutch study as well: That group went through a comprehensive diagnostic process prior to transitioning, which included continuous access to mental-health care at a top-tier gender clinic—a process unfortunately not available to every young person who transitions.
Among the issues yet to be addressed by long-term studies are the effects of medications on young people...
Fundamental questions about gender dysphoria remain unanswered. Researchers still don’t know what causes it—gender identity is generally viewed as a complicated weave of biological, psychological, and sociocultural factors. In some cases, gender dysphoria may interact with mental-health conditions such as depression and anxiety, but there’s little agreement about how or why. Trauma, particularly sexual trauma, can contribute to or exacerbate dysphoria in some patients, but again, no one yet knows exactly why. ..
For many of the young people in the early studies, transitioning—socially for children, physically for adolescents and young adults—appears to have greatly alleviated their dysphoria. But it’s not the answer for everyone. Some kids are dysphoric from a very young age, but in time become comfortable with their body. Some develop dysphoria around the same time they enter puberty, but their suffering is temporary. Others end up identifying as nonbinary—that is, neither male nor female.
Ignoring the diversity of these experiences and focusing only on those who were effectively “born in the wrong body” could cause harm. That is the argument of a small but vocal group of men and women who have transitioned, only to return to their assigned sex. Many of these so-called detransitioners argue that their dysphoria was caused not by a deep-seated mismatch between their gender identity and their body but rather by mental-health problems, trauma, societal misogyny, or some combination of these and other factors. They say they were nudged toward the physical interventions of hormones or surgery by peer pressure or by clinicians who overlooked other potential explanations for their distress.
Some of these interventions are irreversible. People respond differently to cross-sex hormones, but changes in vocal pitch, body hair, and other physical characteristics, such as the development of breast tissue, can become permanent. Kids who go on puberty blockers and then on cross-sex hormones may not be able to have biological children. Surgical interventions can sometimes be reversed with further surgeries, but often with disappointing results.
The concerns of the detransitioners are echoed by a number of clinicians who work in this field, most of whom are psychologists and psychiatrists... These colleagues are approving teenagers for hormone therapy, or even top surgery, without fully examining their mental health or the social and family influences that could be shaping their nascent sense of their gender identity...
A growing number of adult gender clinics follow “informed consent” protocols...
For gender-questioning children and teens, the landscape is different. A minor’s legal guardian almost always has to provide consent prior to a medical procedure, whether it’s a tonsillectomy or top surgery. Wpath and other organizations that provide guidance for transitioning young people call for thorough assessments of patients before they start taking blockers or hormones.
This caution comes from the concerns inherent in working with young people. Adolescents change significantly and rapidly; they may view themselves and their place in the world differently at 15 than they did at 12. “You’ve got the onset of puberty right around the age where they develop the concept of abstract thinking,” said Nate Sharon, the New Mexico psychiatrist. “So they may start to conceptualize gender concepts in a much richer, broader manner than previously—and then maybe puberty blockers or cross-sex hormones aren’t for them.” That was true for Claire: A shift in her understanding of the nature of gender led her to realize that transitioning was not the answer for her.
For younger children, gender identity is an even trickier concept. In one experiment, for example, many 3-to-5-year-olds thought that if a boy put on a dress, he became a girl. Gender clinicians sometimes encounter young children who believe they are, or want to be, another gender because of their dress or play preferences—I like rough-and-tumble play, so I must be a boy—but who don’t meet the criteria for gender dysphoria...
What does it mean to be affirming while acknowledging that kids and teenagers can have an understanding of gender that changes over a short span? What does it mean to be affirming while acknowledging that feelings of gender dysphoria can be exacerbated by mental-health difficulties, trauma, or a combination of the two?...
When Max Robinson was 17, getting a double mastectomy made perfect sense to her. In fact, it felt like her only option—like a miraculous, lifesaving procedure. Though she had a woman’s body, she was really a man. Surgery would finally offer her a chance to be herself...
Max recalled that as early as age 5, she didn’t enjoy being treated like a girl. “I questioned my teachers about why I had to make an angel instead of a Santa for a Christmas craft, or why the girls’ bathroom pass had ribbons instead of soccer balls, when I played soccer and knew lots of other girls in our class who loved soccer,” she said.
She grew up a happy tomboy—until puberty. “People expect you to grow out of it” at that age, she explained, “and people start getting uncomfortable when you don’t.” Worse, “the way people treated me started getting increasingly sexualized.” She remembered one boy who, when she was 12, kept asking her to pick up his pencil so he could look down her shirt.
“I started dissociating from my body a lot more when I started going through puberty,” Max said. Her discomfort grew more internalized—less a frustration with how the world treated women and more a sense that the problem lay in her own body. She came to believe that being a woman was “something I had to control and fix.” She had tried various ways of making her discomfort abate—in seventh grade, she vacillated between “dressing like a 12-year-old boy” and wearing revealing, low-cut outfits, attempts to defy and accede to the demands the world was making of her body. But nothing could banish her feeling that womanhood wasn’t for her. She had more bad experiences with men, too: When she was 13, she had sex with an older man she was seeing; at the time, it felt consensual, but she has since realized that a 13-year-old can’t consent to sex with an 18-year-old. At 14, she witnessed a friend get molested by an adult man at a church slumber party. Around this time, Max was diagnosed with depression and generalized anxiety disorder.
In ninth grade, Max first encountered the concept of being transgender when she watched an episode of The Tyra Banks Show in which Buck Angel, a trans porn star, talked about his transition. It opened up a new world of online gender-identity exploration. She gradually decided that she needed to transition.
Max’s parents were skeptical at first but eventually came around, signing her up for sessions with a therapist who specialized in gender-identity issues. She recalled that the specialist was very open to putting her on a track toward transition, though he suggested that her discomfort could have other sources as well. Max, however, was certain that transitioning was the answer. She told me that she “refused to talk about anything other than transition.”...
Because Max had parental approval, the surgeon she saw agreed to operate on her despite the fact that she was still a minor. (It’s become more common for surgeons to perform top surgeries on teenagers as young as 16 if they have parental approval...
Max was initially happy with the results of her physical transformation. Before surgery, she wasn’t able to fully pass as male. After surgery, between her newly masculinized chest and the facial hair she was able to grow thanks to the hormones, she felt like she had left behind the sex she had been assigned at birth. “It felt like an accomplishment to be seen the way I wanted to be seen,” she told me.
But that feeling didn’t last. After her surgery, Max moved from her native California to Portland and threw herself into the trans scene there. It wasn’t a happy home...
Today, Max identifies as a woman. She believes that she misinterpreted her sexual orientation, as well as the effects of the misogyny and trauma she had experienced as a young person, as being about gender identity. Because of the hormone therapy, she still has facial hair and is frequently mistaken for male as a result, but she has learned to live with this: “My sense of self isn’t entirely dependent on how other people see me.”
Max is one of what appears to be a growing number of people who believe they were failed by the therapists and physicians they went to for help with their gender dysphoria. While their individual stories differ, they tend to touch on similar themes. Most began transitioning during adolescence or early adulthood. Many were on hormones for extended periods of time, causing permanent changes to their voice, appearance, or both. Some, like Max, also had surgery.
Many detransitioners feel that during the process leading up to their transition, well-meaning clinicians left unexplored their overlapping mental-health troubles or past traumas. Though Max’s therapist had tried to work on other issues with her, Max now believes she was encouraged to rush into physical transition by clinicians operating within a framework that saw it as the only way someone like her could experience relief. Despite the fact that she was a minor for much of the process, she says, her doctors more or less did as she told them.
Over the past couple of years, the detransitioner movement has become more visible...
Cari Stella is the author of a blog called Guide on Raging Stars. Stella, now 24, socially transitioned at 15, started hormones at 17, got a double mastectomy at 20, and detransitioned at 22. “I’m a real-live 22-year-old woman with a scarred chest and a broken voice and a 5 o’clock shadow because I couldn’t face the idea of growing up to be a woman,” she said in a video posted in August 2016. “I was not a very emotionally stable teenager,” she told me when we spoke. Transitioning offered a “level of control over how I was being perceived.”
Carey Callahan is a 36-year-old woman living in Ohio who detransitioned after identifying as trans for four years and spending nine months on male hormones. She previously blogged under the pseudonym Maria Catt, but “came out” in a YouTube video in July 2016. She now serves as something of an older sister to a network of female, mostly younger detransitioners, about 70 of whom she has met in person; she told me she has corresponded online with an additional 300. (The detransitioners who have spoken out thus far are mostly people who were assigned female at birth. Traditionally, most new arrivals at youth gender clinics were assigned male; today, many clinics are reporting that new patients are mostly assigned female. There is no consensus explanation for the change.)
I met Carey in Columbus in March. She told me that her decision to detransition grew out of her experience working at a trans clinic in San Francisco in 2014 and 2015. “People had said often to me that when you transition, your gender dysphoria gets worse before it gets better,” she told me. “But I saw and knew so many people who were cutting themselves, starving themselves, never leaving their apartments. That made me doubt the narrative that if you make it all the way to medical transition, then it’s probably going to work out well for you.”
Carey said she met people who appeared to be grappling with severe trauma and mental illness, but were fixated on their next transition milestone, convinced that was the moment when they would get better. “I knew a lot of people committed to that narrative who didn’t seem to be doing well”...
“When I look at what the [Wpath’s Standards of Care] describes, and then I look at my own experience and my friends’ experiences of pursuing hormones and surgery, there’s hardly any overlap between the directives of the SOC and the reality of care patients get,” Carey told me. “We didn’t discuss all the implications of medical intervention—psychological, social, physical, sexual, occupational, financial, and legal—which the SOC directs the mental-health professional to discuss. What the SOC describes and the care people get before getting cleared for hormones and surgery are miles apart.”...
No one knows how common detransitioning is. A frequently cited statistic—that only 2.2 percent of people who physically transition later regret it—doesn’t paint a complete picture. It comes from a study, conducted in Sweden, that examined only those people who had undergone sex-reassignment surgery and legally changed their gender, then applied to change their gender back—a standard that, Carey pointed out, would have excluded her and most of the detransitioners she knows.
It stands to reason that as any medical procedure becomes more readily available, a higher number of people will regret having it. Why focus on detransitioners, when no one even knows whether their experiences are all that common? One answer is that clinicians who have logged thousands of hours working with transgender and gender-nonconforming young people are raising the same concerns.
When it comes to helping TGNC young people gain access to physical interventions, few American clinicians possess the bona fides of the psychologist Laura Edwards-Leeper. A decade ago, when she was working at Boston Children’s Hospital, she visited the Dutch clinic to learn the puberty-blocking protocol pioneered there. She helped bring that protocol back to Boston, where she worked with the first-ever group of American kids to go through that process.
Today, Edwards-Leeper oversees a collaboration between Pacific University and Oregon’s Transgender Clinic, within the nonprofit Legacy Health system. At Pacific, she is training clinical-psychology doctoral students to conduct “readiness assessments” for young people seeking physical-transition services...
“I’ve been predicting this for, I don’t know, the last five or more years,” she said. “I anticipate there being more and more and more, because there are so many youth who are now getting services with very limited mental-health assessment and sometimes no mental-health assessment. It’s inevitable, I think.”
Edwards-Leeper believes that comprehensive assessments are crucial to achieving good outcomes for TGNC young people, especially those seeking physical interventions, in part because some kids who think they are trans at one point in time will not feel that way later on. This is a controversial subject in some corners of the trans community. A small group of studies has been interpreted as showing that the majority of children who experience gender dysphoria eventually stop experiencing it and come to identify as cisgender adults...Within a subset of trans advocacy, however, desistance isn’t viewed as a phenomenon we’ve yet to fully understand and quantify but rather as a myth to be dispelled. Those who raise the subject of desistance are often believed to have nefarious motives—the liberal outlet ThinkProgress, for example, referred to desistance research as “the pernicious junk science stalking trans kids,” and a subgenre of articles and blog posts attempts to debunk “the desistance myth.” But the evidence that desistance occurs is overwhelming. The American Psychological Association, the Substance Abuse and Mental Health Services Administration, the Endocrine Society, and Wpath all recognize that desistance occurs. I didn’t speak with a single clinician who believes otherwise. “I’ve seen it clinically happen,” Nate Sharon said. “It’s not a myth.”
Despite this general agreement, Edwards-Leeper worries that treatment practices are trending toward an interpretation of affirming care that entails nodding along with children and adolescents who say they want physical interventions rather than evaluating whether they are likely to benefit from them.
A decade ago, the opposite was true...
I asked the students whether they had come across the idea that conducting in-depth assessments is insulting or stigmatizing. They all nodded... “I told them about things almost being thrown at me at conferences.”
Those conference troubles signaled to Edwards-Leeper that her field had shifted in ways she found discomfiting. At one conference a few years ago, she recalled, a co-panelist who was a well-respected clinician in her field said that Edwards-Leeper’s comprehensive assessments required kids to “jump through more fiery hoops” and were “retraumatizing.” This prompted a standing ovation from the audience, mostly families of TGNC young people. During another panel discussion, at the same conference with the same clinician, but this time geared toward fellow clinicians, the same thing happened: more claims that assessments were traumatizing, more raucous applause.Edwards-Leeper isn’t alone in worrying that the field is straying from its own established best practices. “Under the motivation to be supportive and to be affirming and to be nonstigmatizing, I think the pendulum has swung so far that now we’re maybe not looking as critically at the issues as we should be,” the National Center for Gender Spectrum Health’s Dianne Berg told me. Erica Anderson, the UCSF clinician, expressed similar concerns: “Some of the stories we’ve heard about detransitioning, I fear, are related to people who hastily embarked on medical interventions and decided that they weren’t for them, and didn’t thoroughly vet their decision either by themselves or with professional people who could help them.”
Even some of the clinicians who have emphasized the need to be deferential to young people acknowledge the complexities at play here. A psychologist with decades of experience working with TGNC young people, Diane Ehrensaft is perhaps the most frequently quoted youth-gender clinician in the country. She is tireless in her advocacy for trans kids...
Sometimes, she said, she suspects that a kid who wants hormones right now is simply reciting something he found on the internet. “It just feels wooden, is the only thing I can say”...
Progressive-minded parents can sometimes be a problem for their kids as well. Several of the clinicians I spoke with, including Nate Sharon, Laura Edwards-Leeper, and Scott Leibowitz, recounted new patients’ arriving at their clinics, their parents having already developed detailed plans for them to transition. “I’ve actually had patients with parents pressuring me to recommend their kids start hormones”...
“Everything’s going great, but Mom’s like, ‘My transgender kid is going to commit suicide as soon as he starts puberty, and we need to start the hormones now.’ And I’m like, ‘Actually, your kid’s just fine right now. And we want to leave it open to him, for him to decide that.’ Don’t put that in stone for this kid, you know?”...
The existence of a high suicide rate among trans people—a population facing high instances of homelessness, sexual assault, and discrimination—does not imply that it is common for young people to become suicidal if they aren’t granted immediate access to puberty blockers or hormones... the clinicians I interviewed said they rarely encounter situations in which immediate access to hormones is the difference between suicide and survival. Leibowitz noted that a relationship with a caring therapist may itself be an important prophylactic against suicidal ideation for TGNC youth...
The conversations parents are having about gender-dysphoric children online aren’t always so nuanced, however. In many of these conversations, parents who say they have questions about the pace of their child’s transition, or whether gender dysphoria is permanent, are told they are playing games with their child’s life. “Would you rather have a live daughter or a dead son?” is a common response to such questions. “This type of narrative takes an already fearful parent and makes them even more afraid, which is hardly the type of mind-set one would want a parent to be in when making a complex lifelong decision for their adolescent”...
When parents discuss the reasons they question their children’s desire to transition, whether in online forums or in response to a journalist’s questions, many mention “social contagion.” These parents are worried that their kids are influenced by the gender-identity exploration they’re seeing online and perhaps at school or in other social settings, rather than experiencing gender dysphoria...
Some anecdotal evidence suggests that social forces can play a role in a young person’s gender questioning. “I’ve been seeing this more frequently,” Laura Edwards-Leeper wrote in an email. Her young clients talk openly about peer influence, saying things like Oh, Steve is really trans, but Rachel is just doing it for attention. Scott Padberg did exactly this when we met for lunch: He said there are kids in his school who claim to be trans but who he believes are not. “They all flaunt it around, like: ‘I’m trans, I’m trans, I’m trans,’ ” he said. “They post it on social media.”
I heard a similar story from a quirky 16-year-old theater kid who was going by the nickname Delta when we spoke. She lives outside Portland, Oregon, with her mother and father. A wave of gender-identity experimentation hit her social circle in 2013. Suddenly, it seemed, no one was cisgender anymore. Delta, who was 13 and homeschooled, soon announced to her parents that she was genderqueer, then nonbinary, and finally trans. Then she told them she wanted to go on testosterone. Her parents were skeptical, both because of the social influence they saw at work and because Delta had anxiety and depression, which they felt could be contributing to her distress. But when her mother, Jenny, sought out information, she found herself in online parenting groups where she was told that if she dragged her feet about Delta’s transition, she was potentially endangering her daughter. “Any questioning brought down the hammer on you”...
“At the time I was not happy that she told me that I should go and deal with mental stuff first,” Delta said, “but I’m glad that she said that, because too many people are so gung ho and just like, ‘You’re trans, just go ahead,’ even if they aren’t—and then they end up making mistakes that they can’t redo.” Delta’s gender dysphoria subsequently dissipated, though it’s unclear why. She started taking antidepressants in December, which seem to be working. I asked Delta whether she thought her mental-health problems and identity questioning were linked. “They definitely were,” she said. “Because once I actually started working on things, I got better and I didn’t want anything to do with gender labels—I was fine with just being me and not being a specific thing.”...
To deny the possibility of a connection between social influences and gender-identity exploration among adolescents would require ignoring a lot of what we know about the developing teenage brain—which is more susceptible to peer influence, more impulsive, and less adept at weighing long-term outcomes and consequences than fully developed adult brains—as well as individual stories like Delta’s...
One recent study co-authored by Olson-Kennedy, published in the Journal of Adolescent Health, showed that her clinic is giving cross-sex hormones to kids as young as 12. This presses against the boundaries of the Endocrine Society’s guidelines, which state that while “there may be compelling reasons to initiate sex hormone treatment prior to age 16 years … there is minimal published experience treating prior to 13.5 to 14 years of age.”...
Some LGBTQ advocates have called for gender dysphoria to be removed from the DSM-5, arguing that its inclusion pathologizes being trans. But gender dysphoria, as science currently understands it, is a painful condition that requires treatment to be alleviated"