Reminder: these are the definitions promoted by the newest generation of virulently anti-gay organizations.
Colin Wright: I'm coming from this classical liberal side where, and I thought we were achieving a lot of success in this idea that we were correctly identifying that there was a lot of variation in the degree to which people conform to sex stereotypes - there's masculine and feminine girls, masculine and feminine boys.
And we were at least going in the direction as a society of saying, that's completely normal, if you don't like that, deal with it. Like, these people exist and we should accept them.
And now we've kind of just gone the complete opposite. We're saying, well the boy who's very feminine, you're no longer a boy, you're actually a girl, you're stuck on the wrong body and we need to change you.
I'm just for the hands-off principle. Like, these are just normal people, these are just-- this is just natural variation and we need to let them be who they are. But then they would interpret "be who you are" as like, well they're born in the wrong body, so being who they are is modifying.
Andrew Gold: It's sort of-- I feel like there's authoritarianism coming from a benevolent dictator...
Wright: It was on the right path and then it just somehow, just totally got derailed and that's when I jumped off the train before it went off over the cliff.
Gold: Humans in big groups, they're just always going to do that, they're always going to start telling people they're in the wrong body, they're in the wrong thing, there's something wrong with who they are.
Both the right and the left have a really big problem with gender non-conforming individuals. You had the people on the far Christian right who don't like their feminine sons potentially being homosexual, and so they tried to change their brains to match your body, you know try to change your behaviors.
And then on the far left we have just the opposite, where they're, you know, they claimed to be accepting of it but now they're saying, well we need to change your body to match your brain.
It's just two ways to achieve the same end result basically.
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Full episode:
By: Christina Buttons
Published: Apr 1, 2024
A new Dutch study relying on long-term data found that the majority of adolescents expressing a desire to be the opposite sex no longer felt that way in adulthood. This adds to a growing body of research showing that gender dissatisfaction in adolescence is often temporary and declines with age.
Research on youth experiencing gender dysphoria often lacks long-term data, leading to significant disagreement about the most ethical ways to support these individuals. The authors drew attention to this research gap, observing that most studies focused on clinical samples from specialized gender clinics with only one follow-up assessment.
Their objective was to investigate the development of gender dissatisfaction in a sample comprising both clinical (youth psychiatric care) and general populations. They sought to explore associated factors such as sex, sexual orientation, self-concept, and mental health.
Their study included 2772 participants, with 53% being male, and provided a rare view of long-term data on dissatisfaction with one’s sex among youth. Spanning over 15 years, it followed individuals from late childhood to early adulthood, covering ages 11 to 26.
The study introduced the concept of “gender non-contentedness,” defining it as feeling unhappy with one's sex. The authors explained that this might be observed in a young adolescent girl who prefers activities typically associated with boys and feels discomfort with the physical changes of puberty.
To measure gender non-contentedness, the study relied on responses to the statement: "I wish to be of the opposite sex.” This question was part of a self-report survey provided by TRAILS, a long-term research project in the Netherlands tracking the development of adolescents and young adults through regular assessments. Data from this question was collected and analyzed from participants at six different time points between 2001 and 2020.
Additionally, the researchers measured behavioral and emotional problems using various survey instruments. Global self-concept, an assessment that measures self-esteem, self-confidence, and self-value, was evaluated at age 11, and sexual orientation was assessed at age 22 through self-report.
Key Findings
Findings revealed that approximately 11% of participants reported gender non-contentedness in early adolescence, with the prevalence decreasing to 4% by the last follow-up around age 26. Only 3 individuals, representing 0.1% of the total sample, consistently reported gender non-contentedness throughout adolescence and adulthood.
A majority of adolescents surveyed conformed to three identifiable trajectories: those who consistently reported never experiencing any gender non-contentedness (78%), those who reported gender non-contentedness in early adolescence that did not persist into adulthood (19%), and those who demonstrated the opposite pattern, with reports of gender non-contentedness increasing with age (2%).
Gender non-contentedness was most prevalent around age 11, and girls were more likely than boys to report it at ages 13 and 16. By approximately age 25, individuals on the decreasing gender non-contentedness trajectory no longer reported experiencing these feelings.
The authors posit that the large percentage of individuals with “temporary, declining gender dissatisfaction” may be attributed to the extended duration of the study, unlike typical research in this field, which often involves short-term follow-ups. Consequently, the study found “a clear declining trend in gender non-contentedness with age.” This was consistent with other studies, like a study from Taiwan, which found 8% (of 1806 children) who experienced gender dissatisfaction around age 13 no longer did by around age 22.
The study showed that individuals with both an increasing and decreasing trajectory of gender non-contentedness had lower global self-worth, more behavioral and emotional problems, and more often had a homosexual or bisexual sexual orientation compared to individuals without gender non-contentedness.
The authors find it noteworthy that both groups experiencing increasing and decreasing gender non-contentedness had lower self-esteem at age 11 compared to those who did not indicate gender non-contentedness, aligning with findings from previous studies. They suggest a connection between feeling dissatisfied with one's sex and having a negative self-perception applies not only to children seeking help at gender clinics, but also to the general population.
Acknowledgements of research on ROGD and desistance
The authors of this study made several important acknowledgements regarding research that is often overlooked or disregarded by activist researchers and clinicians. They identified a group that began reporting gender non-contentedness in mid to late adolescence, confirming that these feelings may emerge after puberty, supporting late-onset gender dysphoria or rapid-onset gender dysphoria (ROGD).
The authors also acknowledged research indicating that children who socially transitioned in early childhood were more likely to have persisting feelings of gender dysphoria. Socially transitioning children can have significant iatrogenic effects that solidify a child’s transgender identity, increasing the likelihood of seeking medical interventions. A review by the National Health Service England stated that social transition is not a “neutral act” and could have significant effects on psychological functioning.
The authors recognized the existing longitudinal studies in gender clinics showing that the vast majority (61-98%) of individuals who experienced early childhood gender dysphoric feelings did not have those feelings persist into adolescence and adulthood. They also recognized clinical research indicating that childhood gender dysphoria is linked to a homosexual orientation in adulthood, and that studies on childhood gender nonconformity tended to show a bisexual or homosexual sexual orientation later in life. Their new study corroborated these findings, showing that a decreasing trajectory of gender non-contentedness was a significant predictor of a homosexual or bisexual identification in adulthood.
Study Impact
The authors acknowledge that general population studies are scarce, and much of the existing research relies on clinical samples with only one follow-up assessment. Because this study draws from both clinical and general population groups over an extended period of time, it offers "more reliable epidemiological knowledge" about how prevalent feelings of dissatisfaction with one’s sex are among adolescents, as well as new insights into the association with mental health problems.
The researchers conclude that their study results should reassure teenagers who feel unsure about their identity and desire to be the opposite sex during adolescence, that this is a normal and common experience. Additionally, they hope their findings will “provide some perspective” to clinicians who mainly treat teenagers with “intense gender dysphoric feelings.” This understanding could give them a broader view of how common it is for young people, both in the general population and those receiving mental health care, to question their sex.
Broader Implications
Importantly, the findings from this study challenge commonly held beliefs promoted by gender activists about an innate, fixed “gender identity” from birth. These beliefs underpin arguments for medical interventions for minors, designed to align their physical appearances with their self-perceived "gender identities."
In recent times, there has been a shift among gender activists towards de-emphasizing the diagnosis of gender dysphoria, preferring instead to define transgender identity purely based on an individual's self-perception as incongruent with their biological sex. Activists argue for a concept of "gender identity" that is brain-based, constant, and identifiable from a very young age—around 2 or 3 years old—asserting that children "know who they are" and should be taken at their word.
This evolving definition tends to merge transgender identity with common gender nonconformity, potentially leading individuals to interpret any deviation from gender norms as indicative of a transgender identity. According to this viewpoint, “gender identity” is entirely about the extent to which an individual identifies with the societal roles and stereotypes associated with either sex. Thus, anyone aligning with stereotypes opposite to their biological sex might be considered to have a cross-sex identity, raising concerns about prematurely labeling children based on nonconforming interests or behaviors.
Inspired by the "born this way" campaign of the gay rights movement—which posits sexual orientation as an innate and immutable aspect of identity—transgender activists have similarly portrayed transgender existence as a fixed and unalterable trait.
However, there is a problem with this conceptualization. Although there is substantial evidence indicating that sexual orientation is determined in utero, there is no strong empirical support for a biological basis for an innate “gender identity.” The notion of transgender identities being fixed at birth is contested by the increasing number of detransitioners and extensive research on desistance among children, suggesting that such identities can often be temporary coping mechanisms for young people in distress.
The authors of the current study do not challenge the existence of “gender identity” but argue against its perceived immutability, illustrating that gender dissatisfaction, including the desire to be of the opposite sex, can evolve well into adulthood. This insight contributes to a growing body of research advocating for a more cautious approach to medical interventions for children and adolescents, recognizing that their identity development is ongoing.
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Study:
By: Sasha Ayad and Stella O’Malley
Published: Dec 12, 2023
Parents of gender-questioning children—boys and girls who believe they might be “born in the wrong body”—typically fall into one of two camps. Either they enthusiastically embrace (or “affirm,” according to the preferred jargon) their child’s wish to transition to an opposite sex identification; or they have concerns, and would like to slow things down, so as to provide their child with more time to explore why they feel as they do.
Those who fall into the first category—the affirmation camp—will find no shortage of books, web sites, summer camps, social-media groups, therapists, activist organizations, (highly profitable) clinics, and even television shows available to help push their child along a path toward transition.
On the other hand, those who believe that hasty social and medical transition isn’t necessarily the best option for their child will find far fewer resources. In part, this is because many of those who’ve expressed alarm over the skyrocketing rates of trans-presenting children have been vilified in the media, within their families and peer groups, and online. They’ve been told that trans-presenting children will become suicidal if their beliefs are subject to even mild scrutiny. Many of the doctors who are supposed to support parents in keeping their children healthy have instead pressured mothers and fathers to go against their instincts.
These parents often come to realize they have few places to turn for real help. In some cases, they’re able to find a therapist who can deal thoughtfully with their child’s beliefs. But in other cases, they have to act as (in effect) their family’s own gender-dysphoria first responders.
For those parents, our message is: You can do this. You are the adults who are most deeply invested in your child’s flourishing. You have the widest perspective on his or her future potential and past difficulties. The advice that follows, based on experience we’ve accumulated helping families cope with this phenomenon, will help get you started on developing an authoritative, loving stance toward your gender-distressed child.
1. Don’t Let Others Gaslight You
Trust yourself. Trust your parental instincts built over the life of your child. Be careful about whom you recruit for help, and don’t let anyone gaslight you into believing that your viewpoint is phobic—even if they present their advice as the unassailably scientific consensus of impressive-sounding organizations. This is a relatively young field of research that has been largely dominated by ideologues and activists, not objective physicians. Nobody knows or loves your child more than you do, and thinking for yourself is crucial.
2. Mind Your Own Mental Health
The fact that you are reading this—that you are open to facts and opinions about gender dysphoria that diverge from affirmation-based dogma—suggests that you are in the process of educating yourself. Perhaps you have already fallen into a research “rabbit hole,” and are spending every available hour reading about childhood gender dysphoria. This process of immersion often will include participation in online support and discussion groups populated by other parents who find themselves in the same situation.
Connecting with others can be a grounding experience. Humans are social creatures, and none of us like to feel isolated. It comes as a relief to know that you’re not the only parent who feels the way you do. On the other hand, it’s also easy to become overwhelmed by this process of immersion. And it can generate a process of mutual isolation within your own household, as you and your dysphoric child both come to inhabit different information silos. Your own mental health may come to decline in parallel with that of your child’s.
There will be sleepless nights, bouts of uncontrollable crying, and the onset of a difficult-to-describe sense of numbness. For many parents, dealing with a child’s assertion of a trans identity will mark the first time they’ve felt themselves lose control—and even a sense of authority—over their child’s care and safety. The resulting sense of powerlessness can feel terrifying.
Relationships become strained, especially if one’s partner takes a different approach. You need to take care of yourself and find balance, including by modelling the kind of self-awareness and behavioral moderation that you’re urging your child to apply. Attend the support group when it feels right. Avoid the support group when it doesn’t. Figure out what helps you stay grounded and allows you to lean in to this parenting challenge in a sustainable way. Build a routine of getting outdoors, eating well, exercising, reading novels, seeing trusted friends, and enjoying hobbies that help you restore your spirit. Do not lose yourself in the process of trying not to lose your child.
3. Be Firm in Describing the Truths of the World
Whether your child is exhibiting actual signs of gender dysphoria, or is merely asserting that he or she is transgender, consider the potential root cause of the child’s gender discomfort (whether real or imagined). Decades ago, most observed pediatric cases of gender dysphoria occurred in early childhood. Multiple studies documented that the majority (upwards of 80%, though the exact figure is disputed) of such cases resolved by early adulthood—as long as a “watchful waiting” approach was followed, instead of an immediate program of social transition. Be mindful of the possibility that your child’s trans presentation may comprise a psychologically deflected means of dealing with other issues, such as homosexuality, trauma, or fear about his or her changing body.
As a parent, you can do much to help your child come to terms with his or her (unchangeable) biological sex. In this moment of crisis for your child, it may be tempting to accede to his or her beliefs about their “true” identity, on the basis that this will help relieve the child’s psychic distress. But this short-term strategy will only set your son or daughter up for disappointment in the long term, when the facts of biology become more evident. Biological sex is real. It isn’t “assigned at birth” by doctors.
We strongly advise against trying to enforce rigid gender norms, however. Many young children who express a desire for clothes and toys that are culturally associated with the opposite sex will grow up to be same-sex-attracted (i.e., gay or lesbian). Accepting a little boy’s preferences to dress up as a princess, without letting him lose sight of the fact that he is a boy, and that he will grow up to be a biological man, will help him accept himself for who he is (including, eventually, the possibility that he is gay).
Decide on household rules about presentation that you can implement and stick to. Some families freely allow gender-non-conforming boys to wear skirts and dresses at home, but require them to dress in a more gender-neutral fashion for school. In some cases, this is because, in today’s environment, a child who cross-dresses is simply assumed to be transgender; and so may be continually asked for his or her pronouns, or placed in groups with opposite-sex children, by educators and caregivers eager to demonstrate an enlightened attitude.
It’s sad to observe that nominally progressive teachers and day-care providers now enforce this kind of old-fashioned pink-and-blue logic when deciding who is a boy and who is a girl. But that is the reality many of us now inhabit. In the face of this kind of external pressure from ideologically motivated third parties, it may be easier for a young child to stay in touch with his or her biological reality if parents place limits on the way that he or she self-presents.
(If your son wants to experiment with make-up, it’s okay to explain that make-up is for grown-ups and teenagers. That said, it can be fun for children of either sex to get dressed up and play with cosmetics, nail polish, high-heeled shoes, and the like, even while acknowledging that, when it comes to daily usage, these generally aren’t appropriate for young children.)
4. Stay Vigilant—and Positive
For children who are already gender-distressed, puberty is an especially difficult period, because the changes they observe in their bodies tend to create a painful sense of cognitive dissonance. This comes on top of the baseline anxieties that all children (especially girls) now feel about their bodies, thanks in large part to social media.
To take the focus off mere aesthetics, encourage your child to become proud of what his or her body can do—be it rowing, running, climbing, swimming, or other activities that are challenging, but whose mechanics don’t highlight sex differences in any obvious way. Spend time seeking out role models, in real life or online, who might resonate with your child—including men and women who are confident and successful even as they challenge gender norms.
Monitor what kind of influences your child is exposed to on the internet: Gender-non-conforming children are less likely to accept their bodies and genes if they are told by charismatic influencers that their souls are trapped in “the wrong body.” Over time, this propaganda can have the same effect as religious or cult indoctrination, which similarly promises troubled souls a form of psychic deliverance from their pains through a process of metaphorical rebirth.
If your child first asserts a trans identification while in middle or high school, you might wonder whether he or she has fallen under the influence of one or more trans-identified peers; or whether your child’s school is promoting “gender ideology” (for lack of a better term) as part of its curriculum. Peer-reviewed research suggests that many adolescents who assert a transgender identity in their tween or teenage years, without having previously exhibiting signs of gender distress (a phenomenon described in the literature as Rapid Onset Gender Dysphoria, or ROGD) are apt to emerge in clusters through a process of social contagion that some have analogized to anorexia.
Adolescence is a time when children push back against their parents and seek more autonomy, so it’s inevitable that a trans-identified child who demands immediate affirmation will regard your more cautious attitude as adversarial. But even so, it’s important that you don’t let this adversarial tone come to define your relationship. Beware of letting the gender issue crowd out every other issue in your child’s life. Don’t allow it to become a full-time battleground. Consider an 80/20 rule: the majority of your interactions with your child should have nothing to do with difficult gender talks.
The prospect of having fun with your child might seem far-fetched if your son or daughter has become withdrawn, moody, rude or sarcastic. But in most cases, there will be activities that the two of you can still enjoy together—such as baking, hiking, or watching your favorite show.
If your child is struggling with social, scholastic, or emotional concerns (whether or not you believe they are related to his or her gender distress), offer lots of loving support, and explore ways to address these difficulties. Find avenues to connect with your child, and to express your affection and parental pride. You might make space to talk about what is hard about being a boy (or girl), as well as what’s great about it. Remind them that there is no “right” way to be a girl or a boy. Our bodies just are, and we don’t get a say in the biological cards we were dealt. But those cards don’t dictate what interests we pursue, how we behave, or (most importantly) whom we love. Even within the limits that biology places upon us, we all still have plenty of autonomy when it comes to making these choices.
The type of interventions we are describing here may not work for all children—especially older ones. But it never hurts to at least try to encourage alternative interests, so that your child isn’t always dwelling on gender. One mother we know of, for instance, dealt with her son’s gender fixation as follows:
“Step by step, we helped him stretch. We started with individual activities (chess and composing lessons). Then group things: philosophy camp, chess club, wilderness camp. We were ‘unavailable’ for get-togethers with the [trans-identified] friend/s. I…removed the pro-trans channels from his Reddit feed…After six months, his trans behaviour started breaking up. After nine months, it was very inconsistent. Around fourteen months [in], he stopped shaving his legs. Finally, at around eighteen months, he cut his hair. Had we made it through? Around twenty-two months in, I gently asked where he was ‘with the whole gender identity thing.’ He responded, ‘Mom, I never want to talk about it again.’”
5. Don’t Walk on Eggshells
There’s a temptation to walk on eggshells with a trans-identified child. But it’s usually better to combine respect with candor—not only in regard to biology, but in regard to your own mindset. Words like: I know you really want us to use different pronouns for you. This is something I’ve reflected on a lot, and it just feels inauthentic for me. We’ve always been honest with each other in the past. And I simply can’t refer to you in a way that feels like I’m lying to you, or being fake.
During discussions, try using open-ended questions, and avoid segueing into political debates that draw in references to external actors or culture-war protagonists. You are coming to these discussions as a parent, not as a spokesperson for any political party, author, or podcaster. Defend your own views, not those of anyone else.
Don’t accuse your child of being brainwashed (even if you suspect that may be the case), and listen intently. Thank your child for the moments when he or she is willing to talk in a sincere fashion.
Express an understanding of why your child might be seeking a new identity: I know you’re trying to feel better about yourself/find a peer group that feels right for you/create a sense of comfort in your body/carve out your own unique identity, etc. You should also give yourself license to make tentative observations that you acknowledge as such: I could be wrong, but it seems that part of what’s going on here may be that you’re trying to run away from yourself and become a new person.
It’s also fine to start conversations and end them inconclusively, disengaging when things are becoming heated or otherwise unproductive. A common element among many families that have dealt with a trans-presenting child successfully is that progress tends to come from many small conversations instead of one big one.
That said, your child should know where you stand on red-line issues—medical transition, most notably. If your adult child is no longer living at home, acknowledge his or her need for independence, but make room to share what you believe, especially the fact that it’s risky to change one’s identity and embark on medical transition, before resolving life’s other difficulties, developing financial stability, getting experience, and having healthy romantic relationships.
At the very least, this advice might help a teenage trans-identified child avoid joining the tragically long list of gender-distressed youth who end up in dire straits—even homeless—having single-mindedly pursued their transition dreams at the expense of everything else in life.
Some parents find that their child is so resistant to any dialogue that it is easier to avoid the subject of gender completely. You may be fearful that your child will cut all ties with you. In some cases, the child will have embraced the fairy-tale-style conceit that there is some “real” family out there that understands him or her in a way that you never could—a sort of “glitter family” or “queer house” where everyone is happy. (In this respect, it is notable that many trans-identified boys and men, in particular, tend to psychologically inhabit fantasy worlds based on Japanese cartoons and videogames that prominently feature androgynous child-like fairy creatures. In these online milieus, the trans world is sometimes presented metaphorically as a realm of youthful wizards, with their “cis”—i.e., non-trans—counterparts playing the role of gender muggles.)
In such cases, parents must carefully weigh the potential risk of total estrangement and proceed accordingly. If at all possible, it’s always best to provide a child with a sanctuary of some kind, in which parent and child can maintain some kind of functional relationship.
6. Maintain High Expectations
As noted above, when teens express distress through the language of gender, they often are channelling a separate core problem, such as trauma. Take some time to reflect on what such a problem might be. Is your child looking for a way to rebel and carve out his or her own identity? Is your child afraid of growing up, and so is subconsciously seeking a way to delay his or her maturity—including through the literal avoidance of puberty?
But even if you understand your child’s behaviour to reflect this kind of underlying anxiety, maintain high expectations of his or her behavior. Some young people spend a lot of time online arguing with strangers about their perceived verbal transgressions, a habit that can lead them to take on an air of intellectual superiority (and even invincibility). This can have anti-social consequences if they come to believe (as many do) that they can crush any dissent (including from their parents) with clever arguments or slogans. Dinnertime and other family gatherings then get ruined, as every disagreement or misspoken word is pounced upon as an excuse for a hectoring sermon. Make it clear that the strength of your child’s beliefs don’t relieve them of their duty to show respect to others.
Ask any questions you might have about your child’s beliefs and politics, but also protect your right to disagree about the answers; and, perhaps most importantly, protect your right to make mistakes (real or imagined) in articulating your position. The well-being of a family can unravel if children are allowed to dictate the rules of conversation, and so it is essential that you retain your sense of authority. (Also remember that other siblings are watching when these arguments take place, and will govern their own behaviour according to the precedents they observe.)
In some cases, a trans-identified child may be seeking a means to publicly express a desire for a better world in which marginalized populations get better treatment. The trans persona thereby becomes a sort of political statement—a gesture of solidarity with the larger LGBT community.
In such cases, your child may benefit from a broad exploration of the many issues involved in social justice, such as advocacy for the disabled, support for migrants, prisoners, and other vulnerable groups, efforts to help the environment, women’s rights, and so on. With some guidance and thoughtful conversation, parents may be able to gently nudge a child’s curiosity in such a way that his or her narrow focus on gender as a byword for social justice gets broadened out.
7. Consider a Lifestyle Shift
If your resources permit, consider new experiences that push your child, and hopefully the entire family, beyond the ruts of day-to-day web surfing and bickering. Ideally, this would serve to expand your child’s sense of self.
Structured, age-appropriate travel opportunities, in particular, can offer a fantastic way for a child to develop a new perspective. Is there an option for a foreign-exchange program that allows your child to live with another family and become immersed in another language and culture? Are there volunteering opportunities that give your child a chance to contribute to society in a hands-on way, possibly away from home? It sometimes helps for a child to learn that the best way to help humanity usually involves face-to-face interaction, instead of spreading hashtags and arguing with strangers on Reddit.
Do you have (like-minded) family in another part of the country who might host your child for a spring or summer break? A rural environment can provide a novel experience for a child who’s spent his or her whole life in the city. Working with animals, enjoying nature, looking up at a sky full of stars, and learning new physical skills are all great ways to help develop a child’s understanding of the real world that exists outside his or her mind.
8. Mitigate Unhelpful Influences
If you’re already engaged in the strategies we’ve discussed so far, but have been undermined by other actors—such as an educator, therapist, or online personality who seeks to convince your child to equate parental concern with transphobia, it may be necessary to take further steps. In some cases, this can mean changing schools and therapeutic programs.
In the case of online influences, it might be helpful to educate your family about the need for digital wellness. The Social Dilemma, available on Netflix, discusses the ways in which social media algorithms hijack our attention. Share some of the ways in which you have felt drawn in by these technologies. Cutting down screen time, restricting apps, and implementing parental controls can be useful. Some families bring their computers into a common area during the evenings, and then limit the time they spend alone in their bedroom with devices. Encourage your child to use one-on-one text messaging when connecting with friends, instead of immersive social-media platforms; or, better still, encourage your child to spend more time with friends in person.
Once you have a plan, we recommend communicating your strategy to close family members, friends, and loved ones. If other adults in your child’s life cannot co-operate with you, or insist on undermining your parenting goals, you may find yourself with difficult decisions to make about those relationships. As we have witnessed, some adults have become so highly vested in gender ideology that they’ve come to believe that its precepts supersede the wishes and instructions communicated to them by parents.
Parting ways, at least temporarily, with these people can be a painful sacrifice. But nothing is more important than protecting your child’s welfare. And as with any important mission, success comes from creating a realistic plan, and making the decisions necessary to see it through.
Adapted, with permission, from When Kids Say They’re Trans: A Guide for Parents, by Sasha Ayad, Lisa Marchiano, and Stella O’Malley. Published by Pitchstone Publishing, in arrangement with Swift Press Ltd. Copyright © 2023 Sasha Ayad, Lisa Marchiano, and Stella O’Malley.
By: Ben Appel
Published: Mar 17, 2024
On February 5, 2024, The Free Press published the whistleblowing account of Tamara Pietzke, a Washington State mental health therapist. For six years, Pietzke worked at MultiCare, one of Washington state’s largest hospital systems. In her essay, Pietzke explained why she chose to leave MultiCare in January.
“In the past year I noticed a concerning new trend in my field,” Pietzke wrote. “I was getting the message from my supervisors that when a young person I was seeing expressed discomfort with their gender—the diagnostic term is gender dysphoria—I should throw out all my training. No matter the patient’s history or other mental health conditions that could be complicating the situation, I was simply to affirm that the patient was transgender, and even approve the start of a medical transition.”
Pietzke described the case studies of three patients she treated at MultiCare. One was a 13-year-old girl who had an abusive mother, was a victim of multiple sexual assaults, and had been diagnosed with “depression, PTSD, anxiety, intermittent explosive disorder, and autism.” After the girl was diagnosed with gender dysphoria, despite the girl’s complex history, the Mary Bridge clinicians recommended she take medication to suppress her periods and consider taking testosterone. When Pietzke voiced her concerns to her program manager, she was told to “examine [her] personal beliefs and biases about trans kids.” The girl was then promptly removed from her care.
Another patient, a 16-year-old client who had anxiety, depression, and ADHD, told Pietzke that, during the pandemic, after reading online about gender, she didn’t feel like a girl anymore. Soon, she started using she/they pronouns and wearing a chest binder. In 2022, she went to Mary Bridge, where she was prescribed birth control to stop her period, since the girl’s father wouldn’t consent to allowing testosterone treatment. After a hospitalization for swallowing a bottle of pills, the girl told Pietzke she identified as a “wounded male dog” and talked about wearing ears and a tail in order to feel more like her true self. Pietzke’s concerns were minimized by her colleagues, who seemed to have no issue with patients identifying as animals if it made them happy.
In 2022, Pietzke began treating a female in her early twenties who had transitioned as a teen. The patient, who rarely left the house and spent most of the day in bed, had been diagnosed with autism, anxiety, gender dysphoria, depression, Tourette syndrome, and a conversion disorder. Mary Bridge prescribed the girl testosterone in 2018, when she was 17, “despite the fact that this patient is diabetic and one of the hormone’s side effects is that it might increase insulin resistance,” wrote Pietzke. “The patient’s mother, who has another transgender child, strongly encouraged it.”
“My biggest fear about the gender-affirming practices my industry has blindly adopted is that they are causing irreversible damage to our clients,” wrote Pietzke. “I am desperate to help my patients. And I believe, if I don’t speak out, I will have betrayed them.”
In mid-February, I spoke to Pietzke over Zoom. She had just been fired from her new job.
After Pietzke left MultiCare, she was hired by a therapy clinic to provide mental health counseling and neurofeedback, a treatment that helps patients produce more positive brainwaves. From the beginning, Pietzke’s new boss had insisted that, if neurofeedback wasn’t for her, she could switch to counseling full time. And yet, when Pietzke requested this change, her boss said that wasn’t an option and promptly let her go.
The way Pietzke described it, it sounded like her whistleblowing had contributed to her boss’s decision. Now, Pietzke hopes to open her own practice in order to avoid running into this issue at yet another clinic.
“I just want to be able to do my job and help people,” she told me.
In Washington, conversion therapy laws include “gender identity” along with sexual orientation, which means that therapists can face legal repercussions for failing to properly affirm a patient in his or her trans identity. I asked Pietzke if this concerns her.
“Believe me, I’m making it very clear that I’m not trying to change anybody,” she said. “All I want to be able to say is, ‘Let’s put a pin in it. Let’s process this and work through this and not rush to medicalize. You’re a child.’”
I explained to Pietzke how I first got involved in this issue. After I learned that gender-nonconforming youth were being medicalized, I began to wonder what the difference was between a “trans kid” and the effeminate little boy that I had been growing up.
“I was teased all the time as a kid,” I said. “In middle school, I was often asked, ‘Are you a boy or a girl?’ Most of my friends were girls and I loved girly things. I was really athletic, but I wanted to play with the girl's lacrosse stick rather than the boy's lacrosse stick. So, to imagine that there would be this ideology, for lack of a better word, that said, 'Which sex do you feel like? Which sex do you identify as, according to these gender norms?’ I can’t imagine, being young, I would’ve been able to answer, ‘Oh, I know I feel more like a boy.’”
“It would’ve been so confusing,” said Pietzke.
“And, because I was raised really religious, I couldn’t reconcile my sexuality with my upbringing,” I said. “So, I’m sure I may have thought, ‘Good, this isn’t a moral defect, it’s just a medical problem that I can fix. I’ll feel more comfortable, I’ll blend into society more, and the bullying might stop.’”
That was why I asked about the conversation therapy laws, I told Pietzke. “Like you said, you’re not trying to change anybody. But there needs to be some exploring here, because there can be other things at play, including the possibility that you’re just dealing with a gender-nonconforming kid who will grow up to be gay.” In other words, “gender-affirming care” can be a new form of gay conversion therapy.
“My understanding is that about 85 percent of gender-distressed youth who are allowed to progress through puberty normally resolve that distress,” said Pietzke. “And oftentimes they do end up being gay. For a kid to even have the thought that they might have been born in the wrong body is just so unfair.”
She continued. “And that is what kids are talking about now. They don’t even need an adult to say it. Their peers start to identify as another gender, and they think, ‘OK, maybe I am, too.’”
To describe what’s occurring in the medical system when it comes to “gender-affirming care,” Pietzke said that, in the past, she has hesitated to use the word “corruption,” only because “it feels so extreme.”
“But that’s what it is,” she said. “A level of corruption that makes me heartsick. I have to wonder, do people really think they’re doing what’s best for people? Or, are they personally benefiting from providing these treatments in some way? I’m trying to figure it out. But it’s scary to me.”
Last year, I spoke with Dr. Laura Edwards-Leeper, the founding psychologist for the first hospital-based pediatric gender clinic in the U.S. During our conversation, Dr. Edwards-Leeper, who adapted the “Dutch Protocol”—puberty blockers followed by cross-sex hormones and surgery—to be used in the U.S., used the word “cult” at least five times to describe what’s become of her field. Practitioners, she said, are ignoring nearly everything they’ve learned about childhood development and instead taking cues from colleagues who might have the “lived experience” of being trans but who lack medical training. Often, practitioners fear being labeled transphobic if they fail to follow the dictates of these colleagues.
I asked Pietzke if she agreed with Dr. Edwards-Leeper’s observations.
“Absolutely,” she said. “I definitely think people are afraid of being labeled transphobic.” She described a virtual gender-affirming care training she attended while working for MultiCare. For asking basic questions about possible side effects and health consequences of cross-sex hormones, and about the high correlation between gender dysphoria and other mental health disorders in girls, “that [label] was thrown out at me almost immediately,” she said. “They said I was harming people and that I need to keep ‘politics’ out of it.” After the training session, four people reached out to Pietzke to say that they had the same concerns, but they were afraid to speak up because they saw how she had been treated. “They’re scared,” she said.
When it comes to the politicization of this issue, I told Pietzke, I’m often reminded of Newton’s third law of motion: for every action in nature, there is an equal and opposite reaction. That is, if one side objects to, say, cross-sex hormones for gender-distressed teenagers, the other side doubles down by proposing even more radical interventions or by fear-mongering about suicide. It becomes a game of ping-pong, with vulnerable kids stuck in the middle.
Another activist tactic that really bothers me, I continued, is when they accuse people who object to sex-trait modification for minors of opposing gender-nonconformity in general.
“In reality, it’s the exact opposite,” I said. “I want society to make more space for young people who innately transgress gender norms. All I’m saying is that defying stereotypes is not a medical problem that needs to be fixed.” Especially when the “fixing” means severe health consequences, infertility, and often, particularly for males, anorgasmia.
Pietzke agreed. “Why can’t we just let people be people without making them think there’s something wrong with the way they’re wired?” she said. “Adolescence is uncomfortable for everybody. Let’s be the adults in this situation and guide them through it, rather than rushing to medicalize them.”
To learn more about Pietzke’s preferred approach to counseling young people, I posed a scenario. “Let’s say a thirteen- or fourteen-year-old comes to you for therapy. She’s really masculine-presenting, likes hanging out with boys, is rough and tumble, and she says that she doesn’t feel like a girl. How would you handle this?”
Pietzke didn’t take long to respond. “I have a few thoughts,” she said. “My first inclination would be to ask her, “What does being a girl mean to you? What does feeling like a girl mean? Because if what you’re saying is that you don’t like fake nails and fake eyelashes and going shopping, well, that doesn’t mean you’re not a girl. That’s just one type of being a girl.”
Pietzke continued, “I’ve puzzled over this a lot. I’ve thought, what if a kid came in and said she was going to kill herself because she thought she was in the wrong body? Well, that made me ask myself, what would I do if a person with depression said she was going to kill herself? The solution isn’t fixing the thing that appears to be causing distress. You need to treat the resilience piece, so that when hard things happen or difficult feelings arise, you don’t automatically default to thinking, ‘I don’t want to be alive anymore.’ Of course I’d tell my patient, ‘Yes, I absolutely hear that you’re in pain and I care so much about that. But this suicidal piece, we need to work on that. Because life is hard, and I certainly want to help you have the resilience to be able to navigate the hard things.’”
Pietzke and I talked about the data, in particular the fact that there is no evidence showing that kids and adolescents who don’t receive puberty blockers or cross-sex hormones are at greater risk of suicide, despite activists’ dogged insistence on peddling this narrative. In reality, these treatments could be making things worse for many people.
Pietzke said, “If we just assume that someone’s struggles are strictly because of gender distress and we don’t teach them the skills to navigate depression, anxiety, or whatever else they might be struggling with, we’re not doing them any favors.”
I told Pietzke that I sometimes fear that the LGBT organizations that push this false suicide narrative are actually creating a greater risk of suicide contagion among young people.
“Exactly,” said Pietzke. “If I were 14, and I was told that, if the adults in my life don’t let me do this one thing, I might commit suicide, there’s a good possibility that I would start to think, ‘Maybe I am suicidal.’ I think it just amplifies the distress.”
Since Pietzke went public with her story, she said that no one from MultiCare has contacted her. This doesn’t surprise me. But it surprised Pietzke.
“I really thought, ‘How can people hear this information and the facts and statistics and still think that I’m in the wrong?’” she said. “I know that makes me sound naïve, but I just don’t understand.”
“It’s crazy-making,” I said.
“It is crazy-making. I’ve thought, ‘What is wrong with me?’ I feel like it’s The Twilight Zone, where I’m screaming that the sky is blue and everyone says, ‘No, it’s orange.’”
As Pietzke spoke, I thought back to just a few of the myriad times I’ve questioned my own sanity when it comes to this issue. I told her that I’m constantly asking myself whether I’ve missed some important detail.
“I don’t think the other side is questioning themselves like we do,” said Pietzke. “At least I don’t hear them doing it. If you’re not willing to reconsider your position on things, then you’re pushing for an ideology rather than what’s best practice for the people you’re treating.”
What has helped Pietzke is the support she’s received since she came forward with her story. “I have had people contact me and thank me for speaking out,” Pietzke said. “I’m so grateful for that, because this is a lonely process.”
She mentioned Jamie Reed, the whistleblower from the pediatric gender clinic at Washington University in St. Louis. Reed, who is now the executive director of the LGBT Courage Coalition, which advocates for gender medicine reform and is a resource for whistleblowers, helped Pietzke through the process.
“I listen to Jamie talk and I think she’s so smart, she has so much knowledge,” said Pietzke. “I’m just a mom and a therapist who wants to give people the best treatment that they deserve. Having the support now has meant a lot to me.”
Today, Pietzke has no regrets about blowing the whistle. She said that she would be “devastated” to learn that a young person she had helped transition came to regret it.
“This isn’t a gray area,” Pietzke said. “Kids can’t adequately consent to these treatments. As a therapist, my loyalty isn’t just to them at 13, 14, or 15. My loyalty is to them 10 years down the road, too.”
--
About the Author
Ben Appel has written for Newsweek, The Free Press, Quillette, Unherd, and many other publications. His memoir, Cis White Gay, about his experience in LGBT activism and Ivy League academia, is forthcoming. Subscribe to his Substack and follow him on X @benappel.
Hi, I’m Aaron Kimberly, Director of the Gender Dysphoria Alliance. I’m a mental health nurse and a transman. I was born biologically female with a rare disorder of sex development. I’m same-sex attracted and transitioned to live as a man as a young adult due to severe gender dysphoria.
There are three pathways to the development of gender dysphoria described in the American Psychological Association diagnostic manual.
Autogynephilia is thought to be the most common and most intense of the three, which can progress to gender dysphoria in adolescence or later in adult childhood.
Child-onset gender dysphoria is highly correlated with later adult homosexuality.
And less common is gender dysphoria related to a disorder of sex development.
In this video, I’ll be discussing the homosexual pathway.
Gender non-conformity is a common and normal dimension of homosexuality, especially inchildhood, which is seen across cultures and even another animal species. However, cultural responses to gender non-conformity varies from total acceptance to open hostility in many places.
In Samoa, for example, boy who exhibit strong, feminine characteristics are identified as fa'afafine, which means "in the manner of a woman," and many of these boys grow up to be highly effeminate gay men who participate in some aspects of social and occupational life with women and attract highly masculine men.
The western concept of gender dysphoria in children is characterised by: a strong desire to be of the other gender or an insistence that one is the other gender; a strong preference for cross-dressing, cross gender roles in make believe play or fantasy play, for the toys, games or activities stereotypically used or engaged in by the other gender, for playmates of the other gender; a strong rejection of sex-typical toys, games, and activities; a strong dislike of one sexual anatomy; and a strong desire for the physical sex characteristics that match one’s experienced gender.
How does this medical model fit what is known about homosexuality globally? There are two studies I’d like to highlight.
The first is by Paul Vasey who studies the fa'afafine in Samoa. After collecting and analysing data about the fa'afafine, he concluded that cross-sex identification and extreme gender non-conformity within the context of social acceptance, do not lead to distress. In other words, gender non-conformity is a universal aspect of homosexuality, whereas gender dysphoria is culture-bound, related to the society responses to gender non-conformity.
A paper by Katherine Heistand and Heidi Levitt on butch identity development from childhood and adulthood leads to a similar conclusion as Vasey's study. The authors expressed concern that a normal aspect of homosexuality is being pathologized. Despite the fact that approximately 85% of kids who express a strong discomfort with their biological sex, do reconcile themselves with their sexuality and their body through adolescence. Only a small percentage of gay men and women do become homosexual transsexuals through hormonal and surgical interventions.
There are a number of motivating factors which include: intense gender dysphoria that persists into adulthood; low economic status; poor understanding and education about gender non-conformity; homophobia; desire to attract romantic and sexual partners; and comorbidities like autism may complicate the developmental process.
Even in places like Samoa, some individuals choose to cosmetically, feminize or masculinize their bodies, but the number one takeaway I’d like to leave you with is this: children who are obviously gender non-conforming are less likely to develop lifelong gender dysphoria if they are well-supported, accepted and integrated into their families and communities as they are. With support they are very likely to grow up into healthy gay adults.
For more information, visit the Gender Dysphoria Alliance at: www.genderdysphoriaalliance.com
By: Lisa Selin Davis
Published: Jul 5, 2023
“Have you seen the latest study?” the psychologist asked me.
I had called Dr. Ken Zucker, a man who had spent decades working with children and young people with gender dysphoria, to talk to him about the history of that diagnosis. I wanted to know who got to decide when something was a variation versus a deviation; who got to decide when a way of being gendered in the world was abnormal, and required treatment.
By this time, I’d been writing about gender issues full time for about four years, since I published an op-ed in The New York Times about people assuming my masculine daughter was transgender and required social transition. Why, I asked, would we create so much meaning from a child rejecting the gender role associated with her sex? Isn’t that what GenX kids like me, reared with the soundtrack of Free to Be, You and Me, were raised to do?
The op-ed was supported by many, but vociferously objected to by some who accused me of transphobia. I was shocked and stung by that reaction. In the piece I said that I supported trans kids, but wanted to encourage children to explore both sides of the pink/blue divide without it reflecting on their identities—how could that be hateful? I reached out to some of my detractors to ask them to explain their views to me, and perhaps because I put in the subject line “What I got wrong,” some of them—including very prominent trans activists—agreed to do so.
I won’t name him, but one person who’d written a response to my piece, which had also gone viral, was a lawyer for an influential non-profit law group. He spent an hour-and-a-half at a coffee shop in the Financial District explaining to me that nuanced arguments like mine were dangerous. Deviating from the script, he said, always provided fodder for the right wing that wanted to oppress trans people and take away their rights and healthcare. Indeed, to my shock, Breitbart had written about my piece as an example of “slamming transgender ideology.” And Laura Ingraham’s people had reached out to me to appear on her show, even though I was clearly a full-throttle liberal. This confused and frightened me. I didn’t want to play for the other team.
Others reached out to me, too, including a healthcare lawyer, and lesbian, who lived in my neighborhood. We met for coffee, and she explained the issue from her point of view: pharmaceutical companies were conducting experiments on gay kids. Though it sounded too wild to be true, ringing of conspiracy theory, her idea dislodged some doubt inside me. Two years before, a friend of mine had made a documentary about trans kids. I’d said to her at the time, “Why do they all seem gay?”
I powered through my doubts, writing a book about gender nonconforming girls, trying to represent diverse points of view in the project. Well, some diverse points of view. My friend who’d written a book about trans teens five years before told me that I should never mention detransitioners; I’m sad to say I took this advice to heart. It was too dangerous for trans people, she said, and I didn’t want to make life any worse for people struggling to be understood and accepted.
Still, I questioned why so many of the people identifying as trans seemed to be rooting their identities in stereotypes. I was nuanced, but not in a way that could excite Tucker Carlson. I knew, like so many people, that something was wrong with the increasingly pervasive narrative about trans kids. I just didn’t have the knowledge and the language to articulate it. (This is something many people identifying as trans also say: they had a feeling. They didn’t have information, or a name.)
Then, almost a year after my book was published, I called Dr. Zucker. He showed me the study, and it was then I knew I’d allowed myself to be captured. The study followed young boys with gender dysphoria over a 15-year period. Almost 90 percent of boys desisted during or after puberty—that is, their gender dysphoria subsided. And almost 70 percent of them were bisexual or gay. Left alone, and not socially transitioned, almost all young kids now labeled as trans would not grow up to identify that way, and most would be same-sex attracted. The only time the media mentions this and the other studies with similar results is to discount them. Kids are routinely taught that gender and sexuality are not connected, but in fact, they are deeply intertwined.
From that moment of awakening, I allowed myself to look at the mountains of disruptive evidence that I had blinded myself to in years before. Once I saw it, I couldn’t look away. The mainstream media narrative about conversion therapy, detransitioners, puberty blockers, trans kids—it’s all deeply distorted and leaves out information that every person—especially every gender dysphoric kid and parent of one—deserves to know.
One reason so many gay and lesbian adults are concerned about the medical treatment of gender dysphoric youth is that they experienced that condition as children. Like so many, they grew out of it, and later identified as gay. There is overlap between childhood GD, and childhood gender nonconformity, and later homosexuality; thus they see these medical interventions as a kind of conversion therapy. The media and medical community’s refusal to acknowledge that has left a generation misinformed. The left wing, and especially the left and center press, have gotten this story very, very wrong.
Perhaps the most shocking thing I learned is that the medical protocol used to “liberate” trans kids is the same protocol once used to treat or cure homosexuality, and still used to chemically castrate sex offenders. What if every brochure, every children’s hospital gender clinic website, every activist organization, led with that fact? Would more of us wake up, and faster? Would more of us covert to be on the side of evidence, truth, and nuance, rather than thought-terminating clichés?
Let’s find out, shall we? Let’s inform people on the left properly, and see if we can push past the culture war to do what’s best for kids.
==
More successful at "fixing" gay kids than the Xian Right ever was.
By: Christina Buttons
Published: Mar 24, 2023
Children and adolescents on the autism spectrum are disproportionately represented among the large, newly emerging cohort of young people self-identifying as transgender.
In recent years there has been an exponential rise in the number of adolescents and young adults adopting transgender identities, stirring intense debate about its underlying causes. Mainstream discourse on this issue has centered on factors such as social influence, greater societal acceptance, and expanding definitions of what it means to be transgender.
However, an important yet largely unexplored factor that may be contributing to this trend is undiagnosed autism, particularly in young girls. Without a diagnosis, and even with a diagnosis but without a clear understanding of how autistic traits can present, these traits can be easily confused for gender dysphoria and cause individuals to pursue inappropriate and irreversible medical interventions.
Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition that affects communication, social interaction, and behavior that presents in varying degrees of severity from individual to individual. However, despite its history and prevalence, it remains a highly misunderstood disorder, especially in girls.
As many as 80% of girls with autism are not diagnosed until they reach adulthood, which can cause significant mental health problems and incorrect early diagnoses. This underdiagnosis is primarily due to the common misconception that autism is a predominantly male disorder. In fact, the Centers for Disease Control and Prevention (CDC) still maintains that “ASD is more than 4 times more common among boys than among girls.”
However, autism experts now believe that the sex ratio is much more evenly matched than previously thought. Girls often fly under the radar because the diagnostic criteria is better at detecting male-typical traits. Girls are also better at masking their symptoms, adapting to social situations, and tend to have interests that don’t fit the stereotypical profile of autism.
During puberty, autistic girls often experience exacerbated social and sensory challenges due to hormonal changes affecting their bodies and brains. These difficulties can be compounded by the pressure to navigate unfamiliar social situations and expectations, which can lead to the development of co-occurring conditions such as depression, anxiety, and body image issues. Unfortunately, the challenge of communicating their experiences may cause mental health professionals to overlook their underlying autism.
Given that autism is greatly underdiagnosed in young girls, I do not believe it is a coincidence that we are seeing a significant surge in adolescent girls self-diagnosing with gender dysphoria. An incorrect early diagnosis can lead to inappropriate treatment, which can result in devastating effects to their mental health and well-being.
This issue is very personal to me because I went through severe mental health struggles during my adolescence. It required multiple psychiatric hospitalizations and a long-term stay in a residential treatment center before I finally received an Asperger’s diagnosis at the age of 30. When I came across the stories of detransitioners, many of whom also came to understand they had autism after their misadventure, I felt a strong connection to them that motivated me to become a journalist and bring attention to their stories.
I’ve interacted with many of these young men and women who formerly identified as transgender, and some I now consider friends and have met in person. The prevalence of autism among them, and how these traits may have played a central role in their transition journey, is too significant to ignore.
While my observations of this cohort are neither comprehensive nor conclusive, I believe they nevertheless provide some much needed insight into this understudied population. These observations were gleaned from my conversations with 48 detransitioners and their written testimony.
Out of the 48 detransitioners whom I’ve come into contact with, 42 (32 females and 10 males) have confirmed autism or suspected autism (identification with autistic traits). Although the remaining 6 were confident they were not autistic, they believe their perceived gender dysphoria was due to a variety of other reasons, including other psychiatric disorders. Among the 42 detransitioners who have confirmed or suspected autism, only 5 had been diagnosed before or during their transition. All 5 told me that if they had fully understood what being autistic entailed and how it could manifest in their lives, they probably would not have believed they had gender dysphoria. They also said that “gender identity” and transgender issues became their “special interest” for a period of time.
This observation was also made by Dr. Kenneth Zucker, a psychologist with 30 years of experience running the largest Canadian childhood gender clinic, who believes that many autistic teens identify as transgender because of their tendency to fixate or obsess over a “special interest.”
As for the remaining 37 detransitioners, about half obtained an official diagnosis after they detransitioned and said that an earlier autism diagnosis could have prevented them from seeking medical transition services they now regret. Some detransitioners have written about these revelations. The other half are either in the process of seeking a diagnostic evaluation or are not interested, but found that they identify with autistic traits. Some of the reasons for not actively seeking an evaluation include long wait times and a general skepticism of mental health professionals who had previously failed to properly assess them.
Detransition among young people is growing. A forum for detransitioners on Reddit now exceeds 45,000 members and is adding roughly 1,000 members per month. In the United States, a 2022 study found that 29% of 68 patients seeking medical transition care changed their requests for hormone treatment, surgery, or both. Another U.S. study from 2022 found that 30% of patients who commenced cross-sex hormone treatment discontinued it within four years for unknown reasons. Two small studies in the U.K. report that between 7% and 10% of patients initially assessed for gender-related medical services later detransitioned.
Detransitioners have described being immediately “affirmed” in their recently adopted transgender identities without careful assessment. Some of them were teenagers when they began transitioning, and many now feel that they have been medically harmed due to the various chemical and surgical interventions they underwent. This is unacceptable and nobody should have to experience this.
One way to help mitigate such outcomes would be to improve education on autism, particularly how it presents in girls, and advocate for early diagnosis. This isn’t to diminish the experiences of transgender adults on the spectrum but rather to rule out false positives. An earlier diagnosis of autism may prevent some from mistaking their autism for gender dysphoria.
Aside from early screening for autism, the affirmative care model used by many US medical organizations poses a significant risk to vulnerable autistic individuals who may self-diagnose with gender dysphoria and seek irreversible medical interventions to alleviate their distress.
The gender-affirmation model that has been adopted widely across the US prevents medical professionals from questioning an individual’s self-reported transgender identity or exploring possible underlying factors causing their perceived dysphoria. The standard protocol for gender affirmation in minors involves administering puberty blockers, followed by cross-sex hormones, and then surgery if desired.
Despite research indicating that roughly 60-90% of children who identify as transgender but do not socially or medically transition will no longer identify as transgender in adulthood, children are still put in the driver’s seat of their own sex change operations.
The affirmative model of care has been abandoned in Florida and in progressive European countries like Finland, Sweden, the UK, and most recently Norway, after conducting systematic reviews of the available evidence and concluding that the risks of pediatric medical transition far outweigh any purported benefits. This resulted in the closure of prominent gender clinics, strict restrictions on the use of cross-sex hormones, and a ban on gender-related surgeries for minors. Italy, Australia, and Spain's medical bodies have also recently raised similar concerns.
If US-based medical organizations were willing to walk back the affirmative model of care and prioritize thorough evaluations and thoughtful, individualized assessments that explore why someone might be feeling distress over their gender, they could prevent misdiagnosis and inappropriate treatment.
It is important to understand how autistic traits can be mistaken for and misdiagnosed as gender dysphoria. I have therefore compiled a list to help with this understanding.
Traits of autism that may be mistaken for gender dysphoria
Autistic people face a number of challenges that are intensified when they don’t have a proper diagnosis or are not adequately educated about how their traits can present. Some of the attributes that can lead to confusion over their “gender” include identity issues, rigid or “black and white” thinking, intense and restricted interests, gender nonconforming behavior, social difficulties and a preference for online socialization, incongruence with the body, and other comorbidities.
Identity
By adolescence, autistic people typically intuit that they differ from their peers, but are unable to pinpoint or describe the reason, which can be distressing. As they struggle to assimilate, they may become preoccupied with understanding themselves and how they fit in with those around them. In a desperate attempt to resolve their distress, they may “try on” different identities or diagnoses to see what “fits.”
Rigid thinking
One of the core features of autism is rigid thinking, a cognitive style that is characterized by inflexible and repetitive thought patterns, behaviors, and routines.
- In recent years, the significance of gender dysphoria as a meaningful diagnosis has been deemphasized in favor of a broader definition of what it means to be transgender, or “gender diverse,” which includes mere nonconformity to sex-based stereotypes. Autistic people could easily interpret this definition to mean they are transgender.
- Autistic people may prefer simple explanations, and be prone to black and white thinking. When they come across overly simplistic views about gender, it can provide them with a quick explanation for their troubles (they are transgender) and a ready-made solution (transition) to achieve what they hope will be a sense of normalcy and comfort in their bodies.
- Sometimes girls who are more gender nonconforming will feel they cannot compete with girls they perceive as more feminine, popular, and attractive. Because autistic girls can easily get locked into black and white thinking, this may cause them to reject femininity and embrace masculinity.
- Autistic people have an aversion to inauthenticity. Once introduced to the concept of “gender identity,” they may reexamine their life history through this lens, looking for signs they may be transgender. Through a process of confirmation bias, they may find traits and life events that conform to a transgender narrative.
- Autistic people have difficulty with flexible thinking and are less likely to change their minds once convinced something is true. They may become deeply attached to their beliefs and find it difficult to consider alternatives. If they become convinced they are transgender, it can be difficult to dissuade them.
- Autistic people also tend to be very literal and so when they come across statements meant to be figurative and promote inclusivity like “trans women are women” and “trans men are men,” they may take it literally. They may come to believe they can actually change their sex.
- Their naivety may also play out in their expectations of social and medical transition, and they can become extremely frustrated if their expectations are not met.
- Their tendency towards rigidity in thinking can make it challenging to adapt to changes in gender norms or expectations. This rigidity may be misinterpreted as a strong identification with one sex and discomfort with another.
Intense and restricted interests
One of the hallmarks of autism is intense and obsessive interests in certain topics or hobbies, also known as “special interests.” Special interests are a common characteristic of ASD and can become all-consuming passions that provide individuals with a sense of comfort, enjoyment, and mastery.
Research suggests that there may be sex differences in the types of special interests that autistic boys and girls develop. For example, one study found that autistic girls were more likely to have interests in people and animals, while autistic boys were more likely to have interests in objects and systems.
It’s quite possible for individuals with ASD, especially females, to become deeply interested in social justice and transgender issues. They may become fixated on exploring and understanding “gender identity,” including their own and the experiences of other “gender diverse” individuals. This interest may involve reading and researching about gender identity, attending support groups or advocacy events, or engaging in creative expressions online or joining online communities.
- Autistic people have a strong sense of justice and fairness, and may become interested in topics of "social justice" they come across in online communities on social media.
- Autistic people may find themselves fascinated with the transgender community and its cultural significance, with its many charismatic transgender influencers and frequent relevance in the news. With the transgender community’s growing popularity, there are endless ways to interact with this special interest.
- “Gender identity” ideology comes from a postmodern social theory developed in college Humanities departments called “Queer Theory,” which has been written about and lectured on extensively. It can provide endless hours of learning for anyone interested in the subject.
- “Consistent, persistent, insistent” are the words used by medical providers as strong indicators that someone has gender dysphoria, but they could easily also describe a autistic person’s relationship to their special interest.
Gender nonconformity
Historically, autistic people have been more likely to display sex atypical behavior. Young people should not be discouraged from gender nonconformity. It is perfectly natural and okay for a girl to have more stereotypically masculine traits and interests and for a boy to have more stereotypically feminine traits and interests – this does not equate to gender dysphoria.
- A 2014 study found that children with ASD were 7.59 times more likely to be gender non-conforming or “express gender variance.”
- A 2021 study found that gender nonconformity is substantially elevated in the autistic population.
- Several studies have suggested that autism spectrum disorder (ASD) and gender nonconformity co-occur more often than by chance in adolescents.
- Sexuality also appears to be more varied among people with autism than among those who do not have the condition. Only 30% of autistic people in a 2018 study identified as heterosexual, compared with 70% of neurotypical participants. And although half of 247 autistic women in a 2020 study identified as “cisgender,” just 8% reported being exclusively heterosexual.
- Gay males may also not be well-detected by standard diagnostic criteria, as some may have more female-typical traits.
- Because of the expanding definition of what it means to be transgender, now defined by major institutions as an “umbrella term” which encompasses mere gender nonconformity, autistic people might believe that because they don’t conform to sex-based stereotypes, they could be transgender.
- Autistic people may socially gravitate towards the opposite sex. They may find it easier to communicate with and have more in common with the opposite sex. This may lead them to believe they actually are, or should become, the opposite sex.
Social Difficulties
Gender is often presented as a “social construct,” and one of the hallmark traits of autism is a host of social challenges. Struggling to adapt to “gender roles” can significantly contribute to a rejection of their perceived “gender role” which can lead to a rejection of their biological sex by extension.
- Difficulty with social communication: Individuals with autism may have difficulty with social communication and understanding social cues, which can make it challenging to navigate gender norms and expectations. These experiences can be frustrating and cause them to reject the norms associated with their sex.
- Repetitive behaviors: Individuals with autism may engage in repetitive behaviors, or “stims,” that can sometimes be misinterpreted as sex-atypical behaviors.
- For girls, repetitive or disruptive movements may be viewed as unfeminine and may lead to social rejection from peer groups.
- Difficulty with social imagination: Individuals with autism may have difficulty with social imagination, which can make it challenging to envision oneself in different roles or identities. This difficulty may be misinterpreted as a lack of identification with one's biological sex.
- Difficulty with perspective-taking: Individuals with autism may have difficulty understanding other people's perspectives or social expectations, which can make it challenging to navigate gender roles and expectations.
- Difficulty with emotional regulation: Individuals with autism may have difficulty with emotional regulation, which can lead to intense and distressing emotional responses to certain situations or social expectations related to gender roles.
- Autistic people often learn to adopt alternative personas to cope with and blend in with different social settings, which may make it easier for them to adopt a cross-sex identity.
Preference For Online Socialization
Individuals with autism have more difficulty with in-person social relationships, leading them to prefer online socialization, which can be easier and less stressful for them to navigate. One reason is that online interactions can provide a sense of control and predictability that may be lacking in face-to-face interactions.
Autistic individuals may find it easier to communicate online because they have more time to process and respond to messages. They can also avoid nonverbal communication that they find difficult to interpret. Additionally, online communication can be less overwhelming and less sensory-stimulating than in-person communication.
Another reason is that online interactions can provide opportunities to connect with others who share similar interests or experiences, which can be more difficult to find in-person.
Currently, there is heavy cross-over between the online autism community and “social justice.”
- Autistic people lack an understanding of social behavior and may be prone to mimicking what they see online. Social media algorithms may feed them a steady stream of content from the online transgender community that may lead them to believe that it is how they are “supposed” to act to fit in.
- They may discover a transgender influencer who is popular as “socially successful” and try to mimic their behavior, clothing, body language, and interests to assimilate. They may desire to create “content” like other transgender influencers.
- Autistic people typically like rules, as they provide a sense of structure and predictability. They may like that the social rules enforced by online Social Justice communities are made explicitly clear in shareable Instagram infographics.
- Some autistic people have a particular talent for visual-spatial skills, which could lead to an aptitude for creative fields such as art or design and some are creative musically or with writing. Creative autistic types may be influenced by “gender expressions” they see online, which include making up your own “neopronouns.” They may want to express their own creativity through their understanding of “gender.”
- Many autistic people feel socially awkward, have difficulty making friends, and are lonely. The growing population of the transgender community that embraces people who are different may seem welcoming and a built-in network of friends and support may be appealing.
- In the online world, people are encouraged to create their “brand.” They may want to find an online persona in a niche community.
- They may be influenced by others to reject the people in their life who do not “accept” them, join “glitter families” or go “no contact” with their real families. With fewer people offline to keep them tethered to reality and provide different points of view, they may further succumb to the echo chambers of online communities.
Incongruence With Body (Disconnect and Discomfort)
Autistic people struggle with interoception (sensing internal signals from your body). They can recognize they feel discomfort but have trouble interpreting their bodily signals and pinpointing where it is coming from. This is worsened by challenges with alexithymia (an inability to identify and describe emotions). Without proper diagnosis, this can contribute to a feeling of incongruence with their body.
Autistic people, especially if they lack a diagnosis, can easily get overwhelmed by sensory input, but may not have the words to articulate what is making them feel uncomfortable. Ongoing discomfort in one’s body may be mistakenly attributed to gender dysphoria.
- Individuals with autism may experience tactical sensory sensitivity, which can make it uncomfortable to wear certain types of clothing or accessories associated with their biological sex.
- For example, girls on the spectrum may prefer clothing that is more typical for boys because it is loose-fitting and more comfortable. They may mistakenly attribute this to being more “boy-like.”
- Especially for adolescent girls, not adhering to the latest fashions of their peers may make them feel like an outcast.
- Individuals with autism may also experience sensory issues with grooming activities, which can make it challenging to adhere to gender norms and expectations.
- Girls may find that makeup feels uncomfortable.
- Girls may prefer to keep their hair short, or in a ponytail everyday because letting their hair down feels irritating on their skin.
- Young boys may want to grow their hair long because they hate the experience of going to the barber.
- Autistic people often struggle with proprioception, which may manifest as having difficulty understanding where their body is in space. This can result in challenges with coordination, balance, and fine motor skills, which may lead to feelings of frustration or disconnection from their physical body.
- Adolescents with developing bodies that don’t feel like they meet stereotypical ideals for their sex may reject their bodies and hyperfocus on their perceived flaws, leading to body image disorders.
- For adolescents, discussions of gender dysphoria in the classroom may be the first time that “discomfort of the body” is introduced and articulated to them, which they may find they can relate to and begin to associate their own bodily discomfort with gender dysphoria.
- The succession of steps involved in social transition and then in medical transition may make them feel that they are on the path towards finally feeling “right” in their body.
Comorbitities
Individuals with autism, especially without a diagnosis, are more likely to experience co-occurring mental health conditions, such as anxiety or depression, which can complicate the assessment of gender dysphoria.
Depression:
Autistic people have social difficulties that make it harder to make and maintain friendships, leading to isolation and depression, and this effect is worsened when individuals do not receive a diagnosis of autism until adulthood.
- A 2022 study found people diagnosed with autism in adulthood are nearly three times as likely as their childhood-diagnosed counterparts to report having psychiatric conditions.
- A 2021 study shows that receiving an autism diagnosis in adulthood rather than childhood can lead to lower quality of life, more severe mental health symptoms, and higher autistic trait levels.
Suicidal Ideation
A growing body of research has found that autistic youth and adults appear to have higher rates of suicidal thoughts, plans, or behaviors than non-autistic youth.
- A meta-analysis found that one in four autistic youth experience suicidal ideation and almost one in ten attempt suicide.
- A Danish study found that autistic individuals had 3 times higher rates of both attempted and completed suicide.
- A 2022 UK study found a significant number of people who died by suicide were likely autistic, but undiagnosed.
Obsessive Compulsive Disorder
Autistic people are more prone to obsessive compulsive disorder and may obsess over their desire to become the opposite sex to escape their unhappiness.
- One study found 17% of autistic people may have OCD.
- An even larger proportion of people with OCD may also have undiagnosed autism, according to one 2017 study.
- It might be helpful to view gender dysphoria as a form of OCD, in which the individual attributes their biological sex as a source of distress and obsesses over the desire to become the opposite sex. Alternatively, some OCD clinics have attempted to distinguish between gender dysphoria and what they termed as “Trans OCD,” which is “an obsession over gender identity.”
Body Image Disorders
Autistic people are more prone to having body image issues that may make them fixate on their weight (eating disorders like anorexia or bulimia) or perceived flaws (body dysmorphia).
- Roughly 20% of people with anorexia are autistic.
- Body dysmorphia is a disorder in which one develops a fixation on perceived flaws on the body that become exaggerated in the mind. It is part of a new category of “obsessive-compulsive and related disorders” that autistic people are over-represented in.
Anxiety
Anxiety is a common co-occurring condition in autistic individuals.
- Research suggests that up to 40-50% of autistic individuals may experience clinically significant anxiety symptoms at some point in their lives.
- One study found that up to 84% of autistic people have some form of anxiety.
Gastrointestinal Distress:
Gastrointestinal (GI) disorders are one of the most common medical conditions that are comorbid with Autism spectrum disorders (ASD). This can contribute to discomfort and incongruence with the body.
- Some studies have suggested that up to 90% of individuals with autism may experience GI symptoms, such as abdominal pain, constipation, diarrhea, and reflux.
- A comprehensive meta-analysis revealed that children with ASD were more than 4x more likely to develop GI problems than those without ASD.
Polycystic Ovarian Syndrome (PCOS)
Research indicates an association between Polycystic ovary syndrome (PCOS) and autism. PCOS is a hormonal condition that involves intricate interactions among the ovaries, androgens, other hormones, and insulin. One prominent feature of this condition is increased levels of androgens or "male hormones." The heightened androgen levels, along with virilization, can be a source of considerable distress for several women and result in a form of gender dysphoria.
- One study found autistic women in the UK have an almost two-fold increase in the risk for PCOS.
- A 2012 study found that women with PCOS have ”problems with psychological gender identification. Duration and severity of PCOS can negatively affect the self-image of patients, lead to a disturbed identification with the female-gender scheme and, associated with it, social roles.”
Trauma:
If an autistic person has a traumatic experience, they are more likely to internalize it. If they are sexually abused or groped they may develop negative associations with the part of their anatomy that was abused and feel the need to reject it.
- Autistic girls are at heightened risk of sexual abuse.
- Research has shown that individuals with autism who have experienced sexual abuse may be more likely to experience internalizing symptoms such as depression, anxiety, and post-traumatic stress disorder (PTSD) compared to non-autistic individuals who have experienced sexual abuse.
- One reason for this may be that autistic individuals may have difficulty communicating their experiences and feelings about the abuse, which can lead to a sense of isolation and helplessness.
- Autistic individuals may also struggle with processing and regulating their emotions, which can make it more difficult to cope with the trauma of sexual abuse.
Other contributing factors:
- The Pandemic: When non-emergency clinics were closed, many young people were socially isolated and depressed, turning towards online mental health communities and self-diagnosing. We saw this happen with the emergence of “TikTok tics” and the resurgence of the once-extremely rare Dissociative Identity Disorder (DID).
- Puberty: Puberty is a time of significant changes in the body and brain, which can affect individuals with autism in different ways. During this window, they may experience worsening mental health, bodily discomfort and social difficulties. Without a diagnosis, autistic adolescents may not understand why they are experiencing these difficulties and may feel isolated and confused.
- Stressful life events: Stressful life events can be particularly challenging for autistic individuals due to difficulties in coping with changes, uncertainties, and unpredictability. Autistic individuals may struggle with changes in routine, unexpected events, and situations that require flexibility and adaptability.
- Loss of Asperger’s as a diagnosis: The diagnosis of Asperger’s Syndrome was merged into an umbrella diagnosis called Autism Spectrum Disorder (ASD) in the DSM-V update in 2013, which may contribute to a lack of diagnosis in those who appear to have less visible symptoms. The general population associates autism with severe disability, and those without an intellectual disability may be less likely to get diagnosed.
- Misdiagnosis: The difficulty that autistic people face in regulating emotions and the trouble they have in relationships can be misinterpreted and is often misdiagnosed as Borderline Personality Disorder, Bipolar Disorder and more.
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~11% of trans identifying people have autism, whereas ~1% of people in the general population have autism.
I'm just going to say it: maybe don't trans the autistic.
Sorry, not sorry.
Andrew: It's the same as what the homophobes used to say, you know. The bullies at school used to say that if a boy was a bit girlie and didn't like football and liked playing with dolls that he was actually a girl, and they used to call him a girl.
And now, that's what Stonewall is saying. That's what Mermaids are saying. It's very likely that if you don't conform to traditional, conservative gender stereotypes you might be in the wrong body, and maybe you should be fast-tracked onto puberty blockers, and maybe we can fix you and make you heterosexual, is effectively what's going on there.
So it is particularly dispiriting to me.
I mean, how did we reach this point? The idea that - I said before the NHS, but also Stonewall supporting an ideology that tries to fix gay people.
So many potentially gay children were being sent down the pathway to change gender, two of the clinicians said there was a dark joke among staff that “there would be no gay people left”.
“It feels like conversion therapy for gay children,” one male clinician said. “I frequently had cases where people started identifying as trans after months of horrendous bullying for being gay,” he told The Times.
“Young lesbians considered at the bottom of the heap suddenly found they were really popular when they said they were trans.”
Another female clinician said: “We heard a lot of homophobia which we felt nobody was challenging. A lot of the girls would come in and say, ‘I’m not a lesbian. I fell in love with my best girl friend but then I went online and realised I’m not a lesbian, I’m a boy. Phew.’”
The specialists expressed concern at how little confusion over sexuality was explored when a young person requested treatment to change their body.
“I would ask who they wanted to have relationships with, but I was told by senior management that gender is completely separate to sex,” a third female clinician said. “I couldn’t get on board with that, because it isn’t. Some people were transitioning their gender to match their sexuality.”
LETTER TO THE EDITOR
Just be yourself in your body
Attention, young people: The folks in your schools with the "genderbread" diagrams are confusing you on purpose. It's a scam. Don't fall for it.
You were born male or female. This reality was recognized and duly recorded. A gender was not "assigned" to you as though plucked from a hat. The eyeball test conducted at the moment of your birth is 99.982% accurate, a lower rate of error than many lab tests.
"Male" and "female" are just words to describe the reality of human reproductive dimorphism-a thing that existed before the human race invented language. It only describes your body.
Neither of the two sexes (there are only two) comes with an inherent set of colors, hobbies, interests or activities. We used to call that sort of idea "sexist."
Nowadays, it is fashionable to say that "gender" is some sort of inner sense of self that makes you like certain games, toys, sports, haircuts, clothes, etc., rather than others.
This is not "gender," however. It is called "having a personality."
No one is "born in the wrong body." The scammers want you to become a $500,000 lifetime medical profit-center by telling you otherwise. But we don't have to adopt interesting new pronouns to become the people we already are.
Just be yourself in your body. Never trust anyone who suggests you are anything else.
Matt Osborne Florence