Pediatric endocrinologists, psychologists, psychiatrists and ethicists are increasingly speaking out in opposition to the practice of diagnosing and treating children as transgender. Below is a collection of publications from professionals questioning the transitioning of children. For more articles from professionals we recommend the excellent organisation Pediatric and Adolescent Gender Dysphoria Working Group: http://gdworkinggroup.org/
Letter to the Editor: Trans clinic is failing vulnerable children
The Sunday Times, November 2019
“The treatment of gender- dysphoric children has become highly politicised and, in many ways, operates outside good medical practice. There is pressure to view patients as consumers who have a choice over their gender, rather than people with underlying conflicts about themselves and their relationship with society.”
Read the full letter from Marcus Evans here
Therapist raised alert at troubling practices at Tavistock clinic
The Times, October 2019
“Ms Evans said: “When you work in the area of gender dysphoria you begin to see that many of these children have other areas of concern or difficulty, such as depression, autism, trauma, childhood abuse, internalised homophobia, relationship difficulties, social isolation and so on.””
No-one is Born in the Wrong Body
William J Malone, Colin M Wright and Julia D Robertson
Quillette, September 2019
“In most cases, the thing that is now called “gender identity” likely is simply an individual’s perception of how their own sex-related and environmentally influenced personality compares to same and opposite sexed people. Put another way, it’s a self-assessment of one’s stereotypical degree of “masculinity” or “femininity,” and it’s wrongly being conflated with biological sex.”
Encouraging children to ‘socially transition’ gender risks long-term harm, say NHS experts
The Telegraph, July 2019
“Parents are risking psychologically damaging their children by allowing them to “socially transition” their gender without medical or psychiatric advice, NHS experts have warned.
Primary school-aged children are increasingly being encouraged to formally switch, in defiance of the recommended “watchful waiting” approach, the Gender Identity Development Service (GIDS) leaders said.”
Dr Bernadette Wren, head of clinical psychology at the trust, said: “Social transitioning has become a really big topic.
“We have never recommended complete social transitioning but it has become a really popular thing and many advocacy groups really promote it.
“We take the long view because our concern has been that what might work to lower anxiety in a younger child may become the thing that is problematic when they get older.
“It can become harder for children as they move into adolescence, they are moving into puberty and the young person suddenly faces a wall of puberty.
“We think that is setting up problems for later.”
An open letter to Polly Carmichael from a former GIDS clinician
Kirsty Entwistle, Medium, July 2019
“I think it is a problem that GIDS clinicians are making decisions that will have a major impact on children and young people’s bodies and on their lives, potentially the rest of their lives, without a robust evidence base. GIDS clinicians tell children and families that puberty blockers/hormone blocks are “fully reversible” but the reality is no one knows what the impacts are on children’s brains so how is it possible to make this claim?”
Meet the Bold Sexologist Questioning Transgender Orthodoxy
An interview with Ray Blanchard
National Review, May 2019
“So, I don’t find the concept of “gender identity” useful for normal people, and the concept of cross-gender identity is really not a normal gender identity which has found itself lodged in the wrong body. Cross-gender identity is a constant preoccupation with, and unhappiness about, the individual’s gender. So, I guess you could say I believe in cross-gender identity, but I don’t much believe in gender identity.”
BLF agrees with SMER’s letter on gender dysphoria
The Swedish Paediatric Society, May 2019
“The physical and psychological maturation process of children and adolescents is individual, but for the vast majority of people it means seeking and experimenting with identities, something that is normal and needs to be done with the nuanced support of the child’s relatives. The rules of society need to balance the child’s own rights against the child’s protection needs. Giving children the right to make life-changing decisions independently that cannot be expected to understand the consequences at a similar age is not scientifically founded and is contrary to medical practice.”
Doubts over evidence for using drugs on the young
Professor Carl Heneghan, The Times, April 2019
It feels like conversion therapy for gay children, say clinicians
The Times, April 2019
““This experimental treatment is being done not only on children, but very vulnerable children, who have experienced mental health difficulties, abuse, family trauma, but sometimes those [other factors] just get whitewashed,” one female clinician said. “If someone was suggesting plastic surgery or any other permanent change we’d be saying, hang on a minute.”
The clinicians have warned that complex histories and adolescent confusion over possible homosexuality are being ignored in the rush to accept and celebrate every young person’s new transgender identity.”
Calls to end transgender ‘experiment on children’
The Times, April 2019
An Interview with Lisa Littman who coined the term ‘Rapid Onset Gender Dysphoria’
Quillette, March 2019
“The findings of the research support the hypotheses that what I have described could represent a new type of gender dysphoria (referred to as Rapid Onset Gender Dysphoria [or ROGD]); that, for some teens and young adults, their gender dysphoria might represent a maladaptive coping mechanism; and that peer and social influences might contribute to the development of gender dysphoria. More research will need to be done to confirm or refute these hypotheses.”
Governor of Tavistock Foundation quits after damning report into gender identity clinic
Guardian, February 2019
“In my 40 years of experience in psychiatry, I have learned that dismissing serious concerns about a service or approach is often driven by a defensive wish to prevent painful examination of an ‘overvalued system’,” he complained in his resignation email.
He added: “I do not believe we understand what is going on in this complex area and the need to adopt an attitude which examines things from different points of view is essential. This is difficult in the current environment as the debate and discussion required is continually being closed down or effectively described as ‘transphobic’ or in some way prejudicial.”
Doctors at England’s only NHS transgender clinic for children warn lobby groups and pushy parents are exposing young patients to ‘long-term damage’
Mail on Sunday, February 2019
“Doctors at an NHS gender identity clinic have warned young patients could be exposed to ‘long-term damage’ due to lobby groups and pushy parents.
The Tavistock Gender Identity Development Clinic in north London has an ‘inability to stand up to pressure’ from campaigners and parents demanding fast-track transitions, doctors have said.
The clinic, part of the Tavistock and Portman NHS Foundation Trust, is also providing ‘woefully inadequate’ care, with some staff citing ‘very serious ethical concerns’ about their workplace, a recent report said.
The report, made by former staff governor David Bell, said some children ‘take up a trans identity as a solution’ to ‘multiple problems such as historic child abuse in the family, bereavement, homophobia, and a very significant incidence of autism spectrum disorder’.”
Safeguarding adolescents from premature, permanent medicalisation
Susan Bewley, Margaret McCartney, Lucy Griffin, Richard Byng
British Medical Journal, January 2019
“While respecting individuals’ right to a different viewpoint, it is neither mandatory to affirm their beliefs nor automatic that transition is the goal, particularly when dealing with children, adolescents and young adults. These risk closing the ‘open future’, as well as life-long physical problems including lack of sexual function, infertility and medical dependency.”
Gender questioning children deserve better science
Richard Byng, Susan Bewley, Damian Clifford, Margaret McCartney
The Lancet, December 2018
“The evidence of medium-term benefit from hormonal treatment and puberty blockers is based on weak follow-up studies. The guideline does not consider longer-term effects, including the difficult issue of detransition.”
Why is Transgender Identity on the Rise Among Teens?
Samuel Veissière Ph.D. Psychology Today, November 2018
“It is clear from Littman’s study that the rise of rapid-onset gender dysphoria, which seems to predominantly involve natal females, points to a complex web of social pressures, changing cultural norms, and new modes of distress and coping that warrant further investigation.”
Trans People May Get Better Access to Hormone Treatment
GCN, July 2018
“However, Professor Donal O’Shea, a consultant endocrinologist at Saint Columcille’s Hospital and one of only two in the country who provides hormone treatment for trans people, told GCN: “We don’t intend to run the service in line with WPATH guidelines. Aligning with them would result in significant harm accruing to those with gender confusion.””
“Dr Paul Moran, a liaison psychiatrist who plays a central role in treating people at the Dublin clinic, says the WPATH guidelines “as they apply to assessment and treatment recommendation, are not part of our model of care, are clinically unsafe, and unsuitable for use in a public healthcare gender clinic.””
Medicine Must Do Better on Gender
Margaret McCartney, the British Medical Journal, March 2018
“Frequently, media narratives describing parents’ realisation that their child may be transgender occurs when the preschool child is interested in doing or wearing things outside society’s expectations. Yet playing with dolls and liking dresses doesn’t make children female, just as playing with trucks and liking mud doesn’t make them male.”
Most children and teens with gender dysphoria also have multiple other psychological issues
Alex Fradera, The British Psychological Society Research Digest, January 2018
“The possibility that disclosure of gender dysphoria may in some cases be driven by earlier psychological vulnerabilities and social problems seems likely to be greater than zero. This is a controversial idea among many online trans activists, but actually it isn’t among health practitioners, even those who espouse the gender affirmation philosophy, who recognise that some young gender identity referrals may be transiently mixed-up individuals.”
Misunderstanding a New Form of Gender Dysphoria
Lisa Marchiano, Quillette, October 2017
“Although not much is known at this time about ROGD, it appears likely that it may be a kind of social contagion in which young people – often teen girls – come to believe that they are transgender. Preliminary research indicates that young people who identify as trans “out of the blue” may have been influenced by social media sites that valorize being trans. In addition, researchers have observed a pattern of clusters of friends coming out together.”
Outbreak: On Transgender Teens and Psychic Epidemics
Lisa Marchiano, Psychological Perspectives, October 2017
“Currently, we don’t have a good understanding of what causes someone to experience gender dysphoria, although it is likely that the etiology of dysphoria will prove to have complex biological, social, and psychological influences. Although scientists acknowledge how little we understand this condition, the mainstream media and the medical and psychiatric establishment have seized upon an easily digestible narrative that is based in the ideology of innate gender identity.”
Put Children’s Safety First, Not Ideology
Katherine Kersten, Twin Cities, July 2017
“In fact, there is very little medical research on the long-term effects of hormone use in the context of gender transition. The effects on children’s brain development, for example, are unknown. Fenway Health, an LGBT medical facility in Boston, warns that “the long term effects” of testosterone use by females and estrogen use by males have “not been scientifically studied and are impossible to predict.””
Growing Pains
Hruz, Meyer, McHugh, The New Atlantis June 2017
“In light of the growing prominence of gender identity issues in our society, and the appeal that puberty suppression may have for parents raising children who identify as the opposite sex, it is worth examining in detail what puberty suppression is, how it works, and whether it is as safe and prudent as its advocates maintain. As we shall see, the evidence for the safety and efficacy of puberty suppression is thin, based more on the subjective judgments of clinicians than on rigorous empirical evidence. It is, in this sense, still experimental — yet it is an experiment being conducted in an uncontrolled and unsystematic manner.”
Transgender Teens: Sometimes Caution is the Right Approach
Lisa Marchiano, Psyched, 2017
“The puberty blockers and hormones that are currently being used to treat gender dysphoria are being used off-label and there is some evidence that we may not understand the long-term effects of these medications. In addition, there is a body of writing and vlogging online by detransitioners – those who pursued transition but then later came to re-identify with their birth sex.”
Gender Dysphoria and Surgical Abuse
John Whitehall, Professor of Paediatrics, Western Sydney University
Quadrant, December 2016
“Yet hardly any paediatricians recall any cases of gender dysphoria in almost 300 cumulative years of practice. Certainly, I have not seen one in fifty years of medicine. I accept cases must exist and consider them tragedies deserving as much compassion and medical care as the three cases of physical intersex I have encountered in my career.
“What astonishes me is the lack of evidence to support massive medical intervention in the face of evidence that it is not necessary. I cannot help wonder how the intervention was approved by the various ethics committees in hospitals, health regions and universities when it took some students and me over a year to get approval for a study that merely asked mothers when they introduced solid foods to their children.”
Layers of meaning: A Jungian analyst questions the identity model for trans-identified youth
4thwavenow, September 2016
“As a social worker and a Jungian analyst, I have become increasingly concerned about the rush to affirm children’s and young people’s transgender self-diagnosis, and then transition them to the opposite sex. I am particularly worried about social and medical transition among teens whose transgender diagnosis arose “out of the blue,” without a significant history of early childhood dysphoria. I fear that, via their well-meaning desire to validate young people in pain, therapists are discarding basic principles of psychotherapeutic care.”
Gender Dysphoria In Children And Suppression Of Debate
Michelle A. Cretella M.D., Summer 2016
“Currently there is a vigorous albeit suppressed debate among physicians, therapists, and academics regarding what is fast becoming the new treatment standard for GD in children. Modeled after a paradigm developed in the Netherlands, it involves pubertal suppression with gonadotropin releasing hormone (GnRH) agonists followed by the use of cross-sex hormones—a combination that will result in the sterility of minors. A review of the current
literature suggests that this protocol is rooted in an unscientific gender ideology, lacks an evidence base, and violates the longstanding ethical principle of “First do no harm.””
John Hopkins Psychiatrist: ‘Transgendered Men Don’t Become Women’
Michael W Chapman, CNS News, May 2016
“The idea that one’s sexuality is a feeling and not a biological fact “is doing much damage to families, adolescents, and children and should be confronted as an opinion without biological foundation wherever it emerges””
Prominent Psychiatrist: Transgender is ‘Emotional Unhappiness … Purely Psychological’
CNS News, February 2016
“Dr. Berger told the committee, “From a scientific perspective, let me clarify what ‘transgendered’ actually means. I am speaking now about the scientific perspective – and not any political lobbying position that may be proposed by any group, medical or non-medical.
“‘Transgendered’ are people who claim that they really are or wish to be people of the sex opposite to which they were born, or to which their chromosomal configuration attests,” he stated. “Sometimes, some of these people have claimed that they are ‘a woman trapped in a man’s body’ or alternatively ‘a man trapped in a woman’s body.’”
“Scientifically, there is no such thing,” he said.”
Why Transgender Kids Should Wait to Transition
Debra W Soh, neuroscientist, Pacific Standard, September 2015
“For a young child whose gender dysphoria would have desisted without intervention, these procedures amount to a needlessly challenging process to undergo—and that’s without considering the implications of choosing to transition back. Even a social transition back to one’s original gender role can be an emotionally difficult experience for children.”
“This is Who He Is, I Have to Respect That”
Guardian report, Sept 2015
Dr Polly Carmichael, the consultant clinical psychologist who leads the Tavistock’s Gender Identity Development Service says:
“When the idea of the blocker being available to younger people was being pushed forward, I think that inevitably – understandably – there were quite simplistic arguments that if you have the blocker then all the problems disappear. In our experience, all the problems do not go away.”
“The blocker is said to be completely reversible, which is disingenuous because nothing’s completely reversible. It might be that the introduction of natal hormones [those you are born with] at puberty has an impact on the trajectory of gender dysphoria.”
Exiles in their own flesh: A psychotherapist speaks
4th Wave Now, August 2015
“As professionals, if we don’t loudly prioritize their identities as being the most important thing about them (and identities do shift constantly in kids and teens), we risk coming across as unsupportive and even immoral. Identity development has always been a teen task, but in the past it wasn’t necessarily supposed to become a lifestyle, or colonize the entirety of your existence.”
Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study
Journal of Adolescent Health, July 2015
These are (anonymous) statements from professionals worldwide who were consulted for this study.
“I find it extremely dangerous to let an adolescent undergo a medical treatment without the existence of a pathophysiology and I consider it just a medical experimentation that does not justify the risk to which adolescents are exposed. Gender dysphoria is the only situation in which medical intervention does not cure a sick body, but healthy organs are mutilated in the process of adapting physical and congruent psychological identity” (Psychiatrist)
“I have met gay women who identify as women who would certainly have been diagnosed gender dysphoric as children but who, throughout adolescence, came to accept themselves. This might not have happened on puberty blockers” (Psychologist)
“I believe that, in adolescence, hypothalamic inhibitors should never be given, because they interfere not only with emotional development, but [also] with the integration process among the various internal and external aspects characterizing the transition to adulthood” (Psychiatrist)
“The positive attitude of many health care providers in giving hypothalamic blockers[…] is based on the need to conform to international standards, even if they are conscious of a lack of information about medium and long term side effects” (Psychiatrist)
“The fact that somebody wants something badly, does not mean that a health care provider should do it for that reason; a medical doctor is not a candy seller” (Professor of health care ethics and health law)
“I believe that hypothalamic blockers treatment satisfies health care providers anxiety, pathologizing individuals with gender dysphoria, inducing them to follow the sex-gender binarism” (Psychiatrist)
“You might think that the experience of gender dysphoria is kind of a solution [for all their problems] that is culturally available for adolescents nowadays[…] I think that the culture is kind of offering or allowing this idea that all problems are stemming from the gender problem. And then they stick to this fixated idea and [they] seek for assessment and we readily see that they have numerous and relatively serious psychological and developmental problems and mental health disorders” (Psychiatrist)
“They [adolescents] are living in their rooms, on the Internet during night-time, and thinking about this [gender dysphoria]. Then they come to the clinic and they are convinced that this [gender dysphoria] explains all their problems and now they have to be made a boy. I think these kinds of adolescents also take the idea from the media. But of course you cannot prevent this in the current area of free information spreading” (Psychiatrist)
You can view the full study here
When Transgender Kids Transition Medical Risks Are Both Known and Unknown
Frontline, June 2015
“While transgender adults have taken hormones sometimes for years, the generation growing up now is among the first to start taking hormones so young. Since most people who start hormones take them for life, doctors say there also isn’t enough research into the long-term impact of taking estrogen or testosterone for what could end up being 50 to 70 years.”
“There are so many unanswered questions around the long-term consequences, and whether your health risk profile really becomes that of a male or female,” Garofalo says. “If we start testosterone today, will you have the cardiac risk profile of a male or female as you grow older? Will you develop breast cancer because we’re administering estrogen?
“I think those are the unanswered questions that really trouble me, and can only be answered with long-term follow-up studies.”
Puberty is Not a Disorder
Letter by Trumbull D, Cretella MA, Grossman M. Pediatrics, May 2015
“The recommendations of the authors to reinforce the delusions of gender identity–confused children, and to prescribe puberty-blocking hormones as though puberty were a disorder, are outrageous. This approach violates the oath physicians take to “do no harm.””
Pink Boys: What’s the Best Way to Raise Children Who Might Have Gender Identity Issues?
Alice Dreger Ph.D, Pacific Standard, July 2013
“But the truth is […] that a lot of “gender nonconforming” kids don’t have a simple story of being “trapped in the wrong body.” They are expressing more subtle, more complex, and more varied messages of self. What they need isn’t therapy; what they need is to know that it’s OK to be gender non-conforming. It’s perfectly OK be a male who has feminine-typical interests, behaviors, and desires, or a female who has masculine-typical interests, behaviors, and desires.”
Inflation of an Idea
David Schwartz PhD, Journal of Homosexuality, 2012
“…the child longs inchoately for an emotional experience like respect and rapidly gains unconscious awareness of the power of gender complaints to bring such gratification.”
“…the trans child has learned, and then enacts, encouraged by these interactions […] that the idea of gender is very powerful, and if you want to get a rise out of people, play with it daringly. The lesson for the parent or clinician should be: Stop talking about gender.”
Abstract
Using three of the clinical articles in this special issue of the Journal of Homosexuality as examples, the author attempts to show how their views of gender may influence clinicians’ conceptualizations and treatment choices in response to children diagnosed with gender identity disorder (GID), or gender dysphoria. In particular the author argues that the belief that gender is a psychophysiological entity that is organismic and transhistorical, that is, the view known lately as essentialism, promotes more invasive interventions (e.g., endocrinological and surgical) and mistakenly deemphasizes psychological therapies as a clinical response to the suffering of trans children. He tries to show that the drawbacks of essentialism and its correlated treatment approaches are twofold, that a) they promote treatments with insufficient attention to our limited knowledge regarding their safety and efficacy, and b) they advance a reified differentiation of the genders that is politically problematic. The author suggests that a better response to trans children would be one that emphasizes the child’s broadly subjective role in his or her construction of transgressive, gender-related psychological and interpersonal phenomena (both painful and not), thus, offering a deeper validation for trans children’s challenges to our gender system.
To view the whole article, which is well worth doing, you must register at the website of Taylor & Francis Online.
No-one Knows the Potential Side-Effects of this Experiment on Young People
Dale O’Leary, Mercatornet, February 2009
“This debate ignores a more basic fact: In reality it is impossible for a person to change their sex. Our sex – male or female is written on every cell of our body. George Burou, a surgeon who performed over 700 SRS operations, admitted: “I don’t change men into women. I transform male genitals into genitals that have a female aspect. All the rest is in the patient’s mind.””
Sex Changes Are Not Effective Say Researchers
David Batty, The Guardian, July 2004
“There is no conclusive evidence that sex change operations improve the lives of transsexuals, with many people remaining severely distressed and even suicidal after the operation, according to a medical review”
Ihlenfield Cautions On Hormones
TRANSITION no 8, 1979
“Among the reasons for exercising extreme care in giving hormones, according to Ihlenfeld, is the fact that 80 percent of the patients who want to change their sex shouldn’t do it. “There is too much unhappiness among people who have had the surgery,” he said. “Too many of them end as suicides.” The transsexual candidate, he added, has been described as “the only patient who diagnoses himself and prescribes his own treatment.”
Ihlenfeld is against giving hormones to persons under the age of 18; in fact, he prefers that they be at least 20 to 21 years old before they start on this route. “I did have one patient who had surgery at 17 and is doing well” he said. “But in general, identity is still fluid in adolescence. There’s a chance that gender feelings still might change.”