Transgender presentation in adolescents – Global Population Health Summit

transgender presentation in adolescents  talk
Sarah Merians Photography

The Global Population Health Summit took place on 26 November 2023 in New York City. Our founder and director was honoured to take part alongside speakers including Swedish psychiatrist Sven Roman; detransitioner and founder of Sex Change Regret, Walt Heyer; psychologist and psychoanalyst Anna Cognet-Kayem; and Assistant professor in clinical psychopathology at the University of Caen, France, Dr Andre LeDrait.

Here we publish the transcript of the presentation by Stephanie Davies-Arai.

Transgender Presentation in Adolescents

Gender dysphoria in children and adolescents is an area where science, medicine, social media and politics intersect. It can perhaps be defined as the first major internet social contagion for this generation of children.

Before the internet, gender dysphoria was very rare. It was completely undocumented in adolescent girls, the cohort spearheading the explosion in referrals to gender clinics globally today.

There have always been children who defy stereotypical gendered expectations. Dr Thomas Steensma of the Netherlands reports in a 2016 paper [1] that a Child Behaviour Check List shows that ‘Behaves like opposite sex’ is endorsed by parents in 2.6% of boys and 5.0% of girls, and ‘Wishes to be of opposite sex’ in 1.4% of the boys and 2.0% of the girls. Psychological functioning is highly dependent upon how gender nonconformity is accepted within a certain culture or environment. A wide range of population studies in children show that gender nonconforming behaviour is often evaluated negatively by other children, and poor peer relations are associated with negative well-being.

Today’s culture conceptualises a child who does not conform to socially accepted stereotypes for their sex as a ‘transgender child’ ie. a child who is really the opposite sex. This is the opposite of acceptance of non-conformity. The social construction of the transgender child is so new that as recently as ten years ago it was not a widely recognised cultural phenomenon.

Ten studies show that childhood gender dysphoria is strongly associated with a lesbian, gay, or bisexual outcome and that for the majority of the children (85.2%) the gender dysphoric feelings remitted around or after puberty. [2] The latest study of boys in 2021, the largest sample to date, showed 87.8 % desisted and 63.6% grew up to be gay. [3] This will be the last study conducted under the developmentally-informed ‘watchful waiting’ approach. There is no evidence to show that this approach caused any harm to children, yet it has been replaced by an activist ‘gender affirmative’ approach which assumes a child is transgender and that the outcome will be a transgender adult.

The first study, published in 2022, of 317 children who were fully socially transitioned under the new gender affirmative model, shows by contrast only a 6% desistance rate. [4] This is not surprising. In a 2013 study Steensma found that a social transition in childhood, especially in natal boys, was strongly predictive for the persistence of gender dysphoria. [5]

Referrals to the Tavistock child and adolescent gender clinic started to rise in 2010/11. This coincides with the Tavistock’s Early Intervention trial of puberty blockers and the reversal of the sex ratio. From majority pre-pubertal boys it became majority adolescent girls driving this increase. In 2015 there was over 100% rise in referrals.

These figures correlate with the rise in use of social media platforms, particularly by teenage girls. In 2015 the platforms pushing a trans identity were Tumblr, Reddit and YouTube. This is now TikTok, Instagram and YouTube.

Around 2018/19 referrals began to plateau but after lockdown they shot up again; there are now around 8,000 children on the waiting list for the Tavistock clinic. This supports the social contagion theory, first posited by Dr Lisa Littman in a 2018 study [6] of parental reports, as young people turned to the internet during lockdown. Lockdown anxiety has been widely reported along with an increase in mental health problems. The outbreak of teenage girls developing tics during lockdown was reported globally [7] and was recognised as the result of social influencers: it was referred to as “TikTok tics.” As with gender dysphoria, Tourettes typically begins in childhood and affects predominantly boys.

Historic cases of mass psychogenic illness were limited to a specific location or community, but this is no longer true in the Internet Age. Most historic cases affect predominantly teenage girls. It was reported that by developing tics these girls gained peer support, recognition and a sense of belonging, but that a significant number were also engaging in self-harm and reported suicidality. Again, this is concordant with what we see in teenage girls who adopt a trans identity.

The gender affirmative model validates and reinforces what adolescents are learning on TikTok. It is now taught in schools as fact that all human beings have an innate gender identity and that this is the criteria for being a boy or a girl, not biological sex. There is no scientific basis for this claim.

The result of the politicisation of this group of children has been the medicalisation of gender non-conformity. The costs are permanent unwanted physical changes and worsened physical and mental health. The effects of treatment include infertility, inorgasmia, sexual pain, surgical complications, and osteoporosis. The testimonies of those who regret their medical transition – detransitioners – are heartbreaking.

The published results of the Tavistock’s Early Intervention trial of puberty blockers showed that 98% of children beginning blockers then progressed to cross-sex hormones. The gender affirmative approach is an iatrogenic pathway to a lifetime as a medical patient. A secondary analysis of the study results showed that in terms of psychological outcomes, between 15% and 34% deteriorate. 37%-70% experience no reliable change in distress, and between 9% and 29% reliably improve. [8] Rates of reliable deterioration as well as recovery rates were comparatively worse than typical child and adolescent mental health services where recovery rates of around 50% are found.

An independent review of the Tavistock clinic [9] by the distinguished paediatrician Dr Hilary Cass found that clinicians felt pressured to adopt the unquestioning gender affirmative approach and that this had led to diagnostic overshadowing, where underlying mental health issues went unnoticed and unaddressed. The clinic is now due to close next year. The evidence base for psychological benefits of blockers and cross-sex hormones for adolescents with gender dysphoria was deemed “low quality” by the UK National Institute of Health and Care Excellence. Similar reviews were conducted in Sweden and Finland and the conclusions reached were the same.

Children are not impervious to the influence of political ideology through the power of the internet and mass suggestion; neither are parents who are persuaded to consent to these treatments through the misrepresentation of suicide data; and nor are doctors and clinicians who fear for their jobs and livelihoods if they ask questions or express concerns.

The same level of critical thinking and the same knowledge of child and adolescent development must be applied to this group of children as with any other. The mental and physical health of vulnerable children and adolescents who are suffering with gender related issues is at stake. The creation of a growing cohort in society who have not experienced the critical growth stage of puberty in order to reach adulthood, and who are dependent on medical treatment for the rest of their lives, is unethical and unsustainable.  

[1] https://zero.sci-hub.se/4841/991744141450db02c20bd4d77852f258/ristori2016.pdf

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841333/

[3] https://www.frontiersin.org/articles/10.3389/fpsyt.2021.632784/full

[4] https://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/Gender-Identity-5-Years-After-Social-Transition

[5] https://www.transgendertrend.com/wp-content/uploads/2019/06/Steensma-Persistence-2013.pdf

[6] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330

[7] https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2022.06.4.19

[8] https://www.medrxiv.org/content/10.1101/2023.05.30.23290763v4

[9] https://cass.independent-review.uk/

This Post Has One Comment

  1. Sarah Wilkinson

    A very good summary of the key facts.

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