Gender-Transition Decisions Should Be Made by Families, Not the State

This month, the New York Times ran a two-part podcast series titled When Texas Went After Transgender Care, detailing that state’s effort to ban “elective procedures for gender transitioning, including reassignment surgeries that can cause sterilization, mastectomies, removals of otherwise healthy body parts, and administration of puberty-blocking drugs or supraphysiologic doses of testosterone or estrogen.” Even those of us who are concerned about the encroachment of ideology on medicine by activists should be alarmed by what Texas is doing. There are now reports of families of trans children being visited by agents from the state’s Department of Family and Protective Services, on suspicion of what they are deeming child abuse (mostly because of the medical interventions’ potential to cause infertility in these young patients later on). The affected parents are understandably upset and confused: Whatever you may think of their efforts to help transition their children, those efforts were consistent with the advice given by such medical groups as the American Academy of Pediatrics, whose relentless focus on gender “affirmation” has led to the use of puberty blockers, cross-sex hormones and sometimes surgeries for patients as young as 13.

But to my knowledge, no prominent mainstream or liberal media outlets have emphasized that this kind of madness is coming from both sides: In some jurisdictions, child protective service agencies are investigating parents who don’t affirm or medicalize their trans-identified children. The theory here is that such parents’ “gender-critical” attitudes are also somehow tantamount to child abuse.

Because I have written a book about girls who break out of sexist gender norms, and publish a Substack about people who challenge stereotypes more generally, I hear from parents going through this kind of ordeal. In some cases, I interview them to get the facts about how they’ve been treated.

One California couple I’ve spoken with spent three years affirming their daughter, a stereotypically feminine child with no previous history of gender issues who was suddenly exhibiting gender dysphoria and suicidal impulses as she entered puberty. Following on what they were told were best practices, the parents facilitated the child’s social transition, including changing her name and haircut to something boyish. She was binding her breasts and taking puberty blockers. Unfortunately, the mother told me, “What we found was that her mental health, her happiness, faded, and her mental health deteriorated and got worse.” Each intervention only seemed to exacerbate her problems.

By the time the child was in eighth grade, the family was in full crisis-management mode. The mother quit her job at the height of her career to try to manage the daughter’s mental health. And it eventually struck her that the affirmation approach seemed to meet the pop definition of insanity: doing the same thing over and over while expecting a different result. So, on the advice of their child’s mental-health and medical experts, the parents reversed course on the affirmation approach—and this is how they got into trouble: When the daughter told her school counsellor that her parents wouldn’t let her transition, they got a call from the local child-services office.

Even before parents get a call like this, they usually have been gaslit as bad parents, thanks to torqued surveys purporting to show that a family’s failure to provide a trans-identified child with instant affirmation will put that child at risk of suicide. The actual suicide rate, as it happens, is somewhere between 0.3 percent and 0.6 percent, with the latter linked study—titled, Trends in suicide death risk in transgender people: results from the Amsterdam Cohort of Gender Dysphoria study—suggesting that transition doesn’t mitigate that suicide risk. Moreover, these rates are similar to the rates observed among children with other mental health challenges that often are comorbid with gender dysphoria.

The propaganda surrounding medical literature in this area has become shockingly sensationalist, and this propaganda has migrated from Internet subcultures into mainstream civil-liberties activism and even clinical practice. In many cases, parents are told—often with their child present—that they can either have a trans child or a dead child. Small wonder that trans-identified children come to see their gender distress in apocalyptic terms.

Thankfully, the last few years have witnessed stirrings of common-sense pushback from clinicians who are looking anew at the science, and rethinking their approach to treating gender dysphoric children. While it seems unlikely that a single, uniform, international treatment standard will emerge in the short term, one point I hope policymakers of all stripes will agree on is that we shouldn’t be punishing parents for their good-faith decisions either to affirm, or to not affirm, a child’s transgender identity. And I hope they’ll consider how other countries are approaching the science of gender-affirming care.

“The scientific evidence is not sufficient to assess effects on gender dysphoria, psychosocial conditions, cognitive function, body size, body composition, or metabolism of anti-puberty or sex-opposite hormone therapy in children and adolescents with gender dysphoria,” Sweden’s national health board recently announced, adding that it would exercise restraint in providing hormones, because of “uncertain science and new knowledge.” Officials at the country’s Karolinska Hospital admitted that children treated with puberty blockers and hormones “have been exposed to the risk of ‘serious care injury’ and that there is a continued risk of incorrect treatment.”

In the UK, the National Health Service has released an interim report critiquing the “American”-style informed-consent model of gender-affirming care, and noting, “There is lack of consensus and open discussion about the nature of gender dysphoria and therefore about the appropriate clinical response.” And in France, the National Academy of Medicine recently announced that “great medical caution must be taken in children and adolescents” because “there is no test to distinguish a ‘structural’ gender dysphoria from transient dysphoria in adolescence.” The Academy also noted “the many undesirable effects, and even serious complications, that some of the available therapies can cause,” and that “the risk of over-diagnosis is real.” This flatly contradicts the North American medical approach and media narrative of transition as panacea.

The above-described situation involving a California family isn’t an isolated incident. Parents in Indiana whom I’ve spoken to lost custody of their son because they had not affirmed the child’s self-identification. (He had come out earlier as gay, and was battling anorexia; they were trying to help him come to terms with his sexuality and find good medical care for the eating disorder, but did not wish to affirm the child’s belief that the solution to these problems was to identify as a woman or take hormones.) And in Canada, one father was actually sent to jail because he refused to stop speaking out against doctors and educators who were, as he saw it, rushing his child through aggressive transition therapies.

Another California case ended so tragically that it attracted national coverage—though far less than it should have. When she was 13, Abigail Martinez’s daughter Yaeli began struggling with depression. In eighth grade, she tried to overdose on allergy pills, which brought the Department of Children and Family Services (DCFS) into family members’ lives, with a social worker routinely checking in.

By the time Yaeli was set to begin 10th grade, her condition had improved, and she seemed happy and comfortable with herself. But at school, Yaeli began hanging out with an older trans boy; then came out to her mother as bisexual; then as a lesbian; and finally as trans, demanding a new name, new pronouns, and testosterone treatment. Despite the various phases and identities that Yaeli had rapidly cycled through, this teenager was now insisting that she’d always been a boy, notwithstanding her stereotypically feminine childhood appearance and demeanor. Her behavior seemed erratic and strange to her mother; she’d been a happy girl over the summer, but was now suddenly a miserable boy during the school year.

Abigail, an immigrant from El Salvador, didn’t understand why her daughter thought these social and medical interventions would help her. At first, she refused to comply with Yaeli’s demands, though eventually assented to the name change—which she thought would help keep her daughter happy. But she drew the line at cross-sex hormones, believing that this was too radical an intervention to embark on given her daughter’s unsettled mental-health state.

But the DCFS social worker, school psychologist, trans friend, and that friend’s mother, all were allegedly counselling Yaeli otherwise. Yaeli learned that if she were removed from her mother’s home, she could then petition the state to give her the hormones she wanted. According to Abigail, Yaeli, by now 16 years old, falsely accused her mother of physical abuse as part of such a plan. Yaeli was removed from the household, sent to a group home, and got her court order for testosterone. (Her three siblings remained at home with Abigail, which suggests that officials did not actually consider her a threat.)

“I asked the judge to send her to a psych evaluation,” Abigail later told me. “I [knew] as a mom [the transition] was not going to work.” And it didn’t. Her daughter developed relentless physical pains that Abigail believes were caused by the testosterone injections, and she didn’t seem better emotionally. Even though Yaeli was now living outside her home, Abigail tried to address her daughter’s underlying mental-health problems. But it seemed that everyone else in the girl’s orbit was interested only in affirming the child’s trans identity, convinced that her anguish could be addressed with faster and more thorough forms of transition.

Eventually, Yaeli committed suicide by lying down on a set of railroad tracks in front of a train that hit her at high speed and scattered her body parts widely. It was an unusually horrific tragedy. But because the arc of the narrative was ideologically “off-message,” only a few journalists bothered to report it, and these few were from conservative outlets. One is left to wonder how much more attention would have been paid to Yaeli’s fate if the suicide had followed, say, an episode of transphobic bullying at school.

The other (anonymous) California mother, whose case I mentioned earlier in this piece, has been able to push back against the system more forcefully. She educated herself about the lack of long-term research regarding medical-intervention outcomes for young people, such as her daughter, who experience gender distress. She also joined a support group for parents of children experiencing rapid-onset gender dysphoria. With the group’s help, she found a doctor and a psychiatrist who more fully explored the sources of her child’s distress, rather than just rubber stamp what the child had decided about herself from listening to Dr. Tumblr.

“I must have talked to about 10 to 15 different providers,” the mother told me. One, she reports, suggested that if a two-year-old pulls a barrette out of their head, that means that they’re transgender and you should transition them immediately. “We wanted somebody who could take a good look at who our daughter was and tell us what was going on. And if they [ultimately] told us, ‘Your daughter is transgender,’ we were prepared to get behind that and support it.”

The doctor who treated her child examined her comorbid conditions and underlying causes of distress. He considered her eating disorder, her cutting, her sleeplessness, her anxiety, her depression and her suicidal thoughts. He concluded that what the child needed wasn’t cross-sex hormones, but rather a less disruptive approach—one that would allow her to get her various issues under control before committing to medical steps that cause permanent changes.

This made sense to the parents, and they saw their daughter improving as she worked with the psychiatrist. Her eating normalized. She stopped cutting. Her suicidal ideation decreased.

But their daughter was disappointed. She’d been dreaming of the magic elixir of testosterone that would destroy her problems, as so many trans men on the Internet claimed it had done for them. That’s when she told her school counsellor that she wanted to medically transition but that her parents wouldn’t support it. Days later, DCFS showed up at their door.

But unlike Abigail Martinez, these parents were lucky. DCFS officials investigated the family, talked to the doctor, talked to the child and the school counsellor—then closed the investigation.

After that, their daughter desisted—stopped identifying as transgender, stopped asking for medical interventions. It’s a happy ending. But the ordeal left the family distrustful of the school, the government, and the medical establishment, all of which seemed eager to back an ideologically constructed theory about the “true” identity of a child whom these officials barely knew. And there is little accountability for ideologues: According to the mother, the school counsellor, who reportedly touted herself as an expert in “gender-expansive” children, recently got a promotion.

The only way to turn down the heat around this issue is to follow the science and to listen to all sides. It is absolutely true that some studies show that cross-sex hormones really do help improve the mental health of persistently gender dysphoric children in the short term—which is why it is wrong for conservative US states such as Texas to make criminals out of the parents who are supplying such treatment to their children. But there is also plenty of evidence indicating that many trans-presenting children can benefit far more from therapists who treat them as complex human beings instead of simple cases of gender dysphoria, and who scrutinize whether a child’s exhibited gender distress is a cause, or symptom, of other problems.

Having supportive families is critical for protecting the mental health of LGBTQ+ children, and helping them flourish. But “support” isn’t synonymous with robotically affirming every passing idea the child asserts, let alone promoting medical interventions with lifelong ramifications. And no parent who insists on this principle should be sanctioned by the state for doing so.


This is a companion discussion topic for the original entry at https://quillette.com/2022/04/25/gender-transition-decisions-should-be-made-by-families-not-the-state/
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Actually, that is not true. The research, some of which I am working to get correctly analyzed, does not show anything of the sort. In fact, the most recent study (Tordoff et al, doi:10.1001/jamanetworkopen.2022.0978) shows no change over 12 M of putting children on puberty blockers or wrong-sex hormones. This can be clearly seen in Table e3 in the Supplemental Materials for the study. But the authors (all of whom are graduate students or medical residents, without a senior author of any kind) claim that the impact is massive - adjusted OR of .4 favoring medication.

This also leaves the reader to ask 2 further questions:

  1. What is the meaning of “reduced depression/anxiety” for the child with gender-dysphoria? Let us say that a child demands an “all-candy” diet, and threatens to kill himself if he does not get it. It is certainly possible to reduce anxiety and depression to give that child all the candy that he wants. But no parent would do that. So why do they give these children wrong-sex hormones?

  2. Why are these children, and many other children, experiencing such strong distressing feelings? These are definitely 1st-world problems. Children in countries where REAL PROBLEMS exist, like Ukraine, do not show gender dysphoria. My belief is that these children have no accomplishments, have no skills, are simply wasting their childhoods tormenting each other on the internet. Getting children off the internet, and out doing something useful (learning to knit, leaning to play an instrument, learning how to do something) would be far better.

Another key point, for the outsider, is the crucial point that the research ALL SUCKS in this area. The Tordoff article is a great example. The study started with 104 children, some male, some female, all mixed together. On the very first point, at baseline, 5 of 104 subjects did not complete the measurement instruments. I have NEVER seen a study where the baseline measurement was not completed by 5 of 104 subjects. By the end of the study, 41 of the 104 participants did not complete the measurement instruments. This is such a high rate of failure to complete that the study is truly worthless. In addition, the participants were required to sign consent forms again, and some did not (number not shown in the paper). Yet their status (a data point) on the puberty blockers-wrong-sex hormones was reported. In other words, data about patients not having signed consent is reported. This is a violation of ethics rules.

A further issue is the unwillingness of most gender-dysphoric persons to actually participate or complete research. Many studies which should be done cannot be done due to the unwillingness of participants to join studies.

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Just to throw some fat in the fire:

Anyway, the article makes it sound like just maybe we’ve hit peak-trans or at least are getting close. Sounds like sanity is returning in Europe, so that’s good news. It seems that moral panics have a way of just evaporating overnight, maybe it will be the same with transmania. Let’s move on to slobs liberation.

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A number of European countries are now restricting the use of puberty blockers or wrong-sex hormones.

“Peak-trans”? In the US, some of this PRO-TRANNIE crap is being implemented into law, and that makes the return to sanity far far far more difficult.

I guess. Blue states will try to fortify their agenda with laws, red states likewise. When laws are ideologically polarized, then if a state flips what you get is the entire legal agenda of the previous government thrown out and replaced with new agenda driven laws. You feel like you’ve moved from California to Alabama while not moving an inch. It makes living in swing states that much more interesting and one can see why both sides will do anything to stop the other. Civil war anyone?

Parents do understand that their kids have access to social media and the internet, right? I think they’re massively overestimating the influence that teachers have over their students.

Shrier’s piece raises some legitimate concerns but she reminds me of another reporter-turned-activist, Christopher Rufo, in that she’s allowed her polemical posture to wipe away even the pretense of journalistic objectivity.

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That’s the thing, once it gets to absolute polarization … well, the first casualty in war is the truth, no? If reasonable people give up trying to communicate with Them, then the field is left to the fundamentalists to fight their totaler krieg and everybody loses, including the kids. I’m pretty absolute myself on this issue – when it comes to protecting the kids I’m not going to be very flexible, but unlike George I’m not ready to start shooting just yet. Yes, God knows who you can believe. Geary! And your good self too. And Data. And the Doc.

Edit:

Really tho, imagine Florida goes Blue and all that DeSantis stuff gets cut out of the law and in it’s place comes an equal and opposite volume of woke law. Nope, the law isn’t a good place for ideology either way. The law should change slowly and with broad support.

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BTW that’s a very good point about the internet. I didn’t even know what a homosexual was until I was in grade 7 and I don’t think I knew there was any such thing as trans until well into adulthood and then, of course, it was presented as an extremely rare mental illness. What passed for Trans was nothing more than gays in drag … most folks thought. So, indeed, kids are going to find out about … everything under the sun … and sooner rather than later. It actually makes a good case [sorry George] for taking some charge of the issue in school.

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Nope. Not even close. Kids will watch violent movies too. There is a constitutional right in the United States to keep and bear arms, yet we don’t train them in the use of firearms in school and ask them to spend time on the school shooting range. I wonder why not?

Now there’s an adventure in logic.

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Right. But so far I don’t think teachers are providing 12-year-olds with lessons on how to fuck, which is what your analogy implies.

Give it time. The woke left will get there… nothing seems out of bounds for some of these people.

But your analysis is a bit wrong. I said shooting at the firing range… so that’s more like putting on the condom. But let’s say shooting is NOT part of the exercise at all… only gun handling. Would that satisfy?

OK, I’ll compromise with teaching them how to masturbate.

Regardless, peers and social media have far more influence on young people than teachers do. People who are panicked about the possibility of their kids being corrupted by educators would be wise to acknowledge that fact.

So true! Which is why my child does not use social media at all. Caveat emptor and all that. In plain point of fact, parents should be much more involved in their children’s social media activity. And, for that matter, in whatever gibberish passes for education in public (or private!) schools.

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Very wise. I don’t use it myself, unless QC counts.

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From 1966-1968, I brought my rifle to school every Wed morning. It was kept in the office. Then we would go as Rifle Club to the town police shooting range and work on our NRA badges. I got to Markesman 2nd class. Good training. It is very difficult to hit a target the size of a pea from 50 ft. You must control your breathing, and your trigger finger. I wanted to teach my kids, but costs had gone up up up, and it would have cost $50 for 1 hour.

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Your point is well-taken, but we have to consider the more extreme activists within the teaching profession. This may be anecdotal and you probably won’t like the source, but the parent in the video is genuine as are her concerns:

Three lessons a week on gender ideology! What sort of school district allows three lessons a week on a fringe subject which at best should only be given a cursory examination and then no sooner than age 11 (when teenage pregnancies in any real sort of numbers begin to appear, historically)? And I agree that it’s anecdotal, but the fact that a school district would allow this sort of teaching to occur when and to the extent that it did, is highly indicative of a system with insufficient safeguards and guidelines as to when gender as social construction or as a spectrum becomes age appropriate.

Plus, there is this- a resource for schools districts which recommends automatic gender affirmation for those with gender dysphoria- something we know is completely wrong, as gender affirmation should only be undertaken after numerous sessions with a clinician- and also because 6 to 9 out of 10 children with gender dysphoria grow out of it, if puberty is allowed to progress.

One of the agencies supporting the literature is the NEA.

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What an amazing video.

This is getting bigger and bigger. The notion that kindergartners need gender information, 2nd graders need to be taught about lesbians, this is all completely nuts, and a huge waste of time. In NJ, the Dem candidate for Gov has begun the process of distancing himself from this insanity. This is what resulted in the win in VA for Youngkin. It’s going to be a big deal in Nov.

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It probably wasn’t an AR-15 and you probably had very little in common with Adam Lanza. That lax gun regulations were quite appropriate then is not sufficient to conclude that they should be equally lax today. Time change and the law needs to change with it.

Peak trans?

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