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Why Trans Kids Need Gatekeepers

I’m a transsexual woman in my thirties who transitioned in my early twenties, and I wish I could have done so earlier. Even so, I am wary of today’s Brave New World of transgender activism in which important safeguards of transition are under attack and any counter opinion, even if made by a trans woman such as myself, are labelled as an attack on trans rights. At first it was easier for me to not ruffle the trans activists’ feathers, but my conscience got the better of me, and now I am continuing to speak up in order to help those who deserve better in their own journey of transition.

Through talking to other trans people in my life, it has become apparent to me that transition surgeries are an answer but not the answer to the long-term health and well-being of gender dysphoria patients. Unfortunately, many trans people get so fixated on surgery for so long, that they may forget that there is more to life and transitioning than just surgery and other medical intervention. The fixation is often driven by the fantasy that surgery, and transition in general, will transform them into a new person, and that all the problems in life will go away.

During my gender transition, I didn’t fixate on surgery even though I was highly dysphoric back then. I’ve had my ups and downs, but I’ve always done okay. To be honest, thinking about sex and gender a lot is unhealthy, particularly during high-conflict public debates on what it means to be transgender and what rights we have to get the help we need. As the debate grows more divisive, the media valorization and glamorization of trans people, especially trans children, is not helping but rather, it is pulling us away from the honest conversations we need to have.

Forty-one percent of transgender people have experienced suicidal ideation or self-harm, though this statistic does not indicate to what extent the attempts were before or after transition, or at what stage of transition. Nevertheless, studies have shown high rates of suicide among (alleged) trans people post-medical transition. Why is this the case and can the quality of transition be a factor?

Traditionally, gender dysphoria patients were expected to undergo extensive ‘talk’ therapy in order to access medical treatment. This is the gatekeeping model, where the ultimate decision on suitability for treatment is made by healthcare professionals. In recent times however, trans activists have argued against what they see as a model built on red tape, preferring the ‘informed consent’ model instead. Under ‘informed consent,’ all the patient needs from the doctor is education and advisement about the risks and benefits of the treatment in question, before making the final decision him/herself. In the simplest terms, trans activism has lead to a degradation of professional medical opinion in the process of transitioning and enabled a medical culture that could rely on nothing more than the personal preference of someone who may or may not have the skills and knowledge to make a sound and informed decision.

The move away from the medical gatekeeping model for treating gender dysphoria is not only unfortunate, it is irresponsible. Over the past few decades, the strictness of the standards of healthcare used to determine suitability for hormone replacement therapy (HRT) and related surgeries have been relaxed significantly. In 2008, the Endocrine Society endorsed puberty blockers as a treatment for trans teenagers. Then in 2011, the World Professional Association for Transgender Health (WPATH) issued new Standards of Care internationally for treating such patients via puberty suppression, while formalizing the ‘informed consent’ model. But it didn’t end there.

Last month here in Australia, new guidelines published in the Medical Journal of Australia gave the green light for potentially more trans children to go on HRT as young as 13, defying international guidelines. Specifically, “decisions about affirming a young person’s gender identity should be driven primarily by the child or adolescent, in conjunction with their family and health care providers.” While this experiment was hailed as world-leading, the minimum legal age for smoking, drinking and voting in Australia remains at 18, and it’s still 16 for consensual sex. So in Australia, a 15-year-old teen cannot consent to sexual activity but they can consent to life-altering medical treatments that they almost certainly cannot fully grasp at that age.

The availability of surgery isn’t the issue nor is removing barriers to surgery; the issue is that trans people are being educated and socially encouraged to abandon a holistic and forward-thinking approach to life. A return to medical gatekeeping, albeit modernized, for the treatment of gender dysphoria would be in the best interest of trans people. This just might slow down transgender contagion, the unhealthy and socially-sanctioned fixation with gender.

I see parallels between this situation, and the situation of trans teenagers stuck in the (predominantly online) echo chamber of gender obsession, where they yearn for a sense of belonging. Compounding this issue is the short-sightedness that’s bred from the self-preoccupations of adolescence. There is more to life than just gender, even for the genuinely gender dysphoric. If we teach our youth that medical intervention is a victory rather than a process, then we are encouraging youth to “achieve” something that may or may not be in their best interest.

Gatekeeping at a minimum requires patients to be evaluated by psychology professionals as suitable for HRT or transition-related surgeries. Prudent gatekeeping requires the minimum, plus giving psychotherapy a ‘fair go’ for at least a few months. A few therapeutic sessions may suffice, or more sessions are warranted before referring to an endocrinologist for HRT. And perhaps psychotherapy should be concurrent with HRT. In short, while the extent of gatekeeping should be based on an individual case-by-case basis, gatekeeping should happen regardless.

This doesn’t mean that historically the gatekeeping model hasn’t had problems, ranging from reliance on gender stereotypes, to narrow sexuality expectations, to mandatory urological examinations that had nothing to do with dysphoria. But that doesn’t mean gatekeeping hasn’t improved or can’t continue to improve.

The role of gatekeeping is critical in examining the underlying causes of distress, and such distress may or may not be strictly gender dysphoria. Indeed, at least 70 percent of people with gender dysphoria at some point also experience psychiatric comorbidity, such as anxiety, depression, anorexia, autism spectrum disorder, ADHD, bipolar disorder, PTSD, borderline personality disorder, or dissociative identity disorder. This 70 percent rate complicates the matter at hand, requiring careful differential diagnosis, exploration of trauma, and questions about sexual orientation. Sadly, this common sense approach is making way for the ‘informed consent’ model, where a quick initial consultation at the doctor immediately follows seeing an endocrinologist to start HRT, with nothing in between except for a consent form.

Emotions can be complex and puzzling because they’re not hard-wired. Specifically, our emotions are founded on past experiences and culture. For example, schizophrenia is largely biologically-driven, but manifests differently in different cultures, and its prognosis is influenced by social factors. As for myself, I generally dress in attire socially deemed female, and my first name is also deemed female, both of which alleviate part of my dysphoria. So how can gender dysphoria be predominantly biological? How can the innate gender identity concept even be valid? It’s ridiculous that the current official diagnostic criteria for childhood gender dysphoria includes “a strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.” We must distinguish science from trends that lead us to fast conclusions.

This is why psychotherapy as part of gatekeeping is critical for treating gender dysphoria, young or old. And that’s not only because understanding one’s emotions and feelings deeply can improve one’s health and well-being. Many patients, especially younger patients, claiming gender dysphoria find difficulty in describing their dysphoria clearly, due in part to not understanding whether other factors are at play or not, such as family dysfunction, trauma or even social pressure.

I transitioned nearly a decade ago, and though I can now describe my dysphoria more clearly than when I was a teenager, to this day I still struggle to describe it clearly. Anyone who genuinely has gender dysphoria (other than Rapid-Onset Gender Dysphoria), and is self-honest, will admit that describing dysphoria to others is achievable, but it’s a complex task that is unique to each person’s experience and potential barriers. This is why some deep, meaningful and productive conversations between the patient and healthcare professionals can go a long way in properly addressing specific problems that may be at play.

Life is tough. It’s tough for everyone in different ways, and sometimes it’s tougher for trans people, but this doesn’t mean that we can ignore or sidestep the real work and then expect positive outcomes. Trans adults and children do not need to evolve into snowflakes, unable to manage their emotions. They need to build their resilience and confidence, which is what gatekeeping can assist them with.

Transition regret has always been an issue of concern but it has been rare. Now it’s more common than before, and those who regret transition should not be overlooked in transgender discourse (as inconvenient as that is for the trans activists who want to defend the process of ‘informed consent’ as being a perfect fit for all). I underwent counseling and psychotherapy for approximately seven years before I started my transition, and dragging it out for that long did very little to treat my gender dysphoria. Still, the development of my emotional granularity and resilience arising from this was invaluable, and it served as proof that I wouldn’t regret transition.

The shift from gatekeeping to ‘informed consent’ is being pushed as a move towards freedom and lower barriers but, in fact, it is a reduction in the service and attention that people considering transition deserve. The inconvenient truth is that there are even gender dysphoria patients who do not regret transitioning, but regret specific decisions they made, the speed of the process, or how they dealt with their transition emotionally.

In a study of detransitioned women, 65 percent received no psychotherapy before starting HRT, and most who did receive psychotherapy received little of it. These are victims of the new ‘informed consent’ model, and the transgender contagion is closely tied to this phenomenon. When we remove gatekeeping and apply ‘informed consent’ to teenagers, the issues become more troubling. This is a slippery slope that gives little regard to the reality of the young person’s brain:

The rational part of a teen’s brain isn’t fully developed and won’t be until age 25 or so…Adults think with the prefrontal cortex, the brain’s rational part. This is the part of the brain that responds to situations with good judgment and an awareness of long-term consequences. Teens process information with the amygdala. This is the emotional part. In teen’s brains, the connections between the emotional part of the brain and the decision-making center are still developing—and not necessarily at the same rate. That’s why when teens experience overwhelming emotional input, they can’t explain later what they were thinking. They weren’t thinking as much as they were feeling.

Compounding the challenges related to this issue of cognitive development is that social gender transition is the first step to medical transition and by taking that first step we risk inadvertently creating unnecessary internal and external pressures to medically transition for the wrong reasons. So if the appropriateness of the ‘informed consent’ model for young adults is at best, questionable, that behooves the healthcare profession to vigorously gatekeep children from unnecessary transition. This is not an issue of personal freedom but rather a moral obligation to give our youth the best resources we have.

Let’s be clear: it is not transphobic to respectfully question someone’s self-determined gender identity while giving them a robust process to help them transition with optimal mental health, but it is certainly cisphobic to guilt parents into believing that if they don’t support their child’s gender transition, that the child will end up suicidal. Not treating gender dysphoria with medical transition can lead to suicide, however, this entire process is fraught with complexity and a gender dysphoria patient could commit suicide for other reasons that also must be addressed. Playing the suicide card as a means to win a political debate is just plain gross.

It’s obvious why trans activists are more comfortable with playing the suicide card, than with both the detransition phenomenon and the gatekeeping model, and I can understand why. I don’t like that I don’t have curves like other women, and I don’t like my deep masculine voice. I don’t like that I didn’t get hormone blockers in high school, but that doesn’t make it any more ethical for me to advocate the ‘informed consent’ model to self-indulge in my woes at the expense of other people’s experiences and mental stability.

Common sense must prevail in approaching what is a difficult and complex subject matter, but where can you find common sense these days post-gatekeeping around the world? Clinical social worker Lisa Marchiano posits in her “Guidance for Parents of Teens with Rapid Onset Gender Dysphoria” that psychotherapeutic treatments are harmless and worth a try, including somatic therapies, dialectical behavior therapy, and psychodynamic psychotherapy. More importantly, The guidance provides sensible advice to parents on how to cautiously manage their children with gender dysphoria, with the kind of compassion and level-headedness that I wish my parents had when I was growing up. Marchiano’s “New Guidance for Rapid Onset Gender Dysphoria” further elaborates on what is essentially a guide to common sense parenting applicable to all families (with or without any gender dysphoric children):

Parents who meet a child’s initial announcement with loving support but without affirmation were more likely to see their child desist in my experience. It appears that the more teens are supported in a belief that they are a member of the opposite sex, the more entrenched this belief becomes, making later desistance more complicated.

Of course, if the child doesn’t desist, and their dysphoria simply grows in the face of common sense parenting and psychotherapy, then that’s proof that perhaps gender transition is more appropriate under those circumstances. I am proof of that. Gatekeeping is not about saying “yes” or “no” straight-up. Gatekeeping is about prudent medical and mental health processes, because even the 2017 Endocrine Clinical Practice Guidelines for gender transition states that “with current knowledge, we cannot predict the psychosexual outcome [whether or not a person eventually identifies as transgender] for any specific child.” But even the law now seems to think otherwise.

Until recently in Australia, children under 18 years old with gender dysphoria required family court approval to undergo medical treatment, including mastectomy at age 15, even if they have parental and medical permission. This approval process was expensive and time-consuming, and therefore especially unnecessary under the robust gatekeeping model.  It was argued that “the courts follow medical advice in their decision-making anyway, making the courts [sic] process unnecessary.” However, in the Brave New World of ‘informed consent,’ the scrapping of the family court’s approval process earlier this year couldn’t have come at a worse time. Apparently it’s 2018, and the Family Court of Australia doesn’t need know about children potentially having transition-related surgeries.

So much for the law doing its job, because at the end of the day, gender dysphoria is not yet well understood. The best conclusion thus far is that there are likely complex biological, psychological, social and cultural factors that cause gender dysphoria. And given that the law has given up, it behoves the healthcare profession even more to resuscitate the gatekeeping model, despite pressure from the trans activists not to. Anyone who thinks that these decisions are better made by judges than healthcare professionals is clearly not thinking through the full ramifications of their activism.

Failing that, here is my message to today’s parents: if your son or daughter is experiencing gender dysphoria, show him or her the compassion and love they deserve, but don’t let that compassion or love silence you from asking important questions and testing every assumption along the way. There is no room for complacency. No parent should ever be silenced or told what to think on important health issues. Instead, they should know that dialogue and professional oversight is not only warranted but in fact an important part of the gatekeeping process. This not only helps to ensure the future happiness of their child but could perhaps even save their life.


Libby DownUnder is an Australian writer in the alternative media scene. Follow her on Twitter @LibertarianinOz.


  1. Has there ever been an issue that affects fewer people than this one, and yet has gotten more attention in the news media? According to JAMA, only 275 people per year undergo some kind of sex change surgery — that’s only one surgery for every 77,708 Americans over the past fifteen years, or just .0013 percent of the population.

    I can understand why the Left is fixated on this issue — they’re relentless in their search for “victim” groups that they can sacralize — but what accounts for the level of interest at more reasonable news and opinion sites like Quillette?

    • nan says

      This issue affects 52 % of the population: Women, who now cannot legally call a male out for hanging around in their gym change room, calling themselves Female in prison (for beheading his former wife) or demanding the gynecologist examine their ‘vagina’ and do a Pap smear once a year, and whose crimes will now be coded Female. This issue affects every girl or woman who is an athlete or aspiring athlete, and can now hang up her dreams as men whose musculature and bone density are competing against them. This issue affects every woman in a nursing home or hospital bed who cannot refuse to share a ward room with males or be bathed by the male on staff who will lawyer up if facility management doesn’t back his sexual fethish.

      It’s entirely reasonable for this issue to be discussed here.

      And for the record, I am a radical feminist and I do not consider the writer to be a woman. A human being deserving of dignity and consideraton yes, but his rights stop at the end of my nose.

      • @ Nan

        “This issue affects 52 % of the population”

        Well potentially affects – there is a difference, and it clearly isn’t going to affect every single woman born! And in that category is 100% of the pop. and not just women!

        “I am a radical feminist”

        It figures!

        “and I do not consider the writer to be a woman.”

        Whatever else Transgender may or may not be what it isn’t it this: “sexual fethish” [sic]. A bit distasteful of you.

        It seems to me that there is something genuinely amiss with people who suffer gender dysphoria. It is old and within every society on earth going. And such people can put up with some horrendous abuse to act out the way they feel.

        As I understand it, it’s mainly a mental or psychological problem. There is little to no biological evidence for it. And it affects people to varying degree. Not everyone suffering gender dysphoria necessarily wishes to change their body to conform to their perceived sex/gender.

        I don’t think you can really alter you biological sex. So trans people will always be trans. But I don’t believe that most of these people wish to hijack the society in the way you think think they wish to. And for most of these, there probably are compromisable solutions that protect the dignity of people on both side.

        • Sceptical says

          I’m not a radical feminist, but I agree with Nan. And btw, I suspect that many “trans women” would be as offended by your post as they would be by Nan’s. They would not accept your statement that you cannot really alter your biological sex, not because they disagree but because they think that biological sex is a “social construct” and that gender identity is genuinely biological. Thus we get female p*nises and male chestfeeding.

          • @ Sceptical

            ” They would not accept your statement that you cannot really alter your biological sex,”

            Fact of reality.

            ” but because they think that biological sex is a “social construct” and that gender identity is genuinely biological.”

            Other way round.

            “I’m not a radical feminist, but I agree with Nan.”

            I don’t agree with her attitude and the fact that this somehow affects women a whole lot more than men.

      • @nan

        “musculature and bone density”

        Say no more nan, say no more…

      • carl m jacobson says

        Well, you could blame Feminism for this one.
        After all, wasn’t it Feminists who insisted that there are no differences between males and females?
        And that anyone who insists that there actually are inherent differences, mentally, physically and psychologically are now considered to be bigots?
        Unfortunately, for many old school Feminists, the belief that MTF transexuals are not actually females will quickly get them attacked by the new generation of radical feminists.
        You reap what you sow.

    • C Young says

      One reason is that it sits on the fault line between two incompatible views of gender – the most divisive issue in the culture war.

      Those views are

      Social constructionism – Traditional gender is entirely socially constructed and thus malleable in the hands of activists. This an article of faith for ‘gender feminists’, who’ve succeeded in making denial of this principle a sackable offense in many organisations.

      Biological essentialism – Some people are born in the wrong body. Their gender identities are set from birth and are not malleable to psychotherapy (or activism). This gender identity typically takes the traditional forms deplored by gender feminists. This is an article of faith for many trans activists, who’ve made some progress is labelling denial of it ‘transphobia’.

      Thus we have two groups of activists who are seeking not to dispute each other’s positions, but to silence the other side by lobbying organisation to institute penalties for speaking it.

      That’s why Quillette should be taking an interest.

    • Ryan Scougall says

      I’d have to say it likely because it is such a hot button topic at the moment. It tends to use a lot of people’s energy for what may well be the wrong reasons, and having a reasonable counterpoint is worthwhile in the public sphere. I certainly do take your point however, that it seems hopelessly overblown in the media, and that constant reporting of “activism” gets very old.

  2. P e t w r says

    OMG。Heretic! brilliantly written, brilliantly argued。Loved it

  3. Mark says

    It’s time we took back the mental asylum from the patients. I had no problem with the transgender movement until children started to be involved. Not simply involved but indoctrinated by radical gender theory (Safe Schools). The social construction idea now taught in schools across the world is simply devoid from reality. Gender is fluid? Give me a break. What utter postmodern drivel.

    Now it’s time for the grown-ups to take back control. We gave activists a chance, and they endangered children. It’s completely unacceptable to confuse children from a young age. Rapid onset on transgenderism (whatever the term is called) is proof. Children are confused, because they are simply too young to understand what they are being taught.

    We don’t allow children to drive, drink alcohol, vote, have sex until they are old enough to take responsibility for their actions. This is no exception.

    I am tired of this complete rubbish. I will not use your silly gender neutral pronouns, and I will not accept radical gender theory being taught to children. It’s hardly surprising Safe Schools was co-founded by a Marxist. Why we continue to allow radical activists to define curricula is beyond me.

    This is child abuse. Plain and simple. When will we start speaking out?

    • LAW says

      This x100. I’m generally for letting people live their lives. You want to pay someone to mutilate your penis into something that looks like a vagina? Fine, go ahead, though I think that is seriously messed up.

      But now that we accept this, children are being pushed to make irreversible life choices before they’re old enough to vote? That is child abuse, plain as simple. These people have to be stopped.

  4. Watchful Waiting says

    As a parent of a rapid onset gender dysphoric (ROGD) teen girl with comorbid conditions, I couldn’t agree with you more. Thank you for your nuanced insights into gender dysphoria and your explanations of why gatekeeping is essential. It should be framed as a mental health issue, not a human rights issue.

    As you point out, the erosion of gatekeeping in recent years makes cross sex hormones very easy for teens to obtain at younger and younger ages with just informed consent. They aren’t prepared mentally or physically. The general public assumes these teens get extensive therapy or that because the hormones are available so easily, they are tested and proven safe. It couldn’t be further from the truth.

    Some ROGD girls’ desire for hormones becomes an obsession. They falsely believe it will “fix everything” and the hormones become the goal, as opposed to how this will change their life and relationships. In some ways it reminds me of a woman who was so singularly focused on getting pregnant as her goal that she gave little thought to the rest of her life–her marriage, the child, or how her life and body would change after a child was born.

    If anything, gatekeeping should encourage a patient to apply critical thinking to the many angles to this huge life choice, as that should build them up to bear the burdens of life no matter what path they take. It’s the only body you get and you have to take care of it. It rarely becomes the utopia these kids think—it’s just a trade off with what you want to live with on one side or the other. For some, the pros outweigh the cons. But seems many youth don’t know about the trade offs of living on another side until they have done permanent things to their body.

  5. A M says

    I, too, am a transgender person and I agree with much of what is being said here, and it’s part of the reason I hate the frequently-cited “40% suicide rate for trans people”. Being transgender is not what makes one suicidal on its own. It is up to your personal responsibility and honesty to realize what problems you have as an individual, and address them sensibly and carefully and grow to handle them. Transition might be very important for you, but you have other work to do, too. Transition is not something to be trivialized either, and to see so many people muddying the waters for people like me, by doing things such as detransitioning because they went into it without proper introspection, and encouraged by people who are dangerously enabling, rather than truly wanting the best and being supportive _and_ intellectual and thorough into their approach is frustrating to see. Even worse are those that cry “Transphobe!”, at the most minor of transgressions (no pun intended) and try to speak for people like myself. As stated, it is gross.

    As a patient, I also found it made me even more afraid of transition, not being asked to discuss it more in depth with my providers. I have had all the reasons in my head consistently for years and well into adulthood to know I’d be much more comfortable with my being post-transition, but going into it blindly just never seemed wise regardless. I wanted to be the best person I could be pre-transition, so that I could be at ease and know it was only uphill from there without regret.

  6. nan says

    ” … frequently-cited “40% suicide rate for trans people”. ”

    40% of 10 is 4.

    Using percentage is a lie. Real numbers are practically infinitisimal and put things into perspective. Also, the ones reporting having contemplated suicide have been coached this is one of the things they must say to get attention/make their bones with the horde/get funding for surgery.

    Dear Quillette Eds:

    It’s great you keep attempting this topic, but as you can see, your readers have no clue and the reason they don’t is, they are misogynistic MRA’s who do in fact know this affects mostly women, therefore, not their issue. If you are going to continue trying to light a fire here in the middle of the swamp you’re going to have to start from the beginning. Show them why this is their business.

    • peanut gallery says

      Man, you caught me! MRAs everywhere! And Nazi!

      I thought women – men transitions were less frequent? Maybe because it’s easier to remove a dangly bit than to add one. (A strap-on doesn’t count). My understanding is that women are more likely to be bi-sexual. I don’t know if this matters in any context.

      I wish everyone well, do what makes you happy (an bad goal btw), but if someone starts trying to confuse kids beyond their abilities they can go straight to hell. YMMV.

    • LAW says

      Dear nan:

      If your goal is to shame people out of discussing a topic because they are the wrong gender/race/sexuality/etc, you’re probably on the wrong site. Lucky for you, your “brave” position of telling “MRAs” they’re not allowed to speak will be quite well-received on 90% of the internet. Feel free to go elsewhere and pick on men to your heart’s content!

    • Bill says

      Nan, what percentage of the Quillette readership would you say are misogynistic MRA’s, and what’s your sample size? Just curious.

  7. @ nan

    “Using percentage is a lie.”

    True it can be misleading. Like this from you earlier.

    “This issue affects 52 % of the population”

    Wrong on two counts.

    “Also, the ones reporting having contemplated suicide have been coached this is one of the things they must say to get attention/make their bones with the horde/get funding for surgery. ”


    “It’s great you keep attempting this topic, but as you can see, your readers have no clue and the reason they don’t is, they are misogynistic MRA’s ”

    Lol! What all of them?

    • Moon Spirit says

      yes Reading Nomad 10 out of 10 misogynistic MRA’s is 100%. Everyone else is just complicit.

  8. @Mark

    I’m with you 100% on this. It should be deemed child abuse to take them to a doctor and have them diagnosed with dysphoria. Shame on the parents, doctors and everyone involved in this disgraceful behavior.

    This is psychological torture being perpetrated on that segment of society that is most vulnerable. Children naturally role play and act out behaviors that may not match their sex. This is not a reason to psychologically derange hem by telling them they were born in the wrong body. It’s sickening to my stomach that this is exactly what some parents are doing.

    The fact that the SJW cultural marxist agenda has targeted children should cause people to pause and think for one moment….. Good that moment should have been long enough for you to realize the fascistic and disturbing depths of the radical leftist movement, a movement that has worked its way in to the mainstream with impressive speed and without raising too much alarm.

  9. ga gamba says

    There might be a good argument for treatments for children if suicidal feelings and the suicide rate decreased, but it’s been found it doesn’t, so “saving lives” isn’t accomplished. I understand the emotive power suicidal claims have, and there is likelihood some claims are bogus, used to shut down not only opponents’ voices but also those who urge caution. Is it suicide data that ought to determine whether or not medical associations decide to advocate transitioning treatments to minors? A problem arises because getting the most relevant data requires some children to be transitioned, and not many people are comfortable making children guinea pigs. Another concern is the risk medical professionals and may be pressured to not thoroughly explain the downsides to a patient seeking transitioning therapies because it’s deemed unsupportive, and the professional doesn’t want to face public rebuke and professional sanction.

    It should also be noted laws have been proposed, and, if their critics are right, have been enacted in Canada, that threaten to remove children from their parents if they refuse to comply with children’s assertions they are trans and want therapies. I concur that we must not “… let that compassion or love silence you from asking important questions and testing every assumption along the way. There is no room for complacency. No parent should ever be silenced or told what to think on important health issues. Instead, they should know that dialogue and professional oversight is not only warranted but in fact an important part of the gatekeeping process.” Yet, if medical associations have been forced to adopt “listen and believe” policies that don’t have the patient “prove” dysphoria, what then? Will medical professionals be required to report parents they perceive as challenging to the authorities? If the parents themselves disagree on the course of treatment, and this leads to a split in the marriage, how does the court rule on custody? The power of the state is mighty and overwhelming, and it will use its many means to break people emotionally and financially. At what point does the intervention (or intrusion, if you prefer) by the state cross the line?

    Within the trans community there is an interesting tension. On one hand there is the argument that because gender is a manmade construct gender normativity, which includes appearance and presentation, is oppressive and othering. There are those who delight in presenting their gender in intentionally confounding ways, a practice sometimes known as “genderfuck.” I’m sure some of us have read or heard the assertion: “Yes, women can most certainly have penises (and the other male characteristics) and men can have breasts (and the other female characteristics).” We read sad accounts of trans men who still menstruate whilst other news articles celebrate trans men becoming pregnant and birthing children. On the other hand there is the want or need to “pass”, to remove evidence of the primary and secondary sexual characteristics so that it never crosses others’ minds the trans person was born a different sex. Some of the advocacy for children’s transitioning is based on the desire to give them a better chance to achieve this, which is then accused of “privileging cis-normativity”. Golly.

    I think we need to scrutinise the game some in the trans community, in particular the genderfuckers, are playing. They purport to advocate liberty, of the “freedom to just be yourself”, and who can argue with that? They ask for space to celebrate themselves and it’s provided. They want others to join in, explore, and celebrate too. And it happens. Then it goes horribly awry because the people enjoying the fluidy freedom are not doing so exactly in the ways our fluidy freedom fighters deem correct.

    In its current form, Genderfuck has become a space where straight, cis people can displace queerness as the focus of the party, instead wearing it as a costume or mocking it altogether. . . . What was initially intended as a space to celebrate queer identity and to interrogate gender presentation has become one where participants engage in an uncritical costuming, trivializing queer and trans individuals trapped and ridiculed by the rigidity of gender expression in society. It has become a tokenized display of queer presentation. Queerness has been decentered in favor of more privileged groups and expressions to briefly “visit” the queer and trans experiences as a party of mockery and appropriation.

    The anti-authoritarians reveal themselves as authoritarian. It isn’t that they oppose labels and constructs, they oppose ones that fail to privilege their views exclusively.

    One of the former organisers said:”I was starry-eyed imagining what the party could be. . . . But despite my dreaming and my drive, I was not able to change much at all. With little administrative support and near nonexistent student energy, there was nothing I could do.”

    Another added: “… the process [of planning the party] took a significant toll on my mental health.”

    It remains that the very concept and core of Genderfuck actually supports a system that it is trying to break down.

    The cis-heteronormative patriarchy pissed in the punchbowl. Again.

    Mind you, this was merely a party of balloons, tents, music, and, hopefully, a bouncy castle. The Swarthmore students hadn’t even experienced the anxiety of assembling tasty nibbles and the trauma of planning a seating plan where Miss Scarlet was placed far from Colonel Mustard and the deadly candlestick. Perhaps their talents are better suited to toppling society, overthrowing capitalism, upending the legislative and judicial systems, and compelling the medical associations to bend the knee. That’ll be something to celebrate, yeah?

    Or, perhaps people ought to say: “Enough already.”

    • Just Me says

      Lol! Another brilliant post, ga gamba!

      Please keep it up. You are always spot on.

  10. MishMash says

    “Nevertheless, studies have shown high rates of suicide among (alleged) trans people post-medical transition.”

    • MishMash says

      ^ Misreading and misusing Cecilia Dhejne’s study never stops it seems.

  11. Really well written article, a sensible contribution which is needed in the current debate.

    The majority of children choosing transgender identities are girls. If they are confirmed in their identity they are much more likely to go on to take puberty blockers, then 100% go on take cross sex hormones. Testosterone can have a severe negative impact on the female body, the majority will end up infertile.

    We should rarely make decisions that affect our entire lives when we are children. So many of the children transing are gay. Young lesbians or gay males ending up infertile. How is this not conversion therapy for gay children? What about gender non conforming children convinced they must now be the opposite sex?

    We should challenge sexist stereotypes so that men can be feminine and women masculine. We should challenge homophobia so that kids are happy when they realise they like their own sex. We should fully support the rare cases of transsexuals and give them all the help they need.

  12. Thank you, Libby DownUnder. I always appreciate your work to bring back gatekeeping.

    I agree that full consideration of psychiatric suitability is always preferable with such invasive surgery and off-label drug use. And, where minors are involved, screening of parents wouldn’t be uncalled for either.

    The problem is, who screens the screeners?

    The psychiatric profession is so into the weeds on this issue, so at the forefront of the reproducibility crisis, and so responsible for the Rapid Onset Gender Dysphoria phenomenon that put my family through a year of hell and every day is doing the same to others.

    I worry that, even if we succeed in reestablishing gatekeeping as the norm, there will be no one left who can be trusted with the job.

    I hope I’m wrong.

  13. Enough is enough says

    Do we really need to give yet more airtime to 0.1% of the population? Surely their Leftist sycophants are already doing enough for them. Let’s keep Quillette for things that matter please.

    • Just Me says

      This is the cutting edge of the culture wars right now, a major social issue affecting health, social services and education practitioners, and leading to social contagion that affects all children and young people. It is a real and major social issue.

  14. There is an inconsistency at the heart of the trans ideology. Activists claim that gender is a social construct and not biologically based. But in the real world, being trans it is treated as a medical problem: psychological counseling, hormone therapy, surgery, etc. Publicly-funded healthcare systems like the UK and Canada generally only cover treatment for illness and medical problems (not cosmetic surgery like breast enlargement). Unless trans activists want to start admitting that gender dysphoria is a form of mental illness then they should stop expecting publicly-funded treatment for it.

    As for the suicide rate, it kinda suggests that people with gender dysphoria have mental and emotional problems. Maybe the gender dysphoria is part of that.

    I’m not saying that gender dysphoria isn’t real. I’m just saying that it’s not what trans activists claim it is. Surely it is kinder and more effective to address problems based on their real nature rather than ideological doctrine.

    • peanut gallery says

      A lot of it is a progressive power-play. Tans is a minority and a “victim” times two, thus have power. (social) If you can get a brown trans person of minority religion you have a 5X victim level 9000 that is an unstoppable juggernaut in any conversation in a progressive social circle-jerk. All must bow before their “truth.”

  15. Constantin says

    You’ve quoted Laurie Higgins? Oh for gods sake… why? Of all things

  16. O.R.Ange says

    Just a few days ago, a few friends and I were discussing this issue and one of them brought up the historical side of gender dysphoria. My immediate thought goes to occurrences like cross-dressing though I’m sure there are more examples of pre-20th Century Transgender display I just can’t think of them presently. My major question however is how the increase of transgender display is part of the decline in birthrates in the West. It would seem that the greatest definer of our gender roles come as potential mothers and fathers. With a decline in these specific roles the reason to define gender in traditional methods becomes old-fashioned and challenged. We’re bombarded today about how expensive children are and with families having only one or two children, the children become show-models along with people proudly telling that they will never have children. I think the sharp rise of gender activism and the decline of birth rates are correlated. Though I would be curious of other people’s thoughts.

    Lastly, however, the discussion of transgender issues strikes me as so incredibly first world. It’s a discussion that we obviously should have, but with such a small portion of the population being transgender, it seems more of a distraction than an actual issue. I’d be curious about studies coming up about transgender people in the Non-West and among minority groups. As this almost seems like a problem of the wealthy. I only know of one transgender person and they work at Google, presumably making roughly six-figures. Can the average person actually afford surgery?

    • Just Me says


      There are many cultures that have institutionalized a third gender, and the trans activists use this fact to argue this is a normal phenomenon that should be normalised.

      But they conveniently ignore the fact these societies see trans people as a third (or fourth, etc.) gender, often imbued with occult powers, not ordinary, “real women” or “real men”, so they shouldn’t be used to argue that refusing to recognise them as such is “transphobic”.

      The most reasonable stance is to recognize this is a universal, but marginal, phenomenon, and that while our societies should accept trans people as such, it should not try to force people to accept them as members of the gender they claim to be. No other society does.


    • Peter from Oz says

      I think you are right about the correlation between the constant discussion of sexuality and gender on the one hand and the decline of the birth rate on the other.
      It’s all part of what I call the worship of the sterile. We concentrate on idolising the homosexuals, the transgender and the career woman. The instant gratification of the senses is satisified, but pradoxically, the broader well-being of society, which the leftists profess to worry about so much is damaged because we have lost our regular culture amongst a lot of alternatives. Evrybody want to be transgressive, cool and bohemian now. But, as WS Gilbert said: if everybody’s somebody, then no-one’s anybody.
      The answer on the left is for more and more conformity to ”diversity,” the cy of the oikophobe throughout the ages.

  17. Frank says

    “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 conducted exclusively for Guardian Weekend.

    The review of more than 100 international medical studies of post-operative transsexuals by the University of Birmingham ‘s aggressive research intelligence facility (Arif) found no robust scientific evidence that gender reassignment surgery is clinically effective.

    Chris Hyde, the director of Arif, said: “There is a huge uncertainty over whether changing someone’s sex is a good or a bad thing. While no doubt great care is taken to ensure that appropriate patients undergo gender reassignment, there’s still a large number of people who have the surgery but remain traumatized – often to the point of committing suicide.” — David Batty, The Guardian

    • LAW says

      You mean ripping off their genitals and pumping them full of artificial hormones doesn’t make them happy? How could this be?

  18. Homosexuality was demedicalized and decriminalized long ago.

    And soon incest will be, as well (between ‘consenting adults’, of course.) We are in the midst of the flood, friends.

  19. I just can’t muster the energy to read this article or even care about this issue anymore. Things have gone too far. Movements that were once about acceptance are now attempting to redefine what is normal. The more these activists push, the more decent, well-meaning people pull away.

  20. This might sound like an issue for a tiny minority but when bulimia nervous was first identified there were barely enough cases to make studying it worthwhile.

    Within a few years it was a global phenomenon – and that was before the internet.

    Social contagion works fast.

  21. Bab says

    Much of the “research” done on this topic is of very bad quality. The study, for example, which is usually trotted out to say that puberty blockers have no effect on executive functioning of the brain used a sample of only twenty subjects.

    The reasoning of trans activists is often very simplistic and essentialist. Eg, “I have a male brain inside a female body”. Exactly what is a “male brain”, and which point marks the boundary between the male brain and the female body? The dura? Or is it the case that someone has an female or male incorporeal soul, somehow divorced from their biology?

    • The differences between male and female brains is statistical rather than absolute. Even a man who’s brain could be mistaken for a female brain is only a male statistical outlier, not a woman.

    • Bill says

      Impossible to have a male brain in a female body…there’s no difference. Male and Female are just social constructs.

  22. We really don’t know what transgenderism is. The vast majority of young people that identify with the opposite sex as kids go back to identifying with there birth sex by about 18. That alone hints that your almost certainly not born that way. I feel in this day an age its most likely a combination of mental illness and fad. There are actually nutjob progressive parents that influence there kids into it with so called gender neutral upbringings and doing malicious bs like dressing up little boys in princess dresses. Most of the trans that persist past a certain age most likely have deep psychological/mental problems. That is reflected in extremely high suicide attempt rates. I’m all for treating people with respect on a individual level but on a macro level no we can’t expect society to acknowledge what is a lie namely that a man can magically become a woman or vice versa. And actually many of them do want to compel us to acknowledge it. I feel sorry for the author she is living in a fantasy world of her own devise or seriously mentally ill. Neither is a good place to be despite her protestations to the opposite.

  23. Pingback: “Why Trans Kids Need Gatekeepers” – written by Libby DownUnder – Miroslav Imbrisevic

  24. Pingback: The role of the gatekeepers for Trans youth « Quotulatiousness

  25. Bill Chaffee says

    Aside from injury to sexually dimorphic parts of the brain, I don’t see how gender dysphoria could be rapid onset. So called rapid onset gender dysphoria is most likely pseudo gender dysphoria. However it could also be a case of someone who has suffered in silence for years and has just reciently expressed the desire to be the other sex.

  26. Just a few years back when gay marriage was being heavily debated, I scoffed at the conservatives who said it was a “slippery slope” that would lead to polyamory, transgender issues etc. I happily donated to the Human Rights Campaign and was thrilled when gay marriage was legalized.

    And yet, with all my progressive tolerance and (still) genuine belief that everyone is deserving of equality, dignity and basic human rights, I cannot get on board with the “normalization” of transgender. A lifetime of medications, surgeries, potential side effects and complications – shouldn’t we all be able to agree that these steps should be a last resort, not the first line of treatment? And why can’t transgender adults accept that not everyone is like them and that’s ok?

    I do wonder if some of this is driven by the need to keep organizations like Human Rights Campaign in business. Now that homosexuality is widely accepted, they need another victim group to fight for, and what better than the people with high rates of suicide – with a seemingly simple explanation (born in the wrong body) and treatment (fix the wrong body)? If only it were that easy!

    Kudos to the author for speaking out.

  27. Anthony Dorazio says

    “Labeled” has one l, not 2. The rule is you use double consonants when the emphasis is on the last syllable. Like “regret” “regretted.”

  28. แมว says

    An excellent balanced article, thanks for that. For my part, I also think that a truly ‘trans’ person probably does have biological elements engaged as well as the other factors mentioned. I write this being now 60, having transitioned (m-f) in my early 20s. I think to deny a possible biological element could be very short sighted, if not hubristic. After all, we cannot know all things and the phenomenon of trans people, as mentioned, crosses a tremendous multitudes of cultures and times/eras going back many millennia it seems. This makes me believe that there are elements at work that we’re not seeing clearly.

    That aside, and writing from outside N. America, I can’t help but be bewildered as the current state of affairs in the trans world in the west at the moment. Many seem to think that things are much easier and perhaps ‘better’ today for someone to transition in. This surely is true in some ways, but I have to say that there’s a part of me that is glad that I was just able to go about my business on my own (difficult as that was) without the inputs of social media and the general flurry and flapping within the current state of things.

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