A recent response published in The BMJ, titled Safeguarding adolescents from premature, permanent medicalisation, argues that when treating cases of gender dysphoria, “it remains legitimate to listen, assess, explore, wait, watch development, offer skilled support, deal with co-morbidities and prior traumas, and consider use of a variety of models of care. 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…With 85% desistance amongst referred transgender children and increasing awareness of detransitioning, unquestioning ‘affirmation’ as a pathway that leads gender dysphoric patients to irreversible interventions cannot be considered sole or best practice.”
In regard to that 85% statistic, I am someone who is in the other 15%. I am an American born Canadian by choice female-to-male transsexual man. And like the authors of the above-referenced BMJ article, I would promote the use of caution in transitioning children.
I started my transition in 1993 by changing my name and pronouns. I took a year before I began the physical part of my transition in 1994 with hormone replacement therapy (HRT) at the age of 21. I remain glad that I made the choice to transition, and that I took the time I did to ensure that it was not just a phase.
Looking back on my childhood, I can say that I always felt different. I never connected with “girly” things. I related to my male cousins much more than my female cousins and my own sister. I wasn’t interested in typical female play or toys. My parents didn’t look at this as weird. They described me as a tomboy, and accepted me, even assigning me male-sounding nicknames. One of my favorite uncles used to call me “butch,” and I loved it.
My folks were always honest with me with regard to my biology, however. I remember the birds-and-bees talk with my mom. She took the time to answer my questions about puberty and what to expect, and she was thorough. I knew to expect breasts. I knew to expect menses and hair growth. I thought I was prepared emotionally. But I wasn’t.
Once puberty set in and my shape started to change, I felt like my body was betraying me. I knew I was a girl—but I really did not like what was happening, and became depressed. My peers started to treat me differently. They didn’t see me as a tomboy anymore. Some tried to help me adjust socially by helping with makeup and hair. But it never felt right. I usually felt discouraged and alienated.
Alcohol helped—until it didn’t. By my late teens, I knew what a male-to-female transsexual was. And I eventually met someone who was transitioning from female to male. We became good friends and remain so today. He helped me get sober. Meeting him opened up a world that I didn’t know existed. It gave me a vocabulary to describe what I was feeling about who I was.
But I didn’t enter into the decision to transition lightly. I wanted to make sure before I started hormones that I was well informed. HRT was my Rubicon: Once crossed, I was committed to medical transition. So, I socially transitioned for a year before committing to HRT. I wanted to make sure that living as a man was a better fit—and it was. That year was a helpful bridge. And I recommend that other similarly situated people try social transition before medical intervention.
It was also worth taking the time to learn about the various side effects and health risks associated with hormones, as well as the various surgical options. Dr. Michael Laidlaw, a California-based endroconlogist recently co-published a letter in The Journal of Clinical Endocrinology and Metabolism (JCEM) expressing concern about children and adolescents being prescribed hormone replacement therapies, noting that “the consequences of this gender-affirmative therapy (GAT) are not trivial and include potential sterility, sexual dysfunction, thromboembolic and cardiovascular disease, and malignancy.” Amid all the talk of trans rights that one now hears, there is little discussion of such risks.
Most importantly, it was necessary that I had proper mental-health support. In some cases, a therapist who specializes in gender issues may provide the support one needs to cope with such issues without the need for any medical intervention whatsoever.
In both North America and the UK, gender clinics have seen a large increase in referrals of children and adolescents seeking puberty blockers or HRT. I’ve talked to parents who tell me that their child was prescribed such therapies after only a single visit. This strikes me as ethically problematic. As Dr. Lisa Littman of Brown University has noted, peer groups and social media may act as influencing factors in prompting a child to seek transition.
It isn’t helpful when the media describes gender as a sort of glorious free-for-all. There are two genders—male and female. Transitioning in either direction is a long, expensive, invasive and sometimes medically risky process. Embarking on hormone replacement therapies for the rest of one’s life—as well as surgeries, which may or may not yield the results desired—comes with many drawbacks. And no matter what anyone tells you: No amount of HRT and surgical intervention will change biological reality.
Here’s what my own life looks like. I take self-administered testosterone injections intramuscularly every two weeks. I’ve had a full hysterectomy and oophorectomy including removal of the cervix. Additionally, I’ve had a double mastectomy with chest contouring so that my chest has a more masculine appearance. I’ve been happy with the results, and I feel fortunate in that regard.
I do, however, still know that I am not a biological man. I am happy with the fact that I walk through the world being perceived as male. However, biology reminds me every day that I’m not.
I still experience dysphoria with my genitalia. However, I’ve chosen not to have any genital modification because I do not find the options available for a female-to-male transsexual aesthetically of functionally desirable. (For those interested: There are two main options in this regard: Metoidioplasty and Phalloplasty.)
I also know that, as noted above, my HRT carries significant health risks. Testosterone is hard for the liver to process, and can increase both cholesterol levels and blood pressure. It also increases the risk for ovarian and cervical cancers, and is associated with some cardiovascular issues. Of course, there are risks associated with any drug, including many common over-the-counter medications. What’s important is that people understand and appreciate these risks before submitting to any course of treatment—especially one that lasts one’s whole life.
Desistance can be a dirty word to individuals who enthusiastically support the affirmation of children who seek to transition. But it does happen, as Dr. James Cantor and others have documented. Children change their minds often—even about their own emotional needs and identity. My goal is not to cast doubt on the idea of gender dysphoria, but to encourage parents and clinicians to press the pause button before the transition process starts, so that everyone involved is sure that transition is the best course of action.
Here’s something else we need to remember: None of us—cis, trans or otherwise—is totally happy with who they are. And we often seek ways to reinvent ourselves in the process of trying to achieve happiness. Right now, trans is trendy. And being comfortable in your own biological sex (and corresponding gender role) is seen as stodgy. Many kids are internalizing this message and claiming that a trans identity is their inwardly felt truth. There are numerous web resources indicating that many people regret the resulting transition. Their stories often are dismissed because they fly against a popular social trend. But they are just as important as the many media-celebrated stories of affirmed transitions leading to happy endings. An individual should not transition if they don’t need to—which is to say, if they don’t actually have gender dysphoria.
Cisgender—a word I’ve come to hate—is the term many people now use for individuals who are not trans. In some progressive forums, the term now is used as a sort of bullying code-word to shame kids and adults who are okay with their biological sex. As a trans person, this bothers me. We are all social animals who learn how to navigate society as kids. We yearn for acceptance and understanding. We all want to fit in, being encoded with evolutionarily learned thought patterns that equate ostracism with death (as indeed often was the case when one was rejected by one’s tribe in ancient times). In response to such psychological forces, kids can go through phases. But just because your little boy puts on a dress one day does not make him a girl. Once puberty starts, the body begins to change, hormones start to surge, and the child may become more comfortable with their biology—even if that wasn’t the case with me.
Maybe your kid is transgender. Maybe they aren’t. Before becoming their biggest cheerleader for transition—including an avalanche of rainbow flags and thumbs-up hospital photos on Facebook and Instagram—let nature take its course for a while and see what happens.
Gender dysphoria, formerly known as Gender Identity Disorder, is a mental-health diagnosis that “involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning.” As defined in the Diagnostic and Statistical Manual of Mental Disorders, it lasts at least six months, and comes with a number of defined symptoms. The prevalence of Gender Dysphoria is not nearly as high as many activists would have you believe. Indeed, it afflicts less than 1% of the population. The determination of whether someone has this condition requires a qualified mental health professional who specializes in the field. Your kids’ teacher and your own Facebook friends don’t qualify.
I am not a parent. But I do believe that most parents want the best for their children—to protect them, support them, and stand by kids’ own decisions that help them thrive and grow. But it is also the job of parents to keep children safe from harm, including harm that arises from decisions they may not yet be ready to make.
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