I first met Jo and Carol in Manchester two years ago, when I spoke as a clinician on a panel at what is believed to be the first conference dedicated to the issue of detransitioners (people who once presented themselves as transgender, but then decided to live in accordance with their biological sex). At this event, seven young women spoke publicly about why they transitioned, why it wasn’t successful, and how they came to the decision to detransition. All of these women had undergone mastectomies, and some had hysterectomies and even oophorectomies (the removal of both ovaries). They had all taken testosterone, which permanently deepened their voices, and gave rise to new forms of body and facial hair. Although they had experienced much in their lives, none was over the age of 25. As you might imagine, these testimonials were shocking and harrowing.

Jo and Carol both have daughters embroiled in the trans-activist cause. (As at all points in this piece, I am using terms such as “girl,” “boy,” “son,” and “daughter” in reference to a person’s biological identity.) After hearing the detransitioners’ stories, they approached me to ask whether any help could be provided for parents whose lives had been ripped apart by a child’s gender-related distress. As a psychotherapist who has worked with many such families, and as a woman who had my own challenging experiences with gender confusion as a young girl, I agreed that these people needed more help. This meeting led me to become involved in setting up two groups—the Gender Dysphoria Support Network (GDSN) and the International Association of Therapists for Detransitioners and Desisters (IATDD).

The therapeutic work of the latter group is trauma-oriented, as most of the clients we serve are young adults who’ve gone through a medical transition that they regret, and so require a deep healing process. As with the panel members in Manchester, their bodies and their voices have changed, often irrevocably, and it can take time to come to terms with this.

By contrast, work at the GDSN is faster-paced and more intense, as we deal with parents who are urgently seeking to help distressed children confront their emotional challenges before they commit to a full medical transition. We also hold reflective meetings for parents of children who’ve already medicalised—these parents tend to move into a different mental space once their children take cross-sex hormones and begin the process of medical transition.

Since Jo, Carol, and I set up the GDSN a year ago, hundreds of parents have attended our online therapeutic support meetings. And the demand is growing: We run meetings for parents four or five times a week, as well as further meetings for siblings. We are also in the process of rolling out a program for detransitioners. The parents are from all over the world, and from all political camps. Perhaps because Jo, Carol, and I are generally liberal in our political attitudes, however, the majority of parents we serve generally skew progressive and left-leaning. They approve of same-sex marriage, often have marched for gay pride, and have happily waved LGBTQ+ flags.

I note this by way of indicating the self-selection bias at play in regard to the observations that follow. Presumably, more conservative parents seek parent groups that tend to be more politically right-wing than ours.

* * *

The ongoing series of Quillette essays by Angus Fox, When Sons Become Daughters, describes the pain experienced by many parents of trans-identified children. Fox came by these accounts through journalistic interviews, while I facilitate in a psychotherapeutic capacity at parents’ support meetings. Yet our conclusions are similar. Like Fox, I have yet to hear a single truly bigoted remark over the course of my many meetings. “Blindsided” is the most common word parents use to describe their response to a teenage child’s sudden and unexpected announcement that they are transgender. These kids typically are already very troubled, and present with a variety of pre-existing emotional problems. Gender dysphoria often feels like another diagnosis on a list that’s already quite long.

These parents are seeking a deeper understanding of their children’s gender identity. Most are well-educated and -informed, and are put off by simplistic slogans that don’t make much sense. “How can my son be born in the wrong body?” asked one woman. “We’re in our bodies when we’re born … there’s no other option.”

These parents also tend to feel misunderstood and vilified by others around them. In some cases, they’ve been shunned by family and friends simply for expressing concern that their child’s autism, attention deficit hyperactivity disorder, anxiety, depression, and other comorbid conditions might be connected to these sudden expressions of gender dysphoria.

They also feel frustrated when friends casually presume that medical transition is somehow analogous to coming out as gay, an impression that is easy to get from the way that the media covers the issue. Being gay doesn’t carry a heavy medical burden; nor does it require a wholesale revision of years of childhood memories, so that documents from the past accord with newly picked pronouns. Coming out as gay will not risk rendering you infertile, nor will it impair your sexual functioning, negatively impact your heart, or weaken your bones in the way that medical transition often does.

Gender dysphoria is a real condition experienced by those who persistently wish to be the opposite sex. I experienced what would now be described as gender dysphoria as a child from roughly the age of three to 10: During these years, I was loud and proud in my overt desire to be perceived as a boy. But like roughly 80 percent of children who experience early-onset gender dysphoria, I eventually grew out of it. (For a child who begins the process of medical intervention, on the other hand, that figure falls to roughly two percent.) Puberty was difficult for me, but also necessary, as it was through my sexual development that I came to be comfortable in my own skin.

The process of desistance, whereby a trans-identified child comes to no longer identify as the opposite sex, often is viewed by parents as the best option, as it frees the child from life-long medicalisation of their body. But it also runs contrary to the ideologically approved belief in many circles that the best—and, indeed, only—option when a child presents as gender dysphoric is to enthusiastically “affirm” the child’s desire to transition, and to cheer them along every step of that transition.

There is no uniform outcome following transition. Some children end up having surgical interventions, continue to take hormones for the rest of their lives, and live happily ever after. Some choose to stop taking hormones—in some cases because of unpleasant side effects, but still remain trans-identified. Some regret transitioning, but remain transitioned because they believe they’ve passed the point of no return. Still others, as noted, will detransition.

Many trans-identified children say they possess what is now commonly called a “gender identity”—a soul-like quality that exists outside the observable biological realm. Others reject this, and say that gender is a combination of roles, behaviours, and expectations imposed upon us by society. None of this makes for easy conversation.

Those who demand that trans-identified individuals (including children) must immediately have their new identity affirmed typically embrace the unprovable (but also unfalsifiable) idea that we all possess some innate gender identity that is distinct from our biology. Of course, adherents should be free to espouse this understanding of human identity. But in doing so, they too often dismiss detractors as presumptively bigoted (i.e., transphobic). Many parents who reject gender identity theory (as some call it) are agnostics (in the usual non-religious sense), and have difficulty endorsing ideas that seem very much like a new take on the traditional Christian idea that we all possess some divinely imbued spark of identity.

The young people who seek to transition, by contrast, tend to be in a different place. They typically haven’t given much thought to such gender theories. Nor are they usually aware that they are buying into an ambitious and unproven form of ersatz spirituality.

Almost all of the parents at GDSN meetings describe their children as experiencing what Dr. Lisa Littman has termed Rapid Onset Gender Dysphoria (ROGD), which she discussed in a 2018 study of parents’ accounts of teenage children who suddenly announce themselves to be transgender after a childhood in which (in most cases) they hadn’t shown any sign of gender-related distress. In many cases, these announcements are done in dramatic style, by means of a boilerplate manifesto of the type that one may find on the many Internet sites devoted to this movement.

ROGD is not a formal diagnosis, but rather a description of a phenomenon that seems to manifest among a certain, identifiable type of quirky, highly intelligent, isolated, socially awkward teenager. The growth in the numbers is startling. For example, there was a 53-fold rise in the numbers of (biologically) female children presenting at the Tavistock Gender Identity Development Service in the UK over the last decade. Nobody knows exactly why so many lonely children with this particular personality type are seeking transition. But to some extent, simple behaviourist principles are at play: children who announce as trans often find themselves the focus of positive attention and support within the same Internet communities that encouraged them to transition in the first place (and typically provided them with the road map for doing so).

At the GDSN, we try to nurture a non-judgmental atmosphere at meetings, so that parents feel free to discuss fears about their beloved kids. Unlike children with early-onset childhood dysphoria (that is, who presented as gender non-conforming from an early age, as I did), ROGD kids tend to have other conditions that, even on their own, are difficult to manage. These parents wish to understand why their children would suddenly come to believe that transition could be the answer to all of these complex and intractable problems. As noted above, the parents I’ve dealt with are typically liberal themselves, and so these meetings often will feature them grappling with what they regard as their own internalised bigotry, privilege, and so forth.

Hovering over everything is the ideologically-mandated insistence (often by a child’s educators and therapists) that most or all of their children’s problems can be chalked up to the difficulties associated with inhabiting a transphobic society—a claim that casts the parent as villain (or even oppressor) if he or she responds in any way that is not seen as instantly affirming of a child’s newly announced demands. The parent must either accede to this judgment and pretend to endorse a course of treatment that he or she knows is wrong, or speak up and thereby go to war against his or her own child (not to mention that child’s entire enabling ecosystem of supporters).

I should emphasize that ROGD children tend to follow different paths than those followed by children with early-onset childhood dysphoria. Experts in gender non-conforming children have pointed out that, in the latter case, “the whole town” usually can observe that the child is non-conforming. Many of these gender non-conforming kids could be described as “pre-gay,” as they often end up being gay, lesbian, or bisexual as teenagers and adults.

* * *

The difference between sexual orientation and gender identity is an important one. Being gay refers to the nature of a person’s outward sexual attraction—whether toward male bodies or female bodies—while being transgender refers to an internally felt condition that has no uniformly exhibited behavioural characteristics. The popular confusion over this difference is one of the reasons why parents at our meetings are so concerned. Many suspect that internalised homophobia has driven a child to repress their sexuality (which is real and unchangeable) in favour of gender identity, which operates on the basis of self-declaration.

After all, a closeted gay boy who announces as a trans girl suddenly becomes (nominally) straight. “I’m fully sure my child is a butch lesbian,” said one mother, “but she is 13 years old and just isn’t ready to own this yet. Her sexuality hasn’t fully flowered, and she thinks lesbians are disgusting. It’s much cooler to be a brave trans kid than a clichéd butch lesbian.”

As the GDSN meetings unfolded over the last year, it became clear that there were distinct differences between the manner in which ROGD boys typically present, as compared to ROGD girls. It was for this reason that we decided to provide two different meeting schedules, one for parents of boys and another for parents of girls. As Fox noted in his reporting, ROGD boys seem to be drawn to a sense of self-understanding whereby they feel encased by softness, gentleness, and other attributes that are stereotypically associated with being female. Prior to declaring as transgender, many such children were teased as shy “momma’s boys.” The ROGD girls, by contrast, often tend to hunger for power, strength, and confidence.

One enormous irony at play here, in fact, is that while the concept of gender identity is presented as a highly progressive phenomenon, it is largely animated by a stereotypical 1950s-era understanding of what it is to be a man or a woman. And it is notable that many older men who come out as transgender in middle age will often embrace an aesthetic that is typical of their mothers’ (or even their grandmothers’) fashion era.

There are other differences between the two groups, as Fox notes. At our meetings, the average age of the ROGD boys being discussed is 18, while the average age for the girls is 14. In practical terms, this makes a big difference, as anyone who is 18 or over can begin medical transition without a parent’s permission.

The girls also tend to exhibit the same preoccupation with appearance as non-trans girls, except in inverted form. While many girls of a certain age wouldn’t dream of leaving the house without carefully applied makeup, some of these girls feel uncomfortable leaving the house without a binder—a tight, constrictive piece of fabric that winds around a girl’s body and flattens her breasts. (Generally speaking, breasts can be a source of deep shame for ROGD girls—far more than the actual genitals. And some parents, having read up about the dangers associated with testosterone treatments, have encouraged their girls to get a mastectomy rather than take such drugs.) Likewise, the proper shoes, sweatshirts, jeans, hair style, and even toiletries become an important part of exhibiting a stereotypically casual male teenage look. Ironically, these self-described trans boys exhibit an attention to detail that would be alien to most biological boys. They tend to perceive gender as performative and spare no effort to stay in character.

ROGD boys, too, can tend toward performative flourishes, though this more often is manifested through the creation of (sometimes unsettling) online communications that garner support and attention within their digital subcultures. In general, they tend to be more forward-looking, and less inclined to show an interest in the aesthetic fripperies of gender. In their view, they are transwomen, full stop, and so need access to hormones as soon as possible. Some of them don’t want to mess around with nail polish or makeup.

At this stage, the boys can be terrified of attracting too much attention—although, later on, when they begin their medical transition, they sometimes begin to revel in it. It can be a two-stage process. For some ROGD boys, the female paraphernalia at first feels too much like a fake act. What they want is access to real therapies that will physically transform them in a way that aligns with their desires. Once that process begins, they sometimes will shift to a performative style, and come around to the view of many ROGD girls that clothes, shoes, hairstyle, deodorant, and other superficial elements are what maketh the man or woman.

As one examines these cases over time, there is sometimes a quantum shift in the degree to which the child will go public with their trans identity. ROGD girls, in particular, might keep their transgender identification a secret, or confine the knowledge to a close circle of friends. At this stage, they might ruminate at great length about their “true” gender identity, trying to figure out whether they are non-binary, genderqueer, trans-masc, or any of the dozens of other fissiparous gender classifications. Yet part of them also longs to become publicly vocal about their newfound identity—as many, in fact, do—so that they can encourage others to come out publicly, experience a sense of belonging and camaraderie within their newfound tribe, and do their part to fight (as they see it) the transphobia that suffuses society.

Like everyone else their age, these children seek answers and advice online. As Fox notes, this can lead to the child becoming alienated from his or her parents. This is because members of self-styled trans-support communities often persuasively present themselves as having the child’s true interests at heart—while mothers, fathers, and siblings are said to have nefarious and transphobic motives.

The sexual histories of these teenagers can be obscure. The parents I have spoken to are often struck by the way in which their trans-identified children seem uninterested in sex (and may even find the topic unmentionable), even though these are typically liberal households in which candid discussion of sexuality, straight or not, is encouraged. Whether this arises from a deep-rooted sense of shame or from a repressed libido remains unclear.

Many ROGD girls in their mid-to-late teens seem to have never been kissed (or wanted to be kissed). When they find a boyfriend or girlfriend, there seems to be little sexual interplay, but rather a lot of talking about sex. Some parents assure me that their boys have not yet developed sexually. But other parents observe the opposite phenomenon: Their children’s online history betrays endless forays into obscure fetish-porn communities—including the variant sometimes described as “sissy hypno,” in which men in lingerie are forced to submit to feminization rituals. Some of the boys, who describe themselves as lesbians, will seek to engage in elaborate forms of sexual interplay with older transwomen. They also tend to be deeply enmeshed in fantasy subcultures such as Japanese anime, whose narratives and characters they adapt in symbolic ways.

These kids appear to be desperately unhappy, and it isn’t surprising that many are searching for a simple answer to their distress through medical technology. As one parent asked, “Is there anything more alluring in life than to be told, ‘Take this medication and you can leave yourself behind, leave behind your old identity, and become a completely different person?’” Even in the period that precedes medical treatment, the child can take some superficial solace in the belief that his or her anxiety and depression is caused by external hatred imposed by non-trans individuals, as opposed to internal issues that will be challenging to resolve.

The ideology itself, in other words, provides a psychological means of externalizing a child’s negative emotions. Many boys will spend long hours in the bathroom, removing their body hair, while ROGD girls dream about the day when they will have a strong jaw and a beard. Either way, there seems to be an expectation that these rituals, if conducted with sufficient care and dedication, will provide some quasi-mystical form of deliverance from their pains.

* * *

So what should parents be doing to help their gender-questioning children? First of all, they should tread carefully, slowly, and compassionately. There is no high-quality medical evidence to support aggressive medical intervention as a baseline response. Indeed, there will rarely be any sort of grandiose one-size-fits-all solution—and that includes a solution involving flatly denying the child’s dysphoria.

It is wiser to treat this as a long-term process that may take years to resolve itself (as most cases do). A much-repeated mantra in our GDSN meetings is “heavy on boundaries, heavy on warmth,” meaning that the parent needs to be clear and consistent with the behavioral boundaries they do impose (in regard to what sites the child can visit, or what they can post online, for instance), while also placing a strong emphasis on love and affection. It is very lonely to be a misunderstood teenager. Even the knowledge that parents have tried to connect, albeit in a clumsy or unsuccessful way, can ease a teenager’s sense of isolation.

Although parents are generally in a rush to find the best therapist, there is a shortage in the field, as there are few therapists who are well-informed about gender issues. Sending your distressed child to a professional who is poorly informed, or who reacts to your child’s case with a simplistic perspective, may do more harm than good.

Moreover, some of the most useful advice I give parents is basic, and doesn’t require clinical supervision: Don’t forget the importance of sleep, nutrition, exercise, and the development of high-quality friendships in a child’s life. In some cases, simple improvements such as these can help a child realize that identity issues connected to gender don’t always lie at the root of his or her unhappiness.

It is essential that parents involve themselves in their children’s online behaviour if they are to gain an understanding of the underlying emotional distress. This may feel like snooping in some cases. But never before have young, naïve children had access to such a vast pool of misinformation, nor so much exposure to manipulative actors. Even as adults, many of us are living in echo chambers that read back to us our attitudes. So imagine how this process can play out for a teenager who lacks self-awareness and is desperately looking for someone to provide positive reinforcement.

More generally, it’s important that parents honour their own instincts, even as they honour those of their children. One of the unfortunate themes encoded within prevailing ideologies surrounding gender is the idea that parents are entirely ignorant—and in many cases, even actively malevolent—in regard to a child’s basic identity. The most strident gender ideologues try to convince sceptical parents that they are bigots who must reform their attitudes, lest they drive their child to further sorrows, or even suicide; and that all their parental observations and opinions about their sons and daughters, developed over many years of parenting, suddenly become void once a child announces new pronouns.

It’s a form of gaslighting, in other words, and one that works particularly well on liberal parents who already are predisposed to castigate themselves for any number of ideological sins. One of my jobs is to help convince these parents not to succumb to this process of denigration, which can cause them to feel incapable of performing their parenting role. In the end, parents must always listen to their children. But when it comes to choosing the correct path forward, the parent’s voice is also valid and important.