We are very pleased to publish this submission from Lucinda Stoan. She is a social justice activist in Washington State in the US. Redline published her detailed and comprehensive source-linked overview of trans issues and what is at stake in December 2019. This was followed by an article on cancellations at the Seattle Library in January 2020. Lucinda is using a pseudonym to protect her job and her ability to speak on environmental issues.
There has been an exponential rise in recent years of children declaring themselves to not be the biological sex observed for them at birth.[i] They say they “feel like” and therefore “are” the other sex, or in some cases a mythical sex beyond male or female, or no sex at all.
Teachers, parents and others are told that it is vital to affirm children’s self-declared identities and their “transitions” through which they become their “true selves.” Transitioning will supposedly help children lead happy lives and keep them from killing themselves.
But those claims are not backed up by credible scientific evidence. Transitioning may actually increase the risk of self-harm and perpetuate feelings of unhappiness and gender dysphoria.
Moreover, transitioning causes real physical harm to children, much of it irreversible. This article provides an overview of the ways in which transitioning damages children’s bodies and their health.
When children “socially transition”, they publicly announce a new “gender identity,” disavowing the sex observed for them at birth. Teachers, parents and others are asked to affirm whatever children declare. New pronouns are to be used and children are to be allowed into sex-segregated spaces and programs based on their feelings rather than biological reality.
Most of the things children do as part of socially transitioning don’t directly cause them physical harm. There is one important exception, however: breast binding. The practice of severely compressing breasts is widely practiced by girls who wish to be boys or “non-binary”.
Binding is regularly treated as a benign activity to be supported by teachers, parents, and other adults. Public libraries have even been known to raffle off binders as part of Pride events.[ii] And some universities make free binders available to their students.[iii]
But breast-binding is not benign, and it should prompt concern rather than praise among adults responsible for girls’ wellbeing.
Even websites promoting breast-binding acknowledge the damage it does. “Prideinpractice.org” refers to shortness of breath, skin damage, musculoskeletal damage, rib bruising and fractures, overheating, and lung damage.[iv] A 2017 study by researchers at the Boston University School of Medicine found that 97.2% of a group of 1800 women who bound their breasts, reported at least one negative physical symptom, such as back pain, overheating, chest pain and shortness of breath. Other symptoms included numbness, bad posture, and lightheadedness.[v]
Accounts from those who bind their breasts and from the adults who care for them are sobering.[vi]
A 17-year-old who has bound her breasts daily since age 13 describes maximizing compression by buying a binder one size too small and wearing it at night. “My arms and hands would feel numb and tingly off and on,” she says, “from how tight the material was around that area.” Removal of the binder revealed skin that was “severely chafed and raw.”
Tami Staas, president of a Trans Youth and Parent Organization in Arizona notes that her 12-year-old daughter “had trouble in gym class and breathing trouble.” According to Staas, “[I]t was like trying to run a marathon in a tight bustier.” Using male pronouns for her daughter, Staas says “It was difficult to watch him cause himself physical pain in order to be comfortable in his own skin.”
Brie Jontry describes how her daughter stopped running, rock climbing, backpacking, and swimming, when she started binding. “We would go for our evening walk and she would get winded and dizzy,” Jontry says. “She stopped climbing trees. She stopped doing things where any degree of upper-body flexibility was important.” Binding, Jontry says, “encourages the idea that people’s distress and anger and trauma should be turned inward toward their own bodies instead of outward toward the culture that feels oppressive to them.”
Many medical associations are turning a blind eye to the harmful impacts of breast-binding. The American Academy of Pediatrics advocates a “gender affirmative care model” and takes no official position on binding, for example. Thus, instead of receiving guidance from adults that steers them away from self-harm, and that enables them to participate fully and safely in physical activities like sports, girls are being affirmed in self-harming and self-limiting behaviors.
Breast-binding causes immediate physical harm to children. It also puts them on a path to medicalized transition, which causes further physical harm. Most of the binder-using patients of Dr. John Steever at Mt. Sinai Adolescent Health Center in Manhattan tell him “the next things they want to do, like testosterone, mastectomy and maybe phalloplasty.” (Phalloplasty is a multistage surgery that irreversibly damages female genitals and creates a fake penis.)
Other social transition measures, such as insisting on different pronouns, don’t cause immediate physical harm to children. They do, however, prime children for medical transitioning which does directly and severely harm them. Having been told for years that they truly are the other sex, children are unlikely to become comfortable with their actual bodies. Instead they sign up for drastic medical interventions to alter those bodies.
Puberty Blockers: Background Puberty blockers are chemicals given to children to prevent their bodies from going through puberty. They include “Gonadotropin-Releasing Hormone agonists” (GnRHa) and “Luteinizing Hormone-Releasing Hormone (LHRH) agonists”, more commonly referred to as triptorelin and leuprorelin. In the U.S., leuprorelin branded as “Lupron” is what’s generally prescribed.
These puberty blocking chemicals were first developed to treat prostate cancer in men. They are also used to treat endometriosis and uterine fibroids in women where use is limited to 6 months. These same chemicals have been used to chemically castrate sex offenders.
Lupron and other puberty blockers are licensed for blocking precocious puberty in children— that is, puberty happening in girls under 7, and boys under 9. They are “off-label” and not licensed for blocking age-appropriate puberty.
Doctors first used chemicals to halt normal puberty in the Netherlands in 1998, prescribing blockers to a 16-year-old girl who wished she was a boy. Over time, doctors there prescribed blockers to more and more children at younger and younger ages. The “Dutch Protocol” entails prescribing puberty blockers at age 12 (Tanner Stage 2 of development), cross-sex hormones at 16, and surgery at 18. This protocol was developed by scientists who received financial support from Ferring Pharmaceuticals, a manufacturer of puberty blockers. Under the Dutch Protocol, only children who’ve experienced childhood gender dysphoria that worsens at puberty are supposed to receive blockers. Their families must approve and the children must have no other mental health problems.
These limits have not been adhered to in other countries. Puberty blockers are prescribed to children as young as 10 and to children who have only recently expressed discomfort with their sex. And the presence of various mental conditions doesn’t stop doctors from prescribing them.[vii]
Puberty Blockers: Long-term Impacts on Sexual Development
Gender ideology organizations and the clinics they influence have long declared that the impacts of puberty blockers on sexual development are completely reversible. These claims are fabricated out of thin air.
The FDA has not approved Lupron or similar drugs for blocking normal puberty. There haven’t been any randomized controlled studies for such use. Moreover, there’s plenty of cause for concern about long-term impacts.
If puberty proceeds, in males the penis enlarges, has erections, and becomes capable of ejaculation. Mature sperm are produced, which can fertilize an egg. In females, the labia, vagina and uterus develop, and breasts develop and mature. Ovulation begins, and an egg capable of being fertilized is released during each menstrual cycle. Puberty blockers bring all of this to a standstill. Children’s bodies are “frozen” in whatever developmental stage they’d reached when blockers were first used.
Doctors assure children and their parents, that if they decide to go off the blockers, they’ll seamlessly commence puberty. The process will be unfrozen, and the impacts of having blocked puberty will be reversed. But is that really the case? Will children be able to catch up with the sexual development their bodies would have had? Will their genitals and gonads ultimately look and function as they would have in the absence of puberty blockers? The answers to these questions are not at all clear. And the longer a child stays on blockers, the less likely it is that their body will ever develop as it would have in the absence of medical interference.
Further doubt is cast on claims of reversibility by pharmaceutical tests of Lupron used in treating endometriosis in women and prostate cancer in men. These have shown pituitary impairment long after administration of the drug ceases. Dr. David Redwine found in an exhaustive review of the raw data from the manufacturers of Lupron that “62.5% of patients had not regained baseline estrogen levels by one year after stopping Lupron.” In a study of adult males using Lupron for prostate cancer, scientists found that the median average for testosterone levels to return to the normal range, was nine months. Two full years after ceasing Lupron use, a full 26% had failed to regain normal testosterone levels. [viii]
Puberty Blockers: Impacts on Bones
Children treated with puberty blockers end up with dangerously low bone density as compared to their untreated peers. This long-predicted impact has now been documented in a study of children at the Tavistock gender clinic in the UK.
When forced to finally publish some of their findings, researchers disingenuously emphasized that puberty-blocked children experienced no drop in bone density. They implied that simply maintaining density during adolescence is a good thing. It’s not.
“Bone density should NOT BE MAINTAINED during adolescence. It should be BUILDING,” endocrinologist Michael K. Laidlaw explains. “This ‘treatment’ with puberty blockers is leading these adolescents to a much higher risk of early osteoporosis and fractures.”
According to endocrinologist William Malone, “Humans acquire more than half their bone density they will ever have during their teen years. This is the most critical time for long term bone/skeletal health.”[ix]
In the Tavistock study, after two years on puberty blockers, significant percentages of children had bone density levels of clinical concern. An analysis of the data by Dr. Michael Biggs found that for the hip, one third of the children had very low bone density scores (Z-scores below -2.) For the spine, over a quarter had very low scores (below -2, with some even below -3.)
Despite the impact of puberty blockage on bones, Tavistock did not collect data on fractures for children in its care. Biggs heard of one patient who started blockers at age 12 and had 4 broken bones by age 16. If that child’s Z-score was below -2, that along with the history of fractures would meet the diagnostic criteria for pediatric osteoporosis.[x] Nor is there any tracking of long-term impacts after children become adults.
Female pelvic development during puberty affects women’s child-bearing capacity and experience. Estrogen changes the shape of the pelvis, allowing room for a baby to pass through the birth canal. “[T]he female pelvic inlet and outlet become wider and more oval-shaped, the pubic arch develops a significantly wider angle, and the sacrum (or tailbone) becomes less angled so as to not get in the way of the pelvic outlet.”[xi]
It is not known whether restarting puberty after halting it for a period of time will result in a fully developed female pelvis which optimizes the ability to give birth. If the female pelvis does not fully develop, both mother and baby can be at increased risk during birth. Complications can involve oxygen deprivation for the baby, which can be fatal. Mothers with pelvises that are not fully developed risk infection, postpartum bleeding, uterine rupture and obstetrical fistula.[xii]
Some proponents of puberty blockers suggest that children may catch up on bone density when they stop using the blockers. But, as Dr. Laidlaw points out, “We do not know if there is an endpoint to the window of time in which puberty can take place. In other words, if one stops normal puberty at age ten and then allows it to be begin again at age fifteen, we do not know if the signaling mechanism will return fully. There is evidence to suggest it will not.”[xiii]
Puberty Blockers: Impacts on Brain Development
Brains develop during puberty as well. But doctors prescribing puberty blockers to young patients have been flying blind regarding potential impacts on cognitive abilities. And they have failed to track their young patients’ mental capacities over the course of treatment and beyond.
Doctors in Brazil did gather cognitive data for one boy in their care who was put on puberty blockers at age 11. A reduction in Global IQ (GIQ) was observed. “At the end of 28 months of treatment, speed processing and memory remain lower than before GnRHa treatment,” they reported. The patient “presented a decrease in their overall intellectual performance after the onset of pubertal block, pointing to immaturity in her cognitive development.” (Note: the authors used the pronoun “her” despite the fact that the child is a boy.) The authors note that the intelligence tests they used are grounded in “a theoretic and practical presuppose that intelligence grows between the ages of 8 and 16.”[xiv]
These findings are consistent with other human research cited by the study’s authors. They are also consistent with findings in animal studies—the kind of studies that are generally done, given ethical concerns regarding medical research on children.
Researchers from Glasgow University teamed up with Norway’s leading gender identity clinic in a study that compared the performance of sheep in a complex maze which they learned to navigate in order to get food. The “teen-age” sheep who were not given puberty blockers easily found their way through the maze after an absence. Those who were given puberty blockers did not; their spatial memory was impaired.
While the researchers focused on the impacts of puberty blockers on memory, they also noticed distinct emotional impacts. Rams given puberty blockers were more emotionally reactive after blockers were stopped than rams that were not given them. The scientists concluded that “perturbing normal hippocampal formation…may also have long lasting effects on other brain areas and aspects of cognitive function.”[xv]
Chemical interactions in adolescent sheep are comparable to those seen in humans, as is the sort of rewiring that happens in sheep’s brains during adolescence. Intelligence and body mass also make sheep a good species for assessing the potential impacts of puberty blockers in humans.
The implications of negative impacts on brain development are enormous. Reduced IQ, impaired memory, and emotional reactivity can all undercut a child’s ability to learn and function well in the world. There may also be adverse effects vis a vis a child’s gender dysphoria. While most children overcome dysphoria when they go through puberty, those for whom puberty is blocked remain convinced that their sex is not real or appropriate for them. Preventing maturation of children’s brains may trap them in dysphoria. It may deny them the mental maturity to understand and accept the biological reality of their bodies.
Puberty Blockers: Impacts on Social Development and Desistance
Children put on puberty blockers remain immature as their peers go through a normal rite of passage: growing up. This can have serious negative social, psychological, and emotional impacts.
If children feel out of place already due to gender dysphoria, they are not likely to feel less so, as peers develop, and they don’t. Moreover, the message a child internalizes from the puberty blocker experience is fundamentally one of disempowerment. Influential adults could assure children that they have the fortitude to grow and could guide them through the changes and challenges of puberty, but instead they confirm children’s insecurities. They say that “the other children are growing up, but you’re not ready. Other kids make it through okay, but it’s just too hard for you.” The natural process of puberty is cast as something dangerous, harmful, and frightening.
The longer puberty blocking goes on, the more out of place the child on blockers will feel. They remain children in a world of young adults. They retain a child’s view of others, while their peers experience sexual sensations and relationships.
The failure to grow physically, emotionally, and socially is likely linked to an important negative outcome of blocking puberty: it virtually ensures that gender dysphoria will persist. Most gender dysphoric children given a chance to go through puberty end up desisting.[xvi] They become comfortable with their sex. Most who go on blockers move on to other medical interventions.
Gender clinics assure families that puberty blockers are like a “pause button” a child can push to have a little more time to figure things out. But puberty blockers aren’t a Pause button. They’re an “All Systems Go” button for on-going, long-term medicalization.
Most children who take puberty blockers move on cross-sex hormones. These generally include, but are not necessarily limited to, testosterone for females, and estrogen and anti-androgens for males.
Endocrinologist William Malone and others warn that it is inherently risky to deliver hormones to children and adults in concentrations for which their bodies are not designed. Trans-identifying people are guinea pigs in a huge uncontrolled experiment. We already have strong indications of some of the problems that can arise.
Heart Attacks, Strokes, and More
Trans-identifying individuals who receive cross-sex hormones have increased risk for cardiovascular events, including strokes, heart attacks and blood clots, according to a study published in 2019 in the American Heart Association’s journal Circulation.[xvii]
The study analyzed medical records of 3875 Dutch individuals given hormones for transitioning between 1972 and 2015. Trans-identifying males were followed for an average of 9 years after starting hormone therapy; trans-identifying women for an average of 8 years. The men (aka “transwomen”) had more than twice as many strokes as women, and nearly twice as many strokes as other men. They had five times as many deep-vein clots as women, and 4.5 times more than other men. Heart attacks happened at more than twice the rate among the trans-identifying men than women. As for women identifying as men, they had a more than three-fold elevation in heart attack risk compared to other women.
Previous studies provide clues as to mechanisms that may be involved in these elevated cardiovascular risks. Triglyceride and insulin levels both increased as a result of estrogen therapy in previous studies, and both are known to promote clogging and inflammation of the blood vessels. Estrogen therapy can also make the blood more prone to clotting, which could explain higher rates of strokes and blood clots among men who take estrogen.
In a review of the book, I Am Jazz, endocrinologist Michael Laidlaw lists some of the adverse health effects associated with cross-sex hormones.[xviii] “Males taking female hormones are at high risk for blood clots, which may be fatal if lodged in the lungs. They are also at increased risk for breast cancer, coronary artery disease, cerebrovascular disease, gallstones, and high levels of the lactation hormone prolactin.” According to Laidlaw, “Females taking male hormones are at high risk for erythrocytosis (having a higher than normal number of red blood cells). They are also at increased risk for severe liver dysfunction, coronary artery disease, cerebrovascular disease, hypertension and breast or uterine cancer.”
PUBERTY BLOCKERS PLUS CROSS-SEX HORMONES
Puberty blockers and cross-sex hormones can significantly impair sexual function. Those who have been chemically treated may find it difficult or impossible to have orgasms.
Jazz Jennings, protagonist in the I Am Jazz book used in many schools, was left with a child’s penis as he entered adulthood. This led him to undergo additional surgeries to create a fake vagina because there was not much penis to work with. (In typical surgeries skin from the penis is used to line the fake vagina.) It also affected his ability to experience sexual sensations. Jazz told his doctor “I haven’t experienced any sexual sensation.” Regarding orgasms, he noted that he hasn’t experienced one. As Dr. Laidlaw puts it, “for adolescent males similar to Jazz who are receiving puberty blockers, I can see little to no sexual function occurring either now or into adulthood.”[xix]
It is widely acknowledged that children who are given puberty blockers and cross-sex hormones will likely be rendered sterile. It is also well understood that children cannot grasp the implications of destroying their fertility. As they begin their chemical treatments, few have much understanding of what sexual intercourse entails.[xx]
Dr. Laidlaw explains that “because of puberty blockers, Jazz’s male genitalia are stuck at Tanner stage 2. The estrogen he is receiving will allow for breast development to the level of an adult female. However, his testicles are unable to produce sperm capable of fertilizing an ovum. In fact, it is not even possible to store sperm for use in future fertility, because it has never been given the opportunity to develop within Jazz’s testicles.”[xxi]
Changed Bodies and Voices
Transitioning leads to many other changes in a person’s body which may be permanent. Women who undergo treatments to appear male may always have extra facial hair, deeper voices and other long-term impacts even after detransitioning, for example.
Many who take puberty blockers and cross sex hormones go on to surgically altering their bodies.
Euphemisms obscure the true nature of the major surgeries young people are undergoing to alter or totally remove healthy body parts. “Top surgery” is a euphemism for mastectomies. Girls and women who receive “top surgery” have their healthy breasts cut off.
“Bottom surgery” for males includes dissecting the penis and other major body alterations. If a fake vagina is constructed, a dilator is placed in it after surgery to keep it from collapsing. For women, bottom surgery can involve hysterectomies (and the early onset menopause that can go with that), removing the ovaries, and major alterations in the urogenital area.
If a male has a tiny penis due to puberty blockers preventing its development, he likely will not have enough skin to line the fake vagina. Options for dealing with this include using a section of the intestine along with the penis skin to make the fake vagina.
The surgeries mentioned above provide only a glimpse at the wide range of highly intrusive operations young adults are undergoing in an attempt to present as the opposite sex. In addition to surgeries focusing on secondary sexual characteristics and gonads, people can sign up for facial feminization surgeries, tracheal shaves, voice feminization procedures and more.
The impacts of these surgeries are formidable and irreversible. When genitalia have been altered, breasts have been removed, faces have been restructured, or other surgeries have taken place, there is no going back. Reversal surgeries can be attempted in some cases, but a person’s body can never return to what it would have been without surgery.
Nor will a surgically altered individual be able to regain sexual functioning that has been lost, or the ability to have biological offspring. By removing testicles, ovaries, and the uterus, young people render themselves permanently infertile.
While sex reassignment surgeries are not legal for people under 18 in some jurisdictions, parents may opt to take their children to other locations where such regulations do not exist. Susie Green, head of Mermaids in the UK, took her son to Thailand for surgery.
In any case, plenty of people under 18 are receiving sex reassignment surgeries.
Look at the chart below from a May 2018 article in the Journal of the American Medical Association.[xxii] Notice the significant number of children under 18 who had had surgery, including many children under 16.
Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults, Comparisons of Nonsurgical and Postsurgical Cohorts
This graph was featured in an article about a 16-year-old girl named Penny who had her breasts removed at age 15.[xxiii] She launched a GoFundme page to try to raise money to try to reverse her double mastectomy.
Penny is one of countless young people who regret the irreversible damage done to their bodies by puberty blockers, cross-sex hormones and surgeries.
It is painful to read the words of people regretting their decision to undergo surgeries. Consider this man on a subreddit in 2019, regretting the impacts of sex reassignment surgery done in 2016. He titled his post “Suicidal thoughts. 3 years post-op SRS and still having discharge and pain.” The discharge and pain came from his “neovagina.” “Orgasming is very difficult these days and when I do I feel less than half of what I used to feel down there,” he notes. Dating is described as very difficult, with people turning him down when they hear about him having a neovagina. “I find life very draining these days. I have to clean my vagina with isobetadine to keep smell away and to keep the discharge at bay. I have to dilate once a day still because if I skip days it becomes painful and the tissue feels so sore. I feel like I’m completely on my own on this.” This distraught individual notes that he’s been crying himself to sleep almost every night for a couple of weeks.
See the link in the endnote[xxiv] for an even more horrifying story, this one from a woman who underwent surgery to create a fake penis. The surgery did not go well.
Anyone encouraging children to be on a path that may lead to sex reassignment surgery, should look at photos of what happens in those surgeries. They should read about what surgically-altered individuals experience in recovery and over the course of their lives. They should study the complications that can occur and what those mean for the men and women involved.
FAILING TO ADDRESS UNDERLYING PROBLEMS
There is another harm that comes from affirming children’s gender identities and putting them on a path of social and medical transitioning. Underlying causes for disliking one’s sexed body are not examined. As a result, children don’t receive the help they need.
It is widely acknowledged that gender dysphoric youths are at high risk of having mental health problems, such as depression, suicidality, self-harming behaviors, and eating disorders.[xxv]
- A review of the UK’s Tavistock gender clinic by former staff governor Dr. David Bell, a psychiatrist, found that some children “take up a trans identity as a solution” to “multiple problems such as historic child abuse in the family, bereavement, homophobia, and a very significant incidence of autism spectrum disorder.” [xxvi] The review said that the Gender Identity Development Service (GIDs) was failing to fully consider psychological and social factors, such as whether a child had been abused, suffered a bereavement or had autism, all of which can influence decisions about whether to transition.[xxvii]
- According to Sven Roman MD, a specialist in child and adolescent psychiatry, “[r]esearch shows that at least 75 percent of patients with gender dysphoria have other psychiatric problems. In the group of children and young adults, autism, eating disorders, self-harm behavior and abuse are common. For all these conditions there is evidence-based treatment. Given such, gender dysphoria often disappears, as it is usually secondary to these conditions.”[xxviii]
- A 2021 study found that young people with gender dysphoria had childhoods characterized by at-risk attachment patterns vis a vis caregivers and high rates of unresolved traumas and loss. The study compared gender dysphoric children to other children receiving medical care for psychiatric disorders. Both groups had similarly high rates of at-risk attachment patterns and unresolved traumas and losses.[xxix]
This study contradicts the “minority stress model” which underlies gender identity proponents’ insistence that families and schools must affirm children’s gender identities. That model posits that poor mental health status among trans/non-binary-identified people occurs as the result of them being victimized and discriminated against due to their identities. The study suggests instead that it is bad childhood experiences that lead to mental health challenges, and to distress regarding one’s sex.
- A study of adolescents with trans identities which began after they started puberty, found that 63% had had “one or more diagnoses of a psychiatric disorder or neurodevelopmental disability” before announcing they were transgender. Almost half had self-harmed, and 50% had suffered a traumatic event in their lives such as sexual abuse, being bullied and parents divorcing.[xxx]
The connection between trans/non-binary identities and autism is very strong. A study published in European Psychiatry[xxxi] found that 14% of transgender and non-binary individuals had a diagnosis of autism, and an additional 28% reached the cut off point for an autism diagnosis, suggesting high numbers of undiagnosed individuals. (The control group had a 4% rate of autism.)
Between 2011 and 2018, 48% of young people seen by Gender Identity Development Services (GIDS) in the UK scored in the mild to severe range for autism. Ten percent of the females scored in the severe range, as did 7% of the males. [xxxii]
This is important for many reasons. For one thing, with or without gender confusion, autistic females have a risk of suicide 10 times higher than females without autism.[xxxiii] For another, difficulty in forming friendships, may make autistic children especially susceptible to on-line promises of an always-accepting “glitter” family available to those who believe themselves “born in the wrong body.”
For the perspective of an autistic woman who is grateful that trans wasn’t a big thing when she was an adolescent, read Jane Galloway’s essay “Autistic Girls: Gender’s silent frontier.” Galloway describes the isolation and thinking patterns characteristic of autism which would almost certainly have led her to embrace a trans identity had she come in contact with the concept earlier in life. She describes how she grabbed onto anything that seemed like a solution to the distress she felt when she was young. Unlike other false solutions to her problems, trans identification would have left her with a permanently damaged body.[xxxiv]
Trans advocacy groups have begun to openly acknowledge the overlap between autism and trans/non-binary identification. In Washington State, for example, TransFamilies recently reported that it has teamed up with The Arc, which serves people with intellectual and developmental disabilities in King County. TransFamilies explains that “[p]arents with kids who were gender-diverse and neuro-diverse were showing up in our group in record numbers” and simultaneously The Arc was fielding increasing numbers of inquiries about gender support. Together the groups are launching a program called “Thriving on Two Spectrums.”
In other words, the two groups are greasing the skids to shuttle autistic children forward into a world of gender transition.
The affirmation-only model stands in the way of providing children with the counseling and other help they need to address the roots of psychological problems. Those who seek to conduct psychological assessments and offer psychotherapy are regularly labeled “transphobes” and attacked. Many U.S. states have passed laws making it unlawful to provide psychotherapy to a trans-identifying child in an attempt to help them become comfortable with their sex.[xxxv]
In the UK, multiple resignations by clinicians at Gender Identity Development Services, (GIDS) has highlighted this reality. Those resigning were appalled by the lack of adequate psychological counseling and other problems undercutting the welfare of children in their care.[xxxvi]
Dr. Kirsty Entwistle wrote an open letter[xxxvii] to GIDS director Dr. Polly Carmichael, complaining about pressure placed on clinicians to move forward with puberty blockers and hormone treatments without exploring the roots of children’s distress.
“I wish to make it clear to other Clinical Psychologists that most of the gender identity assessments being undertaken at GIDS are not being underpinned by the psychodynamic approach that the Tavistock is famous for,” Entwistle wrote. “There are children who have had very traumatic early experiences and early losses who are being put on the medical pathway without having explored or addressed their early adverse experiences.…In my Clinical Psychology training and in other services the loss of or abandonment by a parent would be something to be explored and the impact understood but I felt that at GIDS this factor was often minimized or dismissed. I was also shocked by the complexity of referrals. I read many referrals of children who have been sexually abused and many children have witnessed and/or been subjected to domestic violence.”
Entwistle also brought up the socioeconomic circumstances of families seeking medical transitions. “I also felt that [there] was an overrepresentation of the young people who were living in poverty,” Entwistle said. “How is it ethical to undertake a gender identity assessment with the view to a medical pathway when there are children and young people [who] do not have their most basic needs met?”
A new study has reinforced her concerns. The charts of adolescents who medically transitioned were examined to see how they fare in “real life”. “Those who did well in terms of psychiatric symptoms and functioning before cross-sex hormones, mainly did well during real-life. Those who had psychiatric treatment needs or problems in school, peer relationships and managing everyday matters outside of home continued to have problems during real life.”[xxxviii]
Who are the children encouraged to alter their bodies with puberty blockers, cross-sex hormones and surgeries? Many are particularly vulnerable individuals with serious mental health issues, histories of trauma and loss, and challenging economic situations at home.
Mindless affirmation does not help children. It hurts them. It sets them on a path of irreversible damage, as the roots of their distress remain unaddressed.
THE INADEQUATE EVIDENCE UNDERPINNING MEDICAL TRANSITIONS
Those promoting transitions for children insist that even if harm results, it’s worth it. Some compare children with trans identities to children with cancer. If we don’t intervene medically, a child may die, so intervention makes sense, they maintain.
But does transitioning save children’s lives by preventing suicides? Does it make gender-confused children happy in the long run? Studies cited by trans activists on this matter do not provide the documentation they claim. Not even close. For an excellent in-depth review of the limited research relied upon by affirmation-only advocates and what it actually shows, see Transgender Trend’s article, Suicide Facts and Myths.[xxxix]
That article also delves into some of the evidence that medical transitioning may actually increase the psychological problems and distress of trans-identifying children. Data from the Tavistock clinic in the UK shows that after a year on puberty blockers, girls experienced more behavioral and emotional problems. They expressed more dissatisfaction with their bodies, and there were significant increases in the numbers of children saying they deliberately tried to hurt or kill themselves.[xl]
The inadequacy of the evidence underlying medical transition protocols has become clearer and clearer in recent years. Various comprehensive reviews have found the evidence relied upon by those pushing for the transing of children to be of very low quality.[xli] Meanwhile key studies widely quoted in support of medical transitions have been found to contain major errors, which invalidate their conclusions. And a principal author of the “Dutch Protocol” relied upon by children’s gender clinics throughout the world, has published a commentary declaring that the protocol is being applied to young people for whom it was not designed and who might not benefit from it.[xlii]
In the UK a young woman named Keira Bell has successfully sued the Tavistock clinic over the irreversible physical harm she has endured because of its practices with regard to gender dysphoric children. Bell went on puberty blockers and cross-sex hormones and had her breasts cut off in an attempt to become male, and then deeply regretted what she had done. In its strongly worded decision, the High Court expressed surprise at the inadequacy of the gender clinic’s evidentiary basis for its protocols.[xliii]
TURNING THE TIDE
As the veil has been pulled back revealing just how paltry the evidentiary basis is for transition protocols, some major institutions around the world have moved away from those protocols. Sweden’s Karolinska Hospital has ended the use of puberty blockers for children under 16.
Finland has issued new guidelines for the treatment of gender dysphoria in young people, which prioritize psychological treatment over treatment with hormones and surgeries.[xliv]
In most places around the world, however, medical transitions of children continue unabated. In the U.S., state laws are being passed which effectively prohibit psychologists from engaging in psychotherapy that aims to help children become comfortable with their sex.[xlv] The number of gender clinics has skyrocketed from 1 in 2007 to at least 65 today.[xlvi] Schools, medical associations and other institutions are enthusiastically steering children towards transitions and censoring the voices of those who object.
This is a medical and child abuse scandal of enormous proportions. It is more than time to change course.
[i] https://www.theamericanconservative.com/articles/the-transgender-craze-is-leaving-thousands-of-young-victims-in-its-wake/ See also: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5227946/; https://www.transgendertrend.com/current-evidence/; https://genderreport.ca/10x-growth-in-referrals-to-gender-clinics-in-canada-and-our-consent-based-model/; https://bestcosmeticsurgeons.com/gender-reassignment-surgery-is-booming-in-2020/
[v] Amy Sohn, Chest Binding Helps Smooth the Way for Transgender Teens, but There May Be Risks”, New York Times, May 31, 2019
[vii] Michael Biggs, “Puberty blockers for gender dysphoria, 1. The Dutch Protocol”, December 2020 slide presentation.
[viii] Michael Laidlaw, Public Discourse, The Journal of the Witherspoon Institute, The Pediatric Endocrine Society’s Statement on Puberty Blockers Isn’t Just Deceptive. It’s Dangerous, Jan 13, 2020.
[ix] William Malone twitter, as shared in https://newsakmi.com/news/usnews/endocrinologist-puberty-blockers-cause-huge-decrease-in-bone-density/
[x] SEGM, The Effect of Puberty Blockers on the Accrual of Bone Mass, May 1, 2021; Reviewing data from Dr. Michael Biggs, Revisiting the effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria, Journal of Pediatric Endocrinology and Metabolism, March 2021.
[xi] Michael Laidlaw, Public Discourse, The Journal of the Witherspoon Institute, Jan. 13, 2020, “The Pediatric Endocrine Society’s Statement on Puberty Blockers Isn’t Just Deceptive. It’s Dangerous.”
[xiv] Schneider et al, Brain Maturation, Cognition and Voice Pattern in a Gender Dysphoria Case Under Pubertal Suppression, Frontiers in Human Neuroscience, Nov 14, 2017.
[xv] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333793/ and also this thread https://twitter.com/TwisterFilm/status/1338994912902123524 for discussion of this animal data.
[xvi] Kaltiala-Heino et al, “Gender dysphoria in adolescence: current perspectives”. Adolescent Health, Medicine and Therapeutics, 9:31-41, (2018-03-02)
[xvii] American Heart Association news release, Feb. 18, 2019: https://newsroom.heart.org/news/hormone-therapy-may-increase-cardiovascular-risk-during-gender-transition?preview=be4b
[xx] 4th Wave Now, TMI: Genderqueer 11-year-olds can’t handle too much info about sterilizing treatments-but do get on with those treatments, https://4thwavenow.com/2021/04/13/tmi-genderqueer-11-year-olds-cant-handle-too-much-info-about-sterilizing-treatments-but-do-get-on-with-those-treatments/
[xxiii] J.D. Robertson, Double Mastectomy at 15; Detrans 16-year-old Now Seeks Reversal, The Velvet Chronicle, July 10, 2020; https://thevelvetchronicle.com/double-mastectomy-at-15-detrans-16-year-old-now-seeks-reversal/
[xxv] Schneider et al, Brain Maturation, Cognition and Voice Pattern in a Gender Dysphoria Case Under Pubertal Suppression, Frontiers in Human Neuroscience, Nov 14, 2017
[xxvi] Dyer Chris; Workers at transgender clinic quit over concerns of ‘unregulated live experiments on children’, Daily Mail.com, April 7, 2019.
[xxvii] Jamie Doward, Governor of Tavistock Foundation quits over damning report into gender identity clinic, The Guardian, Feb. 23, 2019.
[xxviii] Transgender Trend, Suicide Facts and Myths, https://www.transgendertrend.com/the-suicide-myth/
[xxix] Alcock et al, Attachment Patterns in Children and Adolescents with Gender Dysphoria, Front Psychol., 12 Jan. 2021, https://www.frontiersin.org/articles/10.3389/fpsyg.2020.582688/full; Society for Evidence-Based Medicine (SEGM) New Study Raises Questions About the Gender Minority Stress Model, March 17, 2021
[xxx] Transgender Trend, Suicide Facts and Myths, https://www.transgendertrend.com/the-suicide-myth/
[xxxii] Anna Churcher Clarke and Anastassis Spiliadis; ‘Taking the lid off the box’: The value of extended clinical assessments for adolescents presenting with gender identity difficulties, Clinical Child Psychology and Psychiatry, 2019 By; https://www.docdroid.net/57t8V1q/clarke-2019-extened-clinical-assessment-pdf#page=3
[xxxiii] Jane Galloway, Autistic Girls: Gender’s silent frontier, May 3, 2020, Transgender Trend Blog
[xxxvi] Chris Dyer, Workers at transgender clinic quit over concerns of ‘unregulated live experiments on children.’ Daily Mail, April 7, 2019,
[xxxviii] Riittakerttu Kaltiala et al, Adolescent development and psychosocial functioning after starting cross-sex hormones for gender dysphoria, Nordic Journal of Psychiatry, 2019.
[xxxix] Transgender Trend, Suicide Facts and Myths, https://www.transgendertrend.com/the-suicide-myth/ See also:Andre Van Mol, MD: “There is no long-term evidence showing gender affirmation therapy reduces suicides. It’s not there.” In the film: Trans Mission: What’s the Rush to Reassign Gender” June 2021; Riittakerly Kaltiala et al, Adolescent development and psychosocial functioning after starting cross-sex hormones for gender dysphoria. Nordic Journal of Psychiatry, Vol.74, 2020. https://doi.org/10.1080/08039488.2019.1691260 and Blanchard, Suicide or Transition: The only options for gender dysphoric kids? 4thWaveNow, 9/8/2017
[xl] Michael Laidlaw, Public Discourse, The Journal of the Witherspoon Institute, Jan. 13, 2020, “The Pediatric Endocrine Society’s Statement on Puberty Blockers Isn’t Just Deceptive. It’s Dangerous;” Michael Biggs, The Tavistock’s Experiment with Puberty Blockers, July 29, 2019.
[xli] Society for Evidence-based Gender Medicine (SEGM), 2020 Gender Medicine Highlights, Dec. 19, 2020; SEGM, New Systemic Reviews of Puberty-Blockers and Cross-Sex Hormones Published by NICE, March 3, 2021;
[xlii] Society for Evidence-based Gender Medicine (SEGM), 2020 Gender Medicine Highlights, Dec. 19, 2020
[xliii] Transgender Trend, Keira Bell: The High Court hands down a historic judgment to protect vulnerable children, Dec. 2021
[xliv] SEGM, 2020 Gender Medicine Highlights, Dec. 19, 2020; SEGM, Sweden’s Karolinska Ends the Use of Puberty Blockers for < 16, May 5, 2021.
[xlvi] Michael Laidlaw, “The Pediatric Endocrine Society’s Statement on Puberty Blockers Isn’t Just Deceptive. It’s Dangerous,” Public Discourse, the Journal of the Witherspoon Institute, January 13, 2020