Sex Matters has recently posted an article confirming what we already knew about the science behind early treatment of gender dysphoria in children.1 There is not enough science available to confirm that medical affirmation is either helpful or safe. Not enough good science has been done in order to justify the risk of puberty blockers, hormones, breast binders, mastectomies, or any other medical intervention. There is not enough data to justify the intervention on the premise of suicide prevention. There is not enough data, not enough good analysis, not enough reason to push forward policies and laws to prevent talk therapy from being pursued in order to deterine antecedents to a belief a child may have that they were “born in the wrong body” for their true self.
Meanwhile, there is strong evidence that this medical pathway causes physical harm. It can lead to infertility and loss of future sexual function; among multiple side effects, bone health suffers. These might be justifiable if the mental-health benefits were significant. They aren’t, though. Perhaps there are some teenagers for whom the cost-benefit analysis works out – but we have no evidence to tell us which ones, or under what circumstances. We do know that the physical impacts are significant, and the mental-health improvements minimal.
What data that mental health providers do have shows that such treatments do not have a better success rate than placebos in reducing the suicidal tendencies. There are three reports included in the post, and I urge my readers and everyone else to download and read them, because science is an important tool and proper analysis is warranted in setting a course of action for children and teens who do not want to be who they are.
Having read the reports myself, I come away with the following impressions.
Affirmative Care for trans identifying kids is based on self-reporting and, here is the astounding part, self-diagnosis. In medical care, there are some diseases that people can diagnose on our own such as flu, rhinoviral colds, streptococcus infection, shingles, and a list of others. However, even for these, we need to consult with doctors or other trained professionals for a confirmation that the symptoms we describe are consistent with the disease we assume we have.
For children and teens who believe themselves to be born the wrong sex, there are many alternative explanations to being trans. For starters, being trans relies on a definition that can’t be tested and only described using the concept of “gender identity.” Gender identity can’t be used as a marker, because by itself it can’t be proven other than through self-reporting. This is all very nebulous, and certainly nothing that can be measured in an objective way that would provide useful data for testing. Therapists need to be exploring for specifics on why a child would have such an experience of his or her self.
As a skeptic, I don’t deny that people have experiences. I deny that we need to take the first answer that comes up as a definitive answer. If someone is resuscitated and reports an out-of-body experience, I can’t deny what they experienced, but I can be skeptical that they went to heaven and a bright white light told them to go back and finish their business. So, when we hear “Believe the children, they know who they are,” I think it only right to be dubious that a child can know that they are the other sex inside. Satanic Panic, an episode we now look back upon in shame for how easily we prosecuted people, was carried forward by a demand to “believe the children.” People’s lives were ruined.
If we take what we know of gender’s structures of masculinity and femininity, and how these complex social structures vary from culture to culture, we realize that there is a complex maze of expectations that we are expected to find our way through as children and adolescents based on our sex. We know that in order to fit in with peers, we shape our behaviors and our social expectatins based on our perception of what we desire and how we are limited. Developing children may take several different side routes to get to who they are as adults, including explorations of those objects and expectations of the other sex.
A worried mother sent me an email question about her five-year-old son who likes dolls that look like princesses and, on occasion, likes to wear girl’s clothes. She has two older sons and never encountered this before.
Young children love to play the roles they see their parents and other adults playing. For some children, this includes boys sometimes wanting to wear girls’ clothes. After all, that is what mom does. Also, girl’s clothes seem so much more colorful and fun than the ones that boys wear. In fact some boys want to play with dolls and doll houses. [YES!]
Branding a child as being trans2 if they follow an unexpected path may act as a positive reinforcement to continue on a path that they might not ordinarily follow. In fact, this is very likely, since children look to adults and, as adolescents, towards peers for guidance on who they are. We are, all of us, malleable. Our personalities may show tendencies due to inviduality, but rarely are we fixed for life. We adapt based on social pressure, new information, empathetic learning as a reflection on how others respond to our words and actions.
Our personalities are never fixed.3 Children and teens even less so than adults. And yet, the guidance from therapists currently looks to affirmation-only treatments according to such organizations as WPATH. (In February, Sweden’s announced that after thorough evaluation, they were rejecting the WPATH standards of care.) There is a presumption of trans, and to deny this self-diagnosis in determing care is referred to as “conversion therapy.” And for those who have looked at Conversion Therapy, it is a dangerous road to travel for any patient. Gays and Lesbians have been subjected to it by zealots eager to make them straight, and involves phsyical and psychological torture.
Alternate therapies to affirmation care are not conversion therapy. They are methods of care that include watchful waiting, and talk therapy to examine the reasons that a child or teen may believe that they are trans. With the contra-indications to the radical treatments involving hormones and excisions of healthy tissue, watchful waiting seems to be the most prudent care.
The Sex Matters report also examines “social care,” in which children and teens are moved to the gender roles and fashion affectations of the other sex. The science supporting this as an effective treatment, is similarly weak and unsupported by the preponderance of data.
The supposed benefits of social transition also give way under scrutiny. Using a different name and pronouns for a gender-questioning child is linked to gender dysphoria persisting. We don’t know if the link is causal – but the possibility should not be ignored by schools and other institutions that are supposed to put child safeguarding ahead of all other considerations. Schools that accommodate social transition, for example new names, “preferred pronouns” and perhaps even allowing children to use facilities for the opposite sex if that is how they identify, should rethink. It is anything but kind to act in ways that prolong children’s distress.
Such treatments most likely extend the distress that kids and teens encounter when they take a turn through the gender maze, because it doesn’t give them the ability to work it out for themselves. Having been a parent to three grown adults, my kids had to face their issues in growth and my role was not to steer them but to guide them. With babies, we put barriers in the way to protect them from danger, With toddlers, we teach them not to do things, as their ability to incorporate language into learning developes. We can tell them that touching an electrical outlet will hurt badly, so that they don’t pull out the safety plug and stick a fork in the hole. As teens, we can teach them about why social roles develop differently for each sex, and how they can try to navigate through them if they think those roles don’t fit. It’s often necessary to use enforceable rules to prevent them from doing irreversible harm to themselves. How many parents would circumvent the law to allow their kids to start smoking at 12 or 13 years old?
But now, how many parents are being led to believe that if they don’t consent to dangerous treatments for their children, though the risks are high for long-term damage, it is better to have a sterile adult than a dead teen from suicide?
Science is highly abused in politics, and in the social realm. We all want to believe that the science supports what we already think about controversial subjects. We are easily misled by graphs and charts that look “sciency,” and especially when scientists share them as evidence. Sean Carroll is a respected physicist, but he has stepped in on the issue of gender identity, and this lends athority to the belief that science backs the gender movement. Sabine Hossenfelder, another respected physicist has made a video which seems to show that the science supports transgenderism. She even cited “peer reviewed” papers.4
One thing that we should all conclude about science, is that science is not conclusive. There are no “final answers” in science. But in this area, this idea that gender identity not matching a physical body, the science that supports it is particularly weak. The studies used to claim that medical intervention is the only way to prevent suicide in gender-confused kids, is weak and not solid enough to determine a course of action. The science used to justify dangerous treatments with potentially life-long effects, is weak and should be set aside for further study.
In the meantime, the best course of action is to watchfully wait. Existing science in developmental psychology indicates that as we grow, we constantly undergo a process of metamorphosis as we grow. The best, safest course, is to guide our kids through the changes, but to allow them to develop as they learn who they are.
While the evidence base is reassessed and decent-quality studies are commissioned, a better approach is “supportive waiting”. There is a lot of evidence to support it in mental-health research, although it too needs to be interrogated and tested in the field of gender dysphoria. Its major benefits are that it has little potential to cause harm and a lot of promise for alleviating distress. It means validating children for who they are – what they think, what they feel, what they enjoy. It means accepting gender non-conformity. It means helping children to reconnect with their bodies and to form stronger relationships with those around them.
None of this is easy. Families of gender-distressed children will need a great deal of help. But if the institutions that form the backdrop to teenagers’ lives – their schools, their healthcare settings, their clubs – set aside shoddy research and avoid facilitating distress, it will be possible to find a path to something better.
Hormonal, surgical, and social forcing does not do this for them. They alter the course as surely as digging a canal alters the course of a river.
I mean here to say what we suspected and believed very strongly, as opposed to “knew” absolutely.
And, as in the revelations from Tavistock, many such kids were steered towards transition because their parents did not want a gay child.
This is the only thing that the “genderqueer” get right. They believe that their gender shifts from day to day, hour by hour, and the rest of use are responsible for keeping track. The correct saluation now can be wrong later in the day.
I’m probably generalizing, but it seems to me that theoretical physicists arrogantly step into subjects for which they don’t have training and make declarations that are unwarranted. I find it hard to respect them when they do this. Michio Kaku was once asked a question on whether evolution has stopped, and rather than deferring to an evolutionary biologist, answered that, yes, human evolution has stopped. I don’t believe a word he says anymore.