Australian ‘60 Minutes’ Report Misrepresents Trans Youth Medical Care

Kelley Winters, PhD

aust60min

On September 10, the Australian media giant, Nine Entertainment, aired a long-anticipated news report “about what can go wrong when doctors misdiagnose a child as transgender.” The story headlined their Australian version of the American CBS program, “60 Minutes,” describing a teen youth, Patrick Mitchell, who had socially and hormonally transitioned from male to female, and back to male again. The segment was promoted as a breaking scandal about “how experts can get it wrong” and bring “self-discovery marred by misdiagnosis” to youth suffering distress of gender dysphoria. Producers suggested that affirming medical and mental health providers make “fast judgements” and fail to allow youth “time to figure it out.” A dark, foreboding teaser video flashed an all-caps headline, “THEY CHANGED HIS BODY,” to suggest that care providers caused physical harm to Patrick with cross-sex hormonal treatments, having permanent, undesired consequences.

These sensational charges, however, were contradicted, debunked, by Nine Entertainment’s own news report and announcements. They acknowledged that Patrick was prescribed puberty blockers, not cross-sex hormones, by medical providers. Most important, they revealed that it was Patrick’s mother, Ali, not physicians or mental health clinicians, who ignored medical advice and gave her own prescription hormone pills to her child. It was the mother, not the supportive experts, who inflicted partly-irreversible changes to her own child’s body and denied Patrick the time needed to reach appropriate care decisions. Tragically, these changes were ultimately regretted.

Medically supervised blocker care would have given this youth time to mature, to give informed consent for cross-sex hormonal care at a later point, or to discontinue treatment and resume pubertal development of their birth-assigned sex without irreversible consequences. The 60 Minutes report neglected to mention internationally respected Standards of Care for trans individuals, published by the World Association for Transgender Health (WPATH). The current 7th Version of the standards clarify that puberty suppressing medications give “adolescents more time to explore their gender nonconformity and other developmental issues,” for those facing trauma and possible disfigurement of incongruent natal puberty. Such treatment prevents “the development of sex characteristics that are difficult or impossible to reverse if adolescents continue on to pursue sex reassignment.”

The broadcast report omitted comments and interviews from experts in trans youth care and medical policy, even though 9News producers had previously contacted Dr. Sam Winter, an Associate Professor of Health Sciences at Curtin University in Perth and a member of the WPATH Board of Directors. Remarks by Dr. Elizabeth Riley, a Sydney based clinical specialist and scholar in the care of trans youth, were also absent from the broadcast, though she appeared on a 9News web page.

Instead, the report offered only a single authority, Dr. John Whitehall, a Professor of Pediatrics at Western Sydney University. Whitehall is an outspoken opponent to social authenticity for trans children and blocker and medical transition care for gender dysphoric adolescents. His rhetoric about trans children closely resembles that of Toronto psychologist, Dr. Kenneth Zucker, whose practice of gender conversion psychotherapies on nonconforming and trans children at the Centre for Addiction and Mental Health (CAMH) was famously shut down in 2015. Moreover, Whitehall refers to corrective transition surgical care as “surgical abuse” and has literally compared himself to Jesus Christ as a “martyr” to “intimidation” by activists. Most telling, Dr. Whitehall promotes himself as an expert on trans youth treatment issues, on the basis of his tenure in pediatric practice, yet he admits that, “I have not seen [a case of childhood gender dysphoria] in fifty years of medicine.”

In his 60 Minutes interview, Dr. Whitehall stereotyped trans youth as mentally ill, repeating that hormonal transition care is “experimental” and smearing those who disagreed with him as opposing “science”–

There is no proof that this is going to work. You think that their emotional problems are going to get better by giving them estrogen? … It’s not called scientific method.

In truth, the stereotype equating gender diversity to mental illness has been refuted by WPATH, the World Health Organization, and other authorities worldwide. Moreover, the efficacy and medical neccesity of hormonal transition care is recognized by a growing consensus of medical experts, including WPATH, the American Medical Association, the American Psychiatric Association, the American Psychological Association, and others.

Dr. Whitehall frequently cited Zucker’s trademark “80% desistance” axiom, which postulates that gender dysphoria and non-birth assigned gender identities are just a passing phase for the vast majority of young, gender dysphoric children–

The good news is that in all the major articles, these children will revert to the natal sex through puberty. What we should to, then, is have confidence in the statistics and not mess the child up along the way.

In fact, the Toronto and Dutch studies behind the “80% desistance” stereotype have been criticized for shortcomings in rigor and unsupported conclusions, including:

  •  Sample Bias in Intake Criteria
  •  Results Skewed by Punitive Psychotherapy Practices
  •  Omitted Long Term Followup
  •  Conflation of “desistant” gender identity with closeted gender identity
  •  Discarded Retrospective Evidence
  •  Mis-stating nonparticipation at followup as “desistence”

Moreover, even if we accept the “desistance” axiom at face value, Whitehall is mistaken to apply it in Patrick Mitchell’s case. It is intended by its promoters for young, prepubertal children, not 14 year-old teens. For example, Zucker and CAMH colleagues have stated

we take a very different approach when we work with adolescents with GID than when we work with children with GID. This is because we believe that there is much less evidence that GID can remit in adolescents than in children…if the clinical consensus is that a particular adolescent is very much likely to persist down a pathway toward hormonal and sex-reassignment surgery, then out therapeutic approach is one that supports this pathway…

In science, those making the claim bear the burden of proof to defend that claim, and the “80% desistance” axiom has fallen far short of that standard.

Anti-trans extremist groups in the U.S. wasted no time capitalizing on the Australian 60 Minutes report. These included GenderTrender, a Raymondian, or Trans Exclusionary Radical Feminist (TERF), blog site and the Family Research Council, a hate group according to the Southern Poverty Law Center and a central influence to President Trump’s policy banning transgender servicemembers.

Parents of Gender Diverse Children, an Australian support organization for affirming parents and families of trans and gender diverse children, issued a calm response that defied the stereotypes proffered by Nine Entertainment–

Families are faced with many difficult and complex choices throughout this journey, and we encourage parents and their young people to seek support, advice and guidance from the appropriate paediatric and adolescent gender services in their state. There are clear and specific guidelines for treating trans and gender diverse young people with regard to puberty blockers and stage 2 hormones, and we encourage all families to work within those guidelines and laws.

Finally, the timing of the 60 Minutes broadcast is as troubling as its content. Nine Entertainment had delayed the broadcast from it’s initial date of September 3 to the following Sunday, the 10th. This delay coincided with an Australian High Court decision on September 5 to dismiss legal challenges to a national referendum on Australian marriage equality. The national postal vote, which has energized anti-LGBTQ political extremism, is expected to proceed this week, just days after this inflammatory and misleading 60 Minutes broadcast. If Nine Entertainment had intended to influence the marriage equality vote, their timing could not have been more convenient.

This is not a story about “the experts … getting it wrong” in providing respectful, evidence-based care to gender dysphoric children and youth, in accordance with internationally recognized standards. Rather, this is a tragedy of a horrible, unethical parental mistake and political exploitation of its victim.

Copyright © 2017 Kelley Winters

Revisiting Flawed Research Behind the 80% Childhood Gender Dysphoria ‘Desistance’ Myth

Kelley Winters, Ph.D

 

 

In followup to the excellent WPATH Standards of Care, Version 8, meeting at the USPATH conference in February, I would like to re-share my presentation from the 2014 WPATH Symposium titled, “Methodological Questions in Childhood Gender Identity ‘Desistence’ Research.” I’ve formatted it as a video. It includes a specific recommendation to remove unsubstantiated and harmful statements on the statistical likelihood of non-birth assigned gender identity “persistence” in the section on Childhood Social Transition in the Standards of Care.

It is frequently repeated in mental health literature and popular media that the vast majority of children whose gender identity differs from their assigned birth-sex, or who are severely distressed by their birth-sex, will “desist” in their gender identities and gender dysphoria by adolescence. As a consequence, gender dysphoric children are pressed to remain in their birth-assigned roles throughout the world. But are gender dysphoria and diverse gender identities just a phase?

This presentation reexamines research in Canada and The Netherlands that underlies the “desistance” axiom, with respect to methodological rigor and validity of claims.

Please note corrections to slide 27 but not reflected in my original audio recording.

For more information, please see my original 2014 blog post about this presentation.

 

References
American Psychiatric Association (2014). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Byne, W., Bradley, S.J., Coleman, E., Eyler, A.E., Green, R., Menvielle, E.J., Meyer-Bahlburg, H.F.L., Pleak, R.R. & Tompkins, D.A. (2012). Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder. Archives of Sexual Behavior, 41(4):759-796.

Drescher, J. (2013) “Sunday Dialogue: Our Notions of Gender,” New York Times, June 29, http://www.nytimes.com/2013/06/30/opinion/sunday/sunday-dialogue-our-notions-of-gender.html

Drummond, Kelley D.; Bradley, Susan J.; Peterson-Badali, Michele; Zucker, Kenneth J. (2008), “A follow-up study of girls with gender identity disorder,” Developmental Psychology. Vol 44(1), Jan 2008, 34-45.

Kennedy, N. (2012) “Transgender children: more than a theoretical challenge,” Goldsmiths College, University of London, http://academia.edu/2760086/

Reed, B., Rhodes, S., Schofield, P., Wylie, K., (2009) “Gender variance in the UK. Prevalence, incidence, growth and geographic distribution,” GIRES – the Gender Identity Research and Education Society, http://www.gires.org.uk/assets/Medpro-Assets/GenderVarianceUK-report.pdf

Steensma, T.D., Biemond, R., de Boer, F. & Cohen-Kettenis, P.T. (2011). Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Clinical Child Psychology & Psychiatry, 16(4):499-516.

Wallien, M.S.C. & Cohen-Kettenis, P.T. (2008). Psychosexual outcome of gender-dysphoric children. J American Academy Child & Adolescent Psychiatry, 47:1413-1423.

Winters, K. (2013) Response to Dr. Jack Drescher and the NY Times About Childhood Transition, GID Reform Weblog, July 5, https://gidreform.wordpress.com/category/childhood-social-transition/

World Professional Association for Transgender Health (2011), Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People: Author. http://www.wpath.org

APPLES, ORANGES, AND FRUIT SALAD: SORTING OUT TRANSGENDER, GENDER NON-CONFORMING, & NON-BINARY CHILDREN AND YOUTH

Diane Ehrensaft, Ph.D.
Director of Mental Health
Child and Adolescent Gender Center
University of California Benioff Children’s Hospital
Associate Professor of Pediatrics, UCSF

A presentation to the Gender Infinity conference
Houston, TX
September, 2016
Posted here by permission

Presentation slides:
2016ehrensaftgenderinfinity 

applesoranges

Gender Madness in Psycho-Politics: Transgender Children Under Fire

A presentation to
Gender Infinity
Houston, Texas, USA
September, 2016
Kelley Winters, Ph.D.
GID Reform Advocates

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Presentation Slides:  201609infinityg1

 

The Quadrumvirate of Anti-Trans Defamation:

My little taxonomy of false stereotypes about trans adults, adolescents and children, crediting the individuals responsible for searing them into public consciousness:

  • Raymondian–alleging that trans women are “deceptive,” sexually “predatory” “men” whose existence poses a threat to the safety of others; and that trans men are “women” rather than authentic men. (Dr. Janice Raymond, University of Massachusetts in Amherst, 1979)
  • McHughian–alleging that trans women are “delusional,” “confused,” “mentally ill” “men” (and vice-versa for trans men), and that accepting, respecting or providing transition medical care to trans  people in our authentic roles represents “collaboration” with “mental disorder.” (Dr. Paul McHugh, John Hopkins University, 1979)
  • Blanchardian–alleging that most trans and transsexual women are psychosexually disordered “paraphilic” “men,” motivated only by sexual deviance/fetishism. Dr. Blanchard later included trans men to this false stereotype, by adding a so-called “autoandrophilia” specifier to his “transvestic disorder” in an early draft of the DSM-5. (Dr. Ray Blanchard, Clarke Institute of Psychiatry/Centre for Addiction and Mental Health, 1989)
  • Zuckerian–alleging that gender dysphoria in the great majority, around 80%, of gender dysphoric children is a passing phase that will “desist” or “remit” by adolescence. Zucker has long promoted and practiced gender conversion “therapeutic intervention,” to enforce birth-assigned gender identities and expressions. (Dr. Kenneth Zucker, Clarke Institute of Psychiatry/Centre for Addiction and Mental Health, 1989)

These stereotypes have been weaponized by political extremist groups to inflict unprecedented systemic, strategic attacks on the human rights and medical care access of trans people and especially trans children.

 

Strategy of Anti-Trans Political, Social and Media Attack:

Coordinated legislation, litigation and misinformation aimed at:

  • Eliminating access to Public Accommodation and Education
  • Eliminating gender marker correction in official Documents & Records
  • Eliminating access to transition medical care
  • Legalizing and promoting Gender-Conversion Psychotherapy

 

Architects of systemic public policy attack:

  • Family Research Council–authored the blueprint for anti-trans political, social and media attacks in 2013 that has been followed by US extremists nationwide
  • Southern Baptist Convention Theological Seminary
  • Heritage Foundation
  • Republican Party

 

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Strategic medical policy issues for the 20-teens:

my own priority list…

  • WPATH: clarify and correct the childhood “desistance” myth statement in the SOC7
  • WPATH: Issue a public policy statement discrediting the practice of gender-conversion psychotherapies that is consistent with the SOC7
  • APA: clarify and correct the childhood “desistance” myth statement in the DSM-5
  • APA: remove “Transvestic Disorder” category from the DSM-5
  • WHO: initiate substantive conversation on converging the Adult/Adolescent Gender Incongruence categories in the proposed ICD-11 with the childhood category to refute the historical stereotype of childhood gender “confusion” and practice of gender conversion psychotherapies
  • US Dept. of HHS: align transition related categories in ICD-10-CM to ICD-11 in 2018
  • US Dept. of HHS/CMS: issue a National Coverage Determination for surgical transition care that is recognized as medically necessary by US and international medical authorities

 

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A Call to Action

Attention to medical policy reforms that clarify evidence, reduce harm, and benefit health and mortality is as urgent in today’s world as ever. It is an essential step in fixing society for all of the Leelah Alcorns in our midst.

 

References

(under construction…)

Blanchard, R. (1989) “The Classification and Labeling of Nonhomosexual Gender Dysphoria,” Archives of Sexual Behavior, v. 18 n. 4, p. 322-323.

Brennan, C. and Hungerford, .E, (2011) “2011 Letter to the UN on ‘gender identity’ legislation,” http://sexnotgender.com/gender-identity-legislation-and-the-erosion-of-sex-based-legal-protections-for-females/

Drummond, Kelley D.; Bradley, Susan J.; Peterson-Badali, Michele; Zucker, Kenneth J. (2008), “A follow-up study of girls with gender identity disorder,” Developmental Psychology. Vol 44(1), Jan 2008, 34-45.

Ford, Z. (2014) “Three Days In Nashville Talking To Southern Baptists About Homosexuality,” Think Progress, Center for American Progress. http://thinkprogress.org/lgbt/2014/10/30/3586418/southern-baptist-erlc-homosexuality/

McHugh, Paul (1992). “Psychiatric Misadventures,” The American Scholar,
Autumn, http://www.lhup.edu/~dsimanek/mchugh.htm

P. McHugh (2004) “Surgical Sex,” First Things 147:34-38, http://www.firstthings.com/ftissues/ft0411/articles/mchugh.htm , http://www.firstthings.com/article/2004/11/surgical-sex

Raymond, Janice G. (1979) The Transsexual Empire: The Making of the She-male. New York: Teachers College,

Raymond, Janice G. (1980) “Technology on the Social and Ethical Aspects of Transsexual Surgery,” http://www.susans.org/reference/usts1-9.html

Stone, Sandy (1987) THE EMPIRE STRIKES BACK: A POSTTRANSSEXUAL MANIFESTO, http://sandystone.com/empire-strikes-back

Southern Baptist Convention (2014) “On Transgender Identity,” Resolution. http://www.sbc.net/resolutions/2250/on-transgender-identity

Williams, Cristen, (2013) “TERFs & Trans Healthcare [UPDATED],” http://theterfs.com/terfs-trans-healthcare/

Winters, K. (2008) “Disallowed Identities, Disaffirmed Childhood,” GID Reform Weblog, October, https://gidreform.wordpress.com/2008/10/28/disordered-identities-disaffirmed-childhood/

Winters, K. (2008) https://gidreform.wordpress.com/2008/11/10/autogynephilia-the-infallible-derogatory-hypothesis-part-1/

Winters, K. (2008) https://gidreform.wordpress.com/2008/11/19/autogynephilia-the-infallible-derogatory-hypothesis-part-2/

Winters, K. (2008) https://gidreform.wordpress.com/2008/07/01/the-horns-of-a-false-dilemma/

Winters, K. (2012) “These Aren’t the Droids You’re Looking For: Gender Diversity, Scapegoating and Erasure in Medicine and Media,” https://gidreform.wordpress.com/2012/04/21/these-arent-the-droids-youre-looking-for-gender-diversity-scapegoating-and-erasure-in-medicine-and-media/

Winters, K. (2013) “Response to Dr. Jack Drescher and the NY Times About Childhood Transition,” GID Reform Weblog, July 5, https://gidreform.wordpress.com/category/childhood-social-transition/

Winters, K. (2014) “Methodological Questions in Childhood Gender Identity ‘Desistence’ Research,” 23rd World Professional Association for Transgender Health Biennial Symposium, reposted GID Reform Blog, Feb. 25. https://gidreform.wordpress.com/2014/02/25/methodological-questions-in-childhood-gender-identity-desistence-research/

World Professional Association for Transgender Health (2011), Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People: Author. http://www.wpath.org

 

It’s Time to Update the Title of the International Journal of ‘Transgenderism’

Kelley Winters, Ph.D.
GID Reform Advocates

The International Journal of Transgenderism (IJT) is a quarterly academic journal on topics of transgender healthcare, policy and education, and it is the official journal of the World Professional Association for Transgender Health (WPATH). WPATH is best known for publication of internationally respected standards of care for trans people who require transition related hormonal and/or surgical treatment. The Journal was founded in 1998 and has been published by the U.K. based Taylor & Francis Group.

The IJT has a good reputation for reliable scholarship on trans issues among a cohort of sexology journals where attitudes and bias toward trans and gender diverse people are not always respectful. However, the term, “transgenderism,” in the title is anachronistic in the 21st Century. It reflects a historic pathological model of gender diversity, lacks focus on the aims of the journal and is widely considered derisive.

I call on the President and Board of Directors of WPATH, as well as the Editor and Editorial Board of the journal, to update the title of the International Journal of Transgenderism to:

The International Journal of Transgender Health.

The Merriam-Webster Dictionary defines the noun suffix, “ism,” in terms of acts or practices (such as racism and sexism); states or pathological conditions (such as barbarianism and alcoholism); or doctrines or political orthodoxies (such as Calvinism and conservatism). None of these meanings relate to the experience of being transgender. No other communities in LGBTQ spectra are called, “isms.” We don’t refer to our diverse populations with terms like “homosexualism,” “lesbianism,” or “queerism.”

Moreover, the term, “transgenderism” has a long history of defamatory use by those opposed to human rights and civil justice for trans individuals. Opponents prefer that term, because it conveys  illicitness and inspires fear. The theo-political extremist group, Focus on the Family, has published more than eight anti-trans position papers in recent years with the term, transgenderism, in their titles, including, “‘Transgenderism’ Brings Chaos from Order,” “Desensitizing Society on Transgenderism,” and “Title IX and Transgenderism: The New Threat in Your Child’s School.”

The GLAAD Media Reference Guide refers to “transgenderism” as a problematic term for social and historic reasons:

This is not a term commonly used by transgender people. This is a term used by anti-transgender activists to dehumanize transgender people and reduce who they are to “a condition.” Refer to being transgender instead, or refer to the transgender community. You can also refer to the movement for transgender equality.

Finally, in 2007, the Harry Benjamin International Gender Dysphoria Association (HBIGDA) changed its name to the World Professional Association for Transgender Health (WPATH) to clarify in its title the mission “to promote evidence based care, education, research, advocacy, public policy, and respect in transgender health.” It is time to align the title of WPATH’s scholarly journal to its mission and its message.

—————————–

Note:  I am a member of the World Professional Association for Transgender Health. The opinion given here is solely my own.

Media Misinformation About Trans Youth: The Persistent 80% Desistance Myth

Kelley Winters, Ph.D.
GID Reform Advocates

Jesse Singal, Senior Editor at nymag.com, has enlisted his New York Magazine blog in the promotion of the 80% “desistance” stereotype for gender dysphoric children and youth–the widely publicized presumption that painful distress with birth-assigned sex and gender are just a phase for the great majority of children who suffer it:

While the actual percentages vary from study to study, overall, it appears that about 80 percent of kids with gender dysphoria end up feeling okay, in the long run, with the bodies they were born into.

Singal praised the 80% “desistance” presumption as “solid scientific consensus” and boasted that “every”  study, not some, but “every study that has been conducted on this has found the same thing.” He scorned those who do not accept the 80% presumption (Tannehill 2016, Serano 2016, Olson and Durwood 2016) as “part of problem,” as essentially “ignoring” science, and preventing “intelligent, informed discussion.”

The real problem, however, is that Singal’s support for the 80% presumption and its promoters from the Toronto Clarke Institute/Centre for Addiction and Mental Health (CAMH) and the Dutch VU University Medical Center rests on a critical, misleading statement in this article:

It’s hard to imagine a kid meeting all the necessary criteria in the DSM-IV and not ‘actually’ being gender dysphoric… Since 63 percent of the subjects in Singh’s study met these criteria, this really wasn’t a sample of children who were ‘just’ gender nonconforming.

The author preceded these remarks with a listing of the 1994 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV, APA, 1994)) diagnostic criteria for “Gender Identity Disorder of Children” (GIDC, 302.6) that were used for intake selection in childhood “desistance” studies in Toronto and Amsterdam, but the actual diagnostic criteria contradicted his conclusion. In fact, the DSM-IV Subcommittee on Gender Identity Disorders deliberately chose to allow diagnosis of GIDC without any “explicit wish to be of the opposite sex” (Bradley, et al., 1991)–a loophole that sidestepped gender dysphoria and was corrected in the DSM-5. Subcriterion 1 of Criterion A referenced nonbirth-assigned gender identity but was not required for diagnosis:

“1. Repeatedly stated desire to be, or insistence that he or she is, the other sex.”

Only four of five subcriteria were required to meet Criterion A, and all of the other four subcriteria described gender nonconforming behaviors. Therefore, children could be judged to meet criterion A strictly on the basis of gender nonconformity, with no indication of actual gender dysphoria or incongruent gender identity.

Criterion B referenced gender dysphoria (in the Fisk, 1973, sense of distress with physical sex characteristics or assigned gender roles) but once again had loopholes that allowed diagnosis because of behavioral gender nonconformity without evidence of actual gender dysphoria. Birth-assigned boys could meet criterion B with “aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities.” So could birth-assigned girls with a “marked aversion toward normative female clothing.”

Criterion C excluded diagnosis for children with intersex conditions.

Criterion D was the clinical significance criterion, added to almost all categories in the DSM-IV. It required significant distress or impairment in “social, occupational, or other important areas of functioning.” However, the GIDC supporting text in the DSM-IV Text Revision (DSM-IV-TR, APA 2000, p. 577) maintained that distress from societal prejudice, rather than from gender dysphoria itself, would meet criterion D according to its authors.

Gender nonconforming children with no actual evidence of gender dysphoria were very easily misdiagnosed with “Gender Identity Disorder of Children” because of flawed diagnostic criteria the DSM-IV. Those criteria, and, astonishingly, subthreshold fulfillment of them, were used for sample selection in questionable studies that to this day are cited to support the 80% “desistance” myth (Winters 2008, 2014).

Conflation of a much larger superset of gender nonconforming children with a much smaller subset of gender dysphoric kids is not “solid scientific consensus.” Gender nonconformity is not gender dysphoria. Children who were never gender dysphoric to begin with are not “desistant.”

——

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C.

S. Bradley, Ray Blanchard, et al. (1991). Interim Report of the DSM-IV Subcommittee on Gender Identity Disorder. Archives of Sexual Behavior, Vol. 20, 4, p. 339.

Fisk, N. (1973). Gender dysphoria syndrome. (The how, what, and why of a disease). In D. Laub & P. Gandy (Eds.), Proceedings of the second interdisciplinary symposium on gender dysphoria syndrome (pp. 7–14). Palo Alto, CA: Stanford University Press.

Olson, K. and Durwood, L. (2016) Are Parents Rushing to Turn Their Boys Into Girls? Slate, Jan. 14. http://www.slate.com/blogs/outward/2016/01/14/what_alarmist_articles_about_transgender_children_get_wrong.html

Serano, J. (2016)  placing Ken Zucker’s clinic in historical context. Whipping Girl, Feb. 9.  http://juliaserano.blogspot.com/2016/02/placing-ken-zuckers-clinic-in.html

Singal, J. (2016). What’s Missing From the Conversation About Transgender Kids, Science of Us, New York Magazine, July 25. http://nymag.com/scienceofus/2016/07/whats-missing-from-the-conversation-about-transgender-kids.html

Tannehill, B. (2016). The End of the Desistance Myth. Huffington Post: the Blog, Jul 18. http://www.huffingtonpost.com/brynn-tannehill/the-end-of-the-desistance_b_8903690.html

Winters, K. (2008). Disallowed Identities, Disaffirmed Childhood. GID Reform Blog: Issues on reform of the diagnostic categories of Gender Identity Disorder and Transvestic Fetishism in the DSM-5, Oct. 28. https://gidreform.wordpress.com/2008/10/28/disordered-identities-disaffirmed-childhood/

Winters, K. (2014). Methodological Questions in Childhood Gender Identity ‘Desistence’ Research. 23rd World Professional Association for Transgender Health Biennial Symposium, Feb. 16, 2014, Bangkok, Thailand. https://gidreform.wordpress.com/2014/02/25/methodological-questions-in-childhood-gender-identity-desistence-research/

Zucker, K. and Bradley, S. (1995). Gender Identity Disorder and Psychosexual Problems in Children and Adolescents, Guilford Press, p58

There is Truly Nothing Wrong with These Children

A Guest Post by
Karen Adams,
a Colorado Mother
Founder, Transgender Youth Education & Support
PFLAG Boulder County

The proposed stigmatizing diagnosis of Gender Incongruence of Childhood should be completely removed from the ICD-11.

Having facilitated a family support group for 7 years, personally worked with over 100 families and connected online with hundreds more, I have a great deal of experience with gender-expansive children. For the past several years, the majority of families have been contacting our group when their children are younger than 10 years old. Most of the children have been on a clear path to transition, and have proceeded into medical transition at a later time. Others have displayed gender-nonconforming behavior, become comfortable with their gender expression for several years, returned to our support group at the onset of puberty, and started their medical transition shortly after. A significant percentage of children work through clarification of their identity and settle into something other than gender conformity or transition. I am only familiar with a small handful of children who have expressed a cross-gender identity who later settled into a comfort level with their assigned birth sex. What stands out most from my experiences is how incredibly unique each child and family can be. I often say that the only thing I know for certain, is that the next time I pick up the support line, I will hear a story that is unlike any other I’ve heard before.

Our families encourage each other to love their child unconditionally and share resources so parents can educate themselves regarding the medical, social, and legal implications of raising a gender-expansive child. The only time outside services are required prior to puberty are when the parents need support to accept and understand their child’s needs, or when the child needs assistance clarifying their gender identity.

Simply based on the extremely wide variation in identities and needs I observe, our prepubescent children, defy any sort of classification system. Services for these children should readily be available under more generic service codes.

Were I to identify any singular thing that would dramatically improve the lives of all gender-expansive children, it would that be that each and every one of them needs to know that there is nothing wrong with them. Even basic parental acceptance dramatically improves the life and mental health of our kids. This is something I have observed in nearly every gender expansive child I know. Children who live in more liberal areas, who are able to more fully integrate their gender identity due to greater community acceptance, thrive. Even with parents who powerfully support their child, it’s amazing to observe the positive changes children experience when they move from a stigmatizing community to one that celebrates them. There is truly nothing wrong with these children. Changing the perspective from an understanding of gender as a binary absolute to more accurately reflect the experiences of humanity is the only category modification that is needed. The proposed stigmatizing diagnosis of Gender Incongruence of Childhood should be completely removed from the ICD-11.

De-pathologising gender difference is probably the most important step that can be taken to dramatically improve the lives of gender-expansive children.  The World Health Organization (WHO) has an opportunity to help gender-expansive children experience their birthright: the love of their family and community.