Response to Dr. Jack Drescher and the NY Times About Childhood Transition: Part 3, by Jenn Burleton

Coy Mathis

GID Reform Advocates respond to the question, “When a child identifies with the other gender, what to do?” Dr. Jack Drescher’s commentary on the Coy Mathis Civil Rights Case in Colorado appeared in the Sunday Dialogues Feature of the June 29, 2013 New York Times. Here is the discussion that the Times did not publish.

A Guest Post by Jenn Burleton
Founder and Executive Director of
TransActive Education & Advocacy
Portland, Oregon

To the Editor:

The letter you recently published from Dr. Jack Drescher regarding the case of the Colorado transgender child contained several misleading and outdated statements regarding the future transgender identity of the young girl in question. Most specifically, his categorical statement that “most [transgender/gender dysphoric] children grow up to be gay, not transgender.”

This statement vastly over-generalizes the complexity and diversity of gender nonconforming self-expression and identity in children and youth. As a result, Dr. Drescher helps perpetuate the harmful notion that children who are gender nonconforming or transgender are simply “going through a phase”. His comments not only lend fuel to those who practice gender-reparative therapy (proven to do great psychological harm to these children) but they encourage those who wish to deny the very existence of transgender identity.

At TransActive, we have provided clinical counseling and medical referral to more than 100 of these children and youth over the past 6 years. At present, we currently have a Portland, Oregon-area client base of approximately 150 family units and we work in various ways with many more families nationwide.

In our experience we find no evidence that those who socially transition gender early desist in their self-identity when that identity represents something other than their assigned sex at birth. Additionally,  while our experience tells us that Dr. Drescher and others are in error when they suggest that an over-generalized majority of all gender dysphoric children will grow up to be gay and not transgender, it is safe to assume that some of these kids will grow up to identify as gay, lesbian, bisexual, queer or pansexual. Their eventual sexual orientation will, however, be most likely based on their experienced gender identity and NOT on their assigned birth sex. In other words, a transgender girl attracted to males will most likely identify as heterosexual and a transgender boy attracted to males would most likely identify as gay.

At one point Dr. Drescher states that, “experts can’t tell apart kids who outgrow gender dysphoria (desisters) from those who don’t (persisters)”. This statement is, to be blunt, not at all reflective of our clinical experience here at TransActive. One can tell these kids apart, not by simply evaluating data acquired with questionable sampling protocols, but by observing the daily lived experiences of these kids and their families. It is vitally important to differentiate children who are gender nonconforming, with no interest in gender transition, from those who are what we call transitional transgender. Simply put, there is a significant difference between kids who say “I like boy/girl things” and those who say “I AM a boy” or “I AM a girl”.

Dr. Drescher has stated that he believes that the treatment (we prefer to approach it from an ‘affirmation’ model rather than a ‘treatment’ model) of gender dysphoric children is “controversial”, and he cites his own article “Controversies in Gender Diagnoses” in support of this opinion.

While controversy exists in some circles around transgender identity and gender nonconformity in general (unavoidable in a misogynistic and patriarchal culture), this controversy is based primarily on socio-political ideology and theology. This controversy is only exacerbated by those who wish to elevate flawed research above the lived reality of transitional children, youth and their families.

For those of us actively working with this population of kids, there is, I believe, considerable consensus as to the most effective care models. At TransActive, we follow a ‘Best Practice’ framework called RACE; Recognition, Affirmation, Congruence and Empowerment. Key aspects of this framework include:

  1. Affirm the child’s gender identity/expression without pushing them in one direction or another. Encourage the family to do so as well.
  2. Support and, if necessary, help facilitate social gender congruence to whatever degree the child expresses a need for.
  3. Diagnose Gender Dysphoria when it exists based upon clinical guidelines and when necessary to access additional services
  4. Remain open to evolving childhood gender identity and expression
  5. Facilitate access to pubertal suppression treatment if desired by the adolescent
  6. Facilitate access to surgical procedures (if desired) when appropriate and in consultation with therapists and medical personnel.
  7. Do not attempt to use gender expression as an indicator of future sexual orientation and, in particular, do not make clinical judgments about ‘desirable’ outcomes with regard to either gender identity or sexual orientation.

“My continued concern is that, in the absence of consensus, the literature still seems to lean toward A) overgeneralizing persistance/desistance in GNC children and, B) suggesting that taking a “do nothing/wait and see” approach will, in the majority of cases, result in desistance. The reality out here, Dr. Drescher, is that far too many parents (and providers/advisors) will interpret “do nothing” as ‘reinforce gender norms’ and/or ‘ignore the repeated and desperate self-expression of the child’.

I realize that neither you, nor the American Psychiatric Association (APA) or World Professional Association for Transgender Health (WPATH) are responsible for the ways in which individuals might implement or use this information. It is, however, vitally important that you understand that the ‘data’ you endorse and promote is clearly incomplete and not sufficiently differentiated. This ‘data’ is, in many cases, contributing to negative outcomes for transitional transgender children and youth. Service providers working in clinical situations (like TransActive and others) are left to either pick up the pieces or go to enormous lengths to explain complex variations in gender expression to parents, social services agencies, etc. simply to overcome the simplified, primary take-away that, “Most gender nonconforming kids desist or turn out to be gay”

I encourage parents of transgender and gender nonconforming children and youth to not be dissuaded from seeking assistance from organizations and individuals that specialize in working with (not researching) this population of children by those who believe that any data, no matter how flawed, is superior to the real world, boots on the ground, daily interactions that care providers are having with these kids and their families.

Jenn Burleton

Jenn Burleton is a leading expert in advocating for the rights and gender affirming care of transgender children and youth, is the Founder and Executive Director of TransActive Education & Advocacy and a co-founder of Trans Youth Family Allies. She has served on the Board of the Oregon Safe Schools and Communities Coalition and currently serves on the Advisory Board of the Trans Youth Equality Foundation, the Multnomah County DHS LGBTQ Youth Workgroup and the Development Committee for the Oregon Health & Science University Transgender Program. She was also named to the inaugural “Trans 100” list of individuals working towards positive change for transgender people and recognized by the National Gay and Lesbian Task Force as one of “90 Women Leading the Way To Equality”.

About Kelley
Dr. Kelley Winters is a writer and consultant on issues of gender diversity in medical and public policy. She is the author of Gender Madness in American Psychiatry: Essays from the Struggle for Dignity (2008) and a past member of the International Advisory Panel for the World Professional Association for Transgender Health (WPATH) Standards of Care, the Global Action for Trans* Equality (GATE) Expert Working Group, and the Advisory Boards for TransYouth Family Allies (TYFA). She was recognized in the 2013 Trans 100 Inaugural List for work supporting the transgender community in the US. Kelley has presented papers and presentations on gender policy issues at annual conventions of the American Psychiatric Association, the American Psychological Association, the American Counseling Association and the Association of Women in Psychology. Kelley wanders the highways of America in an old Mazda, ever in search of comfort food.

5 Responses to Response to Dr. Jack Drescher and the NY Times About Childhood Transition: Part 3, by Jenn Burleton

  1. pasupatidasi says:

    Reblogged this on Pasupatidasi's Blog and commented:
    this is something that had to be done…translating the broad generalisations regarding gender diverse/transgender children that is often spouted by those who are merely “researching” …

    in practical experience these statements cannot hold up…my transgender daughter says she IS a girl…not that she wants to be one or ‘likes girl things’. as a matter of fact, she isn’t into the whole societally imposed “girls like dolls and pink”….
    altho it remains to be seen, since she is only 10 now, whether her stated sexual preference will change (right now she identifies as a lesbian) one thing i’m absolutely sure of: this girl will never see herself as ‘male’, nor will she settle for less than a full gender reassignment. for seven years she has declared who she is….that’s more than 2/3 of her life thus far…and as she approaches puberty, one big fear she has is that we won’t ‘catch’ something in time…that her voice will deepen, or she’ll get facial hair…but her biggest fear of all, is that she might die before the surgery that will make her ‘all girl’ can be done.

    thanks to the author of this blog, for setting the record straight. we parents of transgender kids have it hard enough without misconceptions being perpetuated, no matter how well meaning.

  2. misswonderly says:

    I am so glad you people are going on the record here with the support of your evidence base to rebut the “only a phase” meme. In my opinion many in the adult trans community have been far too timid for far too long in allowing this meme to be propagated without challenge.

    Thank you, Jenn Burleton

  3. misswonderly says:

    Every bit as important of course to rebut the ‘you can’t tell them apart’ meme … for starters why would it be important to do so? … But Im glad to see you clearly state this as a result of your clinical experience: ‘we find no evidence that those who socially transition gender early desist in their self-identity when that identity represents something other than their assigned sex at birth.’

  4. mermaidsuk says:

    A good response to Drescher’s letter. ‘It’s just a phase’ should not be applied carte blanche to every case of a gender variant child or youth. For some, yes, it can be a phase, but one that will last for some years – usually until they reach puberty. Such a phase can be painful, lonely and traumatic, so professional advice and support can be beneficial. For many more, it is not a phase, and can be even more distressing. I do agree that it is essential that education and publicity is necessary to improve understanding, but I don’t entirely agree that one can always easily tell these kids apart. At this early age it isn’t always easy to tell if a child will still be gender variant after puberty. I’ve known children who did say I am a boy, or I am a girl, who were happily not gender variant following puberty. – from Linda, one of Mermaids’ founder members in 1995.

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