July 7, 2013 5 Comments
A Guest Post by Jenn Burleton
Founder and Executive Director of
TransActive Education & Advocacy
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 Jack Drescher regarding the case of the Colorado transgender child contained several misleading and outdated statements regarding the future transgender identity of the young girl in question.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:
- Affirm the child’s gender identity/expression without pushing them in one direction or another. Encourage the family to do so as well.
- Support and, if necessary, help facilitate social gender congruence to whatever degree the child expresses a need for.
- Diagnose Gender Dysphoria when it exists based upon clinical guidelines and when necessary to access additional services
- Remain open to evolving childhood gender identity and expression
- Facilitate access to pubertal suppression treatment if desired by the adolescent
- Facilitate access to surgical procedures (if desired) when appropriate and in consultation with therapists and medical personnel.
- 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 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”.