In an age of rising depression and anxiety in teens, the last thing they need is to be told that their problems can be resolved by becoming the opposite sex. What they need is to be heard, given compassion and help to dig deep into their pain. We live in a world that wants to put every problem in a box, fix it and move on. As physicians we are anxious to give concrete help and I often feel this way. There are so many ailments that we don’t completely understand and often we just write a prescription. This isn’t because we don’t care but we fall into the same trap that parents and counselors do. We hate to see kids hurt, so we do our best to give any help- even if it’s a band aid. But we’ve walked into dangerous territory. When kids come to us and say they are gender-confused or dysphoric, we are too quick to advise a dangerous solution – medical transition.
Dr. Diane Ehrensaft director of the University of California San Francisco’s Mental Health Department said “Parents say to us, ‘what do you really know about the long-term effects of puberty blockers? Who has really studied children over 20 years? We say: That’s what we plan to do.’”
Gender dysphoria and confusion is a complex issue. I fear that taking children down the road of “fixing” their dysphoria with hormones and/or surgery will deepen their angst.
Several years ago, a young boy I had seen since he was a baby came to me saying that he wanted to transition to a girl. He was confused and depressed and he was getting worse. He wore camouflage pants, sparkly nail polish and one half of his hair was buzzed and the other long. My heart sank because I could list the reasons he was depressed and one of them was not desiring to be a girl.
He grew up as the oldest of four kids. Mom and dad divorced and two of the younger kids struggled with the divorce so he stepped in to “parent” them. Dad was a drug addict and sold drugs out of his home during the days and nights the kids stayed with him.
“I would hear men’s voices in the living room after we went to bed. I cringed. They were using drugs. Some of them would say weird things about sex and I was terrified they would come in one of our rooms and hurt my sisters.”
As the years went on, he kept going to his dad’s because the court said he had to. His mother knew this was going on but was too afraid to confront her ex-husband for fear that he might become violent. She met a boyfriend and he moved in. “He hated us” my patient said. “We never liked being around him because he was mean.”
This went on for years. He would often cry when he came into my office and we spent countless hours talking over the years.
When he came in at 12, his mother came along. She did most of the talking. About halfway through the appointment she said, “We need to call him Clare now, Dr. Meeker. He wants to transition to a girl and we fully support that.” FYI – from my experience, parents frequently push for gender transition, believing that they are genuinely helping their kids.
I stared at my patient. He looked empty. “We’re taking him to U. Michigan to the gender transition clinic.”
I tried hard to get them to wait. “We need to treat his depression aggressively before we consider this. I cited research. A 30 – year long study from Sweden showed that 10 years after reassignment, transgender patients were 19 times more likely to die from suicide. And -those transitioning from male to female are at higher risk.”
My pleas failed. He went to U. Michigan and here is what he told me happened. He was interviewed for two hours by therapists and then one hour with a physician. Then, he came home with the first round of puberty blockers. I felt sick. I had known this boy for 12 years and they talked to him for three hours and began the process of changing the trajectory of his life. If only…
This is happening all over the country. Health care workers are well-intentioned. The problem is, they don’t know these kids. They give them a ‘fix’ because they are anxious to help. But giving kids growth hormones to stop puberty doesn’t help.
There is a plethora of data arising on the harmful effects of transitioning children. Researcher, Irene Erickson and Stan Weed from The Institute for Research and Evaluation meticulously reviewed hundreds of papers on it. Here is a summary of what they found.
First, “Scientific evidence has not shown that cross-sex medical treatments are beneficial to children or adolescents. The research making these claims is not scientifically liable. In fact, there is evidence of harmful impact. Consequently, a growing number of scientific agencies do not recommend such treatments. Instead, they recommend counseling and watchful waiting for gender-confused youth”.
I want to be clear. We are not denying that children with gender dysphoria have legitimate feelings and desires to transition. What we must do is fastidiously examine our response to these feelings.
Second, many parents and practitioners fear that if gender-confused children aren’t transitioned, they are more likely to commit suicide. The mantra, ‘it’s better to have a transitioned child alive than one who wasn’t, dead’, is recited.
Fear is a powerful motivator and I get it. But here’s what the research shows. “Research does not show that medical gender transition is necessary to prevent suicide. In fact, there is evidence that medical transition procedures may increase risk of suicide in gender-confused teens.”
Even if you are a staunch advocate of gender transition in kids, there is powerful evidence to at least pause. Empathetically embrace the child and help him/her with his/her feelings.
Third, many believe that if kids aren’t allowed to transition, they will live with gender confusion for the rest of their lives. This isn’t true. “Research shows gender dysphoria in children usually goes away on its own by young adulthood, if transition is not encouraged. This avoids the harmful effects of cross-sex medical interventions.”
Fourth, “Scientific evidence indicates that the causes of gender dysphoria are complex. Social and cultural factors have significant influence on whether a young person will identify as transgender.”
The research goes on and on. Here’s the bottom line. There is enough evidence from the most respected institutions around the world that the real and long-term effects of transitioning kids is unknown. Therefore, it is completely unreasonable to put puberty blockers into children to transition them. Changing a child from male to female or female to male is very serious business and we’d better be 100% sure that it will definitely benefit, not harm them, before we begin medical transition.
An article in the prestigious European Child and Adolescent Psychiatry states, “Empirical evidence concerning the psychosocial health outcomes after puberty suppression and gender-affirming medical intervention of adolescents is scarce.” This alone is justification for not giving puberty blockers. Realize too, that the hormones: growth hormone, estrogen, progesterone and testosterone are not approved by the FDA for use in transition. This is sobering.
The best response we should give for gender dysphoria in children is: wait. Understand and empathize. Talk to the kids. Tell them that gender transition is not a treatment that should be done on children and if that they, when they are 25, still want to undergo the transition, they are the ones to decide. But any teenager is completely incapable of making such a life-changing decision. As adults, we must step in and stop such a serious process.