This is the first part of a two-parter on transgender youth. Heretic TOC’s tentative conclusions on trans kids’ rights and well-being, including the right to puberty blocking, will be deferred until part two. By all means send comments straight away, but it would not make sense to judge my opinions until you know what they are. As for the conclusions being “tentative”, I think that as an outsider parachuting myself into this difficult issue for the first time, that’s the way they should be. My view is offered with due humility and I welcome reasoned dissent, not least from one or two people here whose knowledge goes far beyond my own.
What is best for transgender youth? Noisy militants demand the “right” of even little children to adopt the gender of their choice, so that every Stephen can become a Stephanie, start wearing dresses, long-hair and makeup, use the girls’ toilets at school and require everyone to call her “she”.
And every tomboy Stephanie, it is asserted, should be free to do the opposite. Thus the path may be cleared, or so it is hoped, for a smooth transition at adolescence and beyond to a more complete reversal, if so desired, of young people’s originally assigned sex, through hormone treatments and surgery.
Heretic TOC has always keenly advocated children’s rights, so cheerleading for the right of youth with gender dysphoria to change their gender may seem an obvious choice. What is definitely a no-brainer is that we should favour policies and practices aimed at securing their dignity and well-being – aims which should include promoting both a happy childhood and long-term flourishing in adult life.
These welfare aims are not necessarily best advanced, however, simply through declaring and implementing a child’s right to transition. This is because, unlike children’s sexual expression and self-determination, gender transition involves setting out on a path that becomes increasingly harder to reverse as time passes; and irreversible changes of a profound nature, especially sex reassignment surgery (SRS), are sometimes profoundly regretted.
This is not to say there should be no early start to transition. Some children make their feelings very clear, very early. From as soon as they learn in infancy about the traditional dress codes and gender roles, they will begin telling their parents they have been assigned to the wrong gender. They just know, from as early as age two or three, that they are really a girl not a boy, or vice versa. In the mantra of therapists approved of by the trans community, if these children are “insistent, consistent and persistent” in such beliefs, then it makes sense to start treating them as belonging to their chosen gender, with a first name and clothes, etc., to match, perhaps just at home to begin with and later at school.
There is nothing irreversible about these symbolic changes, and for that reason there can be no strong reason for making a child’s life miserable by sternly ruling them out. But there are hazards, even at this stage. “Being” a girl instead of a boy, or a boy instead of a girl, may be relatively easy if your mum and dad are relaxed about it and they are the only ones to know; and so will changing back again if so desired. At this stage, there is no commitment beyond the level of any other “let’s pretend” game.
It is much more of a commitment to go to school with a new name and gender though. And a vastly bigger commitment if – as is increasingly happening now that transgender is suddenly such a fashionably high-profile phenomenon – your life as a trans child is featured on a TV reality show such as I Am Jazz, or if your photo is featured on the front cover of National Geographic magazine, as happened to nine-year-old Avery Jackson last month. Once things have reached this stage changing course could be as psychologically tough as getting to the altar with the dreadful sinking feeling that your betrothed is not going to be Mr or Mrs Right after all, but you are already caught in a trap.
The psychiatrist Richard Green, a pioneer in the field of transsexuality since the 1960s, expressed a dim view of transgender children being exposed to the full glare of the media when I heard him speak in London last month on the development of transsexual surgery for adults from its beginnings in the 1930s.
“I’m not convinced that going on TV to announce your child is dysphoric is the best way to ensure their development,” he said. “It might even be considered child abuse. Better if it’s under the radar: allow the child to go to a new school. You test the water. Being on the cover of National Geographic is not necessarily in that kid’s best interests.”
I agree. The high-profile route is a sign not of children being legitimately insistent, consistent and persistent, but rather of militant activism by adults who have shown themselves all too willing to use ruthlessly dishonest tactics. Think of the aggressive noisiness we hear all the time from “victims” of “historic child sexual abuse”: the pushiest ones tell the most sensational yarns and grab the most media and political attention. In this post-truth era, few seem to care whether their stories – with lurid “Satanic abuse” and improbable conspiracy theories based on “recovered memories”, or outright lying – have any basis in reality.
It’s the same, unfortunately, with some trans activists. On BBC’s Newsnight last month, for instance, an activist called Shon Faye made swingeing allegations against Dr Ken Zucker, one of the world’s most eminent clinicians in the transgender field. He falsely claimed that Zucker’s peers, in a review of his clinical practices, found he had a habit of taking unnecessary photos of his young patients “in various states of undress” and he was “asking them very lurid sexual questions”. Zucker’s long-time colleague Ray Blanchard, also on the programme, intervened to say the allegations were untrue. The presenter stopped Faye from going any further, but by then the damage had been done. The allegations appeared to have been an attempt to recycle an earlier one. A former client, now an adult, claimed Zucker asked him to remove his shirt in front of other clinicians present, laughed when he complied, and then referred to him as a “hairy little vermin”. The accusation was subsequently retracted by the accuser. The resurrected form of the accusation on Newsnight was potentially even more damaging; its vagueness hinted at the possibility of a sexual motive on Zucker’s part – and we need no persuading as to how destructive that can be.
What is certainly true, as H-TOC has reported previously, is that there has been a long-term campaign against Zucker, who is seen by some as a monster who practised a brutal form of “conversion therapy” in which he tried to make kids’ gender identity “normal”, otherwise known in the terminology as cisgender. All this agitation led to a highly critical external review last year of Zucker’s work at his clinic, Toronto’s Centre for Addiction and Mental Health (CAMH), as a result of which he was sacked. Investigative journalist Jesse Singal wrote an in-depth series of articles about this, and concluded:
…the truth about Zucker and his clinic is a lot more complicated. Many of the claims activists have made about him are false or seriously overblown, and the “external review” that led to his firing… was absolutely riddled with errors and falsehoods. CAMH itself quickly decided it couldn’t stand by the review it had commissioned; after we reported that the single most damning allegation in the review was completely false, CAMH yanked the document off its website entirely, replacing it with a toned down “summary.” Zucker has since sued CAMH for releasing what he and his lawyer claim was a defamatory report, and that suit is ongoing.
Zucker had a great chance to put the record straight last month in a BBC 2 documentary called Transgender kids: Who knows best?, and to a significant degree he succeeded – despite a vigorous censorship bid in the shape of a the petition aimed at stopping the show going out, and Shon Faye’s libellous trashing of Zucker, broadcast as part of a Newsnight preview of the show. The programme as a whole was generally well-received by mainstream reviewers, who judged it “cautious”, “well worked out”, “even-handed” and “sophisticated”.
Crucially, it considered the controversial and all-important question of what gender dysphoria actually is. There are those, including clinicians and activists, who believe it always reveals a key aspect of an individual’s innermost, stable identity, by showing there is mismatch between their gender identity and their assigned gender, as traditionally determined by their visible genitalia at birth. Thus until they transition they will never feel at ease with who they are. Arguably, they feel a bit like a gay person before liberation or a Kind one now – forced to hide and deny a fundamental aspect of themselves, and hating the idea that the medical profession wants to wish them out of existence through a “cure”.
Zucker does not deny the importance of the fundamental identity question, but as a clinician he is also aware that people are very complicated and that any particular case may actually be driven by other factors. “Taking any behaviour in isolation when thinking about gender dysphoria is not the way that I think about it,” he says. You also need to know about the child’s family and life history. He gave the example of a girl whose mother had been murdered when she was four. The child wanted to be a boy, he said, in the belief that a boy would have been better able to protect her mother and look after himself too.
It sounded very plausible, but I note that Mike Bailey, one of the top research scientists in the field, is sceptical. Addressing him on Sexnet, Bailey said:
Ken, this mantra that there are many ways to gender dysphoria is possibly true, but it is also possibly false. That your clinical team comes up with various formulations about family dynamics that make sense to the team and that the child gets better when problematic dynamics are treated are not very convincing to me as evidence. (I think a plausible alternative is that the passage of time and a shared commitment to helping the child desist are the active ingredients.) Clinical formulations of this general type (family dynamics) have virtually no evidence supporting them.
What does have strong evidence going for it, though, is a connection between gender nonconformity and autism spectrum disorder (ASD), which can definitely be a profound mental health issue at the severe end of the spectrum. According to paediatric neuropsychologist John Strang, children and adolescents on the autism spectrum are seven times more likely than other young people to be gender nonconforming. And, conversely, children and adolescents at gender clinics are six to 15 times more likely than other young people to have ASD. Zucker has himself pointed out this connection; pro-trans activists play it down.
James/Jasmine, are you reading this? Our brilliant, geeky, teenage male-to-female transgender contributor here at Heretic TOC a couple of years ago also identified as autistic, but at the mild end of the spectrum, such that she felt it was not a mental health problem but a valid and positive aspect of her identity. If you see this, Jasmine, we’d love to hear your reaction!
Even more convincing evidence on Zucker’s side came in the programme from “Lou”, who was born female and had a double mastectomy as part of transitioning to a man. Now she feels “freakish” and regrets it deeply. She says it is a decision that “haunts” her and she feels her gender dysphoria should have been treated as a mental health issue. The identity that now feels truest to her is as a cisgender lesbian.
And yet when she was a girl entering puberty she was desperate to be a boy. Distressed by her unwanted periods, she attempted suicide. She was told by the trans community she really had no choice: it was transition or die. She did not think he had a mental health problem.
Also on Who Knows Best? was trans therapist Hershel Russell, who is based in Toronto, like Zucker, and was one of the people who helped get him sacked. Russell tried to talk Lou’s case away as a rare exception. But even one exception is enough to prove that matters are not as simple as the more gung-ho activists would have us believe. They also have a problem with the widely-touted claim (albeit the figures are disputed) that around 80% of children and adolescents diagnosed with gender dysphoria do not in the end go through with transition: they desist, sticking with their sex as assigned at birth.
In the Q&A session following his talk on transsexual surgery, I asked Richard Green about the reasons for this desistance. I was particularly interested to know whether he thought the persistors were mainly people with a potentially diagnosable gender-related biological condition underpinning their gender dysphoria, whereas perhaps the desistors had become transgender for socially-motivated reasons.
He favoured a biological explanation for persistence, especially when it was really insistent and consistent. As for those who desist, he said a lot of them become gay or lesbian. And nobody knows better than Green, who wrote a classic book on the subject, that gender non-conforming boys tend to be homosexual later on. It appears to me that gender dysphoria and sexual orientation probably have a connected common origin. Given the present scientific consensus that sexual orientation has pre-natal biological origins, it also seems a good bet that gender dysphoria is triggered further back in an individual’s development than any social influences.
For yet another Toronto angle on all this I can thank Peace, who has guest-blogged and commented here. Transitioning from female to male, Peace has chosen not to guest-blog about his personal journey, but responded instead to my request for general information, thoughts and resources on the subject. One such resource I found particularly helpful was Families in TRANSition: A Resource Guide for Parents of Trans Youth, published by Central Toronto Youth Services.
What struck me most from this publication was its calmly reasonable tone – a million miles, one might think, from the militant, angry activism that sees Ken Zucker libelled and branded a monster. Bizarrely, however, one of those pleasant, sensible contributors turns out to be none other than Hershel Russell, one of Zucker’s most strident critics. He confesses he worries a bit about parents who seem immediately very accepting of their child’s wish to transition. Zucker himself could have written that!
A point I feel Peace would particularly agree with is this:
Trans people often describe puberty, the point at which their bodies begin to change and visibly betray their inner experience, as traumatizing – “nature’s cruel trick” – and a time of true despair. It is a time when feelings of depression or thoughts of suicide may emerge or worsen.
But the guide makes clear that being transgender is not always about heading towards radical anatomical change:
Some youth are clear that their survival depends on fully transitioning from one gender to another. Other youth find that they only need to change one aspect of their bodies, or need no medical interventions at all but rather wish to express their unique gender identity through clothing and behaviour. Whatever the case, these needs come from inside the child and, for better or worse, are unlikely to be changed by pressure or persuasion.
The next part of this two-part blog will go deeper into the question of what being transgender really means. It will introduce the scientific basis for a striking claim: that there is such a thing as an intersex brain. It will also discuss transgender choices in relation to wider cultural issues.