It is vital we talk about the welfare of trans kids

Transgender children have once again been in the news spotlight, following the NSPCC’s cancelled debate and the somewhat confusing story of a possibly trans child taken away from their mother.

A spate of troubling Daily Mail headlines ensued, attacking the charity Mermaids and the BBC and stirring up some hefty moral panic about children being encouraged to be transgender, as if it’s possible to make somebody trans when they are not.

The impact this will have had on trans children and their families is considerable.

Child welfare is a serious matter. As a therapist who has mainly worked with children and young people, and a trans trainer for schools and colleges, it is my number one priority.

It is absolutely right to want a thorough analysis of the welfare of trans children. Far from wanting to close this discussion down, many in the trans community want to open it up, and deepen it.

But how can we have a discussion when there is such a profound lack of knowledge of the issues? When people instinctively worry about “child abuse” when a trans child is raised as their identified gender, but not when we raise cis (non-trans) children in deeply gendered ways?

Often, as with the NSPCC debate, we are offered theatre rather than an education on the issues. We offered the opinion of journalists, rather than the assistance of experts to analyse a complex issue.
Trans children deserve better.

Clarifying what we are talking about

First, let’s be clear on terminology, so we know what we’re discussing.

Trans is an umbrella term, describing anyone who feels incongruence with the gender they were assigned at birth. We say gender here, not sex, because words, pronouns, birth certificates, gendered clothes, toilet doors, the letters M or F on a passport, etc are all social, not biological processes.

Some trans people experience physical incongruence (medically known as dysphoria) with their bodies. Some do not.

Throughout history, there have always been people who need to live differently in relation to social gender. Also throughout history, there have been people who have modified their bodies. Medical technology has opened up many possibilities in this area.

The NHS now offers ways for trans people to modify our bodies. Why? Because they have discovered that for some people medical changes through hormones and surgery can lead to those people living healthier, happier lives. The solution is cost effective, which is why it gets funded.

Healthier, happier people; benefits everybody, takes away from nobody.

In the UK, trans people have also been given legal rights to live as a different social gender than that assigned to them, whether or not they have medical treatment. Although recognition of non-binary trans people is still being fought for, this has been a positive advance for the trans community and again, despite panic and fear from some, nobody has been harmed by trans civil rights being gained.

How do we deal with transgender children?

Anti-trans campaigners will tell you that c.80% of trans children grow up not to be trans. This is a wilful misreading of the evidence. It is true that c.80% of gender non-conforming (GNC) children do not grow up wanting to medically transition, but it’s equally true that this 80% figure bears no relation to the group “children treated for gender dysphoria”, but includes a much wider trans/GNC  “umbrella”.

There are children who “crossdress” and those children need to simply be allowed to crossdress. There are children who don’t conform to gender norms. We need to let them not conform, and leave them be. There are children who experiment with different identities or are fluid, but don’t show a consistent desire to live as another gender. We should accommodate them to express themselves as they need.

Then there are children who show a persistent need to live as another gender. Studies show their gender identity is just as consistent as that of cis children. So, why not allow them to live as their gender? Or, if we believe children are too young to live gendered lives, then why gender them at all?

Healthcare for trans children

“But what about medical treatment of trans children?” critics ask, while meanwhile staying silent over the medical and coercive gendering of intersex children. If there was any doubt over whether “assigning sex” was a purely biological process, the experiences of intersex children evaporates it.

There is general opposition, which I largely share, to irreversibly treating children for gender dysphoria prior to the age of Gillick Competence.

The treatment available to young trans people in the UK is counselling and (reversible) pubertal blockers. The latter pause the physical changes that happen at puberty. Under the NHS, doctors wait until a child has started puberty, to see if the already persistent dysphoria is still present.

Few GNC kids have physical dysphoria. They will not be diagnosed by competent doctors with something they don’t have. “Is it possible to identify a child as trans without relying on sexist stereotypes?” Critics ask. Well, yes, of course – feeling incongruence with your physical body has nothing to do with sexism, and that will be the criteria upon which doctors treat pubertal adolescents.

There is no evidence that this particular subset of gender dysphoric GNC kids are going to “grow out of it“. There is evidence that their outcomes will be better if they are allowed medical treatment. Treated dysphoric kids have “similar or better” mental health to their cis peers, contrasted with a generally high mental health impact for trans young people.

Gillick competent young people, who have a clear and consistent narrative of who they are, can be given the autonomy to make (still reversible) choices about their own bodies. Always remembering that to do nothing will bring the irreversible changes of puberty. Increased suffering, and increased risk to the young person.

Meanwhile, we need to learn the difference between children wanting to socially fit in with their own gender by following some of the conventions of that gender and some bizarre myth that there are doctors diagnosing kids as trans because they like the colour pink.

There is no evidence that children are being medically treated because they wore the wrong clothes or played with the wrong toys. The problems of sexist gender stereotyping are incredibly important but separate issues.

Knowing where the real concerns are

The medicalisation of trans people is problematic; for instance, referring to a trans women as “pre-op”, or misgendering those who have not had medical intervention. Many critics are against gender recognition for trans people who have not had surgery. Such prejudices push trans people towards medicine, in the hopes of social acceptance and clearer civil rights.

I share many trans people’s concerns that parents of trans children may also push them towards treatment that will “normalise” them, so they don’t stand out as transgender. This is why we must put the decision as much as possible in the hands of young people who have capacity to make such decisions. Supported by unbiased and knowledgeable doctors who are able to offer thorough, informed consent.

However, I think the evidence stands that however hard parents push their children to be any particular gender, the child’s gender will not change. Pushing gender onto children is pervasive and normalised, and deeply damaging to trans children, and yet pushing gender is only seen as “abusive” when the parent is perceived as pushing a trans identity. This needs to be understood as society asserting that trans identities are significantly less desirable.

Social acceptance will always influence the choices trans people make, because welfare depends so much on acceptance. This is why it is so vital, particularly in reducing unnecessary medical intervention, that we simply allow children and adults to express their gender, through their clothes, pronouns, names, activities and in any other way, without requiring they undergo medical treatment to be acceptable.

But we need segregation, don’t we?

But what about toilets and changing rooms? It often comes down to these issues. Well, we know that decades of trans women using gendered facilities has not created a risk for cis women.

But actually facilities that are made safe for all genders, for instance individual locking cubicles in an open plan space, are places where less crime and bullying can occur. Segregation is loved by the right wing, but we really don’t need an entire social order built around where and how we pee.

Just accept trans children

We know that trans people often recognise their identity early in life. Trans children authentically experience an untenable incongruence with their socially assigned gender, and sometimes with their bodies as well. This is never going to change.

Allowing children to change their social gender harms nobody. Even if they change back, the sky will not fall in. Yes, we should be exceptionally diligent before we allow medical treatment, but let’s stop treating names and pronouns with such over-loaded reverence. They are merely words that for some have been spun into traps.