Tag Archives: Trans Children

Setting the record straight on trans issues

This is a more fully referenced copy of a letter I sent to the BACP Journal Therapy Today

I read with dismay the two letters published in December’s Therapy Today in response to Kaete Robinson’s excellent piece Look beyond the binary. I have been reflecting to myself whether such prejudice would have been published were it related to another minority group, although it is of course impossible to draw comparisons between the struggles of different marginalised minorities.

Obviously, Therapy Today does not publish all letters, and as such it must believe the ones it does publish have some merit. I wish to contradict this assumption.

Bev Gold’s letter first: In it she compares gender dysphoria with anorexia, and with negative self beliefs that lead someone to be “uncomfortable in their own skin”. But we have recently heard conclusive evidence from a Lancet study that gender dysphoria is indeed not a form of mental illness, but a legitimate phenomenon that needs not to be pathologised. She talks about the mental distress of trans people but ignores the sizeable body of evidence that suggests any mental health issues are created by stigma, negative attitudes, and barriers to transition, with studies demonstrating that support in transition and acceptance alleviate this distress, while efforts at reparative therapy, what she is clearly suggesting, only do harm.

I am left wondering if someone was as clearly arguing for reparative therapy of gay people, would their letter have been published? As someone who is a member of both trans and LGB communities, I experience a disparity between a growing intolerance of anti-LGB ideologies and an abiding tolerance and dissemination of anti-trans ideas.

In addition, Ms Gold makes the frustrating conflation that accepting someone as transgender will necessitate them having surgical transformations. Many trans people do not have medical treatment. For those that do, it has been proven to be inordinately successful in alleviating dysphoria, with very low evidence of regret. Ms Gold infers the opposite, that this is somehow a dangerous and tragic path.

Ultimately, trans identities need to be accepted and validated whether or not someone has made medical changes. The underpinning message of Ms Gold’s letter is that if a client enters the room and states their name and pronouns and how they experience themselves, we should cast doubt on this, pathologise it and force them to explore it, whether or not that is what they are asking for in their therapy. This is profoundly unacceptable and contrary to the principle of Autonomy in the BACP Ethical Framework.

The second letter is referenced, which lends it a veneer of respectability, however it transpires that one of the references, although appearing to be a reputable journal, is actually a renowned anti-trans blog, another reference is from Tumblr, a social media site, and that the author herself is a prolific anti-trans campaigner. The letter trots out some well-worn anti-trans myths. That detransition is common (it is rare); that the fact detransition occasionally happens means that transition is overall harmful (strong evidence refutes this); and that 80 per cent of trans children “desist” – this is evidenced in many places as a conflation of trans and gender non-conforming children.

In fact, studies have shown that genuinely gender dysphoric children have gender identities that are as consistent as those of cisgender children. In other words, if we talk about not allowing trans children to express their gender through pronouns, clothes, and gendered names, then we should equally be concerned about gendering cisgender children in the same manner.

Most concerning of all is her characterisation of “the autistic spectrum disorder teenage daughter [sic]who suddenly declares herself [sic] to be a boy”. First, let’s be clear that while there is a known correlation between autism and gender dysphoria (birth differences come in clusters, no surprise there), there is no evidence that autistic people lack the self-knowledge to understand their own gender. In fact, my local gender clinic in Nottingham has an autism specialist on staff whose main role is to help gender doctors to take autistic trans people as seriously as they would any other trans person, and not engage in blatant discrimination or infantilisation of the autistic community.

Secondly, she talks about “sudden onset” of symptoms, apparently having no knowledge or understanding of the lengths of time involved in obtaining a diagnosis of, and treatment for, gender dysphoria, or that clinicians will be looking for a consistent pattern and enduring and stable gender identity. Evidence demonstrates most trans people identify their dysphoria from a young age, and any “sudden onset” symptoms would not lead to treatment in anything less than years. Meanwhile, this child will be subject to the relentless doubt, questioning, bullying and attack that you trans people are subject to. It is far more plausible that trans children are dissuaded from transitioning by this stigmatising and hostile world than that we live in a culture where being trans is over-enabled. Anyone making this assumption is fundamentally unaware of the reality of trans lives and likely to do considerable harm.

There are many other inaccuracies and prejudices, too numerous to comment on. I experience the disrespectful tone of Ms Davies-Arai as unprofessional, and not appropriate for a journal, again out of chime with the Ethical Framework’s principles. She talks about “Transgender Indoctrination” as if it is possible for our tiny community to outbalance the from-birth indoctrination of cissexism – that is, the assumption that we should attach entire legal and social structures, names, pronouns, toilet arrangements and much more to the shape of people’s genitals. Not forgetting that intersex children often endure normalising surgery in infancy and later sometimes hormonal treatment, to artificially fit this binary – an issue that somehow incites considerably less outrage than the treatment of trans children in adolescence with entirely reversible puberty blockers.

The treatment of transgender children and adults is, contrary to these letters, slow-paced, conservative, well studied over nearly a century, and very well clinically evidenced. While there are intersections between the gay and trans communities, to suggest that trans people are simply confused gay people or that being trans is somehow more accepted and supported than being gay is not only ludicrous, it is a deeply regressive attitude that does not merit sharing in the pages of a professional journal.

My own article referenced below contains links to many of the studies referenced in this letter, and further information is available in the resources section of my website.

Sam Hope

MBACP, Accred.

FURTHER REFERENCES

https://hopecounsellingandtraining.wordpress.com/2016/11/17/it-is-vital-we-talk-about-the-welfare-of-trans-kids/

http://www.chicagotribune.com/news/nationworld/ct-transgender-mental-illness-classification-20160729-story.html

https://hopecounsellingandtraining.wordpress.com/research-papers/

http://www.torontosun.com/2015/06/08/suicide-rate-much-higher-for-transgender-canadians-study

Update 2018: 1. It transpires Ms Davies-Arai is behind Transgender Trend, a well funded anti-trans organisation that have been sending glossy booklets to schools, urging them not to support trans children. BACP have since published a second letter from her.

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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.

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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.dysphoria-diagram

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?

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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.

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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.

 

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