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I’m a Pediatrician. How Transgender Ideology Has Infiltrated My Field and Produced Large-Scale Child Abuse.

trans_childrenI’m a Pediatrician. How Transgender Ideology Has Infiltrated My Field and Produced Large-Scale Child Abuse.

Professionals who question the unscientific party line of supporting gender transition therapy could find themselves out of a job.

Michelle Cretella | July 5, 2017

Transgender politics have taken Americans by surprise, and caught some lawmakers off guard.

Just a few short years ago, not many could have imagined a high-profile showdown over transgender men and women’s access to single-sex bathrooms in North Carolina.

But transgender ideology is not just infecting our laws. It is intruding into the lives of the most innocent among us—children—and with the apparent growing support of the professional medical community.

As explained in my 2016 peer reviewed article, “Gender Dysphoria in Children and Suppression of Debate,” professionals who dare to question the unscientific party line of supporting gender transition therapy will find themselves maligned and out of a job.

I speak as someone intimately familiar with the pediatric and behavioral health communities and their practices. I am a mother of four who served 17 years as a board certified general pediatrician with a focus in child behavioral health prior to leaving clinical practice in 2012.

For the last 12 years, I have been a board member and researcher for the American College of Pediatricians, and for the last three years I have served as its president.

I also sat on the board of directors for the Alliance for Therapeutic Choice and Scientific Integrity from 2010 to 2015. This organization of physicians and mental health professionals defends the right of patients to receive psychotherapy for sexual identity conflicts that is in line with their deeply held values based upon science and medical ethics.

I have witnessed an upending of the medical consensus on the nature of gender identity. What doctors once treated as a mental illness, the medical community now largely affirms and even promotes as normal.

Here’s a look at some of the changes.

The New Normal

Pediatric “gender clinics” are considered elite centers for affirming children who are distressed by their biological sex. This distressful condition, once dubbed gender identity disorder, was renamed “gender dysphoria” in 2013.

In 2014, there were 24 of these gender clinics, clustered chiefly along the east coast and in California. One year later, there were 40 across the nation.

With 215 pediatric residency programs now training future pediatricians in a transition-affirming protocol and treating gender-dysphoric children accordingly, gender clinics are bound to proliferate further.

Last summer, the federal government stated that it would not require Medicare and Medicaid to cover transition-affirming procedures for children or adults because medical experts at the Department of Health and Human Services found the risks were often too high, and the benefits too unclear.

Undeterred by these findings, the World Professional Association for Transgender Health has pressed ahead, claiming—without any evidence—that these procedures are “safe.”

Two leading pediatric associations—the American Academy of Pediatrics and the Pediatric Endocrine Society—have followed in lockstep, endorsing the transition affirmation approach even as the latter organization concedes within its own guidelines that the transition-affirming protocol is based on low evidence.

They even admit that the only strong evidence regarding this approach is its potential health risks to children.

The transition-affirming view holds that children who “consistently and persistently insist” that they are not the gender associated with their biological sex are innately transgender.

(The fact that in normal life and in psychiatry, anyone who “consistently and persistently insists” on anything else contrary to physical reality is considered either confused or delusional is conveniently ignored.)

The transition-affirming protocol tells parents to treat their children as the gender they desire, and to place them on puberty blockers around age 11 or 12 if they are gender dysphoric.

If by age 16, the children still insist that they are trapped in the wrong body, they are placed on cross-sex hormones, and biological girls may obtain a double mastectomy.

So-called “bottom surgeries,” or genital reassignment surgeries, are not recommended before age 18, though some surgeons have recently argued against this restriction.

The transition-affirming approach has been embraced by public institutions in media, education, and our legal system, and is now recommended by most national medical organizations.

There are exceptions to this movement, however, in addition to the American College of Pediatricians and the Alliance for Therapeutic Choice. These include the Association of American Physicians and Surgeons, the Christian Medical & Dental Associations, the Catholic Medical Association, and the LGBT-affirming Youth Gender Professionals.

The transgender movement has gained legs in the medical community and in our culture by offering a deeply flawed narrative. The scientific research and facts tell a different story.

Here are some of those basic facts.

1. Twin studies prove no one is born “trapped in the body of the wrong sex.”

Some brain studies have suggested that some are born with a transgendered brain. But these studies are seriously flawedand prove no such thing.

Virtually everything about human beings is influenced by our DNA, but very few traits are hardwired from birth. All human behavior is a composite of varying degrees for nature and nurture.

Researchers routinely conduct twin studies to discern which factors (biological or nonbiological) contribute more to the expression of a particular trait. The best designed twin studies are those with the greatest number of subjects.

Identical twins contain 100 percent of the same DNA from conception and are exposed to the same prenatal hormones. So if genes and/or prenatal hormones contributed significantly to transgenderism, we should expect both twins to identify as transgender close to 100 percent of the time.

Skin color, for example, is determined by genes alone. Therefore, identical twins have the same skin color 100 percent of the time.

But in the largest study of twin transgender adults, published by Dr. Milton Diamond in 2013, only 28 percent of the identical twins both identified as transgender. Seventy-two percent of the time, they differed. (Diamond’s study reported 20 percent identifying as transgender, but his actual data demonstrate a 28 percent figure, as I note here in footnote 19.)

That 28 percent of identical twins both identified as transgender suggests a minimal biological predisposition, which means transgenderism will not manifest itself without outside nonbiological factors also impacting the individual during his lifetime.

The fact that the identical twins differed 72 percent of the time is highly significant because it means that at least 72 percent of what contributes to transgenderism in one twin consists of nonshared experiences after birth—that is, factors not rooted in biology.

Studies like this one prove that the belief in “innate gender identity”—the idea that “feminized” or “masculinized” brains can be trapped in the wrong body from before birth—is a myth that has no basis in science.

2. Gender identity is malleable, especially in young children.

Even the American Psychological Association’s Handbook of Sexuality and Psychology admits that prior to the widespread promotion of transition affirmation, 75 to 95 percent of pre-pubertal children who were distressed by their biological sex eventually outgrew that distress. The vast majority came to accept their biological sex by late adolescence after passing naturally through puberty.

But with transition affirmation now increasing in Western society, the number of children claiming distress over their gender—and their persistence over time—has dramatically increased. For example, the Gender Identity Development Service in the United Kingdom alone has seen a 2,000 percent increase in referrals since 2009.

3. Puberty blockers for gender dysphoria have not been proven safe.

Puberty blockers have been studied and found safe for the treatment of a medical disorder in children called precocious puberty (caused by the abnormal and unhealthy early secretion of a child’s pubertal hormones).

However, as a groundbreaking paper in The New Atlantis points out, we cannot infer from these studies whether or not these blockers are safe in physiologically normal children with gender dysphoria.

The authors note that there is some evidence for decreased bone mineralization, meaning an increased risk of bone fractures as young adults, potential increased risk of obesity and testicular cancer in boys, and an unknown impact upon psychological and cognitive development.

With regard to the latter, while we currently don’t have any extensive, long-term studies of children placed on blockers for gender dysphoria, studies conducted on adults from the past decade give cause for concern.

For example, in 2006 and 2007, the journal Psychoneuroendocrinology reported brain abnormalities in the area of memory and executive functioning among adult women who received blockers for gynecologic reasons. Similarly, many studies of men treated for prostate cancer with blockers also suggest the possibility of significant cognitive decline.

4. There are no cases in the scientific literature of gender-dysphoric children discontinuing blockers.

Most, if not all, children on puberty blockers go on to take cross-sex hormones (estrogen for biological boys, testosterone for biological girls). The only study to date to have followed pre-pubertal children who were socially affirmed and placed on blockers at a young age found that 100 percent of them claimed a transgender identity and chose cross-sex hormones.

This suggests that the medical protocol itself may lead children to identify as transgender.

There is an obvious self-fulfilling effect in helping children impersonate the opposite sex both biologically and socially. This is far from benign, since taking puberty blockers at age 12 or younger, followed by cross-sex hormones, sterilizes a child.

5. Cross-sex hormones are associated with dangerous health risks.

From studies of adults we know that the risks of cross-sex hormones include, but are not limited to, cardiac disease, high blood pressure, blood clots, strokes, diabetes, and cancers.

6. Neuroscience shows that adolescents lack the adult capacity needed for risk assessment.

Scientific data show that people under the age of 21 have less capacity to assess risks. There is a serious ethical problem in allowing irreversible, life-changing procedures to be performed on minors who are too young themselves to give valid consent.

7. There is no proof that affirmation prevents suicide in children.

Advocates of the transition-affirming protocol allege that suicide is the direct and inevitable consequence of withholding social affirmation and biological alterations from a gender-dysphoric child. In other words, those who do not endorse the transition-affirming protocol are essentially condemning gender-dysphoric children to suicide.

Yet as noted earlier, prior to the widespread promotion of transition affirmation, 75 to 95 percent of gender-dysphoric youth ended up happy with their biological sex after simply passing through puberty.

In addition, contrary to the claim of activists, there is no evidence that harassment and discrimination, let alone lack of affirmation, are the primary cause of suicide among any minority group. In fact, at least one study from 2008 found perceived discrimination by LGBT-identified individuals not to be causative.

Over 90 percent of people who commit suicide have a diagnosed mental disorder, and there is no evidence that gender-dysphoric children who commit suicide are any different. Many gender dysphoric children simply need therapy to get to the root of their depression, which very well may be the same problem triggering the gender dysphoria.

8. Transition-affirming protocol has not solved the problem of transgender suicide.

Adults who undergo sex reassignment—even in Sweden, which is among the most LGBT-affirming countries—have a suicide rate nearly 20 times greater than that of the general population. Clearly, sex reassignment is not the solution to gender dysphoria.

Bottom Line: Transition-Affirming Protocol Is Child Abuse

The crux of the matter is that while the transition-affirming movement purports to help children, it is inflicting a grave injustice on them and their nondysphoric peers.

These professionals are using the myth that people are born transgender to justify engaging in massive, uncontrolled, and unconsented experimentation on children who have a psychological condition that would otherwise resolve after puberty in the vast majority of cases.

Today’s institutions that promote transition affirmation are pushing children to impersonate the opposite sex, sending many of them down the path of puberty blockers, sterilization, the removal of healthy body parts, and untold psychological damage.

These harms constitute nothing less than institutionalized child abuse. Sound ethics demand an immediate end to the use of pubertal suppression, cross-sex hormones, and sex reassignment surgeries in children and adolescents, as well as an end to promoting gender ideology via school curricula and legislative policies.

It is time for our nation’s leaders and the silent majority of health professionals to learn exactly what is happening to our children, and unite to take action.

“Gender therapy” doctor admits to advising kids to fake being suicidal to get transgender “treatments”

“Gender therapy” doctor admits to advising kids to fake being suicidal to get transgender “treatments”

By Jonathon Van Maren

wallace-960x480Earlier this year, I noted that transgender activists were going to use data on the suicide rate in the transgender community to go after schools they consider insufficiently supportive of their ideological agenda, despite the fact that there is no evidence that physical transition actually reduces suicidal ideation. As it turns out, there are some medical quacks willing to go quite a bit further in their crusade to assist young children in the transition process, including a psychologist from British Columbia, Canada:

Dr. Wallace Wong…is facing calls for an inquiry into the conduct of his practice. On February 28…Wong spoke at an event hosted by Vancouver Public Library. In a tape of the event obtained by Canadian pro-family group Culture Guard, Wong is heard proudly describing the scope of his children-only “gender therapy” practice, noting that his youngest client is not yet three years old and that he has 501 orphans and foster kids in his local practice.

If true, this indicates Wong has likely used his relationship with the BC Ministry of Children and Family to diagnose more than 10 to 20 percent of local children in government care as needing his “gender therapy,” according to Culture Guard President Kari Simpson.

In Wong’s own words, his practice began in 2010 with just “four clients at the ministry” but in the course of nine years, there was such an enormous surge of need within that population that he now has “more than 500 kids, [with] just the Ministry alone…. So we can imagine the demand of service is soaring…. The phenomenon is happening a lot faster than – than we expected.”

Simpson expressed outrage at this “soaring” demand, claiming Wong was “gender-jacking” vulnerable children from the Ministry and “profiting” handsomely into the bargain.

Wong also had some startling advice for a parent seeking to get a child referred to his program. Although the questioner had not indicated any particular urgency, Wong explained that parents should exaggerate the severity of their child’s condition to their local health offices.

Wong said a suicide threat was an effective means of accomplishing this goal. While Wong framed the matter as the government’s fault and explained to his audience that it is “up to us as advocates” to change the situation, his message could not have been lost on anyone present.

“So what you need is, you know what? Pull a stunt. Suicide, every time, [then] they will give you what you need,” Wong said, adding that gender-dysphoric kids “learn that. They learn it very fast.”

This is a revealing, although unsurprising, admission, and I’m glad that it was caught on tape. Suicidal ideation has long been a preferred tactic of progressives in the culture wars—not only is it used in the transgender context to achieve their goals, but they also claim that any failure to implement LGBT programming in schools and other institutions is sure to cause suicides amongst gay and lesbian youth. Suicidal ideation has even been used in the abortion fight—Irish courts first permitted abortion in limited circumstances when faced with the hypothetical of women promising to commit suicide if they were refused abortions.

Dr. Wallace Wong is a hero in the transgender community because he helps them get what they want, regardless of whether he has to brazenly lie to do so. He does this while claiming that parents who do not whole-heartedly embrace physical transition for their children pose a threat to their own sons and daughters. These facts appear to indicate that the very opposite is true

Gender Dysphoria and Surgical Abuse

Gender Dysphoria and Surgical Abuse

trans teenIn recent years, the issue of transgender identity in children has leapt from the periphery of public consciousness to centre stage of a cultural drama played out in the media, courts, schools, hospitals, families, and in the minds and bodies of children. It is a kind of utopian religion with committed believers.

The drama is “gender dysphoria” and it is about children believing they belong to the opposite sex[1]. It is about parental anguish and commitment, court battles to instigate some therapies, laws to prevent others, cross-dressing, drugs that will block puberty, others that will transform an adolescent towards the opposite sex, pending feats of surgery that will castrate while turning a penis into an opening like a vagina, or producing a penis from a forearm in a foray into reproduction unrivalled since the days of eugenics. It is no wonder this drama is repeated on the media, especially as its players may be toddlers whose future is in the hands of the audience. Accept the pathways of “medicine”, we are urged. Welcome transgender as but one hue in a natural rainbow. Or the children will kill themselves[2].

But is this massive intrusion into the minds and bodies of children necessary? What will happen if parents do nothing but “watch and wait” while their child muses on its gender? Can the child grow out of it?

The answer astonishes. While proponents argue for massive intervention, scientific studies prove that the vast majority of transgender children will grow out of it through puberty if parents do little more than gently watch and wait. Studies vary but from 70 to 97.8 per cent of gender-dysphoric male and 50 to 88 per cent of gender-dysphoric female children have been reported to “desist” prior to the onset of puberty. This likelihood of “growing out of it” is declared in no less than the current, official Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association[3] (DSM-5), and is supported by a number of independent studies[4][5].

The Western medical profession boasts that it rests on “evidence-based medicine” but the tiny fraction involved with “affirmation” of gender identity in confused children is proceeding without supportive evidence for claims of high incidence, the need and safety of medical and surgical intervention, the avoidance of self-harm, and for the concept that the process will produce a happier human being in a happier society. Faith is needed for affirmation.

During a discussion on these matters, a leading endocrinologist declared to this writer, twice, that the issues of gender dysphoria are “utterly arbitrary … utterly arbitrary”, and that his greatest fear was that a mistake would be made by intervention. If most gender-dysphoric children desist without treatment, the “utterly arbitrary” medical pathways are also utterly unnecessary.

How common is childhood gender dysphoria?

No one really knows because there is “an absence of formal prevalence studies”[6][7] and estimates vary greatly. The leader of Toronto’s Transgender Youth Clinic at the Hospital for Sick Children, Dr Joey Bonifacio, says estimates based on adult dysphoria clinics range from 0.005 to 0.014 per cent for men convinced they are women and 0.002 to 0.003 per cent for women convinced they are men, but believes they are “likely modest underestimates”[8]. Bonifacio’s statistics are the same as those declared in the bible of psychiatry, DSM-5[9].

In Australia, prominence has been given to a cross-sectional questionnaire distributed to 8500 adolescents in New Zealand (“Youth 12”) which reported 1.2 per cent answered “Yes” to the question, “Do you think you are transgender? This is a girl who feels like she should have been a boy, or a boy who feels like he should have been a girl.” 95 per cent denied being transgender, 2.5 per cent replied they were “unsure”, and 1.7 per cent “did not understand” the question. The estimate of 1.2 per cent is promoted by leaders of the gender dysphoria service at Melbourne Children’s Hospital[10], but the progenitors of the “Safe Schools” program appear to have inflated the figure to 4 per cent by adding the unsure 2.5 per cent.[11]

Results of such tick-in-the-box questionnaires are unreliable. According to DSM-5, childhood gender dysphoria can only be diagnosed if there is “a marked incongruence” between natal and perceived gender lasting “at least six months”, “manifested by at least six” features, including “a strong desire … and insistence”, together with a “strong preference” for the company, clothing and toys of the opposite sex and its role in fantasy play, and associated with rejection of the stereotypes of its natal sex, including anatomy. Also, to comply with “dysphoria”, there should be “significant distress or impairment … in functioning”.

The unreliability of such questionnaires is emphasised in the Journal of Homosexuality in its consideration of the prevalence of suicide in sexual minorities[12]. It warns that conclusions are limited because they are based on “retrospective” data, “do not effectively allow cause and effect relationships to be discerned” including “co-occurring mental disorders”, are “restricted” in the number of questions they can ask to elucidate facts and are weakened by the possibility of incomprehension of the questions.

Is it any surprise that reliability of responses from adolescents has been questioned?[13] In the New Zealand survey deemed authoritative by some in Australia, 36.5 per cent of adolescents in this land of the All Blacks declared they did not understand the question: have you ever been “hit or physically harmed by another person?”

It is false to claim 1.2 per cent of the population is transgender on the basis of the survey. That would make its prevalence rival the 1 to 3 per cent of mental retardation. It is wrong to conflate the figure to 4 per cent for the “Safe Schools” program. That would mean one in twenty-five of all children would be transgender.

A straw poll of twenty-eight generalist paediatricians with a cumulative postgraduate experience of 931 years conducted for this article reveals eight children to have been observed with gender dysphoria. Four were remembered to have had severe associated mental disorder, one associated attention deficit/hyperactivity, one had been investigated for neurological disease on the basis of strange fidgetiness, and two had suffered sustained sexual abuse. In reality, childhood gender dysphoria is a rare condition whose prevalence is unknown.

How common are associated mental problems?

There are at least four reasons why a child with gender dysphoria might have associated mental disorder. The first is that transgender is but a symptom of a general disturbance. The second is that mental disorder could be caused by gender dysphoria. The third is it could be caused by external ostracism. The fourth would be a mixture of the above. Though studies reveal mental disorder, the cause remains elusive.

A study of Dutch children with dysphoria aged from four to eleven revealed associated psychiatric disease of at least one type in 52 per cent [14] with diagnoses including anxiety, phobias, mood disorders, depression, attention deficit and oppositional behaviour. A study by school teachers reported significant behavioural and emotional problems in about one third of 554 dysphoric Dutch and Canadian children under twelve[15]. At the first presentation to a US gender clinic of ninety-seven children with mean age of 14.8 years, 44.3 per cent had a history of psychiatric diagnoses, 37.1 per cent were already on psychotropic medications and 21.6 per cent had a history of self-injurious behaviour[16]. In an Australian study of thirty-nine dysphoric children of mean age ten, behavioural disorders were observed in a quarter, and Asperger syndrome in one in seven[17].

Proponents claim psychiatric problems are secondary to ostracism, but the American authors suggested gender dysphoria, itself, might be causal: “psychiatric symptoms might be secondary to a medical incongruence between mind and body”, because the symptoms tended to abate with hormone therapy.

The frequency of autism spectrum disorder in children with gender dysphoria, and the known indifference of those children to the opinion of others, would argue transgender was a symptom of an underlying disorder and not a result of ostracism. Autism has been found in 7.8 per cent of transgender children in a Dutch clinic[18], around 13 per cent in London[19] and 14 per cent in Australia.

The answer to the question of whether dysphoria is primary or secondary is unknown and probably unknowable. This renders optimistic, if not delusional, the concept that massive intervention may secure happiness.

What is the risk of self-harm and suicide?

Risk of self-harm has been reported in gender-dysphoric children and is the argument for “treatment” and against inaction. Is self-harm another manifestation of an underlying disorder, or is it due to frustration from gender dysphoria alone, or due to ostracism? Proponents of affirmative treatment proclaim the latter and declare an “alarmingly high rate” of self-harm and suicide attempts, exemplified by highly publicised and tragic youth suicides in the US[20].

As with most data related to gender dysphoria in children, studies are limited by lack of numbers and methodological bias, and the true rate of self-harm due to external ostracism is unknown. Other factors are very common and very important and seem neglected in the argument.

One London study retrospectively reviewed letters from referring doctors and its own notes regarding 218 gender-dysphoric children with mean age of fourteen. Of forty-one aged from five to eleven, it reported self harm in 14.6 per cent, suicidal ideation in 14.6 per cent and suicidal attempts in 2.4 per cent. Higher rates were reported in adolescents. A similar rate of ideation is reported from Canada[21], though associated with a lower rate of self-harm or attempted suicide (17 per cent as against 6.2 per cent). As in London, rates increased with age. Neither study revealed features of self-harm and attempted suicide.

The study reported high associated rates of psychiatric co-morbidity in children under eleven: autism spectrum disorder from 12.2 to 17.1 per cent, attention deficit hyperactivity in 14.6 per cent, anxiety in 17.1 per cent, depression in 7.3 per cent and psychosis in 2.4 per cent with, on the whole, rates increasing with age. It reports bullying and abuse in almost half to two thirds of all children but does not discuss whether it was provoked by transgender characteristics or those associated with autism, hyperactivity and psychosis.

Furthermore, though detailing living arrangements of the children, the authors do not comment on their influence, though the effect of family chaos on the mood of offspring is well known. The study found only 36.7 per cent were living with both biological parents, and 58.3 per cent “had parents who had separated”. “Domestic violence was indicated” in 9.2 per cent, maternal depression in 19.3 per cent, paternal depression in 5 per cent; and parental alcohol or drug abuse in 7.3 per cent.

Nor does the study consider the significance of autism it found in 12.2 to 17.1 per cent of its children. Elsewhere, 14 per cent of children with autism aged from one to sixteen have been reported to experience suicidal ideation or attempts, suggesting a rate twenty-eight times greater than that for typical children (0.5 per cent)[22].

The New Zealand survey of adolescents (“Youth 12”) deemed authoritative by some in Australia asked about “self-harm” in the previous year. Of non-transgenders 23.4 per cent replied “Yes”, as did 45.5 per cent of “transgenders” but 23.7 per cent reckoned they did not understand the question. When asked about attempted suicide, 4.1 per cent of non-transgenders replied “Yes”, as did 19.8 per cent of “transgenders”, but 13.3 per cent declared incomprehension.

In other studies, between 19[23] and 29 per cent [24] of all adolescents are reported to have a history of suicidal ideation, and between 7 and 13 per cent to have attempted suicide; though what constitutes an attempt is not described in these studies, or in those above from London and New Zealand.

The question, then, is whether transitioning of transgender children will ultimately reduce self-harm. While Dutch experience concludes that “starting cross-sex hormones early … followed by gender reassignment surgery … can be effective and positive for general and mental functioning”[25], other centres report high rates of suicide in the years following reassignment.[26] [27] To be fair, those reassigned in these studies did not have such a developed “pathway” for affirmation as in Holland. Nevertheless, suicide attempts after surgery have been reported to be more common than in the general population in Belgium (5.1 per cent as against 0.15 per cent)[28] and in Sweden[29].

Conversely, regarding suicide by adolescent members of sexual minorities, the Journal of Homosexuality concludes that “very few suicide decedents [sic]” have been identified as having “minority sexual orientation” in studies in North America: three of 120 adolescent suicides in New York, and four of fifty-five in Quebec; and warns conclusions based on “small numbers … must be regarded as tentative”.

The conclusion of the Journal of Homosexuality is valid. Numbers are small and data is obscure. No one knows how often real suicide attempts occur or their relationship with internal and external factors in gender dysphoria. When I raised the issue with one experienced therapist, it was denounced as “bull****”, merely a “weapon used by ideologues”.

What are personality characteristics of parents bringing children to gender dysphoria clinics?

No studies are available on characteristics of parents despite numerous studies on their children. It is supposed that gender confusion in a child must deeply affect its parents, and the phrase common to those seen interviewed on television, “gut wrenching”, is easy to accept. Perhaps, therefore, it is despair that is driving an increasing number of parents to start “social transition” of their child to the opposite gender before seeking medical help, under the guidance of websites and support groups and the encouragement of an enthusiastic media. Toronto’s Dr Bonifacio says many have progressed far into transitioning before attending his clinic: parents are dressing and entertaining the child as the opposite sex, applying new pronouns and a new name. Such commitment, he explains, paves the way for further treatment.

A leading but nameless therapist agrees: about a third of children are already being “socialised”. This therapist worries that they are at risk of being “conditioned” by parents who have become “enmeshed” to the degree of being “cheer leaders”. This could lead to the child becoming “scripted” to repeat phrases that would convince therapists. One example is the declaration of a five-year-old that he was “transgender” when featuring with his mother in a recent documentary on childhood dysphoria by Louis Theroux shown on ABC television.

Becoming a “cheer leader” in therapy for a child is, of course, not uncommon. Many if not most parents become passionate for their children and are on the sidelines at soccer and in advocacy groups for advances in treatment of malignancy. But, unpleasant as it is to raise the matter, every paediatrician knows there is a tragic condition known as Munchausen syndrome in which symptoms are fabricated for some kind of benefit. In Munchausen’s-by-proxy, the benefit accrues to the carer. I asked an experienced therapist whether this ever complicated gender dysphoria? Shoulders were shrugged: there are no studies. But, if mental illness affects 45.5 per cent of all Australians at some point in their lives and 20 per cent of those aged from sixteen to eighty-five will have experienced it in the previous year[30], the relevance of Munchausen’s-by-proxy in carers needs to be considered.

What is the treatment for childhood gender dysphoria?

There are three categories. The first, known as “conversion” or “reparative therapy”, is the attempt to make the child more comfortable in its natal sex and to lead it away from identification with the opposite gender. In the process, the reasons for the gender dysphoria are explored with the child and its parents. The second may be called “waiting and watching” while making the child comfortable in its natal sex until it grows out of it. The third is called “affirmative therapy” and involves supporting transition to the opposite gender.[31]

“Conversion” or “reparative therapy”, in which the child is orientated towards its natal sex, is anathema to transgender activists, and their political campaigns have caused it to be forbidden for minors in some states of North America. Evoking spectres of past brutal medical and societal treatment of transgender and homosexual adults, activists declare that anything less than affirmation in transgender children is inhumane, futile and may provoke suicide: transgender is fixed before and unchangeable after birth, and parents and society must accept the inevitable. The term “reparative therapy”, therefore, has a pejorative, political ring to it. It is wielded more like a weapon than a description of a medical alternative.

The second involves keeping the child as happy as possible within its “own skin” or natal sex, in the expectation it will “grow out of it”. It allows a child to dress and play with toys of the opposite gender but without encouragement and only in the home. It allows that a minority will “persist” into homosexuality but perceives life as a homosexual less complicated than that of transgender.

In practice, this middle option could swing towards dissuasion or affirmation. How much time should a child spend in his mother’s clothes? How much effort into persuading a boy there are other interests than dolls? Depending on emphasis (or perceived emphasis as in the case of Dr Kenneth Zucker below) critics may decry “watchful waiting” as merely another form of “conversion” therapy, while others might fear too much affirmation amounts to “conditioning” towards a role from which the child may find it difficult to escape.

The third option, “affirmation” excludes the first two and commits to a “pathway” that begins with “social transitioning” and progresses to blocking puberty with drugs (Stage 1). Stage 2 follows with stimulation of cross-sex features with administered hormones, in preparation for the possibility of later surgical intervention (Stage 3).

Problems are obvious. How might a child escape the “pathway” when gender re-orientation occurs with puberty? Complications with “second transitioning” after a life as the opposite gender are easily imagined[32]. Worse, what if the child is so intimidated by the fear of coming out again that acceptance of the “pathway” seems the only possibility? Or, what if the child has been so mentally programmed it has no idea how to live as the “opposite” sex? Tragic mistakes are possible.

Stage 1: The blocking of puberty

The induction of puberty begins deep in the brain where it is started by a biological clock and involves a cascade of hormones with various checks and balances. Where and how it starts are unknown, but chemical messengers ultimately influence nerve cells in the hypothalamus to release hormones in pulsatile fashion to initiate a cascade of effects. They stimulate cells in the nearby pituitary gland to secrete other hormones that travel to stimulate the gonads to release yet other hormones that travel to evoke secondary sex characteristics.

The hormones that are secreted by the hypothalamus act on receptors on the surface of the cells in the pituitary. Their pulsatile secretion (every ninety minutes) allows time for the pituitary receptors to reset after they have fatigued themselves sending messages to the nuclei of their cells. If they are continuously stimulated the receptors become exhausted and puberty stalls. Drugs are now available that are similar to the hypothalamic hormones. If injected in slow-release form, these “puberty blockers” will exert a sustained effect, exhausting receptors and blocking puberty.

Since the 1980s these drugs have been used to block puberty when it has begun too early and, so far, no side-effects have been noted. It appears pituitary cells can recover from prolonged suppression and that hypothalamic and other upstream neurons are not damaged by their vain efforts. Activists declare that puberty blockage is “entirely reversible” (and Australian courts echo the conviction) but the international Endocrine Society is cautious, declaring passively that “prolonged pubertal suppression … should not prevent resumption” upon cessation[33]. The Society warns there are no data regarding how long it might take for active sperm and ova to appear after prolonged blockage.

Puberty is associated with psychological changes that reflect hormonal influences throughout the brain. Though used for an abnormal state since the 1980s, blockers have only been used in the presumably normal brain for gender dysphoria since the 1990s and, therefore, in neither case is the effect known in later years of life. The claim they are “completely reversible”, is not yet based on evidence. The trial is too short, the numbers too small, the effect not blinded, and there are no controls.

Puberty is blocked to “give the child more time to consider future options” and, according to Dutch pioneers in treatment of childhood gender dysphoria, should not be initiated before breasts have begun to appear in a girl around ten to eleven years of age, and testes to increase in volume in a boy a year or so later. Distress at the appearance of early signs of puberty is reckoned to indicate likelihood of “persistence” with gender dysphoria, thus aiding diagnosis and the later decision to administer cross-sex hormones. Dysphoria through puberty is believed likely to persist.

There are problems in this process: the blocked child will be left behind by its developing peers and this, by itself, may provoke distress. For example, it will be shorter. More seriously, the blocked child will be asked to approve progression to Stage 2, as if it can comprehend its massive implications. Stage 2 may have irreversible effects on fertility in both sexes, and the ability to breast-feed in a female. Is a blocked and scripted child competent to see that far into the future? Do children ever think differently when their hormones have begun to flow? This competence to understand the implications of treatment is known as Gillick Competence after the decision of an English court[34]. As it appears most children who start Stage 1 continue to Stage 2, the stakes are high for presumed Gillick Competence.

Stage 2: The administration of cross-sex hormones

Cross-sex hormone therapy means giving enough hormones of the opposite sex to evoke and sustain its characteristics. The hormones are given for life and must be monitored for side-effects including cardiovascular and thrombo-embolic disease, cancers of the opposite sex, and worsening of psychiatric disorder. By suppression of gonads, there is a slow process of chemical castration and the possibility of reproduction needs to be assisted by cryopreservation of ova and sperm.

According to international practice, cross-sex hormones may follow and then accompany blocking therapy, and be initiated around sixteen years of age. Some clinics, however, commence therapy as early as fourteen[35].

This “earlier” trend obeys a certain logic: if the parents have already transitioned the child “socially” and, if the child might be distressed by the early signs of puberty and, if delaying puberty is likely to cause its own stress, why wait for early signs of natural puberty? Why not block that natural puberty before it appears and go straight to cross-sex hormones? Affirmation therapy is creeping earlier despite recommendations of the Endocrine Society: “Given the high rate of remission [of gender dysphoria] after the onset of puberty, we recommend against a complete social role change and hormone treatment in prepubertal children.”[36]

Stage 3: Surgery

According to international guidelines, “sex realignment surgery” may be performed from eighteen years, though there are reports of it occurring earlier in private clinics[37]. Mastectomy, however, may be performed at a younger age if developing breasts increase dysphoria.

As the grandeur of realignment surgery may not be appreciated by a lay audience, it may be helpful to consider some details of the fate towards which children on affirmation therapy are headed. There are various components and not all patients progress to the final package, but the project will usually include relatively simple surgical procedures of castration, removal or augmentation of breast tissue, reduction in the size of the Adam’s apple, and alteration of body hair.

Construction of alternate genitals is another matter. These surgeries are difficult, often multi-staged, fraught with complications, and limited in outcome.

Creating ersatz female genitals is easiest: an orifice is created in the perineum, lined with skin from a filleted penis and, sometimes, deepened by transplanted bowel. The scrotum forms labia. The glans is grafted above the orifice and the urethral tube is shortened.

Creating male genitals is harder. One surgeon declared that “the task assumes nearly Herculean dimensions”[38] but this underestimates the ingenuity and range of objectives while exaggerating results. Hercules was always successful: creation of a penis is not. Some patients settle for a clitoris enlarged by male hormones. Others aspire to a penetrative organ, or at least one that can deliver urine when its owner is standing. In these cases, a shaft may be attempted from tissue grafted from thigh or even forearm and stiffened with a length of bone. Reversing the biblical account of the origin of females, bone from a woman’s rib may now turn her into someone with a male phallus. A glans may be fashioned from a graft of inner-skin and the tube that delivers urine may be lined with mucous membranes from the mouth. The appearance of a scrotum may be achieved by creating a sac from the labia and inserting two artificial testicles.

Though techniques are improving with practice, complications are protean. Grafts may die, holes fill in, tubes obstruct, openings appear, bones protrude, bowels perforate and germs invade but, all in all, the result may be “aesthetically and functionally pleasing” to the recipient.

What does the law say in North America?

In California, in September 2012, a law was passed “to prohibit a mental health provider … from engaging in sexual orientation change efforts … with a patient under 18 years of age” which included “lesbian, gay, bisexual and transgender youth”. Such efforts included “efforts to change behaviours or gender expressions” which were deemed “unprofessional conduct and shall subject the provider to discipline”. The Bill cited various national organisations of paediatricians, psychologists and psychiatrists which described such activities as conversion or reparative therapies.[39]

Similar laws have been enacted in New Jersey, Illinois, Oregon and Washington and, in 2015, in Ontario, Canada. Known as “anti-reparative” and “anti-conversion” laws, they oppose any attempts to re-orientate sexuality and to suppress gender identity and expression in order “to save children’s lives”.

In effect, Barack Obama has joined the affirmation team. Responding to a petition for banning “dangerous … conversion therapy” after a prominent suicide by a fifteen-year-old adolescent male who had sought to indentify as a female and allegedly underwent “conversion” therapy at his parents’ church, the White House declared that the “Obama administration supports efforts” to ban conversion therapy for minors “because overwhelming evidence demonstrates” it “is neither medically nor ethically appropriate”[40].

It is hard to gauge the effect of the laws. No charges have yet been laid but many therapists uncommitted to active affirmation are now reported to be unwilling to care for transgender children because they do not want the worry of the medico-legal risk. The result of their withdrawal in the face of increasing public demand is that children and their parents are funnelled towards those willing to continue or initiate the stages of transition.

One definite result of activists’ pressure and the expectation of the law in Ontario was the ultimate sacking of an international leader in management of gender dysphoria, Dr Kenneth Zucker (as discussed below) and the closure of his long-standing clinic in Toronto for allegedly practising “conversion” therapy. In turn, this sacking has brought immeasurable weight to the intimidatory effect of the law.

Ontario Bill 77 or the “Affirming Sexual Orientation and Gender Identity Act, 2015” was passed unanimously and in a “miraculously” short time according to its promoter, parliamentarian the Reverend Cheri DiNovo, who explained, “Bills may take up to years to pass but this one succeeded in only two months”. According to Wikipedia, DiNovo entered Parliament in March 2006, has been prominent in many issues including recognition of the Stalin-imposed famine on Ukraine as “genocide”, has “passed most LGBTQ legislation in Canada”, has conducted a weekly radio program, received literary awards, earned a masters degree in divinity and a doctorate in ministry from the University of Toronto, and has been a minister of the United Church since 1995. In 2001, she officiated over the first same-sex marriage in Canada[41]. Recitation of these educational achievements is relevant to some of the discussion we shared.

DiNovo is smart and at home in her conservative, stylish office in the Toronto parliament. Plainly, she could have been become the leader of her party had not ill-health intervened. Concisely, she declared the object of her law was not punitive but “instructional”: to save children’s lives, gender identity had to be affirmed. “Reparative or conversion” attempts should, therefore, be dissuaded and certainly not remunerated under the Health Insurance Act.

Moving to discussion of one of the clauses in the Act which declares the ban “does not apply if the person is capable with respect to the treatment and consents to the provision of the treatment”, DiNovo was strangely unclear. I asked at what age a child would be deemed capable of consent to treatment. Up to what age would a child be incapable of consent and therefore at the mercy, as it were, of parents and affirmative therapists? DiNovo would not approximate, merely repeating, and now with many words, that the law was “instructional”.

More disturbing was the response of this educated lady to my question as to why active, affirmative, transitioning therapy should be applied when most affected children were going to “grow out of it”? “I did not know that,” she declared. I continued by presenting a book written by Dutch leaders in the field who attest to the majority desisting. She declared she had never heard of them! We went on to theological matters in which she declared her belief in the death and resurrection of Jesus Christ. I left perplexed. Could one so prominent not know most children would desist from transgender confusion? If she knew, could one so theological be so untruthful?

What does the law say in Australia?

In February 2017, a Health Complaints Act will become law in Victoria in which complaints may be raised against fraudulent and negligent practices which will include, according to Health Minister Jill Hennessy, “conversion” therapy. She explained that the Act will:

provide the means to deal with those who profit from the abhorrent practice of “gay conversion therapy” … which inflicts significant emotional trauma and damages the mental health of young members of our community. This bill will enable the new Commissioner to investigate and crack down on anyone making dangerous and unproven claims that they can “convert” gay people.

Though she specified “gay people” and did not define age, Hennessy’s attributed declaration—“any attempts to make people uncomfortable with their own sexuality is completely unacceptable”[42]—suggests a broad intent for the law, in line with North American legislation.

More intimidating than the American laws, the Victorian Act will transfer the onus of proof to the accused, who will need “reasonable excuse” to avoid investigation after a complaint has been laid. In response to whether presumption of guilt would contravene human rights, Hennessy (tortuously) explained:

The reverse onus is required in relation to these offences as the “reasonable excuse” exception relates to matters which are particularly within an accused’s knowledge and introduce additional facts from the subject matter of the offence, which would be unduly onerous for a prosecution to investigate and disprove at first instance. Once the accused has pointed to evidence of a reasonable excuse, which they should have access to if the excuse is applicable, the burden shifts back to the prosecution who must prove the essential elements of the offence to a legal standard. I am of the view that there is a negligible risk that these provisions would allow an innocent person to be convicted of any of these offences. Accordingly, I am of the view that these offence provisions are compatible with the charter[43].

More broadly than Ontario Bill 77 which focuses on therapists receiving National Insurance funding, the Victorian Act will embrace any person or organisation beyond the classical health care providers that offer “general health services” to “maintain or improve … mental or psychological health or status”. Given the antagonism of transgender and other minority sexualities to the Christian church it can be prophesied that, sooner rather than later, a church leader advising “watchful waiting” of a transgender child will be asked for a “reasonable excuse”. The apparent suicide of seventeen-year-old Leelah Alcorn in Ohio in 2014 unleashed ferocity against the parents who had sought help in their Christian church, allegedly forcing their transgender son to undergo conversion therapy. There is the possibility of a similar backlash against pastors in Australia.

By passing these Acts, it is surprising that politicians should be aligning themselves, at least by default, with only one form of management of a medical problem. By banning “conversion/reparative therapy”, they promote affirmative therapy as the single option, despite the fact children will “grow out of it”.

Their punitive bias is not shared by the highest of international organisations. The international Endocrine Society acknowledges a middle path between “complete social role change and hormone treatment” on the “affirmative” end of the spectrum and punitive attempts to dissuade on the other. Implying that the large majority will desist if parents are patient, the Society recommends children should not “be entirely denied to show cross-gender behaviours or should be punished for exhibiting such behaviours”. Given politicians cannot be expected to have full understanding of therapies (even DiNovo claims she has never heard the other side), their commitment must be credited to the lobbying of activists.

Success for activists in Ontario

Transgender activists have had great success in Ontario. After sustained pressure and with Bill 77 in sight, a review was initiated of the management of child and adolescent gender dysphoria by Dr Kenneth Zucker and his colleagues at the Centre for Addiction and Mental Health (CAMH) in Toronto, who have been at the forefront of this discipline for almost four decades. The review was commissioned in February 2015, the law enacted in September, and Zucker and the unit were stood down in December. They were alleged to be performing “conversion-reparative” therapy and were presumed guilty because no evidence could be found that they were not practising in that way. In reality, Zucker was toppled and his unit closed because they were not practising affirmative therapy.

Bill 77 could not have been associated with the toppling of a therapist with greater standing. A psychologist, Zucker is Professor in the Department of Psychiatry at the University of Toronto and is internationally prominent in research, publications, experience and recognition since he began at CAMH in 1975. He has been the editor of Archives of Sexual Behavior since 2002, was a member of the American Psychological Association Task Force on Gender Identity, Gender Variance and Intersex Conditions in 2007 and, in 2008, Chair of the American Psychiatric Association Sexual and Gender Identity Disorders Work Group that developed DSM-5 from DSM-4 (on whose committee he had also served). Zucker was also a member of the committee that revised the standards of care of the World Professional Association for Transgender Health[44]. When he was dismissed, he had just been awarded a grant of close to a million dollars to study brain changes in gender-dysphoric adolescents receiving cross-sex hormones. Internationally, Zucker is almost unrivalled. Only the gender dysphoria clinic at the Vrije Universiteit Medical Center, in Amsterdam, has been as prominent as CAMH. Often, the two units have co-operated in research and publications.

For an Australian perspective on the dismissal of Zucker and his unit, consider a hypothetical sacking of the late cardiac surgeon Dr Victor Chang, and the closure of the Cardiac Unit at St Vincent’s Hospital, Sydney.

Zucker was not available for discussion regarding how he and his clinic handled gender dysphoria but his concepts can be gleaned from his publications and statements attributed to him by his detractors. He described a Developmental, Biopsychosocial Model for treatment of gender dysphoria[45] based on the concept that gender identity was not “fixed” before birth but was “malleable” under the influences of external factors of varying strengths at varying stages of development. Biological factors would include innate chromosomal direction and the effects of antenatal hormones. Psychosocial factors would include attitudes and behaviour of siblings, parents, care-givers and other close associates. All the factors would combine to have particular relevance at varying ages. For example, a four-year-old girl might conclude she was a boy if she wore boys’ clothing and played their games, because until seven years of age gender identity may be confused by “surface expression of gender behaviour”.

Zucker and his colleagues argued that “co-occurring psychopathology” in the child and “psychodynamic mechanisms” in its family influenced gender identity, with the latter sometimes exerting an unrecognised “transfer of unresolved conflict and trauma-related experiences from parent to child”. Examples include “a girl observing her mother as bullied may self-identify as a male, while a boy observing his mother as depressed may self-identify as a female because subconsciously he wants to help his mother”. Conversely, “a mother with unresolved hostility toward men may encourage effeminacy in her son”[46].

Nevertheless, Zucker and his colleagues report that, despite external influences, most transgender children do not persist with that identity after puberty: only 12 per cent of transgender girls and 13.3 per cent of boys. They report:

It has been our experience that a sizable number of children and their families achieve a great deal of change. In these cases, the [gender dysphoria] resolves fully, and nothing in the children’s behaviour or fantasy suggest that the gender identity issues remain problematic … All things considered, we take the position that in such cases a clinician should be optimistic, not nihilistic, about the possibility of helping the children to become more secure in their gender identity.[47]

Perhaps even more disturbing to transgender activists was Zucker’s opinion that parents might be permitted to influence orientation of the child towards its natal gender. Declarations by Zucker that “if the parents are clear in their desire to have their child feel more comfortable in their own skin … [and] would like to reduce their child’s desire to be of the other gender, the therapeutic approach is organised around this goal”[48] became nails in his cross.

CAMH therapy included “open-ended play” to explore “underlying mechanisms” for which “surface behaviours” of gender dysphoria are symptoms, and “which can best be helped” if the reasons are understood. Limitations would be set on cross-sex play and dressing. For example, a boy might be permitted to wear at the home but persuaded against wearing them on trips to the mall. Same-sex “peer relationships” would be encouraged because they are “often the site of gender identity consolidation”. If the boy in question did not like “rough and tumble” play, less physical peers might be sought.

Zucker’s management of childhood dysphoria might be summarised as “minimise stress and maximise comfort” in natal sex, in the expectation most will grow out of it. He fears labelling a child is part of “conditioning” to transgender from which return is more difficult. He cautioned parents to:

resist too much accommodation from [a child’s] teachers. Don’t let the school make him a poster child … don’t let them parade him around for pink assemblies. This is his personal journey and we don’t know where it is going to end up.[49]

The latter advice is relevant for Australia. A spokesperson for the New South Wales Education Department has reported, “We have a four year old who is transitioning to kindergarten next year who has identified as transgender.”[50]

Zucker and his colleagues report that a number of children who “persist” with transgender identity emerge from puberty as homosexuals. They insist, “We have never advocated for the prevention of homosexuality as a treatment goal for [gender dysphoria] in children” and explain to parents, “it will be their job and ours to support the child” whatever the future holds. Some children would desist from gender dysphoria to emerge as bisexual or homosexual. Some would persist with transgender identity and pursue the pathway of hormonal and surgical intervention, but Zucker concludes this to be the least favourable option because “growing up transsexual or transgender may augur a more complicated life”.

Though not anti-gay, and involved in positive transitioning of adolescents to the opposite gender if transgender appeared inevitable, Zucker became Enemy Number One for transgender activists[51]. Their pressure and Bill 77 resulted in Zucker and his unit being dismissed for not being “in step with the latest thinking”.[52] Over 500 colleagues expressed their dismay in a petition of protest which cited Zucker’s contribution to science and medical care. The signatories warned “any clinical researcher who considers working at CAMH: in the event of a conflict with activists for a fashionable cause, CAMH might well sacrifice them [and their patients] for some real or imagined local political gain”.

What do the courts say in Australia?

Decisions of Australian courts have kept pace with the exponential phenomenon of gender dysphoria. As recently as 1992, in Marion’s case, the High Court declared that sterilisation of a fourteen-year-old mentally retarded girl, incompetent to decide for herself, needed the court’s approval as a safeguard because there was a significant risk of making the wrong decision regarding an intervention that was “non-therapeutic, irreversible, invasive and associated with grave consequences”; sterilisation should only be performed “as a last resort”[53]. This conservative attitude was confirmed by the Family Court in 2004 in Re Alex[54] which determined that drug administration to effect transition to the opposite gender in the thirteen-year-old natal girl was a “special medical procedure” associated with “significant risks” of reversible and irreversible nature, and required the court’s authorisation.

In 2013, in Re Lucy [55] , the court relinquished authority over Stage 1 therapy, determining it could be “appropriate” for “preventing, removing or ameliorating … a psychiatric disorder” associated with gender dysphoria. Therefore, departmental guardians (and by inference, parents) could give consent to this therapy on behalf of the thirteen-year-old natal female who was competent to give informed consent with regard to transitioning to a male.

In that case, presiding Justice Murphy laid instructional ground by repeating with emphases the statement of an involved physician that:

It is important to state that the natural course of Gender Dysphoria, untreated, is that psychological stress increases over time, as the person becomes more and more disillusioned with their morphology which does not match their mindset of their assumed appropriate gender. Untreated Gender Dysphoria invariably progresses to immense disillusionment and then, to chronic depression which can often progress to major depression with significant suicidal risk.

In both Re Lucy and the following Re Sam and Terry [56] cases the courts, however, determined their authorisation was needed for implementation of Stage 2 therapy because of the permanence of effects. Deliberation in Re Sam and Terry emphasised the necessary protective authority of the court for two unrelated sixteen-year-olds who were both “Gillick incompetent”.

In 2013, in Re Jamie[57] the Full Court determined court authorisation would be needed for Stage 2 therapy if a child was Gillick incompetent but, if competent, a child could consent to Stage 2 therapy without the need for authorisation. The court declared, however, that a child’s competence needed to be decided by the court “even where parents and treating doctors agree”. These principles were confirmed in Re Shane later that year[58].

In July this year, in Re Quinn [59], the Family Court extended its permission beyond the drug components of Stage 2 into the irreversible surgical components of Grade 3 by approving bilateral mastectomies in a fifteen-year-old natal female committed to male gender. Even more significantly, the court gave its authority despite the adolescent being Gillick incompetent because of associated Asperger syndrome.

Concerns with this symbiotic progress of courts and proponents of affirmation include:

The instructional declaration by Justice Murphy that untreated gender dysphoria invariablyprogresses to immense disillusion is not based on evidence.

Should courts be informed by only those committed to activist therapy?

Should courts rely on statements from a small group already involved with the transition of the patient? Is there no possibility of conflict of interest?

How can Gillick competence regarding future reproductive intent be assumed in an adolescent maintained in a pre-pubertal state? Do adolescents ever think differently when their own hormones flow?

How can irreversible, destructive surgery be permitted on an adolescent judged incompetent to understand the implications? Where is the line between transgender surgery and that for Body Identity Disorder in which the sufferer demands transformation of the physical state to satisfy the mental: for example, the removal of a normal leg in the false belief it is gangrenous?

The not-so-slow march of gender dysphoria through the judicial, medical and political institutions shows little evidence of obstruction. When will any authorisation by the court be declared unnecessary?

Obligation to consult the court rankles activists who consider it: “an expensive, time consuming and ultimately unnecessary intrusion into the complex decision making between the patient, their [sic] parents and the treating medical team [and] a form of institutional discrimination”. The intervention of the court is considered unnecessary by leaders of the gender dysphoria clinic at the Royal Children’s Hospital, Melbourne, because it “almost exclusively” relies on reports from the treating team regarding its client’s competence[60]. They declare change is “urgently” needed given the “increasing acceptance of gender diversity being fuelled by social media and popular culture”. They urge “equitable access” to all chemical blocking and cross-sex hormones and Medicare funding for “gender affirmation surgery”.


The phenomenon of childhood gender dysphoria is exponential. Hundreds of children and their parents are reported to be consulting special clinics in Australia each year. How many undertake transitioning is unknown but the media provides regular confirmation, as do unofficial reports from schools. I attended Fort Street Boys’ High, where at a recent reunion two current student leaders proclaimed the year’s success to be the wearing of a dress to school by a boy, every day including graduation. A teacher from a school near my home reports five children to be undergoing transition.

Yet hardly any paediatricians recall any cases of gender dysphoria in almost 300 cumulative years of practice. Certainly, I have not seen one in fifty years of medicine. I accept cases must exist and consider them tragedies deserving as much compassion and medical care as the three cases of physical intersex I have encountered in my career.

What astonishes me is the lack of evidence to support massive medical intervention in the face of evidence that it is not necessary. I cannot help wonder how the intervention was approved by the various ethics committees in hospitals, health regions and universities when it took some students and me over a year to get approval for a study that merely asked mothers when they introduced solid foods to their children. Ultimately, I had to give my personal phone number to all respondents of the questionnaire lest someone suffer anxiety in the middle of the night.

It is less astonishing these days that laws should be passed to ensure compliance with activists’ wishes. My generation has read the books of George Orwell, and observed the imposition of utopian ideas. Orwell would appreciate many aspects of the phenomenon of gender dysphoria. In Nineteen Eighty-Four obedience was ensured by the watchfulness of Big Brother, whose intimidation continues.

In fifty years of medicine, I have not witnessed such reluctance to express an opinion among my colleagues. For this article, I conducted a straw poll of paediatricians whom I know. Many advised me to be very careful, to appear neutral, and not to quote them despite their strong concerns about the current “fad”, hence my reference to anonymous therapists. One warned I should be prepared for him to “deny me thrice”. When I reminded him that Peter went on to become a martyred follower of Jesus, there was no reply.

My motivation for writing an article is that of another physician, a leading endocrinologist, who declares evidence for intervention in gender dysphoria is “utterly arbitrary”, and his great fear that mistakes would be made in consigning children to transition. I share those fears.

Lastly, I confess a family conundrum. I have a four-year-old grand-daughter who insistently, persistently and consistently declares she is a shark. Worse, she declares her name is “Bruce the Shark”. Reference to DSM-5 dismays: she plays with model sharks, dresses in shark motifs, wears a shark headdress, will take herself to the corner to await fish, loves to sit before the shark ponds in aquaria and thrills to caress their tails in special ponds for children at SeaWorld in California. Not above deriving some benefit from the tragedy, her father coaxes her to finish her meals by suggesting she “eat her fish”. But, dejected, he seeks my private advice: “When should we deliver her to the aquarium?”

John Whitehall is Professor of Paediatrics at Western Sydney University.

[1] [1] Bonifacio HJ, Rosenthal SM. Gender variance and Dysphoria in Children and Adolescents. Pediatr Clin N Am. 2015. 62:1001-1016.

[2] Hiller L, Jones T, Monagle M et al. Writing themselves in 3: the third National Study on the sexual health and well being of Same Sex attracted and Gender Questioning Young People. Melbourne Australian Research Centre in Sex, Health and Society. La Trobe University. 2010 as quoted in Telfer M, Tollit M, Feldman D. Transformation of health-care and legal systems for the transgender population: The need for change. JPCH.2015. 51;1051-1053.

[3] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edn 2013:451-459.

[4] Drummond KD, Bradley SJ, Peterson-Badali M and Zucker KJ. A follow up study of girls with gender identity disorder. Developmental Psychology. 2008;44:34-45.

[5] Wallien MS, Cohen-Kettenis PT. Psychosocial outcome of gender dysphoric children. J Am Acad Child Adolescent Psych. 2008; 47:1413-1423.

[6] Ristori J, Steensma TD. Gender dysphoria in childhood. Int Rev Psych. 2016;28 (1):13-20.

[7] Shumer D, Spack NP.Current management of gender identity disorder in childhood and adolescence: guidelines, barriers and areas of controversy. Current Opinion Endocrinology, diabetes and obesity. 2013;20(1):69-73.

[8] Bonifacio HJ, Rosenthal SM. Gender variance and Dysphoria in Children and Adolescents. Pediatr Clin N Am. 2015. 62:1001-1016.

[9] DSM-V. 2013:454.

[10] Telfer M, Tollit M, Feldman D. Transformation of health-care and legal systems for the transgender population: The need for change. JPCH.2015. 51;1051-1053.

[11] All of Us: 8.

[12] Haas A, Eliason M, Mays V et al. Suicide and Suicide Risk in Lesbian, Gay,

Bisexual, and Transgender Populations: Review and Recommendations. J Homosexual 2011;58:10-51.

[13] Fan X et al. An exploratory study about inaccuracy and invalidity in adolescent self-report surveys. Field Methods. Savon-Williams and Joyner. 2006;223: 33 CHECK REFERENCE.

[14] Wallien MS ,Swaab H, Cohen-Kettenis PT. Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adol Psych. 2007;46:1307-1314.

[15] Steensma TD, Zucker KJ, Kreukels BP et al. Behavioural and emotional problems on the Teacher’s Report Form: a cross national, cross-clinic comparative analysis of gender dysphoric children and adolescents. J Abnorm child psycho 2014;42:635-647.

[16] Children and adolescents with gender identity disorder referred to a pediatriic medical center. Spack NP, Edwards-Leeper L, Feldman HA et al. Pediatrics. 2012;129 (3):418-425.

[17] Hewitt Jk, Paul C, Kassiannan P et al. Hormone treatment of gender identity disorder in a cohort of children and adolescents. MJA. 2012;196(9):578-581.

[18] De Vries AL, Noens IL, Cohen-Kettenis et al. Autism spectrum disorders in gender dysphoric children and adolescents. J Autiism Dev Dis. 2010;40:930-936.

[19] Holt V, Skagerberg E, Dunsford M. Young people with features of gender dyshoria: demographics and associated difficulties. Clin Child Psychol Psychiatry. 2016;164:108-118.

[20] Karasic D, Ehrensaft D. We must put an end to gender conversion therapy for kids. WIRED. 2015. Htp:// Accessed October 18, 2016.

[21] Aitken MA, VanderLaan DP, Wasserman MD et al. Self-harm and suicidality in children referred for Gender Dysphoria. J Am Acad Child Adol Psychiatry. 2016;55(6):513-520.

[22] Mayes SD, Gorman AA, Hillwig-Garcia J et al. Suicide ideation and attempts in children with autism. Res Autism Spec Dis. 2013;7(1):109-119.

[23] Lewinsohn PM, Rohde P, Seeley JR. Adolescent suicidal ideation and attempts: risk factors and clinical

implications. Clin Psychol Sci Pract. 1996;3:25–46. CHECK REFERENCE

[24] Faulkner AH, Cranston K. Correlates of same-sex sexual behavior in a random sample of Massachusetts

high school students. Am J Public Health. 1998;88:262–266. CHECK REFERENCE

[25] De Vries AL, Cohen-Kettenis PT. Clinical management of gender dsyphoria in children and adolescents: the Dutch approach. J Homosexuality. 2012; 59(3):301-320.

[26] Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Murad A, et al. (2010)

Hormonal therapy and sex reassignment: a systematic review and meta-analysis

of quality of life and psychosocial outcomes. Clin Endocrinol (Oxf) 72: 214–231.

[27] Dhejne C, Lichtenstein P, Boman M et al. Long-Term Follow-Up of Transsexual Persons

Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLOS 1. 2011;6(2):e16885.

[28] De Cuypere, Elaut E, Heylens G et al. Long term follow up: psychosexual outcome of Belgian transsexuals after sex reassignment surgery. Sexologies. 2006;15:126-133.

[29] Dhejene C, Lichtenstein P, Boman M et al. Long term follow-up of transsexual persons undergoing sex reassignment surgery:Cohort study in Sweden. PLOS. 2011. Accessed. Nov 10, 16

[30] Department of Health, Australian Government. Prevalence of mental disorders in the Australian population. www.

[31] Ristori J, Steensma TD. Gender dysphoria in childhood. Int Rev Psych. 2016;28 (1):13-20.

[32] Steensma TD, Cohen-Kettenis PT. Gender transitioning before puberty. Arch Sex Behav. 2011;40:649.

[33] Hembree WC, Cohen-Kettenis P, de Waal HA et al. Endocrine treatment of transsexual persons: an Endocrine Society Clinical Practice Guideline. 2009;94(9):3132-3154.

[34] Gillick v West Norfolk and Wisbech Area Health Authority (1986) AC 112.

[35] Shumer DE, Nokoff NJ, Spack NP. Advances in care of transgender children and adolescents. Advances in Pediatrics. 2016;63:79-102.

[36] Hembree WC et al 2009. ibid.

[37] Milrod C. How young is too young: Ethical concerns in genital surgery of the transgender MtF adolescent. J Sex Med. 2014;1:338-346.

[38] Rashid M, Tamimy M. Phalloplasty: the dream and the reality. Ind J Plastic Surgery. 2013;46(3):283-293.

[39] California Legislative Information. Senate Bill 1172. September, 2012. Accessed October 18, 2016.

[42] Tomazin F. Zero tolerance:Andrews to crack down on gay “conversion” therapy. The Age Jan 24. 2016. Accessed October 20, 2016.



Wednesday, 10 February 2016 page 94.

[44] WPATH. Standards of Care. 7th version

[45] Zucker K, Wood H, Singh D et al. Developmental, Biopsychosocial Model for treatment of children with gender identity disorder. J Homosexual . 2012;59:369-397.

[46] Long term Toronto gender identity clinic shuttered in clampdown on “reparative therapy’. Dec 22,2015. Accessed 28/9/2016.

[47] The Bilerico Project. Daily experiments in LGBTQ. Accessed 29/9/2016.

[49] The Globe and Mail. Gender identity debate swirls over CAMH psychologist, transgender program. Feb 14, 2016. Accessed 28/9/2016.

[50] Greg Prior, Deputy Secretary of School Operations and Performance. Hansard, General Purpose Standing Committee No3 Legislative Council. 29 August 2016. P 13.

[51] Dr Kenneth’s war on transgenders. Accessed 29/9/2016

[52] Anderssen A. Gender identity debate swirls over CAMH psychologist, transgender program. The Globe and Mail. February 14, 2016

[53] Department of Health and Community Services (NT) v JWB (Marion’s case) (1992) 175 CLR 218.

[54] Re Alex (2004) 31 Fam LR503.

[55] Re Lucy [2013] FamCA 518.

[56] Re Sam and Terry [2013] FamCA 563.

[57] Re Jamie. (2013) FamCACF 110. Accessed October 21/2016

[58] Re Shane [2013] FamCA 864

[59] Re Quinn (2016)FamCA617(29 July 2016)

[60] Telfer M, Tollit M, Feldman D. Transformation of health-care and legal systems for the transgender population: the need for change in Australia. JPCH.2015;51:1051-1053.

Letter to the Editor: “Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline”

Letter to the Editor: “Endocrine Treatment of
Gender-Dysphoric/Gender-Incongruent Persons:
An Endocrine Society Clinical Practice Guideline”

Michael K. Laidlaw,1 Quentin L. Van Meter,2 Paul W. Hruz,3 Andre Van Mol,4
and William J. Malone5
Michael K. Laidlaw, MD, Inc., Rocklin, California 95677; 2
Van Meter Pediatric Endocrinology, P.C., Atlanta,
Georgia 30318; 3
Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
63110; 4
Van Mol Family Practice, Redding, California 96003; and 5
William J. Malone, MD, Twin Falls, Idaho
ORCiD numbers: 0000-0001-6849-7285 (M. K. Laidlaw); 0000-0003-2831-6480 (Q. L. Van Meter);
0000-0002-1478-3355 (P. W. Hruz); 0000-0001-8678-0025 (A. Van Mol);
0000-0002-5150-292X (W. J. Malone).

transgenderChildhood gender dysphoria (GD) is not an endocrine
condition, but it becomes one through iatrogenic
puberty blockade (PB) and high-dose cross-sex (HDCS)
hormones. The consequences of this gender-affirmative
therapy (GAT) are not trivial and include potential sterility,
sexual dysfunction, thromboembolic and cardiovascular
disease, and malignancy (1, 2).
There are no laboratory, imaging, or other objective tests to
diagnose a “true transgender” child. Children with GD will
outgrow this condition in 61% to 98% of cases by adulthood
(3). There is currently no way to predict who will desist and
who will remain dysphoric. The degree to which GAT has
contributed to the rapidly increasing prevalence of GD in
children is unknown. The recent phenomenon of teenage girls
suddenly developing GD (rapid onset GD) without prior
history through social contagion is particularly concerning (4).
GnRH agonists are used in precocious puberty to delay
the abnormally early onset of puberty to a physiologically
normal age. The goal of PB in the healthy child, however,
is to induce hypogonadotropic hypogonadism to “buy
time” to confirm gender incongruence. In a study of PB in
adolescents aged 11 to 17 years, 100% desired to continue
GAT. They simply “bought” themselves lower bone density
and the need for lifelong medical therapy (5).
Studies show that ,5% of adolescents receiving GAT
even attempt fertility preservation (6). Those started on PB at
Tanner stage II, as recommended by current guidelines, will
be blocked prior to sperm maturation and ovum release.
They will have no prospect of biological offspring while
on HDCS hormones and continuing on to gonadectomy.
The Endocrine Society’s guidelines recommend elevating females’ testosterone levels from a normal of 10 to
50 ng/dL to 300 to 1000 ng/dL, values typically found
with androgen-secreting tumors. The ovaries of women
given testosterone correspond to those found in PCOS,
which itself is associated with increased ovarian cancer
risk and metabolic abnormalities (1). Venous thromboembolism risk is elevated fivefold in males taking estrogen (2).
The health consequences of GAT are highly detrimental, the stated quality of evidence in the guidelines
is low, and diagnostic certainty is poor. Furthermore,
limited long-term outcome data fail to demonstrate longterm success in suicide prevention (7). How can a child,
adolescent, or even parent provide genuine consent to
such a treatment? How can the physician ethically administer GAT knowing that a significant number of
patients will be irreversibly harmed?
Hypothesis-driven randomized controlled clinical
trials are needed to establish and validate the safety and
efficacy of alternate treatment approaches for this vulnerable patient population. Existing care models based on psychological therapy have been shown to alleviate GD in
children, thus avoiding the radical changes and health
risks of GAT (8). This is an obvious and preferred therapy,
as it does the least harm with the most benefit.
In our opinion, physicians need to start examining
GAT through the objective eye of the scientist-clinician
rather than the ideological lens of the social activist. Far
more children with gender dysphoria will ultimately be
helped by this approach.

ISSN Print 0021-972X ISSN Online 1945-7197
Printed in USA
Copyright © 2019 Endocrine Society
Received 5 September 2018. Accepted 20 November 2018.
First Published Online 23 November 2018
686 J Clin Endocrinol Metab, March 2019, 104(3):686–687 doi: 10.1210/jc.2018-01925
Downloaded from by Washington University, Law School Library user on 23 January 2019
Disclosure Summary: Q.L.V.M. is a speaker for Abbvie and is
involved in clinical research with Abbvie on Depot Lupron. The
remaining authors have nothing to disclose.
1. Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer
WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T’Sjoen
GG. Endocrine treatment of gender-dysphoric/gender-incongruent
persons: an Endocrine Society clinical practice guideline. J Clin
Endocrinol Metab. 2017;102(11):3869–3903.
2. Irwig MS. Cardiovascular health in transgender people. Rev Endocr
Metab Disord. 2018;19(3):243–251.
3. Ristori J, Steensma TD. Gender dysphoria in childhood. Int
Rev Psychiatry. 2016;28(1):13–20.
4. Littman L. Rapid-onset gender dysphoria in adolescents and young
adults: a study of parental reports. PLoS One. 2018;13(8):
5. de Vries ALC, Steensma TD, Doreleijers TAH, Cohen-Kettenis PT.
Puberty suppression in adolescents with gender identity disorder: a
prospective follow-up study. J Sex Med. 2011;8(8):2276–2283.
6. Nahata L, Tishelman AC, Caltabellotta NM, Quinn GP. Low
fertility preservation utilization among transgender youth.
J Adolesc Health. 2017;61(1):40–44.
7. Dhejne C, Lichtenstein P, Boman M, Johansson AL, Langstr ¨ ˚ om
N, Land´en M. Long-term follow-up of transsexual persons
undergoing sex reassignment surgery: cohort study in Sweden.
PLoS One. 2011;6(2):e16885.
8. Zucker KJ, Wood H, Singh D, Bradley SJA. A developmental,
biopsychosocial model for the treatment of children with gender
identity disorder. J Homosex. 2012;59(3):369–397.

It feels like conversion therapy for gay children, say clinicians

Thank you Penthesilea Maia Greenleaf for retrieving this article from behind the paywall.

It feels like conversion therapy for gay children, say clinicians

“Inside the clinic rooms of the Tavistock, the private heartache of a new generation of “transgender” youngsters is being laid bare. There used to be about 50 referrals a year, mainly males with a history of gender issues.

Now there are thousands of young females reporting a sudden gender crisis for the first time. Many are convinced that transition – and the powerful drugs that make it happen – will be the solution to their problems.

Until now the specialists struggling to keep up with caseloads have stayed silent, but alarm over the number of adolescents being prescribed body-altering drugs, has prompted five former clinicians to speak out for the first time.

All five have resigned from the Gender Identity Development Service (GIDS) in the past three years as a matter of conscience.
“This experimental treatment is being done not only on children, but very vulnerable children, who have experienced mental health difficulties, abuse, family trauma, but sometimes those [other factors] just get whitewashed,” one female clinician said. “If someone was suggesting plastic surgery or any other permanent change we’d be saying, hang on a minute.”

The clinicians have warned that complex histories and adolescent confusion over possible homosexuality are being ignored in the rush to accept and celebrate every young person’s new transgender identity.

Clinical psychologists carry out each initial assessment at the Tavistock. They are the gatekeepers who decide whether to refer transgender youngsters to the endocrine clinic for the next stage of treatment. Therapists once had months to work through underlying issues before making decisions on medical intervention, but the clinicians claim that young people are now routinely referred for hormone therapy after as few as three hour-long sessions.
They believe that physically healthy children are being medicated in response to pressure from transgender lobby groups and parental anxieties.

So many potentially gay children were being sent down the pathway to change gender, two of the clinicians said there was a dark joke among staff that “there would be no gay people left”.

“It feels like conversion therapy for gay children,” one male clinician said. “I frequently had cases where people started identifying as trans after months of horrendous bullying for being gay,” he told The Times.

“Young lesbians considered at the bottom of the heap suddenly found they were really popular when they said they were trans.”
Another female clinician said: “We heard a lot of homophobia which we felt nobody was challenging. A lot of the girls would come in and say, ‘I’m not a lesbian. I fell in love with my best girl friend but then I went online and realised I’m not a lesbian, I’m a boy. Phew.’”
The specialists expressed concern at how little confusion over sexuality was explored when a young person requested treatment to change their body.

“I would ask who they wanted to have relationships with, but I was told by senior management that gender is completely separate to sex,” a third female clinician said. “I couldn’t get on board with that, because it isn’t. Some people were transitioning their gender to match their sexuality.”

The service said it was “a welcoming place for people from all sections of the LGBT community”, adding that it had made exploration of sexuality a “more explicit” part of the assessment in response to staff concerns.

Nevertheless, the clinician said that her unease grew after meeting an adult woman whose transition to become a man involved having a double mastectomy. She had since changed her mind.

“What can we do? We can’t reverse that. Do we suggest fake breasts?” she said. “We have such a duty of care to these confused young adolescents, but I think we are failing them.”

The clinic rejected the claims. “We always place a young person’s wellbeing at the centre of our work,” it said. “GIDS staff are engaged daily in thinking about the serious ethical dimensions of our practice. The diversity and complexity of individual cases will always be respected.”

Several clinicians suspected that some of the “transgender” adolescents were reacting to homophobia at home.
“For some families, it was easier to say, this is a medical problem, ‘here’s my child, please fix them!’ than dealing with a young, gay kid,” the third female clinician said. At the service’s “family days”, a parent was allegedly heard saying that they did not want their child to have gay friends because they “didn’t want them mixed up in that hedonistic lifestyle”. “It is converting people into heterosexuals,” one of the clinicians said. “We had so many families who would talk about not wanting their daughters to be lesbian.” Young people “repeatedly” confided their own “disgust” that they may be gay, according to the clinician.

In other cases, she felt young people had concluded they were trans because they didn’t fit traditional gender roles.
“Children’s bodies are being damaged in order to treat societal issues,” she warned. She recalled a case of a 13-year-old child “whose parents were really pressurising us for puberty blockers”. When the clinician refused to refer him, she claims one of the parents, a lawyer, wrote threatening legal letters to the service. The child was eventually referred for blockers.

She would have nightmares about her years at the Tavistock. “I would talk about it as an ‘atrocity’. I know that sounds quite strong, but it felt as if we were part of something that people would look back on in the future, and ask, what were we thinking? In the future I think there will be lots and lots of de-transitioners who feel their bodies were mutilated as young people and who will ask, why did you let me do this? It is very disturbing.”

Studies show that the vast majority of youngsters who begin puberty blockers go on to have irreversible hormone treatment at 16. Some go on to have gender reassignment surgery as adults.

All five clinicians expressed concern over how little young people and their families were being told about the impact of hormone treatment on fertility and sexual function as adults. One claimed young people were unable to give “informed consent” because it was regarded as taboo to discuss the impact of medical intervention on later sexual function in such a young cohort.

The clinic said there were no “taboo” subjects in its work, and that it did not “recognise this allegation as reflecting what happens in the service”. It rejected allegations of conversion therapy and insisted that youngsters were being properly advised on the risks of and about what is unknown about medical intervention. Time and care was taken at every stage to ensure that individuals grasped the potential consequences of their choices, it said, adding that the service had become “increasingly aware” of the need to discuss the impact of treatment on future sexual function.

The GIDS’s own internal review identified procedures around consent as an area of concern. It has recommended that written consent should be obtained before referral for blockers.

Another clinician described how youngsters entered his room enthusing about Alex Bertie, a transgender YouTuber, and My Life: I Am Leo, a documentary about a transgender teen broadcast in a teatime slot on CBBC.

“These are very simplified stories about how easy it would be to transition into being trans – that transition is a solution to feeling shit. That is very appealing to lots of teenagers,” the first male clinician said. I felt for the last two years what kept me in the job was the sense there was a huge number of children in danger and I was there to protect them from the service, from the inside.”

One female clinician estimates that she referred about 50 young people for puberty blockers. She now believes she referred too many. Their outcomes remain unclear. “When you start them on puberty blockers, you’re putting them on a pathway that could lead to sexual dysfunction problems and, for the younger kids, will definitely make them infertile. In what other specialism would physical intervention that leads to permanent change to the body be the first line of treatment for a vulnerable child? Activists will tell you it’s unethical not to intervene. But we know that not everyone with gender dysphoria will go on to identify as trans for the rest of their lives.”
One case has haunted her. “All the pushing was coming from the father to put the kid on puberty blockers. Thinking back on it now, I fear that the father was a paedophile and the child was being abused.” There is no suggestion the service knowingly ignored the case, and the outcome is unknown.

The clinic, which is run by the Tavistock and Portman Foundation Trust and whose director is Polly Carmichael, says it is tracking the progress of 44 young people who began puberty blockers in 2011, and that all available evidence is discussed with families. “This is a rapidly developing field and psychosocial and medical professionals are working hard to ensure that we respond to emerging evidence in an appropriate and considered way,” a spokesman said. The growing body of international evidence showed that “thus far, there is little reported evidence of harm,” he added.
“The service undertakes careful assessments over time and continues to see young people whether or not they attend the endocrine clinic following this assessment,” the spokesman said.
The clinic said it was aware of concerns and tensions between different perspectives raised by staff and “clinicians have a duty of care to raise safeguarding concerns”, adding that there were “safe spaces” and structures in place for staff to discuss anything that worried them. It would not comment on specific cases but stressed that a young person’s motivations and choices were discussed at each step.
What began in 1989 as a specialist clinic for gender issues is now under intense scrutiny. A report by David Bell, a former governor at the trust, revealed ethical concerns over “woefully inadequate care”. Staff were furious with the GIDS executive’s response to the report, which stated that its own review found no safeguarding concerns.
The whole service should have been halted when the number of “transgender” cases first exploded, one of the clinicians said. “That’s the point we should have stopped because we didn’t know what we were doing. Are we a service for kids with gender dysphoria, a medical disorder? Or are we a service for ‘transgender kids’?”
A GIDS spokesman said: “We are aware of tensions between different perspectives. These differences are inevitable in such complex work.”
One clinician said it was understandable if her former employer was defensive, saying: “If they are getting it wrong, you have to ask, are they making kids infertile by mistake? Because if they are to truly acknowledge [our concerns], then they will have to ask themselves, what the fuck have we done to thousands of children?”
Gires, GI and Mermaids all denied they viewed transition as a cure-all or that they exerted any undue pressure. Susie Green of Mermaids said the charity “does not encourage parents to demand any particular treatment.” Gendered Intelligence said the allegations against it were “unfounded”. Bernard Reed, founder of Gires, said: “In medical literature, failure to provide timely treatment is described as ‘psychological torture’. As far as we are aware, GIDS has adequate safeguards against irreversible treatments being given inappropriately.”

Inside the clinic rooms of the Tavistock, the private heartache of a new generation of “transgender” youngsters is being laid bare. There used to be about 50 referrals a year, mainly males with a…

A Letter to Violet Louisa Austerlitz



The following is an open, public letter that I am addressing to a man who calls himself Violet Louisa Austerlitz. Mr. Austerlitz is a man I met through my association with The Iowa City Press Coop.  The Iowa City Press Coop is a division of Public Space One, 

Before I moved to Iowa City I considered myself completely open and accepting of all the various sexual orientations. I believed in the concept of “live and let live” and still believe that ADULT people have a right to modify their bodies any way they choose to.

In 2013 I moved to Iowa City and into the River City Housing Cooperative,  The Coop had a supposedly “feminist” way of conducting business which included going around the room and stating our preferred pronouns at the beginning of every house meeting. This was done to respect the feelings of the men and women who lived there who were pretending to be the opposite sex.

I really did believe the transgender phenomenon was  harmless and I had and have no personal quarrel with people who think this is a legitimate thing to be acting out, whether by full sexual mutilation and sterilization or just by cross-dressing and affecting the manners of the opposite sex. And in fact, I owe Mr. Austerlitz a debt of gratitude for being the catalyst that brought me around to peak trans and metaphorically cleared the scales from my eyes about what is really going on inside the transgender cult.

violate austerlitz

Violate Louisa Austerlitz

I met Mr. Austerlitz, as I said, at the Iowa City Press Coop where I participated in workshops on printmaking. Mr. Austerlitz is a tall, blonde, balding white male who was born into and socialized into male privilege. At first glance I assumed he was an effeminate gay man.  (Actually, I believe he IS an effeminate gay man, which is why he claims status in the LGBTQ community. But, in the fun logical world of the transcult,  when a man says he is really a woman it does not make the man heterosexual in his attraction to men, it makes him GAYER than ever!) (If I am mistaken and Mr. Austerlitz is not attracted to other males, then apparently, when a straight guy decides to declare himself female, this instantly makes him a lesbian……which also, conveniently, is justification for Mr. Austerlitz to use the LGTBQ flag as a selling point for his pedestrian artwork.) I was expected to accept that this man’s simple declaration that he is female is sufficient to erase his ingrained sense of superiority over actual XX genital natal females and all the years of living as an entitled white male evaporate like smoke. (POOF! Tranzmajik!!!)

And I was STILL willing to tolerate being gaslighted by the other members who referred to him as SHE and subtly pressured me to lie or face ostracism. Because I wanted to do art and I wanted to belong to the group.


But, then it happened. I received an email from one of the key people at ICPC that ICPC was invited to do art workshops with a day camp for girls called Girls Rock.  I was informed in this email that TRANS were welcome to participate. This stopped me up short. I thought…isn’t rather fucked up to present the idea to girls that if they don’t like their bodies or the social role they are expected to fulfill that all they have to is chop off their tits and have a phalloplasty and – VOILA! – Instant Boy!

I decided to confront my concerns head-on and wrote to the members of ICPC. The “head” of ICPC, John Engelbrecht was dispatched to send an email reading me the riot act. He proposed that I come in and discuss it with the group. I decided that was not acceptable, since I am just one traumatized old lady and I was not able to go fight all by myself for the truth in a group that was opposed to every word I might say. Unfair conditions. And so I walked away.

I did manage to confront Girls Rock over this issue, although they are still promoting this anti-female ideology instead of helping girls accept their bodies and their sexuality.

Confronting The Problem Head-On

I have been feeling bad recently because I am judging myself for not being able to handle this matter in a direct, adult manner; I was afraid of being ostracized and of having to take the heat generated by my outspoken convictions all by myself. But, I’ve decided that what I need to do now is to be as public and confrontive as I can manage and look the problem right in the face.  However, first I need to get something straight. In a way, it seems as if my own propensities and passions and the lessons and wrong turns of my journey have been perfectly crafted for me to grapple with the transcult here in Iowa City. But I am not doing this because I believe I can save anybody or that my activism can can prevent our imminent extinction from climate collapse or even help us solve our universal sex hierarchy/sexual violence problem as we wait for the end.  I’m doing it out of gut necessity. From my SOUL. Because fucking with children’s genitals is the worst crime in the universe and I can’t sit around in silence watching children being harmed this way.

My Public Letter To Violate Louisa Austerlitz
(I call him “Violate” because he is violating female integrity):

v.a.2Dear Mr. Austerlitz,

I understand that you are just one more narcissistic male and that you have the (patriarchal) god-given right to act out whatever misogynistic fantasies float your boat. When I first saw you back in 2015 I I thought you were a typical effeminate gay man with an “affectation” and people were calling you “SHE” in the affected way people refer to drag queens and effeminate gay men as “SHE” knowing full well they are men.

But then the gaslighting began and I was subtly pressured into referring to you as “SHE” when in fact this is a bald-faced lie. I avoided having to lie by referring to you by your fake name rather than saying “SHE” and participating in the gaslighting. You are free to be any kind of destructive asshole you want to be and I have no control over that, but it HORRIFIES me that the “community” is enabling your lie while suppressing the voices of gender critical women like me.

I lived at the River City Housing Coop with people who were pretending to be the opposite sex and I believed this was a harmless lifestyle choice. But soon after I joined the Iowa City Press Coop I began to realize that body-hatred and lies about basic biology were being sold to young girls as some kind of liberating lifestyle option.

Then I did a little research and realized that doctors are poisoning gender non-conforming children with powerful, untested chemicals such as lupron, stopping their normal puberty and then mutilating their healthy sex parts in order to make them APPEAR to be the opposite sex. They are not changing anyone’s sex because sex chromosomes are in every cell in a person’s body and even under the influence of artificial corporate sex chemicals the body will struggle to retain its original integrity.

What the gender doctors ARE doing is chemically sterilizing (rendering the child unable to conceive children in adulthood) and then mutilating the child’s genitals. This results in an inabilty of the genitals to experience the sensation of sexual pleasure. Nice.

Puberty blockers cause brain and bone damage. Boys and girls who don’t fit into the sadomasochistic sex role hierarchy are being made into EUNUCHS.

What does any of this have to do with you, Mr. Violate Louisa Austerlitz? This is all taking place so that you, as a privileged white male, can enjoy your self-obsessed, opportunistic little HOAX,  your male ego trip,  your gaslighting power play,  your misogynistic charade.

39811067_10156573534564844_1405198348746489856_nI call you out as an abuser of children and a violator of female integrity. I hold you personally responsible for the eugenic medical experiments that are being done on gender non-conforming children and for the violation of female integrity and the disappearance of protected female-only spaces. I curse your fake name and your evil existence.

Jeanne Allyn Smith

















Dr. Wobberly’s Guide to FTM Transition

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