a group of 5 children

Let’s Use Caution In Treating Transgender Children

Gender reassignment has become a trending topic over the past few years and we are now seeing higher numbers of 7 and 8 year old children in our clinic who are questioning their birth gender. In fact, intakes for gender dysphoria are estimated to be about two to three times what they were just five years ago. Gender dysphoria (the strong feeling that a person doesn’t identify with the biological gender they were born with, when it causes them distress, and when they have felt this way for at least six months) can happen as early as age 4, although most transgender people don’t start to feel a disconnect with their birth gender until their body starts changing during puberty.

I have no doubt that some transgender children do have an early awareness of their incorrect birth gender, but at this young age most children are still examining what it means to be “me.” Peer pressure and societal pressure can influence gender dysphoria during this period, especially if the child thinks they must act or “feel” a certain way in order to gain acceptance.

So, are the kids who are questioning their gender truly trans children or are they merely children who are trying on different aspects of their forming identities to see what fits? What if we are pushing children into becoming what they’re really not?

In an article about a study done on people who were detransitioning, the Society For Evidence Based Gender Medicine (SEGM) wrote, “Nearly a third (30%) endorsed the response “someone else told me that the feelings I was having meant that I was transgender and I believed them” to describe how they felt about identifying as transgender in the past. Many participants selected social media, online communities, and in-person friend groups as sources that encouraged them to believe that transitioning would help them.”

Adding to the issue are the parents who are trying to be supportive, so they allow the child to go to a doctor and begin taking hormone blockers at an early age or even before puberty. They are doing so partly because today’s culture has reinforced this approach and partly because doctors and parents alike haven’t questioned enough about the potential outcomes of hormone treatment in young people.

In fact, in some states, a child does not even need to get parental approval to begin the transition process. After a brief in-person or video consultation with a doctor, a child can initiate treatment on their own. Planned Parenthood will even provide these hormones after a first appointment and without requiring a letter from a licensed mental healthcare provider.

We have made it far too easy to get these prescriptions!

Why Begin So Early?

Why not wait until age 18 to begin transitioning? What are the long term goals of starting such early hormone blockers for transgender youth? Well, experts say early intervention helps the child avoid the discomfort that can come with a puberty that doesn’t fit their gender image (ie: menstruation, voice changes, growing an Adam’s apple, and so on).

However – we don’t really know if gender dysphoria is a permanent condition, but we are intentionally blocking hormones on these kids. In doing so, we are exposing them to potential health concerns and complications in the future, along with the possibility of infertility, and more.

The New York Times recently said, “…there is emerging evidence of potential harm from using blockers, according to reviews of scientific papers and interviews with more than 50 doctors and academic experts around the world. The drugs suppress estrogen and testosterone, hormones that help develop the reproductive system but also affect the bones, the brain and other parts of the body. During puberty, bone mass typically surges, determining a lifetime of bone health. When adolescents are using blockers, bone density growth flatlines, on average, according to an analysis commissioned by The Times of observational studies examining the effects.”

Because so little is known about prospective outcomes, the National Health Service in the U.K. has blocked this treatment for transgender youth in their country. I believe the U.S. should do the same.

We should also consider that gender reassignment may not make the person feel better about themselves. If you think back to when you were a child or teen, you’ll no doubt remember that you thought your opinions and beliefs were never going to change from that point forward. I’d be willing to bet you have some very different ideas about certain things now that you have matured.

Because they’re still forming, we really don’t understand about our personal beliefs, thoughts, and opinions until we get closer to age 30, so to allow hormone blocking in kids who are 7, 8, 9, and 10 years old is just plain wrong. How can a child make such a life-altering decision with so little life experience to help guide them?

What Is Wrong With Watchful Waiting?

Using hormones during childhood and the teen years doesn’t allow the body to complete maturation, so a young person who takes hormone blockers doesn’t know if they will be able to accept their gender once maturity is reached. The SEGM article I cited earlier noted that 65 percent of females and 48 percent of males who detransitioned said they did so because they ultimately felt “more comfortable with identifying with their natal sex due to a change in personal definition of female and male.”

There’s where that life experience comes into play.

This is in sharp contrast to a statement from the American Academy of Pediatrics (AAP), however. They do not agree with watchful waiting. They say it is an “outdated approach [that] does not serve the child because critical support is withheld. Watchful waiting is based on binary notions of gender in which gender diversity and fluidity is pathologized; in watchful waiting, it is also assumed that notions of gender identity become fixed at a certain age.”

Regardless, it is a fact that many people who have detransitioned wouldn’t have had to go through the trauma of surgery and hormone therapy to transition, and then do it all again to detransition, if they had waited until they’d reached maturity to make a decision.

The AAP also dismisses the idea that a child could have an underlying mental health concern that might be masked by a transgender identity. They say in their statement,” if a mental health issue exists, it most often stems from stigma and negative experiences rather than being intrinsic to the child.”

Yet I know from more than forty years of experience in treating children and adults that there are plenty of mental health conditions that might be at play. Transitioning won’t solve any of them either. It will only leave the person in the same condition, but with a different outer appearance.

As a comparison, it’s interesting to note that the AAP’s view on tattoos and piercings – which are clearly much less invasive body modifications, states “As with any adolescent or young adult, for those with piercings and tattoos, it is advised that the pediatrician conduct a careful adolescent psychosocial history with targeted behavioral interventions to assist in decreasing risk behaviors.”

Stop and take that in for a minute.

According to the AAP, hormone blockers and transgender surgery are perfectly fine and don’t need to be addressed with a proper and thorough mental health intervention…but a child who wants a piercing or a tattoo should undergo “careful adolescent psychosocial history with targeted behavioral interventions” before moving ahead with their plans.

The hypocrisy is mind-boggling.

What If It Doesn’t Help?

It often isn’t so simple that it’s just the person’s gender making them unhappy or feeling incomplete. As I mentioned, there could be something else is underlying, such as past trauma or abuse. Once you start transitioning, you assume you’ll be happy when you’re finished. But what happens if you go through hormones and surgery and don’t get the desired outcome? Regardless of gender, some people will still be depressed or anxious.

Indeed, in a recent study of detransitioned people, the most frequent reason for doing so was that the person’s personal definition of male and female had changed. That said, “Other commonly endorsed reasons were concerns about potential medical complications (49.0%); transition did not improve their mental health (42.0%); dissatisfaction with the physical results of transition (40.0%); and discovering that something specific like trauma or a mental health condition caused their gender dysphoria (38.0%).

Final Thoughts

There is a difference between tolerance and the idea that you’re behind the times if you aren’t on board with early transitioning. Most of the encouragement for hormones and surgical reassignment comes from the woke community, which negatively labels anyone who disagrees with the narrative, and is less likely to want a dialogue. We need to realize that not everyone who disagrees with young transgender intervention is homophobic or misogynistic. It means they are advocating caution and saying, “don’t make these changes so quick and easy”.

I believe that we should support the transgender person, but we should also gather statistics on the outcomes of treatments for gender reassignment before completely jumping into hormones and surgery. What’s wrong with taking a slow and cautious approach? This is not a just psychological idea anymore. There is no more experimenting: we have the science to do this.

So, where does this leave us? Hopefully, with the fairmindedness and ability to allow discussion and restraint about something we know very little about. To immediately label cautionary dissenters as transphobic and to not allow a conversation on such a life changing procedure is the worst form of prejudice and narrowmindedness.

We Are Here For You

If you or your child have questions about whether gender reassignment is right for their unique situation, we can help to address these concerns in a supportive environment. For more information, please contact our Children’s Center in Delray Beach, Florida at (561) 223-6568 today.

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