Bad Parenting Advice

Why does the mental health field insist on medicating gender nonconformity?

For Pride Month, a pediatric mental health organization, Child Mind Institute, sent out a newsletter about “celebrating our LGBTQ+ kids,” while supporting “their mental health and safety.”

Sounds good. But head over to their piece on gender dysphoria and you’ll see one of the enormous problems with this discussion: the conflation of gender dysphoria with gender nonconformity, a phrase which describes when a child does not perform the stereotypes associated with his or her sex.

“The experience of being transgender or gender nonconforming means that a person’s gender at birth (their assigned gender) does not match the gender they feel themselves to be (their affirmed gender),” they open with. This is not true. Gender nonconformity has nothing to do with the midcentury medical idea of gender identity. When a child is drawn to the gender role of the opposite sex, which is a melding of biological and cultural influences, we haven’t the least idea why, or what it means, or what it portends about their future. Being transgender—that is, being of one sex and identifying as another (or neither, as increasingly the case)—is completely different than veering away from stereotypes.

The problem here is that the word gender, which has at least three meanings, has been hijacked so it means only one thing. If you believe gender is an identity, an internal sense of self, then to be gender nonconforming is the same thing as transgender—to have an identity that doesn’t conform to sex. But if that becomes the definition, then any girl who rejects dolls and any boy who embraces them will be facilitated into a new category, rather than expanding the boundaries of their own.

The article goes on, “Gender nonconformity can appear as young as two or three years of age, when children become aware of the notion of gender and they may assert, ‘No, I’m a boy,’ or ‘No, I’m a girl.’”

What the writer should say is: This is the age when children start to understand that there are two categories and that there are stereotypes associated with those categories. But they don’t have the cognitive ability to understand that the categories are based on bodies, thus they will believe that makeup and dresses make someone a woman, and baseball hats and blazers make someone a man. At two or three, children may become aware that, for reasons yet unknown, they are not performing the stereotypes associated with their sex, that they’re different from those in their category, and therefore believe they’re not members of that category. Once they’re old enough to understand gender constancy—their sex stays the same no matter how they present—those feelings may change, as long as we haven’t made a lot of meaning out of those declarations or inclinations.

This article, blasted out to parents whose children may have mental health issues, conflates gender dysphoria, or impairment because of distress at a mismatch between biological sex and gender identity, with gender nonconformity. It conflates both with transgender identity. But not everyone with gender dysphoria is trans, and not everyone who’s trans has gender dysphoria, and none of those people is necessarily gender nonconforming.

Still, the American Psychiatric Association published a guide for “Working With Transgender and Gender Nonconforming Patients,” and clinics provide “Transgender and Gender Nonconforming Care,” implying not only that trans and GNC are the same, but that both necessitate some kind of medical intervention, instead of cultural embrace. Assuming that gender nonconformity is a condition that needs treatment is exactly what doctors like George Rekers did in the 70s and 80s, trying to shame feminine boys and masculine girls out of their behaviors. It was indeed a kind of conversion therapy, and at least one of his patients committed suicide.

What few people writing about this subject seem to understand is that historically, and around the world, extreme childhood gender nonconformity usually had little to do with future transgender identities. Rather, research shows that most gender dysphoric young children (if they are not socially transitioned) will desist, and the majority will later be same-sex attracted. So called “third genders” like Mexico’s muxes, Samoa’s fa'afafine, Brazil’s travestí and India’s hijra, who often emerge as feminine in childhood, become androphilic adult males, attracted to men—not transgender women who feel they’re in the wrong body (though as the idea of gender identity is exported from the West, that may become more common). According to Dr. Paul Vasey, who has conducted many years of field research on some of these cultures, there has been almost no gender dysphoria associated with gender nonconformity in such places. Such a way of being is uncontroversial, the relationship to sexuality understood.

If you grew up in the 1970s, when girls were encouraged to be gender nonconforming tomboys, this Child Mind Institute’s slippery language may confuse or confound you. Cultural norms shift generationally, but tolerance for and understanding of gender nonconformity seems to have had only that one real tomboy phase, and it ended with the dawn of highly feminized and sexualized Girl Power; meanwhile, boys have never been encouraged to stray.

The left wants to medicate gender nonconformity. The right wants children to conform. I want everyone to leave it alone. All we need to do is let these kids dress how they please and play with what they want, and try to create a world where kids feel free to explore what’s marked as for boys or for girls, without shame. But an article like this doesn’t add to that project, and it doesn’t create more room for gender nonconformity.