Dear [Doctor, Therapist, Teacher, Principal, Parent, Friend],

By reader request: a template of a letter you can send

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Several of you asked me to write something you can adapt and send to your doctor or teacher or anyone else in your life who sees this issue fundamentally differently than you do. It had to be short and not didactic. I’ve given it a go. If you have suggestions for what to add, subtract, or do differently, please leave in the comments section. I’ll open them to all subscribers, not just the payers.

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Dear [xxxxx],

I write to you today to share my perspective on the contentious issue of kids and gender, in the hopes that we can eventually have a discussion. Like you, I believe that gender diversity is natural. I want to create more understanding and room for gender-diverse kids, and I believe in the mission of diversity and inclusion.

But I have some objections to the way we’re teaching kids about gender, and to the way the mental health and medical fields are responding to kids with gender distress. Please know that this is not about denying trans people rights or dignity, but about concern for children’s health and welfare. I have developed an understanding of the scientific literature on pediatric and adolescent gender transition, and have come to conclusions that are quite different from those asserted by most of the media—until recently—and medical associations. I’d like to share with you some of the thoughts of doctors and researchers dedicated to working on behalf of gender expansive kids, who don’t believe the science has been reported or interpreted accurately. In fact, you may have seen both Reuters and The New York Times reporting quite differently on this issue in the past few weeks, showing more sides of the story, getting at the complexities and the nuances. These are what I’d like to share with you.

Social transition

Many parents and health and education professionals believe that it is imperative that we allow children to select their own pronouns, and that we facilitate children in social transition—allowing them to adopt the identity and stereotypes of the opposite sex, or, in the case of nonbinary kids, neither sex. They see social transition as a rights issue, not a healthcare issue. But doctors and psychologists aren’t sure if social transition is an appropriate intervention for children with gender dysphoria, or if we should present any child with the option to choose their sex category.

Social transition was “Relatively unheard-of 10 years ago,” per a 2019 paper, which adds that “early-childhood social transitions are a contentious issue within the clinical, scientific, and broader public communities.” This is just one reason why I’m so concerned about the school policies that require schools to keep information about kids’ social transitions from their own parents if the child desires it—these are in fact psychological treatments, even if some people view them as human rights.

What little research we have suggests that social transition greatly increases the chance that such children will go on to medicate. When the preferred method was “watchful waiting,” which did not involve social transition but rather many years of evaluation, the vast majority of children with gender dysphoria desisted—stopped having dysphoria or identifying as the opposite sex—by the end of puberty. The majority of those ended up being same-sex attracted. There’s quite a bit of crossover between childhood gender dysphoria, and/or childhood gender nonconformity, and later homosexuality. This is in contrast to what many kids are taught in school, that gender and sexuality are separate. Some gay adults who endured childhood gender dysphoria worry we are medicating proto-gay children with the same medical protocol once used to treat or punish homosexuality.

This is why it’s complicated to teach lessons to kids as young as preschool about social transition, and read them books about kids who feel they were born in the wrong body, and are liberated once they claim a gender identity different from their sex. Such lessons don’t explain the difficult physical reality of medical transition later. Even The New York Times is now acknowledging the dangers and unknowns of puberty blockers. Many detransitioners and others who regret the physical effects of transition are speaking out, but we don’t tell their stories to kids.

Suicide

It’s oft repeated that trans kids are at increased risk for suicide, but it’s important to put those studies and statistics in context. As The New York Times recently reported, a Dutch study found that “deaths by suicide, which are fortunately rare, though still higher than for the general Dutch population, seem to ‘occur during every stage of transitioning.’” Meaning: transition didn’t mitigate risk.

There is some low-quality research showing that adults who wanted medical interventions as kids and didn’t get them have worse mental health and more suicidal ideation than those who wanted them and got them. But those people may not have been eligible for the medical interventions because of their poor mental health, rather than causality leading the other way. Many of the suicide stats have been debunked. Some kids with gender dysphoria do have higher rates of suicidal ideation and even attempts (very different than completed suicides), but they are similar rates to kids with other mental health conditions, and many teens with gender dysphoria do have other mental health issues. There appears to be some overlap between gender dysphoria and autism, and the diagnosis of autism appears to correlate with suicidality. Of course I take suicidal ideation seriously, and I know many kids are struggling, but we don’t want to overstate the possible benefits of transition to kids’ mental health, nor assert falsely that they are in danger if they don’t transition.

The new cohort

There is a new and almost-never before seen group of teens identifying as transgender—mostly girls with no history of gender dysphoria or nonconformity and who have other mental health conditions. There are also more teen boys coming out than ever before. The small, Dutch study on which the entire medical protocol was based, which shows some psychological improvement for adolescents who transitioned, was not designed for this population. Rather, the Dutch studied young people with persistent, insistent, and consistent dysphoria since early childhood, who did not have other mental health conditions. We’re using the protocol on a different type of patient, in different circumstances, and we have no long-term follow-up on these patients.

Several European countries have abandoned both the gender-affirming model of care and the World Professional Association for Transgender Health’s “standards of care,” no longer advocating for social transition and tightening the reins on medicating youth.

Normalizing gender nonconformity

Some children emerge as “gender-diverse” very young—two or three years old. They become interested in what we have culturally coded as boy or girl items, the opposite of those marketed toward their sex. This does not mean any one thing about a child’s future.

Until about 7 or 8 years old, most children understand the boy and girl category in terms of stereotypes. They may believe that girls wear dresses and makeup and thus anyone who wears a dress or makeup is a girl. This is, in fact, what many of them are being taught when they’re told these are social, not biological, categories. But eventually, kids develop enough cognitively to realize that their category is based on their bodies, not their adherence—or lack thereof—to stereotypes. This is called gender constancy.

Around 7 or 8, you may find extremely gender conforming girls, who’ve been deep in the princess phase, suddenly declare their hatred of pink and dresses, and adopt a more tomboyish style. This is not just because of gender constancy—they know they can wear sweatpants and still be a girl—but because they begin to understand how the world looks down on femininity. Hence, boys at that age do not don Mary Janes and tutus; they often become even more gender conforming.

I think the best thing we can teach kids about gender is that it is a series of ideas about who you’re supposed to be based on your sex, and that we don’t need to heed those ideas. There is ample research showing that gender nonconformity is generally a healthy thing—that if children don’t feel confined by stereotypes, they do better in school, work, creativity.

However, if the number of detransitioners continues to rise, and if we continue to wage the battle over how to treat kids with gender distress in the legislature, I fear that trans people will suffer, and so will our understanding of gender diversity. I am speaking out in hopes of preserving space for gender nonconforming children, and understanding that the vast majority of them simply need permission to be different from those of their sex.

There is so much more to say, so many other issues to cover. I may not have convinced you to see things my way, but I’m hoping I’ve convinced you that the way I see things is legitimate and worth considering. I hope this opens the door to conversation.

Many thanks for your time,

Your Name Here

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