Here's [Some of] What Everyone Needs to Know about Kids and the Gender Debate

An open letter to friends, family, the media, our kids' teachers and doctors, and everyone else I come into contact with ever. Please help me stop ranting.

This post is free for all subscribers because I want you to be able to pass it around. But if you can afford to subscribe and help me keep writing about gender, I would really appreciate it.

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Referrals to NHS’s Gender Identity Development Service

Dear humans,

Recently, I left a dinner with friends feeling isolated and despondent. I had lapsed once again into “gender-spew,” in which I cannot stop talking about what I have learned, and how different it is from what I, and the rest of us, have been told by the media and in educational settings. There are some downright abuses going on in the name of liberation, and often when I try to explain them, I am met with silence, skepticism, or disbelief. Or worse: indifference.

I understand some of this has to do with my rhetorical style—or lack thereof. “Be more professorial,” my husband keeps telling me. Meaning: Stop ranting. Still, few people ask me clarifying questions. Do they just want me to shut up, or do they refuse to take in the complexity of the situation, to see what can’t be unseen?

Either way, this letter is intended to make people see, and to give them a quick tour through some of the [mis]information that has caused me to try obsessively to change the way the media reports about kids with gender dysphoria and trans kids—populations that should not be confused with one another. More on that below.

This letter includes links to articles, podcasts, books, and videos that will help those who are not already start to become properly educated and give them some fodder to ask good questions and fortify them to feel that they have a right to do so. If you have suggestions for other good sources of information, please leave them in the comments and I’ll add them.

People often tell me that they are afraid to ask even the most basic questions, about pronouns or, say, the idea that “boy” and “girl” are social, not biological categories. When we don’t speak up we participate in this culture of decentralized McCarthyism, the result of extremely effective bullying by activists who want us to see these issues through only one lens. We are grownups and parents and we have the right to be heard, to be skeptical, to be properly informed, and to see issues from multiple perspectives.

I cannot survive here alone on this island of inconvenient truths, so please join me. Here’s just a little of what I want you to know:

Nobody knows for sure who a “trans kid” will grow up to be

The vast majority of kids with early-onset (pre-pubertal) gender dysphoria will desist, and many will grow up to be gay—if they are not socially transitioned to live as the opposite sex or another social category. Social transition is a new form of psychological intervention that has become common, likely based on the myth that kids who proclaim they are the opposite sex will be harmed by not being affirmed, or that they will kill themselves if they aren’t transitioned. (Supported and affirmed are not the same thing; they should definitely be supported.) Some clinicians believe that social transition will increase the chances of more severe dysphoria at puberty, therefore creating medicalized trans children who would otherwise have been gay. Some feel that pronouncing a child trans seals the deal on their trajectory, and that it is the end, rather than the beginning, of inquiry.

But we do not know. There is so much we do not know.

Some kids with early onset gender dysphoria will grow up to be neither gay nor trans. While some research suggests that “the persistence, insistence, and consistence of statements, and behaviours in childhood” helps predict whether GD will continue or not, the truth is no clinician, child or parent can know for certain how to forecast from childhood GD or from gender nonconformity. There is no clear clinical test. And medicalization is not the only treatment for GD.

Some clinicians believe that after careful and extensive evaluation, it is possible to discern who will continue to identify as trans and who will benefit from medical intervention—that is, they believe they can identify those for whom medical intervention is the best way to treat GD, despite risks and complications. I respect those clinicians but believe we need a lot more research and open discussion, and careful follow-up of every child who medically transitions in this country. Most of them are quite willing to engage, but the media mostly ignores them.

Some people believe that a child knows themselves from early on and can make this enormous decision and no one should stand in the way. That contradicts almost all research or has not been proven.

Gender and sexuality are not completely separate things

An entire post is soon coming on this, but it is a myth that how masculine or feminine people are, or having a gender identity different from their biological sex, has no relationship with sexuality. See above: Many (but not all!) kids with GD grow up to be gay, and many (but not all!) extremely feminine boys or masculine girls will be, too. For men with autogynephilia, a kind of sexuality in which they are aroused by the idea of having a woman’s body, gender identity and sexuality are deeply intertwined. Many trans women do not want anyone to talk about autogynephiles, but some autogynephiles are greatly relieved when they discover this explanation for their inclinations and wish to share the research.

Schools should not teach that gender and sexuality have nothing to do with each other. It can be very confusing for kids who think, “Oh, my differences are about gender, not sexuality,” which may lead them to believe that changing their body or identity is required. I’ve talked to many young people for whom that was the case.

Leave as much room as possible for kids to find themselves, without labels (and, no, sex categories are not labels, they’re facts) and give them good scientific information.

Gender dysphoria and being trans are not the same thing

There is an assumption today that anyone who has “psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity.” is in fact trans, and always will be. But we know that’s not true, not just from the high desistance rate of children with GD in past studies, but from the growing ranks of detransitioners who did in fact have GD and identified as trans, then realized they weren’t, and that they should not have cut off their breasts or testicles and permanently changed their bodies through cross-sex hormones. Sometimes there are other factors causing the dysphoria. Listen to Dr. David Bell, a whistleblower psychologist who once worked at the UK’s Gender Identity Development Service, explain his point of view.

Others disagree with him and think that for some kids, gender dysphoria is in some pure form connected to gender identity and not other psychological factors like sexuality, and believe very much that trans kids exist and are a discrete category that can be identified.

The bottom line: VERY KNOWLEDGEABLE PEOPLE DISAGREE ABOUT SOME VERY BASIC FACTS AND TENETS. If you see someone saying that it’s completely clear and simple, do not heed that person.

Gender identity is a feeling, not a fact

Last week was “identity week” at my daughter’s elementary school. She learned that everyone has a gender identity, and that sometimes you might feel like a red crayon on the inside but actually be a blue crayon in your mind (or is it the opposite?). Gender identity is a term coined in the medical arena in the middle of the last century to describe a population of what were then called transsexuals and hermaphrodites, whose senses of themselves were different than their bodies.

In some ways, the very concept of gender identity prevents inquiry into why a person might have a sense of possessing the wrong body or being in the wrong social category, which may be caused by autogynephilia, homosexuality or gender nonconformity—or any number of other factors. At any rate, it’s a feeling, quite different from the fact of biological sex (which can be complicated, but the existence of people with differences of sex development does not negate the reality of sex). It is okay to teach kids that some people have a gender identity, and that some people choose to live in the world as the sex that they are not. It is not okay to teach kids that everyone has a gender identity or that which puberty you go through—red crayon or blue crayon—is optional. That does not jive with science or the belief systems of most people on the planet.

Last year, I offered to share my workshop on the history and continued impact of gender norms with the school, but they scheduled and then canceled it (I do not know why). All kids should be learning about gender norms and stereotypes. Identity week included nothing about them, despite how much they shape our identities.

Exploratory therapy is not conversion therapy

The vast majority of clinicians with longterm experience—that is, after 2007, when the first pediatric gender clinic opened in Boston, so not that long—believe in careful evaluation of kids with GD. They believe that there can be underlying factors causing it that, if addressed, could alleviate the GD without medical intervention, and that’s why it’s important to explore. Bans on conversion therapy for “trans kids”—or, as we should be saying, children with gender dysphoria—are dangerous because they end up banning necessary exploratory therapy. We are all evaluated for major psychological and medical interventions, and gender-affirming medical care should not be over-the-counter.

We don’t know how common or rare transition regret is

Most of the previous research on kids who transitioned [after puberty] came from places like the Netherlands, where children and adults were carefully evaluated, sometimes for years, before embarking on a medical path. And in the U.S., adults had to spend years proving that they’d benefit from this medical model, too. (Hear Ray Blanchard talking to Benjamin Boyce about why this was unpleasant and humiliating but ultimately successful.) Thus, because of rigorous evaluation, regret was rare.

Today, we have desisters—who insisted they were trans and wanted to medicate but didn’t—and detransitioners speaking out, but they are often ignored by the media. We silence regretters and then say regret is rare.

We are not keeping statistics on regret so we don’t know how common or rare it is. We just don’t know.

We don’t know how safe or effective medicating kids who identify as trans is

You will hear groups like the American Academy of Pediatrics insist that puberty blockers, cross-sex hormones and gender-affirming surgeries are proven to be safe and effective. But Sweden, Finland, parts of Australia, and the UK mostly stopped providing these medical services after detransitioners emerged. The UK started again after an appeal, but they had already ordered a review of research on puberty blockers and cross-sex hormones and found that the evidence was of “very-low quality certainty.”

Once a child goes off puberty blockers, they can start their endogenous puberty, but that doesn’t mean that blockers don’t have other effects. Puberty has many functions beyond secondary sex characteristics, in brains and bones and regulating organs. Cross-sex hormones have profound affects on the entire body. How safe and effective are these interventions? We don’t know for sure. We just don’t know. We need more and better research.

The media should not call policies that question the safety and efficacy of pediatric medical gender transition “anti-trans”

Bills aiming to curtail access to gender-affirming medicalization may not actually be anti-trans, but rather pro-child safeguarding. The media should stop framing the story this way so that people concerned about everything above can have their voices heard without being called bigots. The only outlet I can find that consistently investigates these issues from multiple sides is Medscape. If you are a confused or concerned parent and want impartial news, I suggest you read articles there.

The clinicians with the most experience in this arena are anti-ban. They don’t want the government deciding how doctors and psychologists should treat patients, just as many of us don’t want the government deciding whether we can access abortions or birth control—though the comparison is weak because birth control and abortion do not permanently alter brains and bodies. I would also prefer that the medical and mental health fields self-regulate, but if they are ignoring information, research and experience that disrupts the narrative on which their policy is based, they won’t do that.

We have a population of kids coming out as trans for whom we have almost no research, whether you call them ROGD or not

The exponential rise in teenage girls (and increase in teenage boys) seeking care for gender dysphoria is well-documented, and a massive shift from the population clinicians have ever seen before. Why? Do the same evaluative and medical protocols apply to them?

We don’t know! We just don’t know. Seems like not?

Some clinicians I’ve talked to who acknowledge this massive shift do not want to use the term ROGD because of its political baggage. (I would say that by leaving only the right to report on it, we have created that political baggage; most ROGD parents are left wingers—or were.) Whether or not it’s in the DSM isn’t the point—heck, homosexuality used to be in there. It’s not like the DSM is some pure and unsullied source; it has been written by people with biases and limited information and those biases and information have changed over time. The point is: They acknowledge this is a new and complex population that’s much harder to treat, but don’t know if this term applies since they had sometimes seen teens with ROGD and no history of gender nonconformity before the massive spike began.

Trans is a huge umbrella term that includes people wanting relief from gender norms and people tortured by their bodies. Their needs may be wildly different.

[I’ll write a separate post around the misinformation around suicidality. That’s important, too.]

Friends, does any of this seem clear? I hope not. The murk and the muck is where the good stories are, and I have tried so hard to get these murky tales into the mainstream media. I have pitched major investigative features to The New York Times Magazine, The Washington Post Magazine, The New Republic, Reason, Time and many other publications, and only one person even bothered to get back to me to say no.

I continue to supply editing help and advice for others wishing to complicate the media narrative. I continue to interview people and pitch stories around their experiences. I continue to listen to multiple and competing narratives and try to make sense of it—or acknowledge when that’s simply not possible—and present that for you here. None of it feels like enough.

I have talked with many trans people who changed their bodies and are glad, and feel that they had lived long enough that they could assent to the trade-offs and this was the best way to ease their suffering. They live as trans men or women but don’t pretend that biological sex is not real or is immaterial (even those with differences of sex development or intersex conditions), and they are thoughtful and concerned about kids. They are speaking up, though are often dismissed as haters. They are not haters.

Others experience some form of transition regret, from mild to excruciating, and wish there had been room for them to be different from everyone else around them as kids, and that they had been better informed about the realities of medical transition and the complexities of gender.

Naturally gender nonconforming kids are often left behind in these debates, and those are the ones I advocate for. I wish to tell them that indeed there is a space for them in this world. There have always been people like them and they are perfect as they are, whatever color their crayon. It is amazing to me that that people can twist this sentiment into hate speech. I am sad and mad and scared, for my child, for my career, for the future of free speech, for humanity, and for our ability to evolve intellectually. 

Watch, read, listen:

Nolan Investigates: Stonewall

Helen Joyce’s book TRANS, which is not about trans people but about trans activism and its effects on society. Here’s an excerpt about autogynephilia.

Genspect’s Stats for Gender, a window into studies that contradict the pervasive media narrative

Abigail Shrier’s piece on “whistle-blower” gender-affirming doctors and psychologists.

Jesse Singal’s piece on how the mainstream media misunderstands the science of gender-affirming care for kids.

I suggest listening to the podcast Gender: A Wider Lens and partaking of some of Benjamin Boyce’s extensive video interviews on this subject. Meghan Daum has also done a great series of interviews and is willing to talk about what we’re not supposed to on her podcast Unspeakable. Trans men Aaron Kimberly and Aaron Terrell tackle complicated subjects around gender dysphoria on the podcast Transparent.

If you don’t do this, then there’s one outcome we do know is certain: You will be subject to my unstoppable gender-spew.

Your annoying friend/colleague/relative/constituent,

Lisa