By Devon Jacobs
I’m an American Mom with liberal political views (Democrat voter, East Coast) who knew nothing about “gender dysphoria” or the experimental nature of treatment in this field until I was thrust into it with my young teenage son’s sudden quarantine announcement. I was shocked to see that anyone who says they are “trans” is automatically “trans” at any age, self-ID is the only test, and “transition” is the immediate treatment. I have to use a pseudonym to protect my family because the aggressive, affirmative, medicalized approach to “trans” is the only option permitted in today’s political and social environment in the US and I don’t believe it makes sense for my child’s well-being.
What is Dysphoria — Transgenderism or Just Puberty?
Transgender kids — you’ve heard about their struggles. If you are like me, you have immense sympathy for them and their families, and support their right to a happy life, free of discrimination in this polarized world. Trapped in the wrong body, these young people struggle with extreme distress as they navigate a world where people do not see them as they are inside, where their mind and body do not match.
Many do not realize, though, “transgender” is not as clear cut as what we see on the news. I know this first hand.
I’m a parent of a trans-identified kid. How do I know? It’s not because I’ve seen my child struggle all his life, exhibit cross-gender behaviors, or have an affinity for the opposite gender’s role. He’s never exhibited any of that, not even remotely. It’s not because he’s withdrawn, or repressed, or depressed or sad. He’s actually a jolly kid, doing well in school, no signs of struggle — not anything out of the ordinary anyway for an early teen.
The only way I know is because one day he said, “I’m trans.” Like most good parents would, I said, I love you always, no matter what — please tell me more. So, he continued. He felt “uncomfortable”, and didn’t like what’s happening to his body, with its deepening voice, broadening shoulders, increasing hairiness. He read descriptions of “gender dysphoria” online, and felt that it “fit”. He’d consulted the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). He read that there was no other explanation for dysphoria other than transgender. He’d been feeling that way for about a month when he told me.
Not Your Parents’ Puberty
I quickly assessed the situation. My child had put a bunch of data into the machine of the internet, let it run, and out popped his answer — transgender!
Although his research sounded pretty official, I don’t just take someone’s word for it, especially when something seems like such a big, life-changing deal. I had never heard of this idea of “gender dysphoria” before, and had no idea what it meant or how you know if you have it, medically speaking. Also, although I thought I understood, until I took a close look, I didn’t realize there was no definition of “transgender” medically speaking, just that if you have “gender dysphoria” you are “transgender”.
Now, like many parents, I have some critical thinking skills, combined with years of experience with my particular child, and a number of decades of experience in my own body. Like every human before me, I had navigated the choppy waters of puberty and emerged, bruised and battered, but whole, on the other side. I remembered the sharp pain of adolescence and the body insecurities I had suffered as an early teen. So, I took all this parental wisdom and took that very same data my son had presented and plugged into my computer. I let it run and pop, out came my equally plausible answer — puberty!
Everyone feels weird about their body during puberty, I explained. That’s normal! Your body is changing in ways you read about but didn’t know how they would feel. Adolescence is an awkward period, full of change and uncertainty. Give yourself some time to get used to your newly emerging body before you throw some labels on yourself.
I thought I had it figured out. My child was clearly doing some quarantine-related self-exploration. He was in no distress, by his own admission, so this was no crisis. I knew that “trans” was part of today’s teen lexicon. But, being a caring parent, I of course wanted to address his concern and consult some experts to get to the bottom of all this.
At that point, since my kid neither looked nor quacked anything like what I had thought related to “transgender”, and I assumed that his case would be treated in an appropriately nuanced manner, reflective of his lack of distress, and clearly tenuous and not longstanding conviction in this identity.
The Affirmative Approach – One Size Fits All
Here’s where things took a strange turn. In our current world, there is just one standard of care: a one-size-fits-all approach, known as the affirmation model. Basically, says that “gender identity” — a representation of the gender you are inside, which cannot be seen or tested — is to be treated differently from any other sort of dysphoria. When the magic word “gender” is invoked, practitioners are to agree that you are the gender you identify as, which is how you feel inside. Then, accordingly, their role is to support your transition to life as the identified gender, up to and including, for boys, medical transition in the form of prescribing experimental, non-FDA approved, testosterone blockers and exogenous estrogen, and even castration, followed by cosmetic plastic surgery (euphemistically referred to as “gender affirming” surgery).
Now, you may hear that children go through months and months of exploration, poring over every angle to make sure that they are in distress, before determining that becoming the other gender is the “fix” that is needed. I’m here to tell you that is not true. The therapist we saw did not consider any other angles. She followed the affirmative model. Within 30 minutes, my kid was “affirmed” as a transgender girl, even though he presented with only a casual attachment to a new identity he read about on the internet and diagnosed in himself, and with no actual gender dysphoria (other than a vague “I don’t totally love my body”), no distress, and no cross-gendered behaviors. We went straight from there to talking about cross-sex hormones and castration with very little in between.
When I expressed surprise and concern to the therapist, I was told that I would probably just need to accept this and that it was bigoted to ask questions – my child knew best. This is something I had never encountered before when it came to health care for my child and it raised a bunch of red flags in my mind. Where was the test? The evidence? Since when was a parent evil or negligent for trying to make informed healthcare decisions or for asking questions and raising concerns? Didn’t you look at all possibilities before diagnosing? Why were moral, philosophical and ideological points being raised in deciding whether or not my child needed medical treatment? Why did my child know best in this situation alone, unlike literally every other aspect of his young life? Apparently, that’s how it works when it’s about transgender. But no one, including the therapist was able to articulate why this was the case.
Maybe you’re thinking that my case sounds like a random outlier: there are usually deep probing conversations over time, or some sort of medical test to diagnose something as serious as having the wrong body. There is no way that kids like my child, as I describe him, would be treated medically in the same way as those kids you read about in the news — the kids that need life-saving treatments in the form of medical transition to another gender.
Well, you would be wrong about that.
I’m not the only one in this boat, not by a long-shot. There are thousands of other caring parents, of all political persuasions, whose kids do not have “classic” or severe presentations of gender dysphoria. Some have no dysphoria at all, but still identify as trans. It’s mind-bending and impossible to explain or discuss. These youngsters came upon their new identities suddenly. They have little to no visible or even subtle signs of distress and often have no grasp of the long-term impacts of the lifestyle and physical changes that are recommended for them. Many lack the maturity to even evaluate the long-term impacts — a reality any parent of a rebellious teen who begs and pleads for a tattoo that they say they will love forever will understand. I think we’ve all seen those regrettable tattoos that result when the parents give in. And transgender treatment is way more than skin-deep.
Many parents, like me, are seeing their kids treat this identity like a fad, to be turned on and off at will. Although this seems very different from the very real and serious condition that we’ve heard others suffer from, clinically, all gender dysphoria (or just self-ID as trans) is treated the same, by the majority of practitioners.
Why does Over-Diagnosis Matter?
So, who cares if my son gets diagnosed as gender dysphoric, and thereby transgender? It’s a reliable predictor, right, even if his is not a classical presentation of the condition? He is how he identifies, and people just know who they are, right?
The answer, it seems, is no.
Take a look at Reddit’s r/detrans site. You’ll notice there are over 19,000 accounts, with users of all ages who feel that they were misdiagnosed and mistreated — that their symptoms were analyzed incorrectly and/or that the treatment they were prescribed by affirming practitioners did not resolve their dysphoria. Many, feeling greatly misled and betrayed by their practitioners that were there to help them, and feel that they did not really understand the risks of the treatment they were given. Many have chosen to revert to their biological gender, or are seriously contemplating it.
I have now heard personally from some of these people, so I can attest that at least some of them are real people, not activists. These people, which include biological males and females, transitioned because they were experiencing dysphoria, or what they interpreted as dysphoria at the time, and were led to believe that made them transgender. They were convinced that social and/or medical transition was the right and only path for them — that they had no other option to live a fulfilling life. Their experience seems just as authentic as those who believe transition was their long-term fix.
Just misdiagnosing gender dysphoria/transgender is problematic from a medical and ethical perspective; but the more concerning issue is that these people are really suffering, mentally and physically, from their misdiagnosis. Sometimes this suffering is worse than the “distress” their gender reassignment or re-identification originally sought to address. The cure for these people has literally proven worse than the condition.
Some of these people took hormones and now have unwanted breast tissue, which leads to feelings of deep regret and depression. Some feel suicidal. Some will no longer ever be able to father children, or feel sexual pleasure due to the changes made to their bodies. Some are cast out of their communities and told they were never “really” trans to begin with. Many are now told that they were misdiagnosed — even those that went through all the proper, state-of-the-art, diagnostic procedures. The girls who go through this have their own problems, like low voices they no longer want, facial hair, and hair loss.
They are surprised and dismayed to find that there is no support for people like them, for life-saving, gender-affirming medical treatment to return them to their birth gender, physically. They do not understand why self-reporting was appropriate to diagnose them, but is deemed insufficient or unimportant when they self-report that they are no longer transgender — or maybe never were to begin with.
As a parent, all this raises serious concerns for me about my course of action. If I were a practitioner, this would also give me pause about the current diagnostics and standards of care. After all, this all started because we (parents, therapists, doctors) were trying to help people.
Is it right to over-diagnose, to cast too wide a net? Is it ok to harm certain people to save the lives of others with the real condition? We need to really think about this.
There is also another problem. By casting the net too wide when we diagnose gender dysphoria, we may actually be risking our ability to medically assist those we were originally trying to help: the ones with the real condition.
Let’s say that later, after treatment, my son changes his mind about all this. Say he’s one of these detransitioners, as, under the circumstances, I would guess he might be. In other words, what if he is a false positive for transgender?
In this case, my grown-up son is bitter and resentful. He feels misled by his parents and the practitioners who allowed him to walk down this path that was not right for him in the long run. He’s incurred bodily harm at the hands of those who treated him. Rightly, he may pursue legal recourse that will result in legal liability, as well as potential medical malpractice charges for those treating transgender people.
Exactly this happened recently in the UK with Keira Bell, a young woman who had been diagnosed with and medically treated for gender dysphoria as a teenager. As she got older, she stopped feeling male, although she had already medically transitioned via hormones. She felt that the affirming approach had pushed her to transition medically. She believed that if she had been questioned, and told that there were ways to feel comfortable in her own body, then she would not have taken the direction she did. She felt misled by authority figures across the board who didn’t really know what they were doing, especially with people like her that really didn’t fit the traditional mold.
Keira joined a legal action challenging the legality of the treatment at her gender clinic, and won. As a result, medical treatment for gender dysphoria is still technically possible for people in the UK who are under 18, but will hardly ever happen in practice. In the US, this is not the case at this time, but with this widely cast diagnostic net, we are sure to wind up in the same place sooner or later. And, when that happens, by lumping all presentations of gender dysphoria together, we may well end up removing medical transition as an option for those for whom it is the last and only option.
So…What Next?
Of course, if my son really is transgender and needs to transition to live his life without distress, I would want him to be able to access all the life-saving treatments he would need. I want him to have all the legal and social protections he would need to live in this world without abuse or discrimination.
Or, maybe it’s just puberty, as my parental instinct believes.
Honestly, it could go either way for my kid. And I no longer believe there is any real way for therapists or medical practitioners to know which “diagnosis” is right for my child.
So, what do we do?
I think we need a better test before diagnosing someone as transgender, and before suggesting transition as the only, best or preferred solution. It seems that not all body discomfort should be diagnosable, clinically speaking, as gender dysphoria, if we are saying that gender dysphoria is the sole criterion for being transgender. If it were 100% predictive, we would not be seeing the growing number of detransitioners who are telling us that we — and they — got it wrong. We would not be facing the legal and moral repercussions of our widely cast net.
So, therapists, practitioners, parents, legislators — are you sure you know how to tell transgender and puberty apart? If so, please explain it to the rest of us! If you have some doubts, isn’t it time we found a better measurement for “distress”? Maybe the label “transgender” is being too broadly applied, especially when there appears to be a host of symptoms and types of presentation.
Maybe it’s time to roll back our blanket definitions, to evaluate if we are recommending and applying the right solution, and to study the long-term impacts of the affirmative approach. Until we have a better test, we will continue to cast too wide a net, to the detriment of all.
