I am incredibly moved by the number of people I see voicing their support for transgender teens on social media, but I can't help but think there's more we can be doing. What is the number one thing we as a community can do to help make things better for the young trans community?
I've found that the number one thing we can do is accept those who are transgender. This doesn't necessarily mean that we understand what it means to be trans, which many of us don't because we're not and it's outside of our experience. But love and acceptance are such important values. I think we also want to do everything we can to make sure our trans kids are safe--in schools, on the street, and at home. Be what's called an "upstander" -- not a bystander. Speak up when you see someone being bullied, harassed etc. Great question.
Dr. Forcier, what is your explanation as to why kids on the autism spectrum are seven times more likely to have gender identity issues (and those at gender clinics 6-15 times more likely to have autism)? Do you believe that an autism diagnosis should be considered before a therapist tries to convince parents to support their child's transition?
Thanks for your question. We don't know for sure
What we do know there seems to an association ...
We do know that with other neurologic conditions- there are menstrual and other reproductive health associations (epilepsy for instance).
We do also know there is an association for gender and autism as well. For autism spectrum youth- maybe it is that not being as clued into or bound by social messages and constructs allows them a more fluid approach to gender and a greater willingness to express that more openly.
For autism spectrum we know there are some differences in brain and neuro function... for persons whose assigned gender and anatomy/phsyiology is different than their identified gender (brain heart soul personhood gender) ... this might be another way or manifestation of different ways brains are built or function in different ways.
Of course a therapist should incorporate ALL aspects of a youths life and experience into their evaluation of them- whether for gender or other issues. A holistic approach is the best policy when we help kids explore their gender.
Michelle Forcier like other gender clinicians, claim that transition dramatically improves the mental health of gender dysphoric teens. If this improvement does not take place, is it right to reconsider either the diagnosis or the treatment? In the case of my child, who experienced sudden onset gender dysphoria aged 20 after a series of traumatic events, without any signs or expressions of gender dysphoria earlier in his life, transition followed by hormone therapy has been followed by a descent into social isolation, altered sleep patterns, anger problems and other symptoms of depression. We live in a socially liberal trans affirmative cultural setting and he attends a trans support group. I suspect other mental health problems and his family and general practitioner suspect that the problem is not gender. But gender clinicians refuse to consider any other diagnosis. In these circumstances, surely, a rush to accept the patient's self-diagnosis is dangerous. Your thoughts?
This is a great question- and yes, many gender patients have other mental health co morbidities...
Even if improvement takes place- we always want a comprehensive approach to mental health, social well being and safety issues.
Not sure that depression, anger, sleep issues after trauma negates an exploration of gender.... but a good primary care doc and mental health provider will take all these aspects of care in context to help the patient be fully evaluated and the whole patient care for....
How is it ethical to put children on a journey of lifetime hormone medication plus to endure the health risks of surgery when if those children are left to work their own life out, 80% will come to accept their biological sex?
What would you do if your child suddenly, out of the blue, announced they were transgender, wanted to change name, pronoun, buy a breast binder? What would you do if you suspected your child might have been influenced by the media? What would you do if you suspected your child had other mental health issues to deal with? Walk in my shoes for one moment. What would you really do if it was your child? What would you do if your gut feeling was that your child was making the biggest mistake of their life? What would you do if everyone around you was telling you to celebrate your child on their brave journey? Please, what would you do?
Honestly, your question reminds me of those from parents in earlier generations who learned their kids were gay or lesbian. So, here's what I'd do: I would try to read materials from the most credible experts, speak with other parents of similar kids (which you can find at PFLAG), and, of course, talk with my child. In other words, I would try to keep an open mind and learn as much as I can. Many parents of gay kids caused great harm to their young ones by not accepting them and but not helping them to accept themselves. I hope we've learned since then. And if I were concerned that my child other mental health issues, I'd seek top notch treatment for that, too.
I'd also note that changing a name or pronouns, even wearing a breast binder, can easily be changed or reversed.
Parents of transgender teens are often told about the high rates of attempted suicide among the transgender population. However, the studies from which these statistics are drawn do not indicate whether attempts occurred before or after transition. Given that several good quality studies indicate that suicidality continues to be high after transition (the Swedish study by Djhene et al. from 2011), what clinical evidence do we have that transition reduces suicidality?
de Vries AL, McGuire JK, Steensma TD, et al. Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment. Pediatrics 2014.
Spack NP, Edwards-Leeper L, Feldman HA, et al. Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics 2012; 129:418.
How do we encourage kids and adults that being a feminine boy or masculine girl is ok, when trans communities use these stereotypes to determine if a kid is trans? Most homosexual adults didn't conform to their gender as kids, will this mean the number of homosexuals is going to decrease because of transitioning? Could this be seen as homophobic?
We encourage kids to be AUTHENTIC!
And we work on society to be less genderized.
Why is it such a big issue how masculinized or feminized children's activities are? These are huge assumptions and social biases.
So as we work with young kids - we counsel that gender play and experimentation pre pubertally is very different than gender nonconformity or asserting a transgender identity around or after the time of puberty. We also counsel that youth gender be evaluated differently based on age, development and other characteristics. We put this in social, family, ethnic and religious contexts as well.
Hi Steven, I'm submitting this question on behalf of my best friend who is a middle school teacher with 25 years experience. This April she will be accompanying a dozen students on a trip to DC and there will be four kids to a room. The students will be sharing beds. Among those students there is a trans young boy (female to male) and the teachers and staff are trying to figure out what is best for this boy. His girlfriends that are coming along on the trip are friends of his and are supportive of his transition. Her first inclination is to room this young man with the girls. She knows for sure that she can't place him in a room with other boys because there are concerns about sexual assault. Does this make any sense? At the middle school age would it just be best to allow him to room with his girlfriends that he is most familiar with? She is going to ask the boy his opinion, but at the end of the day, faculty will most likely be worried about parental concerns.
I would have open conversations with the parents and potential rooming parents involved... If this kid has friends who know and love him and who feel safe and want him to feel safe and all the kids and parents are ok to room together- great!
if not, or if the patient wanted a single room for privacy- that is ok too.
How terrible that we are worried about sexual assault just because there are cia boys in a room...
Wow- we need to teach all our kids about respecting privacy, consent, what no means and a whole host of ways to respect each person's personal space and bodily integrity.
I am a queer woman in my early 30s living in a small town that's quite accepting and tolerant overall, if not super progressive. With a wonderful new female partner and my concerns about the precarious state of LGBTQ+ rights in the US, I've decided to be more open and unapologetic about who I am. People have been great, if sometimes surprised: I'm often perceived as straight due to my appearance and most recent old relationship. Coming out has been really positive and rewarding, and I feel especially lucky to be an out and accepted public school teacher. While I'm certainly understanding of different mindsets in my professional life, in my private life I want to go medical professionals who are fully supportive of me and my sexual orientation. I've been going to a dental practice for eight years, and they've been great. I've had my hygienist for a few years but only recently has it come to my attention how conservative she is. We had a bit of an awkward moment last month when she mentioned her feelings about teens and sex ed, which I shut down by saying "I do not want to discuss politics." I also learned that she's a big fan of an anti-LGBTQ+ evangelical so now I'm wondering if she shares a similar mindset. While she's an excellent professional, having your teeth cleaned is such an intimate experience and I don't want to feel uncomfortable or unwelcome in the chair once she knows who I really am. However, I also know I shouldn't assume intolerance on her part either and probably should give her a chance. Should I come out to her the next time I'm having my teeth cleaned? And if she's negative, speak to the dentist about seeing someone different? Stop going to the practice? I know the new owners are Mormon but I'm under the impression that they care more about doing good work and having good customer relationships than expressing their own personal views. If they are fully negative, then it's an obvious answer. But what if they are trying but still not quite getting it a la "hate the sin but love the sinner"? Thank you.
Good for you!
This is a tough question and one that I've faced personally. To be a bit humorous, if you do decide to say something be sure to say it after she's finished working in your mouth.
But I'm a big proponent of people talking with each other and I'd suggest you speak with the head of the practice and get an understanding of his/her/their values. Tell them what you just wrote me and ask: Will I be comfortable and welcome in this practice?
You also could come out in a contextual way to the hygienist, mentioning that you and your new partner --let's her call her Linda-- just got back from vacation. See how she responds; sometimes we carry our own baggage. Sometimes, it comes from someone else.
Here's some more info that I think you'll find helpful.
My female child turned 18 and only months after learning the concept transgender, was put on testosterone at an informed consent clinic in the LA area after only 2 visits to the clinic. We have a wealth of mental health issues in our families, including bipolar that is very genetic and shows up in older teens/young adults. My child is 19, technically an adult, now on T, but I very much see signs of bipolar. Do you think gender clinics should add controls back in to take longer time with young patients? brain science says the brain is still adolescent until at least age 25, not in any way an adult brain at age 18. My child never went thru any diagnostic testing for mental health issues or autism spectrum that could be clouding her/his judgement. I think only 2 visits to a clinic is way too fast to start any medical transition. Do you have some advice for what I might tell my child about getting this testing done now before getting too far with the HRT? treatment for bipolar could change how s/he thinks, and counsel for ASD would be needed first since ASD can also cloud judgement about social issues. And how can these gender clinics be made aware of the need for gatekeeping for young adults age 18-25 since they can definitely be impulsive and may be dealing with young adult mental health issues that need treatment first.
This is more question that we can really address here- but suffice it to say, good providers will also be following for other mental health issues. Bipolar and gender are two very different things. And for many youth, with or without gender questions, medical providers constantly factor in mental and social health concerns.
Again, so interesting re some of the very biased terminology.... gatekeeping, as reparative therapy has led to significant harm in the trans community. And recommending "gatekeeping" for consent age adults has an interesting paternalistic, controlling twist.
Docs who provide adolescent and young adult care are clear on the literature about the 18-25 years continued brain development. But just as we might listen to a 9 year tell us they have a sore throat, take a history, consider taking a throat swab. Or we might listen to a depressed 16 year old tell us they are sexually active and need chlamydia testing... we need to listen and incoporate a holistic approach to these youths' care.
What does "gender critical" mean?
Those of you who are in the audience who use that term why don't you define it for us?
What is your opinion of this statement? It sounds like the same argument people make to challenge climate change. At the same time, when has science been settled on any issue? And, more importantly, how relevant is what "science says" about gender identity compared to what people feel?
As a biologist and a scientist and a physician -- science and knowledge are always changing! This is good news.
As we have good news on various aspects of care that really do help patients and for which there are low risks for problems or regret.
Identity is complex- and with complex physical, psychosocial and cultural issues- we need to have rich conversations that are real, realistic and respectful of a variety of persons and experiences.
Trans teens in this country now receive drastic surgeries, e.g. mastectomy, as young as age 14. How can such young kids truly give informed consent for such radical measures? There's a good reason we don't trust young teens with huge decisions -- they are immature, by definition. Their brains have not fully developed.
This "drastic surgery" -- again such biased language!- has really changed many trans boys and mens lives- and has low risks and outcomes for complications and regret.
Teens assent to surgery WITH parent consent... we are lucky that many parents understand waiting for arbitrary legal age of 18 for chest surgery for some young teens is cruel and harmful from a physical and psychiatric perspective. There is no one size fits all... no one time or age fits all... there is listening to patients and the data which suggests this surgery is safe, low risk and with low outcomes for regret.
The DSM defines gender identity disorder in children to include the following conditions: A strong preference for wearing clothes typical of the opposite gender A strong preference for cross-gender roles in make-believe play or fantasy play A strong preference for the toys, games or activities stereotypically used or engaged in by the other gender A strong preference for playmates of the other gender A strong rejection of toys, games and activities typical of one’s assigned gender As a gay man, I have to ask, why should any medical diagnosis be based on these sexist and hetero-normative stereotypes of the way children should behave? And do you not think there are many gay men leading happy lives today who might have been transitioned as children if these had been applied to them?
There is no DSM diagnosis of gender identity disorder .... there is an updated DSM 5 gender dysphoria category however....
We actually try to avoid stigmatizing terminology or medicalizing developmental processes that we know are characteristized by very individual experiences, very personal explorations, and more than anything else- need atmospheres of love, acceptance, openness and support in order to help all persons figure out their authentic identity...
Kids are not "forced" into transition. Kids and parents learn more and may elect to move forward with transition.... and kids can move on that gender spectrum and stop transitioning or change plans as to how we might help them with their gender exploration.
Given the growing number of people, especially young women, who have detransitioned in recent years, don't you think it does young women a grave disservice if we don't help them explore why they might want to transition--especially those young women who never expressed gender dysphoria as a child? Many of the detransitioners have talked about the role that trauma played in their decision to transition. And even though my child experienced a traumatic event shortly before her announcement that she believed she was trans, the therapist was convinced not only that she was trans but that she might need to start testosterone even at the age of 14.
I am unaware of your data- please provide. If you are a gender provider and doing research - please send - it would be important to look at this and incorporate into care.
But for clarity's sake- there is no large number of "detransitioning" kids... It is so important to stick to what is actually going on for the majority of gender care youth- not create "alternative facts" that support our opinions.
Gender providers do not just give everyone medications- but do explore many what's and why's behind transitioning. This is time for a rich and honest conversation with patients... we in gender care appreciate that depth and discussion in order to provide patient centered care.
What do you think about the amount of teenagers who would once have just been effeminate gay men or butch lesbian women, now transitioning? Isn't transgenderism promoting heteronormativity?
We work with both gender and sexual minority patients... we know that gender and sex are related but definitely different. We are not promoting anything... we are supporting persons' right to bodily autonomy and their right to live as a safe, accepted part of our civil society.
Gender and sex are different and we can address both needs competently with carefully discussions and care plans.
How safe are puberty blockers such as Lupron for teens and preteens. They are often presented as harmless reversible drugs which buy time for a young person. But they have a list of very well known side effects in adults including liver damage, osteoporosis and depression including suicidal thoughts. Given that trans teens have frequently been shown to have a higher rate of attempted suicide is it possible this could be linked? What assessment of mental health is done before prescribing and are we storing future health problems for our kids in the name of "buying time". Delaying puberty also delays maturation of the brain so could children taking puberty blockers then cross sex hormones actually stay in a state of arrested development rather than maturing and perhapd recognising they are a gay man or lesbian woman, not that they are "trapped in the wrong body"?
The risk of not giving puberty blockers and the harm for continued development in the "wrong" gender far outweighs the minimal risks of totally reversible blockers.
Again, please do not present "alternative facts" as data. There is no significant literature re : liver damage, osteoporosis, or severe depression in hundreds of youth on blockers.
I assume this has been going on since the invention of public toilets, but why are public bathrooms designated by gender? The bathroom law people say "do you want your little girl to go to the bathroom with grown men?" But is this any worse than little boys sharing a bathroom with grown men? Why don't they designate bathrooms like they do supermarket checkouts - regular vs. express?
Love this. Thanks.
And let's not forget that straight men are more likely to be pedophiles than any other group -- by far.
I am trying to contribute and engage, but my comments are not showing up.
Yes, we're live... I'm very sorry you're having problems.
When Michelle says "What is the harm of seeing how a child who is "different" explore their gender?" I should think this potential harm should be obvious. By transitioning kids you are putting them down a path to taking powerful drugs and other medical treatment which can impact their fertility and life long identity. Truly exploring gender would be to say that children can be gender nonconforming without thinking they are in the "wrong bodies", and affirming them in that. I question whether encouraging a transgender identity is truly exploring gender rather than encouraging a rigid hetero-normative conception of gender, which harms gays, lesbians and autistic kids.
Exploring gender does not mean "putting them down a path to taking powerful drugs..."
Some kids need medications, others do not-- but all kids need adults to listen carefully, provide respectful attention to options for care, and provide support for a safe, healthy and hopefully well adjusted adolescence as we can help our kids achieve.
Gender critical means not automatically accepting your child's self-diagnosis and realizing there are many other issues that are at the root of this claim: being gay, social contagion, being on the autism spectrum, having trauma, etc. We do not believe in medically treating a child based upon self-diagnosis.
Gender critical to me describes a 'position' about use of language: i.e. 'sex' refers to biology and 'gender' refers to 'social constructs/norms of behaviour'. As a philosopher, I find the current debates about 'personal identity' to be simplistic, if not facile. As a feminist I have always considered that 'gender' is the obstacle to 'equality' - so in terms of the 'trans debate' I have grave reservations about the whole way the debate is framed! Hope that helps! P.S. I'm English - hence the spelling!
Makes me think of a satirical line from the "All In The Family" opening theme song, "Girls were girls, and men were men."
What is the most polite way to say you prefer to be referred to as gay instead of LGBT?
LGBT or LGBTQ is an umbrella or catch all phrase. Individuals are generally not "LGBT." If this comes up, I'd say: "Actually, I'm gay." Or lesbian. Or bisexual. Or transgender. No big deal.