Approaches to Helping Trans Kids

Perhaps you have read the recent article about trans kids in the New York Times (alternative link here) and were confused or perhaps you are just baffled by what is going on with trans kids in the press. You have every right to be confused, it is a perplexing situation. In any case, I will try to clarify the situation. I have interacted with most of the major players and know some things that they are not telling. (The hyperlinks are to my previous articles on TGForum which provide more detail. )

At a time when being transgender is under attack through state legislation and policies and we can least afford it, there are currently four conflicting schools of thought as to how to help trans kids. The rifts between these schools of thought are now in the political domain and are being used by those both on the right and the left to score political points to gain/keep power. For shame that both sides are using and abusing little children to achieve their aims! If they succeed, they may later erase rights and freedoms for all transgender people.

The four approaches are:

• Affirmative Approach
• Gender Change Approach
• Watchful Waiting Approach
• Psychotherapy Approach

The affirmative approach for trans kids comes out of the affirmative approach for adults but with a twist. The affirmative approach for adults emerged from the 20^th Century. It features the safe exploration of personal congruent gender. Exploration progresses with increasing time periods of safe social interaction in a person’s congruent gender. If all goes well, then a social transition to full-time might occur to see if the person can live and work in their congruent gender. The person might then entertain the least reversible treatments such as medical hormone and surgeries. This is the approach that most of us have followed and is accepted by all professional provider organizations.

Peggy Cohen-Kettenis

The twist in the affirmative approach for trans kids is that they are eligible to obtain puberty blocking drugs after puberty starts and after social transition. These drugs block the release of chemicals from the brain that trigger and maintain puberty. Technically, they are hormones but do not the same effect as “regular” sex hormones that cause secondary sexual characteristics such as breast growth and voice change. The purpose of these blocking drugs is to give the child enough time to safely explore their congruent gender. At age 16, blocking drugs are stopped and the child has to decide whether to undergo normal puberty or undergo transsexual transition starting with “regular” sex hormone therapy. Clinics in the Netherlands pioneered this approach for trans kids, notably a clinical psychologist, Peggy Cohen-Kettenis. Pioneers in the US have been Diane Ehrensaft at the UCSF and Scott Leibowitz at the Nationwide Children’s Hospital and Olson-Kennedy at UCLA. The approach has now spread to over 60 clinics in the US and to independent providers. In addition to the DSM criteria, admission to affirmative treatment requires that the child be insistent, persistent, and consistent about their congruent gender for many months. Thus, the criteria are tighter than used in the DSM and the gender change approach to be sure that the children are actually transgender and not prehomosexual, as described in the next section.

Once trans kid treatment was established, there was a huge growth in those seeking help through the affirmative approach. There was/is a backlog of trans children who never had access to any care and were pretty much ignored or used as foils for those providers attempting to “cure” people of being homosexual as described in the next section.

Ray Blanchard

The gender change approach assumes that the congruent gender of the child can be changed by various conditioning means using reward and punishment. While the more physically injurious procedures are mostly in the past, some procedures are still practiced. None of these procedures work and, at the least, can cause psychological harm. Many U.S. states and countries have banned such practices. While most of these procedures are administered by religious and independent providers, they find support at the academic level. In particular, academic support can be found at the University of Toronto and the Center for Addiction Mental Health (CAMH) in Toronto. The players here are Kurt Freund, Ray Blanchard, Ken Zucker, Susan Bradley, James Cantor, Debra Soh (now freelancing with Playboy, Joe Rogan etc.) and Michael Bailey (at Northwestern). Zucker’s clinic at CAMH was closed because of the gender change approach that was followed. This group has been combative towards transgender people who disagree with

Debra Soh

their positions and Bailey was reprimanded for conducting research outside of academic safeguards. Their approach has been to consider homosexuality and being transgender as fetish behaviors which can be changed by counter conditioning. Indeed, sexual arousal can be learned and unlearned but not gender or sexual orientation. This bunch has been interested in “cures” for homosexuality and when treatment for homosexuality was banned, they used treatment of transgender kids to continue their interests. Prehomosexual kids and transgender kids present quite differently. But there is enough similarity of behaviors (prehomosexual kids occasionally crossdress) that they could pull it off. Plus, they took control of the diagnostic criteria by being on the DSM committees. So, this approach should really be termed the gender change/sexual orientation change approach. Of late, this group has been trying to associate various negative conditions, some pathological, in order to smear transgender people. These include autism. There is a weak correlation between autism and being transgender only with regard to clinic admission but there is no reason to believe that they are related biologically. Correlation does not mean causation.

The watchful waiting approach was a fallback from the gender/sexual orientation approach when it became unpopular. This approach assumes that trans kids will “desist” as they age and stop their transgender behavior but might end up as homosexuals. This approach relied on the statistics from several longitudinal studies in which the investigators tried to track trans kids into adulthood to see if they were still trans. These studies were fraught with methodological problems. In many cases, the investigators could only find half of the trans kids 10 years later, either because they did not want to be found, lost or had no interest. Evidence from the Zucker CAMH clinic is often cited to show that trans kids stop their transgender behavior in adulthood but instead become homosexual. However, further analysis of the records of Zucker’s clinic after it was closed indicate that only a few kids were actually transgender. The great majority were prehomosexual.

The psychotherapy approach is predicated on the idea that early trauma influences unobservable psychological processes to alter behavior to become transgender. Essentially, they maintain that our brains are defective or diseased. The solution according to the proponents is expensive long-term psychotherapy to recall these traumatic events and deal with them to obtain a cure. This is classic psychotherapy ala Freud. There is no objective evidence for either of these ideas, yet they are used as justification for long-term treatment. Yes, provider schools are still turning out believers in Freudian ideology. The ideology is pretty seductive in that it postulates sexualized unconscious forces are at work to cause our behavior. Modern day proponents of this approach include those on the extreme right including Ryan T. Anderson, Abigail Shrier, Helen Joyce, and Kara Dansky (a wrap-around TERF). None of these people are qualified to treat transgender children, but they are right wing yellow journalists and pundits.

Then there is Rapid Onset Gender Dysphoria (ROGD), an idea put forward by Brown psychologist Lisa Littman to justify psychotherapy for transgender kids. She conducted a survey of disgruntled parents of trans kids who blamed contagion from social media for bringing out transgender desires in their daughters. In actual fact, there is no proof that the people taking the online survey were actually parents of trans kids. Even if they were real parents, there were several methodological problems with the study. Embedded in this survey were questions meant to provide evidence for early trauma as the cause of being transgender. This, of course, would require extensive psychotherapy as a “cure”. However, there is no objective evidence for ROGD and professional provider organizations all reject the idea.

What triggered the NYT article was that recently Erica Anderson and Laura Edwards-Leeper have gotten off the affirmative approach and onto the psychotherapy bandwagon requiring extensive “assessments” before trans kids can progress in their journeys. As a member of the USPATH Board, I came to know Erica. At no time did she bring up this subject, I guess it was not important enough to address. There is controversy, mentioned in the article, whether such long assessments should be included in the new WPATH standards of care (SOC8). In typical wokie style, the USPATH Board (subsidiary of WPATH) sanctioned Anderson for public comments to Shrier. Anderson subsequently resigned from both the board and her association with UCSF. Also, in wokie style, Colt St. Amand, a clinical psychologist organized a “collective” to apply “lived experience” to oppose the extension of assessments. It figures; postmodernist Neomarxist wokies believe that cultural mechanisms are used to repress memories of how minorities are exploited by the patriarchy (or kyriarchy). It is thus up to the wokies to raise consciousness. This idea was derived from Freudian ideology of repressed sexual and traumatic memories which has no objective basis either. Erica and Colt can have fun arguing about it in La-la-land at the expense of trans kids.

I hope this helps to understand the NYT article as well as the field of trans kids health. One final note. The title of the NYT article was “The Battle Over Gender Therapy” which is totally irresponsible. (Headline writers are known to be deliberately provocative.) Mental health providers can offer counseling services but these do not include therapeutic “cures” because they do not exist. Transgender is forever.

Tags: featured, trans kids, Transgender

Category: Transgender Body & Soul