Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents

The 2018 Australian SOC for Trans and Gender Diverse Children and Adults... a very strongly affirming document based on the latest research making clear that affirmative treatment approaches - in which the youth's identity is respected and supported, where the youth are provided the freedom and safety to explore their gender without judgment - yield much happier and better adjusted youth and young adults. It also makes clear that disaffirming approaches are unethical and may cause harm.

Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents 

Authors: M.M. Telfer, M.A. Tollit, C.C. Pace, & K.C. Pang.   2018.  

“Being trans or gender diverse is now largely viewed as part of the natural spectrum of human diversity. It is, however, frequently accompanied by significant gender dysphoria (GD), which is characterised by the distress that arises from incongruence between a person’s gender identity and their sex assigned at birth. It is well recognised that trans and gender diverse individuals are at increased risk of harm because of discrimination, social exclusion, bullying, physical assault and even homicide. Serious psychiatric morbidity is seen in children and adolescents. A study of the mental health of trans young people living in Australia found very high rates of ever being diagnosed with depression (74.6%), anxiety (72.2%), post-traumatic stress disorder (25.1%), a personality disorder (20.1%), psychosis (16.2%) or an eating disorder (22.7%). Furthermore 79.7% reported ever self-harming and 48.1% ever attempting suicide.”

“Increasing evidence demonstrates that with supportive, gender affirming care during childhood and adolescence, harms can be ameliorated and mental health and wellbeing outcomes can be significantly improved.”

“Understanding and using a person’s preferred name and pronouns is vital to the provision of affirming and respectful care of trans children and adolescents.  Providing an environment that demonstrates inclusiveness and respect for diversity is essential... Some children or adolescents may request use of a preferred name or pronoun only in certain circumstances, such as when their parents are, or are not, present in the room. This is important to respect and enact to enable optimal patient-clinician engagement, and ensure confidentiality and patient safety.”

“Avoiding harm is an important ethical consideration for health professionals when considering different options for medical and surgical intervention. Withholding of gender affirming treatment is not considered a neutral option, and may exacerbate distress in a number of ways including increasing depression, anxiety and suicidality, social withdrawal, as well as possibly increasing chances of young people illegally accessing medications.” 

“In the past, psychological practices attempting to change a person’s gender identity to be more aligned with their sex assigned at birth were used.  Such practices, typically known as conversion or reparative therapies, lack efficacy, are considered unethical and may cause lasting damage to a child or adolescent’s social and emotional health and wellbeing.”

https://www.rch.org.au/uploadedFiles/Main/Content/adolescent-medicine/australian-standards-of-care-and-treatment-guidelines-for-trans-and-gender-diverse-children-and-adolescents.pdf

Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada

We know from other studies that approximately 40% of trans and gender nonbinary identified people attempt suicide at some point in the lifespan, a number shockingly high. While the study below is not specifically about youth, the same factors apply.

Published in: BMC Public Health. 2015. Authors: Greta R. Bauer, Ayden I. Scheim, Jake Pyne, Robb Travers, Rebecca Hammond.

“Large effect sizes were observed… suggesting that interventions to increase social inclusion and access to medical transition, and to reduce transphobia, have the potential to contribute to substantial reductions in the extremely high prevalences of suicide ideation and attempts within trans populations. Such interventions at the population level may require policy change.”

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2

Young Trans Children Know Who They Are

Young Trans Children Know Who They Are: A new study shows that gender-nonconforming kids who go on to transition already have a strong sense of their true identity—one that differs from their assigned gender.

Published in: The Atlantic. January 15, 2019. Author: Ed Yong

“This study provides further credence to guidance that practitioners and other professionals should affirm—rather than question—a child’s assertion of their gender, particularly for those who more strongly identify with their gender,” says Russell Toomey from the University of Arizona, who studies LGBTQ youth and is himself transgender…”

““When the 85 gender-nonconforming children first enrolled in Olson’s study, her team administered a series of five tests that asked what toys and clothes they preferred; whether they preferred hanging out with girls or boys; how similar they felt to girls or boys; and which genders they felt they currently were or would be. Together, these markers of identity gave the team a way to quantify each kid’s sense of gender.”

“The team, including James Rae, now at the University of Massachusetts Amherst, found that children who showed stronger gender nonconformity at this point were more likely to socially transition. So, for example, assigned boys who had the most extreme feminine identities were most likely to be living as girls two years later. This link couldn’t be explained by other factors, such as how liberal the children’s parents were. Instead, the children’s gender identity predicted their social transitions. “I think this wouldn’t surprise parents of trans kids, and my findings are often ‘duh’ findings for them,” says Olson. “It seems pretty intuitive.””

“…“The findings of this compelling study provide further evidence that decisions to socially transition are driven by a child’s understanding of their own gender,” says Toomey. “This is critically important information given that recent public debates and flawed empirical studies erroneously implicate ‘pushy’ parents, peers, or other sources, like social media, in the rising prevalence of children and adolescents who identify as transgender.””

https://www.theatlantic.com/science/archive/2019/01/young-trans-children-know-who-they-are/580366/

Coming Out as Trans Isn’t a Teenage Fad

Coming Out as Trans Isn’t a Teenage Fad: Conservatives are inventing a “syndrome” to undermine young people’s transitions.

Published in: The New York Times. January 8, 2019. Author: Jenny Boylan.

“At the end of the long weekend when my daughter came out as transgender, she headed back to her car with her girlfriend. I watched them from my apartment window as they packed up. My child looked up, and waved.”

“Then she drove off.”

“I closed the window. Tears rushed to my eyes. She’s saying goodbye, I thought. I’ll never see her again.”

“This, of course, turned out to be malarkey.”

“In the months to come I’d see her lots of times, and each time she seemed happier, and more herself.”

“… The term [Rapid Onset Gender Dysphoria] originated a few years ago on three blogs with a history of promoting anti-trans propaganda. There has been only one study on it, in the journal PLOS One. But the study isn’t about the children in question; it’s about their parents, who were recruited for the study by ads placed in the conservative blogs that had invented the concept of R.O.G.D. in the first place.”

“A child’s transition can indeed seem heartbreaking for parents at first. I understand that because I am a parent who, in experiencing it, felt as if my heart was breaking. And we, trans people, need to understand that too. It was heartbreaking for my own mother, even though she told me love would prevail, and it was heartbreaking for me, in spite of — or because of — the fact that I am trans myself.”

“What was my problem, you ask? Above all, I did not want my child’s life to be hard, in the way that my own life has been hard.”

“But if you want your children’s life to be hard, the quickest way to that end is to tell them that their deepest sense of self is nothing but a fad, and that you know them better than they know themselves.”

https://www.nytimes.com/2019/01/08/opinion/trans-teen-transition.html

A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children

Published in: International Journal of Transgenderism.  2018.  Authors: Julia Temple Newhook, Jake Pyne, Kelley Winters, Stephen Feder, Cindy Holmes, Jemma Tosh, Mari-Lynne Sinnott, Ally Jamieson & Sarah Pickett

“In the media, among the lay public, and in medical and scientific journals, it has been widely suggested that over 80% of transgender children will come to identify as cisgender once they reach adolescence or early adulthood. This statement largely draws on estimates from four follow-up studies conducted with samples of gender-nonconforming children in one of two clinics in Canada or the Netherlands… This article outlines methodological, theoretical, ethical, and interpretive concerns regarding these studies. We clarify the cultural, historical, and clinical contexts within which these studies were conducted to understand and to deconstruct the embedded foundational assumptions of the research as well as the widespread interpretations of the results.”

“While this commentary offers critiques of desistance research and its clinical and popular interpretations, these studies have also made contributions to the literature worthy of recognition:

“1. qualitative data on trans and gender diverse adolescents in clinical care, and

“2. factors in anticipating medical transition for gender-nonconforming children accessing clinical care…”

“We have identified the following methodological concerns in these four studies:

“1.the potential misclassification of child research participants

“2. the lack of acknowledgement of social context for research participants

“3.the age of participants at follow-up, and

“4.the potential misclassification of adolescent andyoung adult participants lost to follow-up…”

“We have identified the following theoretical concerns in the four studies:

“1.assumptions inherent in “desistance” terminology

“2.binary gender framework, and

“3. presumption of gender stability as a positive outcome…”

“We have also identified ethical concerns in these four studies:

“1. intensive treatment and testing of child participants,

“2.questionable goals of treatment, and

“3.lack of consideration of children’s autonomy…”

“We also have concerns with the authors’ interpretation in these four studies, including:

“1.the assumption that unknown future adult needs should supersede known childhood needs, and

“2.the underestimation of harm when attempting to delay or defer transition…”

“Conclusion:

“In this critical review of four primary follow-up studies with gender-nonconforming children in Toronto, Canada and the Netherlands (Table 1), we identify a total of 12 methodological, theoretical, ethical, and interpretive concerns as well as two often-overlooked contributions of this literature. We conclude that, while our understanding of gender diversity in adults has progressed, the tethering of childhood gender identity to the idea of “desistance” has stifled similar advancements in our understanding of children’s gender diversity. As we progress towards a fuller understanding of children’s gender in all its complexity, it will be important to move beyond longitudinal studies of identity that seek to predict children’s futures, and instead prioritize respect for children’s autonomy in the present. For all the resources devoted to studying these children, we have much more to learn by listening to them.”

https://www.researchgate.net/publication/324808865_A_Critical_Commentary_on_Follow-Up_Studies_and_Desistance_Theories_about_Transgender_and_Gender-Nonconforming_Children

Teach your parents and providers well: Call for refocus on the health of trans and gender-diverse children

Published in: Canadian Family Physician.  May, 2018. Authors Julia Temple Newhook, Kelley Winters, Jake Pyne, Ally Jamieson, Cindy Holmes, Stephen Feder, Sarah Pickett and Mari-Lynne Sinnott

“Today, however, we are witnessing a substantial progression of the field—what some have termed a paradigm shift. Globally, health care providers acknowledge that gender is “a matter of diversity, not pathology,” and gender identity is being formally recognized as a deeply personal and fundamental human right... We argue that this narrow focus on prediction is misplaced. An understanding of the developmental trajectory of gender identity is important. However, our main priority is not predicting children’s adult identities; it is supporting children’s present and future health and well-being.”

“Directives regarding the care of gender-diverse children have derived primarily from a small body of research… interpreted to suggest that about 80% of children who we might think of as transgender will not identify as transgender as adults. It has become common to see these studies cited as a reason to discourage children’s assertion of a non–birth-assigned gender, framing transgender children as “confused.” Yet recent reviews suggest the utility of the concept of desistance is limited, and have raised the following 7 critiques:

• “Many children never asserted a transgender identity…”

• “Consistency often leads to continuance…”

• “Assumptions were made about loss to follow-up…”

• “Some assert a transgender identity later in life…”

• “Some assert a nonbinary identity…”

• “There is no evidence of being ‘trapped’...”

• “Studies do not examine harm of suppression…”

“In moving past the desistance myth, researchers and clinicians are then able to focus instead on the more crucial question: How do we foster optimal health outcomes for gender-diverse children? Emerging research indicates that children who are not permitted to express their gender freely within their key developmental contexts, including family and school, might be at risk of negative psychosocial outcomes, both in the short-term and into adolescence and adulthood. These include low self-esteem, low life satisfaction, poor mental health, lack of adequate housing, posttraumatic stress, and suicidal thoughts and attempts.”

“Conclusion:

“Every child is unique. To thrive, every child needs to be seen, valued, and loved for who they are—not for who we expect them to be. Rather than attempting to “fix” gender-diverse children, medical providers have a key leadership role to play in the acceptance of the gender spectrum as a fundamental element of our human diversity. Through affirmation in the present, and celebration of whatever the future might hold, our goal is for all children to reach their full potential in all aspects of their lives.”

http://www.cfp.ca/content/64/5/332

Letter to the US Department of Health and Human Services

A letter signed by the California State Superintendent of Public Instruction, the Direcor of the Oregon Department of Education, and the Washington State Superintendent of Public Instruction challenging the US federal government's possible 'redefinition' of gender, also outlining the severe and predictable harm such a policy would cause on vulnerable trans and gender nonbinary youth and adults.

Find more on affirmative care for trans ad nonbinary youth and adolescents at our site:

www.gdaworkinggroup.com

And like/follow us on Facebook for regular updates:

@gdaffirmative

https://www.oregon.gov/ode/about-us/Documents/Gender%20letter%20Washington%20Oregon%20California-Final.pdf?fbclid=IwAR0avnzU3i26HpRhZIlQuCDNXqpzTxdKYt-u1Qh40KKUQiGtWe0oJgDTYNs

There Is No Evidence That Rapid-Onset Gender Dysphoria Exists

There Is No Evidence That Rapid-Onset Gender Dysphoria Exists

An article highlighting some of the major concerns with "Rapid Onset Gender Dysphoria." Find more on affirmative care for trans and gender nonbinary youth, as well as on the myths of "rapid onset" and "high rates of desistance" at our website: www.gdaworkinggroup.com

Like and follow us on Facebook for regular updates: @gdaffirmative

Published in: PsychCentral. December 11, 2018.  Author: Florence Ashley.

“In March, 21 experts in trans health endorsed an essay concluding that the hypothesis of ROGD is bad science. The group included multiple past presidents of the Canadian Professional Association for Transgender Health, its current president, the heads of the specialized Meraki Health Centre, and the lead investigator of the Montreal arm of the Trans Youth CAN! studies.” 

“Despite significant sampling and interpretive concerns with the study, it is not uncommon for it to be uncritically cited as evidence of a social contagion of trans identities.” 

“The first and most commonly noted problem with the study is its choice of sample. It relies on parental report without independent confirmation and posted recruitment advertising exclusively on anti-trans websites…”

“The second and… biggest problem with the study is that Littman fails to consider alternative, more plausible explanations for her observations.  One of the main findings of the study is that children’s mental health and parent-child relationships deteriorate after coming out… However, parental acceptance of gender identity is a well-known predictor of mental wellbeing for transgender people and children who are not supported in their identities are unlikely to want to maintain a good relationship with their parents.”

“A similar interpretive issue arises with regards to social influence. Parents report that their children increased their internet and social media consumption prior to coming out, found themselves in friend groups with many trans people... None of this is surprising… [p]eople who are questioning their gender tend to find themselves consuming content by trans people, both for informational purposes and because of shared experiences… There’s nothing noteworthy about questioning young people consuming social media content representative of their contemporaneous concerns.”

“There is no evidence that ROGD exists. So far, all evidence proposed in favor of the hypothesis is best compatible with adolescent-onset gender dysphoria against a background of parental hostility to gender identity.”

“It is crucial for practitioners to have an adequate understanding of the facts surrounding ROGD, as a mistaken belief that its existence is established could lead to negative consequences in their practice…  It is essential for parents to move past this disruption to their life story and reconstitute a new one which makes room for their child by accommodating change and giving it meaning within the broader family narrative.”

https://psychcentral.com/lib/there-is-no-evidence-that-rapid-onset-gender-dysphoria-exists/

“You Have to Give Them a Place Where They Feel Protected and Safe and Loved”: The Views of Parents Who Have Gender-Variant Children and Adolescents

A study on parent's experiences and feelings around their trans/'gender variant' youth. Sound familiar as a study topic? This study found that affirming these youth was initially difficult for some parents but ultimately led to better adjusted youth, and more close family relationships.

Find more on affirmative care for trans and gender nonbinary youth on our website, and follow us on Facebook for regular updates:
www.gdaworkinggroup.com
Gender Dysphoria Affirmative Working Group

Journal of LGBT Youth. 2008. Darryl E. Hill & Edgardo Menvielle

“This study focused on the experiences of parents of gender-variant children and teens. The goal was to document issues faced by parents of kids with childhood gender-variant behaviors and/or gender-variant identity… Parents were asked for a history of their child’s gender, focusing on their experiences and their thoughts about how to parent gender-variant youth. Parents spoke about their gender beliefs, how they came to accept their child, and the main challenges they faced.”

“... Another mother of a five-year-old boy shared: ‘You have to love your kid unconditionally. And you have to love them even a little bit more I think when they’re like this, because they know they’re different… you have to give them a place where they feel protected, and safe, and loved, and free to be who they are or what they’re going to be.’ ”

“Such unconditional acceptance had a strong positive impact on her boy, according to a different mother: ‘if you’re there for them and they’re happy and they’re confident, they’re going to be much more successful at dealing with [kids who tease them] than if they’re not and if you’re not there.’ ”

“One mother of a five-year-old boy, at the urging of a psychologist discouraged her boy’s stereotypical feminine interests while rewarding masculine ones: ‘it was probably the most horrible thing we’ve ever put [him] through… I mean you can just imagine what a blow to self-esteem that is for anyone? A four-year-old… You just can’t do that.’ As a result, ‘He became so introverted that he wouldn’t even discuss the issue with us at all…. He would spent countless hours alone in this room... it’s like what you imagine of an adult depressive person. I would never, ever do that to him again.’ ”

“A mother of a five-year-old boy who had censored her son’s behavior found that ‘All I saw was that it created more tension in him, more bad behaviors… Because I think a lot of his bad behaviors were [due to] the fact that he felt so… different and he felt so bad about himself… And since we’ve really started giving him this freedom to be himself within our family unit, he’s been a much, much, happier litte guy and a much more easier going kid.’ ”

“This study sought to portray a nuanced view of the experiences and issues faced by parents of children and adolescents who display variant behaviors… [While parents] initially questioned their role in their child’s gender, some felt unconditional acceptance was important and most discussed strategies they used to ensure their child would be safe.”

“Upon reflecting on their earlier attitudes, some parents came to see their earlier gender-normalizing efforts as either harmful or futile…”

“… Hopefully this study will encourage further development of affirmative interventions for youth with gender-variant behaviors and more rigorous scientific studies…"

https://www.researchgate.net/publication/240242077_You_Have_to_Give_Them_a_Place_Where_They_Feel_Protected_and_Safe_and_Loved_The_Views_of_Parents_Who_Have_Gender-Variant_Children_and_Adolescents

Psychology Today Response

Some of you may have seen an article by Samuel Veissière Ph.D. in Psychology Today​ last week. Below is a response on behalf of the Gender Dysphoria Affirmative Working Group.

Find information on evidence-based, affirmative approaches to the treatment of trans and gender nobinary youth on our site:

www.gdaworkinggroup.com

And like/follow us on Facebook for regular updates:

@gdaffirmative

December 5, 2018

An open letter to the owners, editors, members, advertisers, and others at Psychology Today:

We are a broad, international coalition of prominent medical and mental health professionals, academics, researchers, activists, and allies, some who are transgender-identified and others cisgender allies, all with vast expertise in gender and sexuality and troubled by the notion of “Rapid Onset Gender Dysphoria.”  Together we have published hundreds of peer-reviewed journal articles, written dozens of books, given countless lectures at universities, professional organizations, in the media, and elsewhere, and have counseled thousands of transgender and gender nonbinary youth.  We established the Gender Dysphoria Affirmative Working Group to highlight the overwhelming data demonstrating that evidence-based affirmative approaches yield happier and better adjusted children and that disaffirming approaches produce significant harm.  Our website can be found here: www.gdaworkinggroup.com

We wish to refute in the strongest possible terms the article by Samuel Veissière Ph.D. and the study he cited by Dr. Lisa Littman.

 The Littman (2018) study has been widely contested as methodologically flawed and unethical, proceeding from an overt ideological bias.  The notion of “Rapid Onset Gender Dysphoria” is based solely on that one publication and runs counter to the evidence-based affirmative standard of care - in which the youth’s self-reported gender is respected and where the youth is provided the safety and freedom to explore the gender and identity without judgment or predetermined outcome. 

The World professional Association for Transgender Health(WPATH) and the American Academy of Pediatrics(AAP) both address the need to provide empathetic, nurturing environments, and reject attempts, “to instill fear about the possibility that an adolescent may or may not be transgender with the a priori goal of limiting consideration of all appropriate treatment options.” Furthermore, the AAP, “supports policies that are gender-affirming for children – an approach that is supported by other key professional organizations.” 

The Pediatric Endocrine Society arrives at the same conclusion, stating, "…the purpose of this Position Statement is to emphasize the importance of an affirmative approach to the health care of transgender individuals..."and that “transgender youth have optimal outcomes when affirmed in their gender identity, through support by their families and their environment, as well as appropriate mental health and medical care. For this reason, the Pediatric Endocrine Society Special Interest Group on Transgender Health joins other academic societies involved in the care of children and adolescents in supporting policies that promote a safe and accepting environment for gender-nonconforming/transgender youth, as well as adequate mental health and medical care."  (Lopez et al., 2016)

A more comprehensive list of the dozens of organizations with public statements supporting the healthcare needs of transgender youth and adults can be found here: https://www.lambdalegal.org/sites/default/files/publications/downloads/resource_trans-professional-statements_09-18-2018.pdf

The positions of these organizations, along with our own, are based on the best available research. Affirmative approaches demonstrate far-reaching improvements in quality of life, relationship satisfaction, self-esteem and self-confidence, and clearly show reductions in depression. anxiety, substance use, school dropout, incarceration, homelessness, self-harm, and suicide (Pyne 2016; Riley et al 2011; Russel et al 2018; Snapp et al 2015; Travers et al 2012).  Given space and time, these youth discover what gender is authentic and what level of transition is appropriate for them, if any.  

A 2018 Cornell University metastudy concluded that “[93% of peer reviewed studies] found that gender transition improves the overall well-being of transgender people… None of the reviewed studies showed that gender transition harms well-being.”  Others have documented that rates of regret are miniscule (Olson et al, 2018; Wiepjes et al, 2018).

Conversely, critiques of Littman’s article have cited numerous issues (Ashley, 2018; Ashley & Baril, 2018; Barasch, 2018; Borg, 2018; Serano, 2018; Tannehill, 2018):

·      The sample group of parents was drawn exclusively from websites openly hostile to transgender youth and their issues, thus deliberately skewing the results. 

·      Littman failed to acknowledge or account for the skew she introduced. 

·     Survey questions seem directed toward predetermined conclusions.  The study essentially surveyed the people who invented or were predetermined to support ROGD on whether they believe ROGD is real, then made its conclusions based on these beliefs.

·      She spoke with no trans youth, despite drawing conclusions on how such youth arrived at their trans identities, instead basing her conclusions solely on parents’ suppositions and skeptical beliefs. 

·      The ‘rapid onset’ often reported by parents is not a new phenomenon. Youth very commonly will delay coming out in hostile environments, being afraid to disclose due to minority stress factors including social stigma, internal stress, fears of rejection by family and friends, and legitimate concerns about violence. Given that these parents sought out hostile websites, the fears of these youth would seem to have been justified.

·      The disaffirming approaches suggested by the Littman study and also by Veissière’s post are likely to yield worsening mental health outcomes and a deterioration of the parent-child relationship.

·     Littman herself has no personal experience working with transgender youth.

There are many reports that when Littman presented her preliminary results, she was given extensive critique on the poor scientific quality of her research. She made no attempts to address these issues in her final paper, again suggesting she placed ideology over scientific rigor.  Some members of Gender Dysphoria Affirmative Working Group personally attended those sessions, and we have spoken to others with the same experience.

Studies also demonstrate that disaffirming approaches, such as those advocated by the proponents of “Rapid Onset”, cause harm.  There are a great deal of peer reviewed papers documenting that the high rates of depression, anxiety, substance abuse, poor school performance often identified in this population manifest primarily in youth from unsupportive environments (Bariola et al 2015; Bokting et al 2105; Hidalgo et al 2013; Roberts et al 2012). 

Klein and Golub (2016) report that a staggering 41% of transgender people have attempted suicide, and that 26.3% report misusing drugs or alcohol to cope with stigma related to their transgender identity.  The negative consequences of substance misuse and suicidal ideation and gestures “increased significantly with increasing levels of family rejection.”

Simultaneously, youth from environments where they are provided the freedom and validation to explore and determine their gender for themselves show no higher rates of these issues than their cisgender (non-trans) peers (Durwood, et al 2017; Olson, et al 2016).

More of these studies are excerpted below.

We also refute the charge that those opposing the Littman study are ‘radical transgender activists attempting to silence research we dislike’. We oppose any attempt to manipulate research in a way that would cause harm to our patients, community members, and children.  The Littman study has been widely criticized as being methodologically flawed, ideologically biased, and as such is bigotry masquerading as science. Poor science remains poor science.

Psychology Today represents a trusted source for information and referrals on mental health. Publishing an article based on poor, biased research that encourages practices found to be harmful is both irresponsible and a disservice to your readers and their clients.

We urge you to publish our letter and also to reconsider and withdraw the publication of such a flawed article.    

Sincerely, 

The Gender Dysphoria Affirmative Working Group

Noah Adams, MSW

Elsa Almås, PhD

Erica E. Anderson, Ph.D.

Esben Esther Pirelli Benestad, MD

Ady Ben-Israel, PhD

Peter Chirinos, MA 

Damon Constantinides, PhD, LCSW

Diane Ehrensaft, Ph.D.

Tony Ferraiolo, CPC

Dr. Robert Garofalo

Shawn V. Giammattei, Ph.D.

Melanie A. Gold, DO, DMQ, FAAP, FACOP

Linda A Hawkins, PhD, MSEd, LPC 

Marco A. Hidalgo, PhD

Laura A. Jacobs, LCSW-R

Aron Janssen, MD

Randi Kaufman, PsyD

Colt Keo-Meier, PhD

S.J. Langer, LSCW-R

Sean Lare, LCSW-C

Arlene Istar Lev LCSW-R, CASAC, CST

M. Dru Levasseur, Esq.

Jean Malpas, LMHC, LMFT

Zack Marshall, MSW PhD

Denise Medico, Ph.D

Christine Milrod, Ph.D

Margaret Nichols, Ph.D.

Johanna Olson-Kennedy, MD

Simon Pickstone-Taylor,  MBChB

Marjorie Rabiau, Ph.D. 

Stephen M. Rosenthal, MD

Cianán Russell, Ph.D.

Hershel Russell M.Ed

Dr. Annie Pullen Sansfaçon, PhD

Herb Schreier M.D. 

Judy Sennesh

Julia Serano, Ph.D.

Caroline Shahbaz, BBSc(Hons), MPsych

John B. Steever, MD

Françoise Susset, Psy.D.

Brynn Tannehill, M.S.

Barbara E. Warren Psy.D., LMHC

Erika P. Volkmar, DDS

Linda Wesp, MSN, FNP-C, AAHIVS

1. The Gender Affirmative Model: What We Know and What We Aim to Learn

Published in: Human Development.  October, 2013.  Authors: Marco A. Hidalgo, Diane Ehrensaft, Amy C. Tishelman, Leslie F. Clark, Robert Garofalo, Stephen M. Rosenthal, Norman P. Spack, Johanna Olson

"Children not allowed these freedoms by agents within their developmental systems (e.g., family, peers, school) are at later risk for developing a downward cascade of psychosocial adversities including depressive symptoms, low life satisfaction, self-harm, isolation, homelessness, incarceration, posttraumatic stress, and suicide ideation and attempts…”

https://www.karger.com/Article/Fulltext/355235

2. Family Rejection as a Predictor of Suicide Attempts and Substance Misuse Among Transgender and Gender Nonconforming Adults

Published in: LGBT Health.  May 25, 2016.  Authors: Augustus Klein & Sarit A. Golub

"42.3% of [transgender adults] reported a suicide attempt and 26.3% reported misusing drugs or alcohol to cope with transgender-related discrimination… family rejection was associated with increased odds of both behaviors. Odds increased significantly with increasing levels of family rejection."

https://www.liebertpub.com/doi/pdf/10.1089/lgbt.2015.0111

3. Statement on Gender Affirmative Approach to Care from the Pediatric Endocrine Society Special Interest Group on Transgender Health

Published by: Pediatric Endocrine Society Transgender Health Special Interest Group.  October 20, 2016.  Authors: Lopz, X, Marinkovic, M, Eimicke, T, Rosenthal, SM, Olshan, JS.

"The purpose of this Position Statement is to emphasize the importance of an affirmative approach to the health care of transgender individuals, as well as to improve the understanding of the rights of transgender youth..."

"In conclusion, transgender youth have optimal outcomes when affirmed in their gender identity, through support by their families and their environment, as well as appropriate mental health and medical care. For this reason, the Pediatric Endocrine Society Special Interest Group on Transgender Health joins other academic societies involved in the care of children and adolescents in supporting policies that promote a safe and accepting environment for gender-nonconforming/transgender youth, as well as adequate mental health and medical care."

https://www.pedsendo.org/members/members_only/PDF/TG_SIG_Position%20Statement_10_20_16.pdf

4. Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents

Published By: The American Academy of Pediatrics. September, 2018. Committee on Psychosocial Aspects of Child and Family Health, Committee on Adolescence, Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness

“Supportive involvement of parents and family is associated with better mental and physical health outcomes. Gender affirmation among adolescents with gender dysphoria often reduces the emphasis on gender in their lives, allowing them to attend to other developmental tasks, such as academic success, relationship building, and future-oriented planning. 

http://pediatrics.aappublications.org/content/early/2018/09/13/peds.2018-2162

5. Gender nonconforming youth: current perspectives

Published in: Adolescent Health, Medicine and Therapeutics. 2017. Author: Diane Ehrensaft.

"The gender affirmative model is defined as a method of therapeutic care that includes allowing children to speak for themselves about their self-experienced gender identity and expressions and providing support for them to evolve into their authentic gender selves, no matter at what age.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5448699/

6. Mental Health of Transgender Children Who Are Supported in Their Identities

Published in: Pediatrics, February, 2016.  Authors: Kristina R. Olson, Lily Durwood, Madeleine DeMeules, Katie A. McLaughlin.  

"Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group… socially transitioned transgender children have notably lower rates of internalizing psychopathology than previously reported among children with GID living as their natal sex."

http://pediatrics.aappublications.org/content/early/2016/02/24/peds.2015-3223

7. Demographic and Psychosocial Factors Associated With Psychological Distress and Resilience Among Transgender Individuals

Published in: The American Journal of Public Health. October, 2015. Authors: Emily Bariola, BA, Anthony Lyons, PhD, William Leonard, BSc, BA, Marian Pitts, PhD, Paul Badcock, PhD, and Murray Couch, BA.

“The findings indicated that, relative to other sources, family of origin may have the most influence in protecting against psychological distress… our findings support a need to encourage family members to be open and receptive sources of support.”

“…frequent contact with LGBT peers was revealed as a significant [protective] factor… for transgender individuals, frequent peer contact may be particularly important for developing individual resilience, as gender transitioning can be a complex and challenging process and having peers who share similar experiences may provide not only a sense of support and understanding, but also a sense of belonging.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566567/

8. Social Support Networks for LGBT Young Adults: Low Cost Strategies for Positive Adjustment 

Published in: Family Relations.  July, 2015.  Authors: Shannon D. Snapp, Ryan J. Watson, Stephen T. Russell, Rafael M. Diaz, Caitlin Ryan.

“Our study adds to the growing body of evidence that family support, both general and sexuality specific, is a crucial factor in LGBT youth’s health and well-being…”

“Two variables were most relevant in predicting adjustment: (a) the percentage of friends who knew about participants’ sexual or gender identity and (b) support related to being LGBT from friends. The presence of a network of friends to whom youth can be out has been linked to measures of health and well-being…”

“Although friendship support is clearly associated with positive well-being in young adulthood, it appears that family acceptance has a stronger overall influence when other forms of support are considered jointly.”

https://www.tandfonline.com/doi/full/10.1080/01612840.2017.1398283

9. Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population

Published in: American Journal of Public Health.  May, 2013. Authors: Walter O. Bockting, PhD, Michael H. Miner, PhD, Rebecca E. Swinburne Romine, PhD, Autumn Hamilton, HSD, and Eli Coleman, PhD.

 “… family support, peer support, and identity pride all were negatively associated with psychological distress, confirming that these assets are protective factors. Moreover, peer support significantly moderated the relationship between enacted stigma and psychological distress, thus emerging as a demonstrated factor of resilience in the face of actual experiences of discrimination. Only at high (but not low or medium) levels of peer support was enacted stigma not associated with psychological distress, which suggests that the negative impact of enacted stigma on mental health is pervasive and that regular contact with peers is necessary to ameliorate it.”

“Together, these results offer support for the value of transgender individuals connecting with similar others, possibly providing the opportunity to question stigma from the majority culture and reappraise their experiences in a self-affirmative way, which is consistent with what has been postulated and observed among gay and lesbian individuals. This finding is particularly pertinent because previous research found that transgender people have higher levels of depression and lower levels of peer and family support than their gay, lesbian, and bisexual counterparts. These results support a need to promote resilience by facilitating ample peer support.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698807/

10. The Needs of Gender-Variant Children and Their Parents: A Parent Survey

Published in: International Journal of Sexual Health. 2011. Authors: Elizabeth Anne Riley, Gomathi Sitharthan, Lindy Clemson, Milton Diamond.

“The results of this study support the development of affirmative approaches in supporting gender-variant children and their parents. This is particularly evidenced by the parents’ own approaches to supporting their children where parents experimented with different ways of responding to various scenarios and realized that acceptance of their child was the only option as they learned that their child’s need for expression was not changed by their attitude or management of the behavior.”

http://www.hawaii.edu/PCSS/biblio/articles/2010to2014/2011-gender-variant-children.htm

Citations:

Ashley, F.  (2018). Rapid-Onset Gender Dysphoria: A Parental Epidemic? Impact Ethics.com. 

Ashley, F. & Baril, A. (2018).  Why ‘Rapid-Onset Gender Dysphoria’ is bad science. Medium.com. 

Barasch, A. (2018).  Criticism Is Not Censorship: A poorly designed study of “rapid onset gender dysphoria” deserves serious scrutiny, not protection from “activist interference.”  Slate.com.

Bariola, BA., et al. (2015).  Demographic and Psychosocial Factors Associated With Psychological Distress and Resilience Among Transgender Individuals.  The American Journal of Public Health. 

Bokting, W., Miner, MH., Swinburne Romine, RE., Hamilton, A., Coleman, E.  (2013).  Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population. American Journal of Public Health.

Borg, L.  (2018).  Transgender Article Removed at Brown Brings Controversy.  Providence Journal.

Cornell Chronicle. (2018).  Analysis Finds Strong Consensus on Effectiveness of Gender Transition Treatment.

Durwood, L., McLaughlin, KA, Olson, KR.  (2017). Mental Health and Self-Worth in Socially Transitioned Transgender Youth  Journal of the American Academy of Child and Adolescent Psychiatry.

Hidalgo, MA., Ehrensaft, D., Tishelman, AC, Clark, LF, Garofalo, R., Rosenthal, SR., Spack, NP, Olson,J. (2013).  The Gender Affirmative Model: What We Know and What We Aim to Learn. Human Development.  

Klein, A, & Golub, SA. (2016).  Family Rejection as a Predictor of Suicide Attempts and Substance Misuse Among Transgender and Gender Nonconforming Adults. LGBT Health. 

Littman, L. (2018).  Rapid-Onset Gender Dysphoria in Adolescents and Young Adults: A Study of Parental Reports.  PLOS One.  

Lopez, X., et al. (2016).  Statement on Gender Affirmative Approach to Care from the Pediatric Endocrine Society Special Interest Group on Transgender Health.  Pediatric Endocrine Society Transgender Health Special Interest Group. 

Olson-Kennedy, J., Warus, J., Okonta, V.  (2018). Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults - Comparisons of Nonsurgical and Postsurgical Cohorts. Journal of the American Medical Association.  

Olson, KR, Durwood, L, DeMeules, M, McLaughlin, KA.  (2016). Mental Health of Transgender Children Who Are Supported in Their Identities.  Pediatrics.

Pyne, J.  (2016).  “Parenting Is Not a Job ... It’s a Relationship”: Recognition and Relational Knowledge Among Parents of Gender Non-conforming Children.  Journal of Progressive Human Services. 

Riley , E.A., Sitharthan, G, Clemson, L, & Diamond, M.  (2011).  The Needs of Gender-Variant Children and Their Parents: A Parent Survey.  International Journal of Sexual Health. 

Roberts, AL., Rosario, M., Corliss, HL., Coenen, KC., Austin, SB.  (2012).  

Childhood Gender Nonconformity: A Risk Indicator for Childhood Abuse and Posttraumatic Stress in Youth. Pediatrics.  

Russell, TR., Pollitt, AM., Li, G., Grossman, AH.  (2018). Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth.  Family Relations.

Serano, J. (2018).  Everything You Need to Know About Rapid Onset Gender Dysphoria. Medium.com.

Snapp, SD., Watson, RJ., Russell, ST., Diaz, RM., & Ryan, C. (2015). Social Support Networks for LGBT Young Adults: Low Cost Strategies for Positive Adjustment. Family Relations. 

Stein, F. (2017).  AAP Statement in Support of Transgender Children, Adolescents, and Young Adults.  The American Academy of Pediatrics.

Tannehill, B. (2018).  'Rapid Onset Gender Dysphoria' Is Biased Junk Science.  Advocate.com. 

Travers, R, Bauer, G., Pyne, J., Bradley, K., Gale, L., Papadimitriou, M.  (2012).  Impacts of Strong Parental Support for Trans Youth. Trans Pulse Project.   

Wiepjes CM, et al. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. The Journal of Sexual Medicine.

World Professional Association for Transgender Health.  (2018). WPATH Position on Rapid-Onset Gender Dysphoria.  Retrieved from: https://www.wpath.org/media/cms/Documents/Public%20Policies/2018/9_Sept/WPATH%20Position%20on%20Rapid-Onset%20Gender%20Dysphoria_9-4-2018.pdf

HRC 2018 LGBTQ Youth Report

The survey results from HRC’s most recent survey on LGBTQ youth, including some disturbing information about the real need trans youth have for support. Below are a few brief excerpts.

“Parents and families play an essential role in promoting adolescent health and well-being. Studies have shown the positive health outcomes for LGBTQ youth whose families are supportive and accepting, including greater self-esteem and resilience, and a lower risk of negative health outcomes such as depression, distress, hopelessness and substance use.”

“Most LGBTQ youth are aware of their sexual orientation or gender identity by the start of adolescence. While “coming out” to their parents and close family members is an important and self- affirming developmental milestone, it is often fraught with worry. Many LGBTQ youth report coming out, being outed or being found out by their family as extremely stressful. Moreover, more than three- quarters of youth in our sample rate coming out as LGBTQ to their parents as extremely stressful…”

“…The mental health disparities between LGBTQ youth and non-LGBTQ youth continue to be an alarming trend. Today’s LGBTQ youth face a variety of stressors — harassment, family and peer rejection, bullying from their peers, isolation and a lack of a sense of belonging — that have a major impact on their overall well-being. Studies have shown that, compared to their non-LGBTQ peers, LGBTQ youth report much higher rates of depression, anxiety, alcohol and drug use, and lower self-esteem…”

“…Seventy-seven percent of LGBTQ youth surveyed report that on average they had felt down or depressed in the past week.17 Alarmingly, only 41 percent had received psychological or emotional counseling to address these issues in the past 12 months. LGBTQ youth of color face even greater challenges in accessing counseling services, with large disparities and an average of 37 percent of respondents having received psychological or emotional counseling in the past 12 months. Importantly, youth who had received counseling reported better mental health outcomes.”

“…LGBTQ youth of color often experience additional stress and adverse effects to their health and well- being as a result of bias around their intersecting identities. In addition to homophobia or transphobia, LGBTQ youth of color may encounter racism and discrimination on a daily basis and in various forms that can further complicate their ability to express, explore and/or manage their LGBTQ identities.”

“…Transgender and gender-expansive youth face many serious challenges in the school system. In addition to more overt forms of discrimination such as verbal and physical harassment, they also commonly report being barred from using locker rooms or bathroom facilities that match their gender identity and not being addressed by the appropriate pronouns or their chosen names. These negative school experiences have damaging implications for transgender and gender-expansive youth, and further contribute to hostile learning environments where they feel unsafe and unprotected.”

https://assets2.hrc.org/files/assets/resources/2018-YouthReport-NoVid.pdf?_ga=2.54064298.303729007.1543413813-998314167.1534164039

The Experience of Parents Who Support Their Children's Gender Variance

A study outlining the struggles and needs of parents in supporting their trans youth.

Published in: Journal of LGBT Youth.  2015.  Authors: Annie Pullen Sansfaçon, Marie-Joëlle Robichaud & Audrey-Anne Dumais- Michaud

“Many parents need support in managing stigma and efficiently advocating on their children’s behalf as well as accessing information and specialized services or educating others (such as service providers) about their children’s needs and experiences. Wren’s (2002) interviews with parents of gender-variant teenagers revealed that how parents understood their children’s transgenderism is iteratively linked to their capacity for acceptance.” 

“Wren (2002) identified several successful coping strategies of accepting parents, such as confiding in at least one person, contacting a support group, or seeking help from professionals. Also, Grossman and D’Augelli (2007) found a need for interventions, such as educational programs for parents and caregivers aimed at understanding their child, psychoeducational programs for transgender youth to help them understand their bodily changes during puberty and/or transition, and training programs for mental health professionals to assist them in reducing the youth’s distress.”

“… Participants expressed a need to embrace their child’s identity and support any form of exploration, explaining how they felt they had to “deal with what you’re given.” The drive to mobilize themselves to support their children was grounded in the parents’ desire to protect them from the worst consequences experienced by many gender-variant children and youth—namely, bullying, depression, anxiety, self-harm, and suicide.”

“…their acceptance did not occur overnight. Participants in the group narrated a process of adaptation that took time and was full of pitfalls. Most recognized that they were shocked when they first realized their child was gender variant… There were clearly challenges associated with acceptance. Parents expressed being constantly pressured by social reactions to their child’s gender identity and sometimes felt as though their private and public lives were in conflict.”

“For the participants, being trans—or being the parents of a trans child—comes at a price, and participants were fully aware of it. Transphobia is so present in society that some participants were apprehensive about being identified with the trans community. Indeed, some of the struggles related to the parents’ own acceptance of the child is linked to the judgment of others: Some participants felt uncomfortable discussing gender creativity with their neighbors, friends, and family. Being affirmative of their child’s preferred gender may come at a great personal expense.” 

“… While parent experiences may not come close to the experiences of gender-variant and transgender people themselves in terms of nonrecognition, our findings nevertheless indicate a need to understand that parents experience challenges while supporting and protecting their children, and that greater visibility and recognition is needed for parents as well.” 

“… practitioners working with families containing gender-variant children should facilitate networking among these families so that parents may exchange information and support one another’s development of best practices in parenting a gender-variant child. Finally, as the present study has shown, parents invited to participate in empowering forms of intervention can mobilize themselves. Practitioners can draw from this study to initiate opportunities for support and also action toward challenging oppressive structures that contribute to the challenges these families experience. As highlighted throughout, when presented with empowering interventions, parents possess the requisite skills and knowledge to act on their own behalf.”

https://scholar.google.com/citations?user=0mJq6LQAAAAJ&hl=en#d=gs_md_cita-d&p=&u=%2Fcitations%3Fview_op%3Dview_citation%26hl%3Den%26user%3D0mJq6LQAAAAJ%26citation_for_view%3D0mJq6LQAAAAJ%3ALO7wyVUgiFcC%26tzom%3D300

GDA Working Group Support for the AMA

The Gender Dysphoria Affirmative Working Group wants to express support and thanks to the American Medical Association for it’s strong stance affirming the rights and identities of transgender and gender nonbinary individuals.

AMA Affirms Medical Spectrum of Gender

During its interim meeting last week, the American Medical Association adopted a GLMA-sponsored policy stating that it will “oppose efforts to deny an individual’s right to determine their stated sex marker or gender identity.” This policy passed following reports of a Department of Health and Human Services memo that would attempt to narrowly redefine sex as an immutable condition determined at birth.

The adopted policy also states:

The AMA will educate state and federal policymakers and legislators on and advocate policies addressing the medical spectrum of gender identity to ensure access to quality health care.
and the AMA affirms that an individual’s genotypic sex, phenotypic sex, sexual orientation, gender and gender identity are not always aligned or indicative of the other, and that gender for many individuals may differ from the sex assigned at birth.
“It is essential to acknowledge that an individual’s gender identity may not align with the sex assigned to them at birth. A narrow limit on the definition of sex would have public health consequences for the transgender population and individuals born with differences in sexual differentiation, also known as intersex traits,” said AMA Board Member William E. Kobler, MD.

GLMA was proud to have introduced and sponsored this resolution through our seat in the AMA House of Delegates. The AMA’s public stance aligns it with GLMA and 37 other leading health professional associations and community health centers in opposing any action that would seek to erase federal recognition of transgender people as contrary to medical science.

During this interim meeting, GLMA also introduced and sponsored a resolution that advocates for the collection of demographic data in federal and state surveys that is inclusive of sexual and gender identity.

“The AMA will advocate against the removal of demographic data inclusive of sexual and gender identity from public health surveys and registries without plans for updating measures of these data,” said AMA Board Member William A. McDade, MD, PhD.

In addition, the AMA passed other LGBTQ-related resolutions that were also supported by GLMA:

Improving screening and treatment guidelines for domestic violence against lesbian, gay, bisexual, transgender, queer/questioning, and other individuals
Supporting offering HIV Post-Exposure Prophylaxis (PEP) to all survivors of sexual assault
GLMA is the only LGBTQ organization with a seat in the AMA House of Delegates, the policy-making body of the AMA. GLMA is represented in the HOD by Delegate Jeremy Toler, MD, and Alternate Delegate (and GLMA Treasurer) Desiray Bailey, MD.

These policies enable GLMA and other advocates to utilize the expertise of health professionals and their associations to promote fair and equitable treatment for all LGBTQ patients.

“Parenting Is Not a Job... It’s a Relationship”: Recognition and Relational Knowledge Among Parents of Gender Non-conforming Children

“Parenting Is Not a Job ... It’s a Relationship”: Recognition and Relational Knowledge Among Parents of Gender Non-conforming Children

A study on how parents understand, make sense of, and then advocate for their children’s needs, and how an affirming approach honors the needs of the individual, the family, and is based in individual and social justice.

Published in: Journal of Progressive Human Services.  2016. Author: Jake Pyne.

“A proliferation of social science studies and a burgeoning field of transgender studies have challenged the assumption that gender is the natural and mechanical expression of biological sex, exploring at length the discord between the medicoscientific knowledge of gender versus the historical and social realities of how gender is lived and embodied. Although this distinction may be self-evident to critical theorists, it remains a site of ongoing struggle in the lives of parents of gender non-conforming children.”

“Yet within the past decade, a different response has emerged publically. Supported by a number of mental health clinicians and advocates, some parents are taking an affirmative stance on gender non-conformity, supporting their children to express their felt sense of gender and advocating for their rights and inclusion in social life. In the face of opposition and disbelief, affirming parents support their children to live in non-prescribed gender locations and, at times, facilitate the social or medical transition to a new gender… [in this paper] I explore what participants’ knowledge might make possible, in contrast to the pathology approach to gender non-conformity. The affirming approach is proposed as a justice-based parenting practice.”

“… Proponents of the corrective-treatment approach have cited the prevalence of violence and other potentially painful life experiences as the rationale for conformity’s being best (Green et al., 1972; Zucker, 2006)… We hear concern for the brutal living conditions of gender non-conforming people, but we do not hear proposals for advocacy to challenge these conditions. Instead, what is made possible is the continued subjugation of gender non-conforming people in the name of their own interests. What is foreclosed is the possibility of social change.”

“… participants in this study responded to their children’s genders as subjective experiences of the childrens’, recognizing and learning this experience through relationship. By refusing to problematize their children, parents demanded places of belonging for their children, refocusing the gaze on the policies and practices of institutions. By searching out affirming communities and language, parents sought contexts in which their children’s differences could be valued. By “desacralizing” professional knowledge, they expanded ourways of knowing gender outside of medicalized discourse. By conceptualizing gender transition as a process of sense making and embodiment, they made possible a destigmatized reading of transgender subjectivity. By relinquishing authority over who their children could be, they challenged the framework of parenting-as-job and child-as-product. In responding to otherness without aggression, they opened the possibility of doing justice to difference.”

“… In closing, parents of gender non-conforming children encounter substantial conflict as they negotiate their children’s otherness. For decades, a pathologizing service model has advocated clinical correction (Zucker & Bradley, 1995; Zucker et al., 2012). In opposition, some parents adopt an affirming stance toward their children. This study explored the knowledge underneath this stance, asking parents of gender non-conforming children how they know what they know. Analysis revealed a process of recognition and a knowledge of the children’s needs acquired through relationship. Drawing on political philosophy and psychoanalytic theory, I argue that the affirming approach to gender non-conforming children is a non-aggressive response to the other and a justice-based parenting practice.”

https://www.academia.edu/20203759/_Parenting_is_not_a_Job..._its_a_Relationship_Recognition_and_Relational_Knowledge_among_Parents_of_Gender_Non_Conforming_Children

Impacts of Strong Parental Support for Trans Youth

Yet another study making clear the connection between strong parental support and improved outcomes for trans and gender nonbinary youth.

October 2, 2012. Authors: Robb Travers, PhD; Greta Bauer, PhD, MPH; Jake Pyne, MSW; Kaitlin Bradley, MSc; LorraineGale, MSW; Maria Papadimitriou, MSc, MPH.

“First and foremost, our findings show clear associations between the support that trans youth experience from their parents and numerous health outcomes. The most significant differences show that trans youth who have strong parental support for their gender identity and expression report higher life satisfaction, higher self-esteem, better mental health including less depression and fewer suicide attempts, and adequate housing compared to those without strong parental support.”

“For parents and caregivers, our data have many implications. Our earlier results (not shown) revealed that having a “somewhat supportive” parent did not have a significantly more positive effect on youth than if their parents were not at all supportive of their gender expression and identity. This indicates that anything less than strong support may have deleterious effects on a child’s well-being…”

“…Some parents feel shame or grief because their child is different than they expected and many worry that their child will be bullied or will lead an unhappy life. For some families, a non-judgemental counsellor can help to process these fears. For others, peer support from other parents of trans youth, either on-line or in person, where available, is their greatest resource. Wherever parents seek support, it is important that they express and process these complex feelings with other adults and not with their child. While some parents worry that being trans will cause their child to be unhappy, ultimately our data indicate that it is parents and caregivers themselves who provide the foundation for their children’s health and well-being with their support.”

“Those working professionally in school settings, child welfare, residential and other services should be aware of the risks facing trans youth whose parents are unsupportive of their gender expression and identity....The presence of an active Gay-Straight Alliance (GSA) in a school is an important and crucial resource for trans youth…”

“Trans-inclusive youth programs that provide trans youth with a safe and confidential space to access professional and peer supports are crucial in helping to decrease feelings of depression and the despair that precedes suicidal ideation and attempts.”

“Finally, our data point to an urgent need for policy-makers to make themselves familiar with the needs of this very vulnerable group of youth, and to respond accordingly with resources that will help to ameliorate a very desperate situation. For example, providers in a range of settings, including schools, mental health, child welfare, residential, and social and health care services, require appropriate policies, practices, training and resources to ensure that service provision to trans youth is delivered with dignity and respect…”

http://transpulseproject.ca/wp-content/uploads/2012/10/Impacts-of-Strong-Parental-Support-for-Trans-Youth-vFINAL.pdf?fbclid=IwAR2m69IR3NcLblk1VZaPsjjaYiOSn_pDj9BHfq_B4UIku6do2GMFy7A7f_c

Childhood Gender Nonconformity: A Risk Indicator for Childhood Abuse and Posttraumatic Stress in Youth

Published in: Pediatrics.  2012.  Authors: Andrea L. Roberts, PhD,Margaret Rosario, PhD,Heather L. Corliss, PhD,Karestan C. Koenen, PhD, and S. Bryn Austin, ScD

A study discussing the associations between gender nonconformity and negative outcomes… making clear that lack of acceptance is a significant cause of poorer physical and mental health, poorer school performance, unemployment, substance abuse, and suicide.

“…childhood gender nonconformity has also been associated with a lower sense of well-being in adolescence and mental health problems in adulthood, including depression and anxiety symptoms, distress, body dissatisfaction, attachment anxiety, and suicidality. Thus, gender nonconformity in childhood may be an important health risk indicator.”

 “…Thus, if gender nonconforming children are at higher risk of abuse, they may also be at greater risk for developing PTSD compared with gender-conforming children. PTSD has severe sequelae with particular relevance to youth, including substance abuse, school dropout, teen pregnancy, suicide, mood disorders, relationship instability, and unemployment.”

 “…We identify gender nonconformity as an important indicator of children at increased risk of sexual, physical, and psychological abuse and of lifetime probable PTSD in early adulthood, both among children who will be heterosexual and children who will have a minority sexual orientation. PTSD is associated with serious sequelae, including health risk behaviors, such as unprotected sex and involvement with interpersonal violence, and physical sequelae, including dysregulated immune function, cardiovascular risk indicators, metabolic syndrome, and chronic pain.”

“…Prior research describes possible pathways linking gender nonconformity to abuse. Some parents may be uncomfortable with gender nonconformity in their children, possibly increasing their likelihood of being abusive toward gender-nonconforming children. Parents may also see gender nonconformity as an indicator of same sex sexual orientation or think others will assume their child will be gay or lesbian. If parents are uncomfortable with homosexuality, nonconformity may lead to the child being targeted for abuse. Some parents also believe their own parenting can shape their child’s gender nonconformity and future sexual orientation; thus, their parenting may become more physically or psychologically abusive in an attempt to discourage their child’s gender nonconformity or same-sex orientation…Sexual predators may similarly target gender nonconforming children.”

http://pediatrics.aappublications.org/content/129/3/410

‘More than boy, girl, male, female’: exploring young people’s views on gender diversity within and beyond school contexts

Published in: Sex Esudation.  March 1, 2018.  Authors: Sara Bragg, Emma Renold, Jessica Ringrose & Carolyn Jackson.

An interesting study on the ways in which youth interact with and address issues of gender diversity within schools, largely demonstrating that youth ‘get it’, and that, despite the fears or even homophobia/transphobia of their elders, youth are quite able to integrate gender and sexual diversity in their communities without difficulty, and without being influenced to adopt those identities themselves.  This also directly counters the notions of “social contagion.”  It also provides valuable insights to assist educators.

“…the contemporary context, with its increasing global awareness of gender diversity, offers young people significant new ways of learning about and doing gender. Findings reveal that many young people have expanded vocabularies of gender identity/expression; critical reflexivity about their own positions; and principled commitments to gender equality, gender diversity and the rights of gender and sexual minorities. We also show how young people are negotiating wider cultures of gendered and sexual violence. Schools are providing some spaces and learning opportunities to support gender and sexual diversity. However, overall, it appears that young people’s immediate social cultural worlds are constructed in such a way that gender binary choices are frequently inevitable, from school uniforms and toilets to sports cultures and friendships.”

“For Carlita, ‘old-fashioned’ anti-gay attitudes were seen to be caused by lack of information and education. The Internet, she suggested, is now addressing this:

“People are much more accepting now … 50 years ago if you were gay or anything like that, you would have been heavily judged for that … people would beat you up on the street. But now I think there are people who I know [are gay] here and they don’t get beaten up every day, they don’t get severely bullied, some of them just get on with it and they’re accepted. I think it is slowly getting better … because before we couldn’t spread information as quickly as we can now. Now in a click of a button we can spread information to the whole world in less than a second, but before that was impossible. People are being educated in a different way rather than just (in their) household.”

“Sometimes young people’s experiences of racism and their understandings of racial diversity seemed to prompt them to support sex, gender and sexual diversity, underpinned by a desire that differences of any kind should not be a barrier to self-identity and self-expression. Sometimes it was part of a general morality about ‘live and let live’, letting others make choices that are different from your own:

“If you’re born a female, I think that’s the way you were supposed to be … that’s just what I think … [but] that’s their life, that’s their business … they have made the choice so what can I do about it?”

“If he (Conchita, a trans celebrity) wants, if he wants to be like, wants to do that, I don’t really mind. It’s his life so if he wants to live it.”

“I respect what they’ve chosen. But it’s just something I wouldn’t choose.”

“In some cases, religious beliefs conflicted with young people’s sense of themselves as modern (more accepting or pro-gay):

“I know for a fact, my religion, the most wrongest thing you can do is either be gay or be something that God didn’t choose for you, because God doesn’t make mistakes … Honestly, I think it’s wrong, I’m not going to say that I think it’s right: because you were born like that you should embrace it and everything. But if they don’t feel that way then I’m not going to question it. It’s not up to me.”

“I’m a Muslim but I feel like some of the things are wrong, like … a person should be allowed to marry the person that’s the same gender as them … and, in my religion, that’s really wrong … but I believe in it … and I usually go with my head, rather than my heart … my religion’s in my heart … so head-wise, my mindset is that’s gay … it should be allowed … that’s what I personally believe.”

“…young people were reflexive about conflicting sets of beliefs or values, or why they struggled with particular gender issues. Kushtim, Marek and Lyndal  discussed how they might feel if Conchita [a fictional trans celebrity] walked into their classroom and sat at their table. They shared their fears of feeling ‘uncomfortable’ and why they might feel this way, suggesting that perhaps it related to transgenderism being ‘common’ on television, but more unusual in their communities. Kushtim commented that ‘I think the first time I saw a gay person, like, kissing was in Year 6 [aged 10–11]. I was shocked because I’ve never seen it in my life. Now when I see them it’s just Oh, OK. Like I’ve seen it a few times now’. They agreed that one day transgenderism might be more acceptable, less ‘shocking and new’, less ‘weird’, even if ‘it’s not something they would choose’.”

“However, despite strong support amongst many young people for gender fluidity and for challenging gender norms, from their perspective, schools were generally structured and operated in ways that reinforced the notion of gender identity and expression as binary, especially in regards to school uniforms, toilets and sports. There were some exceptions. For example, the coastal school, which was recently built, had gender-neutral toilets. Yet students expressed ambivalence about sharing such ‘private’ space across genders, as well as about the staffsurveillance it allowed. Indeed, as we have shown here, the contextual contingency of gender r/evolutions continuously rubbed up against sedimented sexist, homophobic and transphobic sentiments, discrimination and violence.”

“Our findings offer many ways forward for educators. They show that adults who want to make changes towards practices which create and support inclusive gender cultures and address gender equity and gender justice can expect to find allies amongst the young people with whom they work. In fact, the challenge maybe in keeping pace with young people’s new modes of expression and sites for learning. Indeed, never has there been a more urgent need for teacher training on critical gender sensitive pedagogies in the context of the historical and contemporary social, cultural, biological and political sex/gender/sexuality landscape…  It also follows that if educators are supported to create conducive contexts through which young people are encouraged to lead the way in some of this work, then potentially rich pedagogical encounters of why, how, where and when gender matters might be formed.”

https://doi.org/10.1080/14681811.2018.1439373

The Future of Sex and Gender in Psychology: Five Challenges to the Gender Binary

Published in: American Psychologist. July 19, 2018. Authors: Janet Shibley Hyde, Rebecca S. Bigler, Daphna Joel, Charlotte Chucky Tate, and Sari M. van Anders.

“Over the past two decades, however, a confluence of forces has challenged psychology’s assumption of the gender binary. These forces range from the transgender activist movement… and the intersex activist movement… to research in neuroscience and psychological science. This article synthesizes research that challenges the gender binary from multiple perspectives, focusing especially on neuroscience, behavioral neuroendocrinology, research on gender similarities and differences, research on the experiences of transgender individuals, and the developmental psychology underlying the psychological process of categorizing by gender.”

“For centuries, the treatment of individuals seeking assistance for mental health problems has been shaped by physicians’ and therapists’ belief in the gender binary (Brabender & Mihura, 2016). Treatment practices that are rooted in the gender binary persist, but they are under increasing scrutiny…”

“In 2015, the APA issued guidelines for psychological practice with transgender and gender-nonconforming people (APA, 2015). The overarching goal is practices that are affirming for transgender, nonbinary, and gender-nonconforming individuals... For example, one of the guidelines asserts that gender is a nonbinary construct and another recognizes fluidity in gender identity over development.”

“The gender binary may have especially serious consequences for the diagnosis and treatment of individuals who seek assistance for mental health issues related to gender/sex. Belief in the gender binary dictates that children should be encouraged to develop identities that fall into one of the two gender/sex categories: male or female. The matter is a highly contentious one in the United States; the last 10 years have seen divisive, protracted debates over diagnoses such as gender identity disorder and gender dysphoria, and their treatment…”

“Following from the expansive view of gender/sex, everyone, including children, should be able to express their felt gender identity. Furthermore, this approach should apply to individuals, including children, whose identities and behavior combine elements traditionally associated with masculinity and femininity as well as those who completely reject gender/sex as an organizing self-construct. For this to occur, it is important to view all individuals as belonging to a common human group that varies in quantitative ways along various gender-related dimensions (rather than as dichotomous groups that vary qualitatively from each other) and to advocate for societal changes aimed at expanding our views of gender/sex, to make space for all identities, expressions, and behaviors.”

http://www.academia.edu/37634758/The_Future_of_Sex_and_Gender_in_Psychology_Five_Challenges_to_the_Gender_Binary

Affirmative Practice With Transgender and Gender Nonconforming Youth: Expanding the Model

Affirmative care - in which the individual’s self-reported gender is respected, and in which they are given the safety and opportunity to explore their identity and expression - has been clearly demonstrated to show dramatic reductions in depression, anxiety, substance use, self-harm, as well as suicidal ideation and gestures. Research shows clear improvements in school/work performance, mental health, and positive outcomes.

Published in: Psychology of Sexual Orientation and Gender Diversity. 2016. Authors: Laura Edwards-Leeper, Scott Leibowitz, Varunee Faii Sangganjanavanich.

“Affirmative care with transgender and gender nonconforming (TGNC) children and adolescents… rests on a premise that appreciates diverse gender expressions and identities within society, and encourages the highest potential for individuals to follow their own paths to positive emotional well-being… Given the current deficits in scientific understanding of gender identity development in youth, the affirmative provider often faces decisions that are challenging, complex, and unclear. This paper describes the theoretical approaches to TGNC youth across development, provides a brief overview of the current research, and offers providers a way to conceptualize and provide care that can be both supportive and scientifically driven when done in a thoughtful, balanced way.”

“Providing affirmative care is important in offering these youngsters a sense of hope, an element that is all too often missing in their lives. Balancing the provision of such care with the complexities and challenges that exist need not be impossible, yet requires providers to be aware of their assumptions and biases, recognize the developmental considerations involved, advocate creatively in the face of many logistical barriers, work within the multiple perspectives of an interdisciplinary environment, and stay current with the evolving science of gender.”

https://www.apa.org/pubs/journals/features/sgd-sgd0000167.pdf

List of professional organisations opposing conversion or reparative therapy targeting transgender and gender non-conforming individuals

Published in: Medium.com. October 4, 2018. Author: Florence Ashley.

“The following list is a compilation of professional organisations which oppose conversion or reparative therapy targeting transgender and gender non-conforming individuals. The list does not include statements which do not clearly and explicitly prohibit practices targeting gender identity. As such, statements which only mention sexual orientation change efforts are not included. “

https://medium.com/@florence.ashley/list-of-professional-organisations-opposing-conversion-or-reparative-therapy-targeting-transgender-f700b4e02c4e