Trans Child

[kiwiwatermelonsugar]

I just need some advice and support on here.

My 15 year old daughter (I don't know if she's still that??) has literally just come out as trans this morning. Wants me to use He/They pronouns but I'm still struggling to come about how exactly I'm supposed to do that. I don't even get They pronouns at all. Or the idea of making pronouns seem like something huge anyway.

I'm just so confused because I thought I supported Trans people despite having some issues with women's voices being silenced over their rights but I'm just finding it so difficult when it's my own child. I never really expected it to be honest but I'm trying to sort myself out for when she comes home as she's currently revising with her friends.

She said she wants to start using a binder and wants to cut her hair and dress more masculine. I'm fine with the cutting of hair and dressing the way she likes but the binder thing worries me - surely that's dangerous, I mean kids have broken ribs and stuff if they're this young. Wants to start hormonal pills as well. 😥

I feel like she needs to wait till she's at least 18 because she's so young and decisions change so easily. But she wants to start now. She says she's been trans for about 3 months which is long enough to her but I don't think it is. I know it's selfish but I'm just mourning my little girl. I'm a single mum and I have 3 younger boys aged 9, 7 and 1 and there isn't really any family who can help me. I don't want to reveal to friends yet as I need time to process.

Absolutely what @TinyRebel said. Harsh but good advice. I would follow this advice to the letter, tbh.

Don't ever affirm her. Keep an eye on things socially, monitor the internet usage and if you feel mighty enough get involved with her school to see what rhetoric is out there.

I would recommend doing your own research. You should listen to trans stories and think about how delicate the situation is they’ll be listening to everything you say and be able to feel how much you are trusting them with their identity. Saying it’s a trend/phase to them won’t convince them otherwise either they’ll do it alone or wait and do it with out you.

This site is known in LGBTQ communities for been anti trans and you should honestly try to figure out why and see if there’s truth to it.

Binders are safe if used for less then 12 hours a day it’s unsafe for them to use DIY one as it affects breathing. If you start on the path to hormones the waiting list is so long I would start worrying about it for until they’re 19.

Doing your own research is sensible advice. And telling a child direct to their face that something is a phase could be patronising or insensitive no matter the topic, so that is also fair advice.

However, if you listen to ‘trans stories’ then I would include in that detransitioner stories.

As for binding, I don’t see how anyone could think this was a good idea, especially for a young developing body.

This site has sections on both detransition and binding (scroll down fo full list of topics): https://statsforgender.org/

Reposting my earlier comment to note that evidence suggests DIY binding actually has fewer adverse effects than commercial binders.

All binding is likely to have adverse effects, of course. But its important to look for the best available evidence.

Edit for typos

I would give any person stating that binding is “Binders are safe if used for less then 12 hours a day”.

This goes against the studies that have been done. This is misinformation.

And as to whether MN is ‘anti-trans’, that is your own prejudiced view. If you cannot back it up with evidence, it also amounts to misinformation.

Spreading misinformation to parents of children and adolescents who have issues that need to be explored around gender is very harmful.

Readers please note that this study was done with adults!

That anyone would imagine that children and adolescent female people would have a better result is quite concerning . That anyone dismisses this study should be scrutinised.

The studies recommend not wearing it consistently for more then six hours in a day 8 hours is considered a maximum (although people I’ve known had binded longer and told me it’s fine but they do continuous stretching as they work from home): https://www.rainbow-project.org/safe-binding-and-packing/#:~:text=You%20should%20avoid%20wearing%20a,out%20your%20muscles%20and%20chest.

I never said Munster was transphobic I just said that the community that this mums child is apart of does see it as so. If you look up is Mumsnet transphobic it is a fact that LGBTQ communities see it as such.

That is an article. It's not a 'study'.

It's from an organisation that was set up to help gay men.

so no evidence of transphobia then? Just you warning parents seeking support that people here are not to be trusted despite many of us having been in similar situations because the advice given and resources suggested strive for balance rather than using the resources and the affirming only nature of other site and support groups?

All because why? Why do you wish to issue such a warning? When the prevailing advice given is read widely and do the in-depth research for yourself, don’t just assume that a group supposedly created to support children and teens will give balanced and unbiased information?

The ‘community this mum’s child is part of’ is the same ‘community’ many of our children are ‘part of’. The person who seems to have prejudice here is you.

Further note - the links in the article posted by 'Helpingmom' are to commercial companies selling binders, who may not be the best source for unbiased information.

Ignore this.

thing that are common held beliefs on this site is that being trans is a social contagion. The paper that states this has some of the worst research where they seeked parents disapproving of their children being trans and asked if it came out of nowhere and of course they said yes. Here’s the article that tried to prove it: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330
the journal as apologised for this article
but if that’s not enough here some people showing the malpractice: https://www.scientificamerican.com/article/evidence-undermines-rapid-onset-gender-dysphoria-claims/?amp=true

the fear of de transitioning is also wildly overblown 3% of trans people de transition that includes social and surgical and most of them do so because of discrimination or money.

these is a myths that is constantly pedalled here in an echo chamber doesn’t make an individual transphobic but willingness to ignore actual information and how one site has a different view to most medical bodies show that there is a want to believe in it to justify not having trans people. It is easier to say no and force a topic to not come up again until it to late for you to have an input then to adapt and accept.

just because you are the parent of a gay or trans person or even if you are yourself you can still be transphobic hard to believe but if you talk to a racist they eventually find a black person who like being a slave.

Your stats are nonsense. It's more like 50 to 60% who detransition not that you'd ever know as for some reason noone can explain medical supervision and long term studies are not done on trans surgery.
Maybe you should ask yourself who the people are advocating for young people to be sterilised, little hint it's not gc terfs.

these is a myths that is constantly pedalled here in an echo chamber

Mate, I cannot even understand what you are trying to say here.

"the fear of de transitioning is also wildly overblown 3% of trans people de transition that includes social and surgical and most of them do so because of discrimination or money."

You seem to have no real evidence for anything you are posting. Again, spreading misinformation is very harmful and you are here doing it.

Here is a new study on a small sample of trans patients and the standard of care.

www.mdpi.com/2227-9032/10/1/121/htm

A few things stand out.
-the number of patients with underlying mental health issues. And how they are being completely let down by affirming only treatment.

-The number of visits before receiving hormones was 2.7 appointments.

-67 patients average age 27.8 years -range was 12- 54
-42 females, 22 males, four NB (3 f / 1 m)
-Female mean age is 18 years, male 23 years.
-Out of the 67, only 9 (13%) had NO mental health diagnosis. 10 (15%) had diagnosed ASD, 4 with ADHD (6%), 3 (4%) with OCD, 1 with Bipolar, 7 (10%) with a Personality Disor

The rate of detransition amongst those who had received at least hormones was 9.8%. This is in line with the European study below which showed a long term detransition rate of medicalised transitioners of males 8.8% and females 8.3%.

From this study

Nine patients had stopped hormone therapy; one related to practice policy because they had not attended any GIC follow-up (the patient has restarted since the audit). Thus, eight patients had stopped hormones voluntarily (20% stopping rate; six trans men, two trans women).

This is the other study with the figures 8.8% & 8.3%:

//www.ncbi.nlm.nih.gov/pmc/articles/PMC5580378/

135 natal males (119 living in the female role, 12 in the male role, 4 did not report their current gender role) and 66 natal females (60 living in the male role, 5 in the female role, 1 did not report a current gender role)

So... 8.88% of males and 8.33% of the females (this does not include those who did not answer the question which if the answer was to detransition would make these figures higher). And in Figure 3. 22.2% of those who socially transitioned, detransitioned.

What is interesting to note is that there are now studies who have published averages of time to detransition. This varies but is usually around 7+ years ( I will go and find the study). It is only from NOW that we are going to be able to identify the detransition rate of the clearly seen 'bulge' of adolescent teenaged female patients who transitioned in that bulge.

Here is Dr Az Hazeem saying he had about 26% of his patients regretted transitioning.

https://www.dailymail.co.uk/news/article-12623643/Being-trans-non-binary-new-sub-culture-risk-raising-nation-chemically-castrated-children-Doctor-spent-12-years-working-vulnerable-teens-Tavistock-warns-gender-ideology.html

He said 26 per cent of his patients at the Tavistock and Portman regretted transitioning.

Would you like to post the source of your 3% figure please? It is not one that I have seen before. I would like to see the study it was derived from.

"just because you are the parent of a gay or trans person or even if you are yourself you can still be transphobic hard to believe but if you talk to a racist they eventually find a black person who like being a slave".

And you have just politicised a group's racial heritage to make your point to shame others who disagree with you on the internet.

Well done you!

"these is a myths that is constantly pedalled here in an echo chamber doesn’t make an individual transphobic but willingness to ignore actual information and how one site has a different view to most medical bodies show that there is a want to believe in it to justify not having trans people. It is easier to say no and force a topic to not come up again until it to late for you to have an input then to adapt and accept."

So, you are the person who has jumped onto a thread to shame other posters and you are now saying that this site is not just transphobic, but an echo chamber. On a thread meant to support someone, you have pushed your own deeply prejudiced beliefs.

If you cannot see the hypocrisy of that, I don't know what anyone can say.

Not only that, you have resorted to more falsity and a cognitive distortion in now positioning posters on MN as justifying 'not having trans people'. It seems your every post is just more misinformation and more deeply entrenched prejudice.

Now, to address your false point about 'different view to most medical bodies', I will start to post some links so that others can read and make the decision for themselves. But I suggest you either start posting evidence that is helpful to the OP and those reading, or you start your own thread and stop making this thread about your own hatred.

There is no such thing as a “trans” child. There are a small number of children who have gender dysphoria. Most of these will become less dysphoric as they go through puberty.

The Dutch Model is falling apart

By Stella O'Malley / 2 January 2023

First, Stella O’Malley writes about an article in Nederlands that is throwing a great deal of light on the Dutch Protocol. It also seems that there will be a review of the patients that the Dutch team had not previously included in their papers.

This article in the Nederlands points out the dangers on only using a nation’s own sources with no international input or even wide review.

genspect.org/the-dutch-model-is-falling-apart/

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Then SEGM has published on Colin Wright’s substack a version of their previously published article.

5 False Assumptions Behind Youth Gender Transitions

2nd Jan 2023

www.realityslaststand.com/p/5-false-assumptions-behind-youth

Here is the original

segm.org/false-assumptions-gender-affirmation-minors

( segm.org )

[This reviewed Stephen M. Rosenthal‘s paper in Nature, 10 August 2021:

“Challenges in the care of transgender and gender-diverse youth: an endocrinologist’s view”

www.nature.com/articles/s41574-021-00535-9 ]

The five unproven assumptions are:

Unproven Assumption 1: Gender identity, which underlies gender dysphoria, is a fundamental personal characteristic that is biologically “ingrained.”

Unproven Assumption 2: The sharp rise in the number of youth presenting with gender dysphoria does not signal a true increase in cases—it’s merely better detection.

False Assumption 3: Medical interventions in gender-dysphoric minors have clear eligibility criteria.

False Assumption 4: Medical interventions for gender dysphoric minors have been demonstrated to be safe and effective.

Unproven Assumption 5: Detransition does not represent medical harm and is rare.

This has then had quite a few interesting links.

www.tandfonline.com/doi/full/10.1080/0092623X.2022.2160396?src=

Some Limitations of “Challenges in the Care of Transgender and Gender-Diverse Youth: An Endocrinologist’s View”

from J. Cohn, Published online: 24 Dec 2022

Abstract:

There is significant disagreement about how to support trans-identified or gender-dysphoric young people. Different experts and expert bodies make strikingly different recommendations based upon the same (limited) evidence. The US-originating “gender-affirmative” model emphasizes social transition and medical intervention, while some other countries, in response to evidence reviews of medical intervention outcomes, have adopted psychological interventions as the first line of treatment. A proposed model of gender-affirming care, comprising only medical intervention for “eligible” youth, is described in Rosenthal (2021). Determining eligibility for these medical interventions is challenging and engenders considerable disagreement among experts, neither of which is mentioned. The review also claims without support that medical interventions have been shown to clearly benefit mental health, and leaves out significant risks and less invasive alternatives. The unreliability of outcome studies and the corresponding uncertainties as to how gender dysphoria develops and responds to treatment are also unreported.

This has many other links to follow.

_

Here is another study:

The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed

E. Abbruzzese, Stephen B. Levine, Julia W. Mason

www.tandfonline.com/doi/full/10.1080/0092623X.2022.2150346

Our analysis of the Dutch protocol has been written with three goals in mind. First, we wanted to definitively refute the claims that the foundational Dutch research represents “solid prospective research” that provides reliable evidence of net benefits of youth gender transition. In fact, it is much better described as case series—one of the lowest levels of evidence available (Dekkers et al., Citation2012, Mathes & Pieper, Citation2017). Second, we aimed to demonstrate that the type of non-comparative, short-term research that the gender medicine establishment continues to pursue is incapable of generating reliable information. And third and most importantly, we wanted to remind the medical community that medicine is a double-edged sword capable of both much good and much harm. The burden of proof—demonstrating that a treatment does more good than harm—is on those promoting the intervention, not on those concerned about the harms. Until gender medicine commits to conducting high quality research capable of reliably demonstrating the preponderance of benefits over harms of these invasive interventions, we must be skeptical of the enthusiasm generated by headlines claiming that yet another “gender study” proved benefits of transitioning youth. This time-honored concern about risk/benefit ratio is a sobering reminder that the history of medicine is replete with examples of “cures” which turned out to far more harmful than the “disease.”

Then there was this review of US Military health insurance records for transition persistence.

academic.oup.com/jcem/article-abstract/107/9/e3937/6572526?redirectedFrom=fulltext&login=false

”Continuation of Gender-affirming Hormones Among Transgender Adolescents and Adults”

Christina M Roberts,
David A Klein, Terry A Adirim,
Natasha A Schvey, Elizabeth Hisle-Gorman

22 April 2022

Results
The study sample included 627 transmasculine and 325 transfeminine individuals with an average age of 19.2 ± 5.3 years. The 4-year gender-affirming hormone continuation rate was 70.2% (95% CI, 63.9-76.5). Transfeminine individuals had a higher continuation rate than transmasculine individuals 81.0% (72.0%-90.0%) vs 64.4% (56.0%-72.8%). People who started hormones as minors had higher continuation rate than people who started as adults 74.4% (66.0%-82.8%) vs 64.4% (56.0%-72.8%). Continuation was not associated with household income or family member type. In Cox regression, both transmasculine gender identity (hazard ratio, 2.40; 95% CI, 1.50-3.86) and starting hormones as an adult (hazard ratio, 1.69; 95% CI, 1.14-2.52) were independently associated with increased discontinuation rates.

Note here the 'discontinuation rate'!

the NICE finding

arms.nice.org.uk/resources/hub/1070905/attachment

The summary of the conclusion is

Conclusion
The results of the studies that reported impact on the critical outcomes of gender dysphoria and mental health (depression, anger and anxiety), and the important outcomes of body image and psychosocial impact (global and psychosocial functioning), in children and adolescents with gender dysphoria are of very low certainty using modified GRADE. They suggest little change with GnRH analogues from baseline to follow-up.

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This is a report on The Swedish changes - based on lack of evidence.

genderreport.ca/the-swedish-u-turn-on-gender-transitioning/

_

Australia and NZ College of Psychiatrists publish a warning there is not enough evidence.

//www.ranzcp.org/news-policy/policy-and-advocacy/position-statements/gender-dysphoria

The Royal Australian and New Zealand College of Psychiatrists have now updated their guidance.

They are now warning that there is NOT ENOUGH evidence to recommend affirming only treatments or indeed any particular treatment plan. They now say that underlying health issues should be treated at the same time. And warn that medicalisation of children and teens be very careful and thoroughly explored considering the ‘paucity’ of evidence at this time.

Interestingly, they indicate that there are a couple of long term studies under way which will be interesting to see when they are published. One is a longitudinal study on trans patients in Australia.
_

The Cass Review Interim Report - stating there is not enough evidence!

cass.independent-review.uk/wp-content/uploads/2022/03/The-Cass-Review-Interim-Report-Final-Bookmarked.pdf

_

A treasure trove of studies relating to whether there is conclusive improvement to transgender people's lives after medicalised treatment paths can be found in this Medium article by JLCederblom

medium.com/@JLCederblom/the-lukewarm-perjury-of-jack-turban-a85903109051

There is an abridged version as well.

It is actually a run down of the evidence presented by Jack Turban's Declaration in Support of Plaintiff's Motion for a Preliminary Injunction in Brandt et al vs Rutledge et al in the US District Court for the Eastern District of Arkansas.

In it is this review listed as footnote 15. Baker, K. E., et al, (2021) Hormone Therapy, Mental Health and Quality of Life Among Transgender People: A Systematic Review. Journal of the Endocrine Society.

academic.oup.com/jes/article/5/4/bvab011/6126016

I was interested particularly in this finding.

Quality of Life

Among adolescents, a mixed-gender prospective cohort (n = 50) showed no difference in QOL scores after a year of endocrine interventions, which included combinations of GnRH analogues and estrogen or testosterone formulations [30]. No study found that hormone therapy decreased QOL scores. We conclude that hormone therapy may improve QOL among transgender people. The strength of evidence for this conclusion is low due to concerns about bias in study designs, imprecision in measurement because of small sample sizes, and confounding by factors such as gender-affirming surgery status.

And this under Depression

Among adolescents, 2 mixed-gender prospective cohorts (n = 50 and n = 23, respectively) showed improvements in depression scores after 1 year of treatment with GnRH analogues and estrogen or testosterone formulations (both P < 0.001) [30, 38]. Another prospective study reported that BDI scores improved almost by half among adolescents (n = 41) after a mean of 1.88 years of treatment with GnRH analogues to delay puberty (P = 0.004) [34]. The overall improvement after several subsequent years of testosterone or estrogen therapy in this cohort (n = 32) was smaller, however, resulting in no significant change from baseline [35]. No study found that hormone therapy increased depression.

Anxiety

Among adolescents, 1 prospective study saw mean anxiety scores in a mixed-gender group (n = 23) improve from 33.0 ± 7.2 to 18.5 ± 8.4 after 1 year (P < 0.001) [38], but another reported no changes in anxiety after approximately 2 years of puberty delay treatment with GnRH analogues and 4 years of hormone therapy (n = 32) [35].

Suicide

The risk of bias for this study was serious due to the difficulty of identifying appropriate comparison groups and uncontrolled confounding by surgery status and socioeconomic variables such as unemployment. We cannot draw any conclusions on the basis of this single study about whether hormone therapy affects death by suicide among transgender people.

_

think it is a good short explainer on why affirming only is problematic.

www.smh.com.au/national/nsw/now-i-m-hopeful-we-can-we-talk-about-teens-and-gender-20211031-p594q6.html

Now I’m hopeful we can talk about teens and gender

Dr Sandra Pertot

I found this very clear as an explanation

Although there is agreement across all clinicians working with gender-questioning adolescents that they typically report a history of mental health problems, increasingly some clinicians will consider the possibility that the client has come to the belief they are transgender as a way of providing an explanation for and resolving their pre-existing problems. In my experience, gender-affirming therapists strongly disagree, believing that anything other than immediately affirming the client’s expressed belief they are transgender will compound the harm. My view is that it is precisely because of the high rate of mental health problems in this group that a careful and comprehensive mental health assessment is required as a first step. Shepherding all of these vulnerable young people down the same pathway is poor clinical practice.

New FDA warning for Puberty Blockers:

publications.aap.org/aapnews/news/20636/Risk-of-pseudotumor-cerebri-added-to-labeling-for?autologincheck=redirected

The Food and Drug Administration (FDA) has added a warning about the risk of pseudotumor cerebri (idiopathic intracranial hypertension) to the labeling for gonadotropin-releasing hormone (GnRH) agonists that are approved for the treatment of central precocious puberty in pediatric patients. These products include Lupron Depot-Ped (leuprolide acetate), Fensolvi (leuprolide acetate), Synarel (nafarelin), Supprelin LA (histrelin) and Triptodur (triptorelin).

The new warning includes recommendations to monitor patients taking GnRH agonists for signs and symptoms of pseudotumor cerebri, including headache, papilledema, blurred or loss of vision, diplopia, pain behind the eye or pain with eye movement, tinnitus, dizziness and nausea.

And

Six cases were identified that supported a plausible association between GnRH agonist use and pseudotumor cerebri. All six cases were reported in birth-assigned females ages 5 to 12 years. Five were undergoing treatment for central precocious puberty and one for transgender care. The onset of pseudotumor cerebri symptoms ranged from three to 240 days after GnRH agonist initiation.

Why is this one so important? Because there are still support groups who tell parents that puberty blockers are 'safe and reversible'. Again, misinformation like that is so fucking harmful to children.

Something about 'social contagion'

jamanetwork.com/journals/jamanetworkopen/fullarticle/2768726

July 28, 2020

Association of Media Coverage of Transgender and Gender Diverse Issues With Rates of Referral of Transgender Children and Adolescents to Specialist Gender Clinics in the UK and Australia

Ken C. Pang, PhD Nastasja M. de Graaf, MSc; Denise Chew, MD;

Question
Is media coverage of transgender issues associated with referrals of transgender and gender diverse (TGD) children and adolescents to specialist gender services?

Findings
In this serial cross-sectional study across an 8-year study period during which more than 5000 TGD young people were referred to 2 pediatric gender clinics in the UK and Australia, a significant association was found between weekly referral rates and the number of TGD-related items appearing within the local media 1 to 2 weeks beforehand, for the UK only in week 1 and for Australia only in week 2.

Meaning
An increase in media coverage of TGD-related topics over recent years was associated with an increase in the number of TGD young people presenting to 2 gender clinics on opposite sides of the world.

However, we are also mindful that others have speculated that increased media content (specifically via social media) might act as a double-edged sword or a means of social contagion, whereby some individuals erroneously come to believe through exposure to such media that their nonspecific emotional or bodily distress is due to gender dysphoria and being TGD

This study has limitations. Our data provide evidence of an association between relevant media stories and clinical referrals of TGD young people but, given the nature of the study design, no indication of causation. Moreover, our study weighted each media item equally (despite likely differences in reach and accessibility) and was unable to quantify actual levels of media exposure among referred patients. Another limitation is that this association might not generalize to other services. After all, the RCHGS and GIDS were chosen for this study because they are publicly funded, do not charge attendance fees, and provide the only specialist pediatric gender services within their respective regions, thus ensuring that their referral data are likely to be relatively comprehensive and complete accounts of clinical demand within each catchment area; most other pediatric gender clinics will not share these same characteristics. Another important limitation of our study is that it only examines traditional forms of media and does not include social media, which are a very important source of information as well as a critical means for finding support and fostering connectedness and community among young people, including TGD adolescents.32-35 Social media were not examined in our study given the difficulties of readily accessing such information across time, but in the future, collaborations with relevant social media companies, such as Facebook, might allow us to address this gap.

Additionally on social contagion:

This document contains some important information. One of which is that even in 2018, Polly Carmichael recognised there was social contagion.

March 2018: Polly Carmichael had told an ACAMH conference:
“without a doubt there are some young people who are finding a community, friends and all sorts of things through joining a group who have an interest around gender and I think that for some of those we would be very foolish not to acknowledge that it's probably the case that they are caught up in something rather than it being an expression of something that has arisen from within. So there is a lot of concern.”

“I have been shocked by some of the things that are swilling around the internet that young people have access to. There are numerous groups on Reddit and Tumblr that many of the young people that are attending our service are going onto..maybe it's also the dissing of expertise, in a way, so that there is a feeling that this is about who I am, so what does anyone else know? It's a very odd situation in some way.`”

www.transgendertrend.com/wp-content/uploads/2023/03/Medical-Scandal-at-the-Tavistock.pdf

How bizarre that even POLLY CARMICHAEL has said there is an issue. Yet, 'helpingmom' posts one paper to refute it. Maybe helpingmom doesn't realise that Carmichael was the medical director of the gender identity clinics in the UK.

This study is well worth a read. It is about the harmful influence of people who are supposed to be supporting these vulnerable children and teens and how groups and individuals who are politically motivated are causing harm through their lack of balance and evidenced discussions with those patients.

journals.sagepub.com/doi/full/10.1177/26344041211010777

Published April 22, 2021
Kasia Kozlowska, Georgia McClure et al

Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service

Part of the conclusion

Our findings indicate that engagement with families, a trauma-informed model of mental health care, and ongoing discourse pertaining to the effects of unresolved trauma and loss need to be part of all gender dysphoria clinics and the services with which they collaborate. Because of their impact on subjective well-being and the development of the self, specific loss and trauma events present crucial opportunities for both long-term psychotherapy and more immediate, targeted treatments. The move to a more comprehensive, holistic model of care—one that takes into account the individual’s developmental history and the experiences that make up that history—has also been echoed in the work of other clinician-researchers (D’Angelo, 2020a; Entwistle, 2019; Giovanardi et al., 2018; Kozlowska et al., 2021; Williamson, 2019).

Our study found that the children and families who came to the clinic had clear, preformed expectations: most often, children and families wanted a diagnosis of gender dysphoria to be provided or confirmed, together with referral to endocrinology services to pursue medical treatment of gender dysphoria. Parents (vs. children) also largely came with the same expectations, though they were more likely to be interested in incorporating holistic (biopsychosocial) elements, including treatment of mental health comorbidities, family support/therapy, and long-term psychotherapy for the child. It was our impression that these expectations had been shaped by the dominant sociopolitical discourse—the gender affirmative model. It will be interesting to track the expectations of children and families in the years to come as sociopolitical discourses become more varied and diverse and as the voices are heard of both those who have done well and those who not done well via the medical pathway.

Our study also found that despite the high rates of family conflict, relationship breakdowns, parental mental illness, and maltreatment (see Table 3)—and our own clinical perspective that both individual and family work were indicated for the majority of families—few families rated themselves as being in a clinically severe range on self-report (SCORE-15). Coupled with the dominant sociopolitical discourse—the gender affirmative model that prioritizes the medical treatment pathway—it is not surprising that the large majority of children and families were not motivated to engage in or to remain engaged in ongoing therapy. These data bring three important phenomena into focus. First, when children and families were given the space and structure to tell the child’s developmental story—nested in the story of the family—they were able to identify and provide a detailed narrative of the key issues that had contributed to the child’s presentation and distress. Without this space and structure, the issues remain undeclared and unaddressed. Second, some families—but also some clinicians—function within a non-holistic (non-biopsychosocial) framework where the child’s developmental experiences are disconnected from their clinical presentation. This non-holistic framework is likely to promote a healthcare delivery model that dehumanizes the child (by not examining the child’s and family’s lived experience) and that promotes medical solutions (correcting the identity/body mismatch) for a problem that is much more complex. Third, as noted earlier, our experience suggests that, insofar as the gender affirmative model is taken as equivalent to medical intervention, clinicians (including ourselves) who work in gender services are coming under increasing pressure to put aside their own holistic (biopsychosocial) model of care, and to compromise their own ethical standards, by engaging in a tick-the-box treatment process. Such an approach does not adequately address a broad range of psychological, family, and social issues and puts patients at risk of adverse future outcomes and clinicians at risk of future legal action.

Sinead Watson detransitioned and is now sterile and has to live with chronic pain. My cousin's non-binary daughter is in a wheelchair. I would rather have a healthy daughter who hated me than collaborate in their self-destruction