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.

These links cover multiple issues. Including desistance AND detransition rates.

Again figures that are certainly higher than 3% and as this is another 'long term' study it does NOT even scratch the surface of the bulge years that we have right now with the significant change in the demographics of the adolescent transitioners being now the majority female versus the past.

And again, a note to readers, that no study has yet been done by any supportive trans group such as mermaids or anyone like that as to WHY that change has occurred. Why is that? Who benefits from not having this issue studied?

Doctor scrutiny on gender clinic reveals legal and safety fears

The Australian , Natasha Robinson, 17th February 2023

www.theaustralian.com.au/science/doctor-scrutiny-on-gender-clinic-reveals-legal-and-safety-fears/news-story/8af81768fde27884caf18fff345ab78a?amp&nk=251396453faa0730705a45251160583c-1676662448

(Plug the above link into archive dot ph)

Senior physicians at the NSW Children’s Hospital Westmead’s gender clinic have studied the physical and mental health of 79 patients in a rare academic study of the outcomes of children who presented with gender distress and gender dysphoria. The findings cast doubt on the scientific basis of the gender-affirming approach followed by the nation’s other children’s hospitals.

In an open access academic paper, CHW psychiatrists, endocrinologists and other physicians, and a senior medical ethics expert, called for a “much more nuanced and complex approach” as analysis revealed 88 per cent of children presenting at Westmead’s gender clinic had at least one co-morbid mental health condition, with more than 50 per cent diagnosed with behavioural disorders or autism. One in five children who consulted the clinic with gender-related distress later had these feelings resolved, and almost one in 10 with a formal diagnosis of gender dysphoria, some who had taken puberty blockers and cross-sex hormones, later discontinued transitioning.

And

The CHW doctors have raised concerns that “many unknowns remain” regarding the long-term effects of puberty blockers, which are described by the Royal Children's Hospital Melbourne as “reversible in their effects”. International evidence is in fact casting greater doubt on whether the effects of these medications are reversible. Endocrine reviews of the CHW patient cohort documented side-effects in 23 of the 49 young people prescribed puberty blockers, including low bone density, hot flushes, weight gain and anxiety. The CHW doctors raised concerns about long-term effects on patients’ sexual function in adulthood.

Within the 9 per cent cohort of patients with a diagnosis of gender dysphoria who had desisted – that is, discontinued the transgender pathway 4-9 years after consulting the gender clinic – three had undergone puberty suppression beginning at the average age of 12. Three had taken cross-sex hormones, one from as young as 15, but not prescribed by CHW. The effects of cross-sex hormones, including infertility, are irreversible.

This is the study

Distress: A Prospective Follow-Up Study

by Joseph Elkadi, Catherine Chudleigh, Ann M. Maguire, Geoffrey R. Ambler, Stephen Scher and Kasia Kozlowska

www.mdpi.com/2227-9067/10/2/314

This prospective case-cohort study examines the developmental pathway choices of 79 young people (13.25–23.75 years old; 33 biological males and 46 biological females) referred to a tertiary care hospital’s Department of Psychological Medicine (December 2013–November 2018, at ages 8.42–15.92 years) for diagnostic assessment for gender dysphoria (GD) and for potential gender-affirming medical interventions. All of the young people had attended a screening medical assessment (including puberty staging) by paediatricians. The Psychological Medicine assessment (individual and family) yielded a formal DSM-5 diagnosis of GD in 66 of the young people. Of the 13 not meeting DSM-5 criteria, two obtained a GD diagnosis at a later time. This yielded 68 young people (68/79; 86.1%) with formal diagnoses of GD who were potentially eligible for gender-affirming medical interventions and 11 young people (11/79; 13.9%) who were not. Follow-up took place between November 2022 and January 2023. Within the GD subgroup (n = 68) (with two lost to follow-up), six had desisted (desistance rate of 9.1%; 6/66), and 60 had persisted on a GD (transgender) pathway (persistence rate of 90.9%; 60/66). Within the cohort as a whole (with two lost to follow-up), the overall persistence rate was 77.9% (60/77), and overall desistance rate for gender-related distress was 22.1% (17/77). Ongoing mental health concerns were reported by 44/50 (88.0%), and educational/occupational outcomes varied widely. The study highlights the importance of careful screening, comprehensive biopsychosocial (including family) assessment, and holistic therapeutic support. Even in highly screened samples of children and adolescents seeking a GD diagnosis and gender-affirming medical care, outcome pathways follow a diverse range of possibilities.

Conclusions

The data from this study show that when young people with gender distress present to health services seeking medical interventions, they end up following a diverse range of developmental pathways. The availability of gender-affirming medical interventions for the treatment of gender dysphoria is a recent one, evolving from the work of clinicians in the Netherlands. Early studies have suggested that medical interventions were associated with positive outcomes. This early body of work consequently served as the foundation for subsequent treatment guidelines and became established in medical systems via streamlined assessment processes and treatment pathways. The concept of medical affirmation was embedded in the broader culture by media and internet channels.

Together, these processes gave young people with gender-related distress a clear message: “This is the best way to proceed,” and “The medical affirmation pathway will take away your gender dysphoria.” For many young people and their families, however, these messages favouring medical interventions, coupled with professionals’ affirmation of this pathway, potentially displaced their consideration of other options or other pathways.

The young people and families who presented to our service typically came to us with settled ideas concerning their prospective treatment pathways. In particular, based on what was known at the time, and given the severity of the young persons’ distress, they and their families considered medical treatment for gender dysphoria to be the single best option. In the last five years, however, the gender-affirming medical model has been questioned by both clinicians (who have highlighted the current lack of a solid evidence base and detransitioners (who have highlighted the potential for adverse outcomes). The current evidence suggests the need for a much more nuanced and complex approach. As research data pertaining to long-term outcomes continues to accumulate, “the best way to proceed” is likely to be seen as ranging over a much more diverse range of treatment options and pathways, with each supported by a stronger evidence base than is currently available.

Sinead recently posted that her testosterone levels are still in the male range four or five years after she stopped testosterone injections.

This is something I have never seen discussed at all. It is hugely concerning for her long term health.

Here are some more links:

An article in the Washington Post from Dr Laura Edwards-Leeper & Erica Anderson

(Note: Dr Anderson is a male transitioner who is also a gender clinician)

“ I think this is a bad idea in 99% of circumstances. Professionals who know what they’re doing should be involved; and by not including parents, it ultimately makes the situation worse for the kid (unless the parent is abusive- that’s the 1%). I’ve actually never seen this go well”

www.washingtonpost.com/outlook/2021/11/24/trans-kids-therapy-psychologist/

mobile.twitter.com/drlaurael/status/1462968319636480004

The Washington Post article points out that many clinicians are not following the WPATH guidelines of comprehensive assessment and rmental health support.

The standards of care recommend mental health support and comprehensive assessment for all dysphoric youth before starting medical interventions. The process, done conscientiously, can take a few months (when a young person’s gender has been persistent and there are no simultaneous mental health issues) or up to several years in complicated cases. But few are trained to do it properly, and some clinicians don’t even believe in it, contending without evidence that treating dysphoria medically will resolve other mental health issues. Providers and their behavior haven’t been closely studied, but we find evidence every single day, from our peers across the country and concerned parents who reach out, that the field has moved from a more nuanced, individualized and developmentally appropriate assessment process to one where every problem looks like a medical one that can be solved quickly with medication or, ultimately, surgery. As a result, we may be harming some of the young people we strive to support — people who may not be prepared for the gender transitions they are being rushed into.

_

Gender-Affirming Treatment of Gender Dysphoria in Youth: A Perfect Storm Environment for the Placebo Effect—The Implications for Research and Clinical Practice

Alison Clayton. 14 November 2022

Introduction

In the last decade, there has been a rapid increase in the numbers of young people with gender dysphoria (GD youth) presenting to health services (Kaltiala et al., 2020). There has also been a marked change in the treatment approach. The previous “common practice” of providing psychosocial care only to those under 18 or 21 years (Smith et al., 2001) has largely been replaced by the gender affirmative treatment approach (GAT), which for adolescents includes hormonal and surgical interventions (Coleman et al., 2022). However, as a recent review concluded, evidence on the appropriate management of youth with gender incongruence and dysphoria is inconclusive and has major knowledge gaps (Cass, 2022). Previous papers have discussed that the weaknesses of the studies investigating the efficacy of GAT for GD youth mean they are at high risk of bias and confounding and, thus, provide very low certainty evidence (Clayton, 2022a, b; Levine et al., 2022). To date, however, there has been little discussion of the inability of these studies to differentiate specific treatment effects from placebo effects. Of note, the term “placebo effect” is no longer used to just simply refer to the clinical response following inert medication; rather, it describes the beneficial effects attributable to the brain-mind responses evoked by the treatment context rather than the specific intervention (Wager & Atlas, 2015). This Letter argues that the current treatment approach for GD youth presents a perfect storm environment for the placebo effect. This raises complex clinical and research issues that require attention and debate.

Sections include:

A Brief Introduction to the Gender-Affirming Treatment Model for Children and Adolescents with Gender Dysphoria

Risks of Gender-Affirming Medical and Surgical Treatments

A Recent Example from Medical History of the Dangers of Medical Advice Based on Weak Evidence: The Iatrogenic Tragedy of Prone Infant Sleep Position and Sudden Infant Death Syndrome

Gender-Affirming Treatment for Youth with Gender Dysphoria: A Perfect Storm for Placebo Effect

Overstatement of the Certainty of Benefits and Under-Acknowledgment of Risks

The Dangers of an Exaggerated Suicide Narrative

An Excessively Negative Portrayal of the Previous Standard and Current Alternative Treatment Options

Clinicians’ Media and Social Media Promotion of Gender Affirmative Treatment

The Exclusive Promotion of Gender-Affirming Treatments within Child and Adolescent Gender Clinics

Conclusion

In conclusion, this Letter has noted that although GAT for GD youth lacks a rigorous evidence base, it is undertaken as routine medical treatment in a strongly placebo effect enhancing environment. It is within this environment that research into its effectiveness is being undertaken. One consideration raised by this relates to clinical practice: When does such a strongly placebo effect enhancing environment meet optimal clinical practice standards? When, if at all, does it veer into the territory of unethical practice that involves deception and undue influence? This Letter has also highlighted that such a placebo effect enhancing environment presents grave problems for research (particularly non-DBRCT research). It seems unlikely that the current research being undertaken in this field will be able to untangle benefits that are due to the placebo effect from those due to the interventions’ specific effectiveness. Thus, especially given the adverse risk profile of the hormonal and surgical interventions, it may be that yet again well-intentioned physicians are engaging in medical practices that cause more harm than benefit (Clayton, 2022b). The research and clinical conundrums presented in this Letter have no easy answers. However, as a first step, there is an urgent need for more awareness of the placebo effect and for rigorous and thoughtful debate over how best to proceed in research and clinical practice in this area of medicine.

link.springer.com/article/10.1007/s10508-022-02472-8

_

Bone density issues caused by GnRH

Bone Health in the Transgender Population
Published online 2019 Jul 2.

Micol S. Rothman and Sean J. Iwamoto

www.ncbi.nlm.nih.gov/pmc/articles/PMC6709704/

This

Also unknown are the long-term effects of puberty blockade, the effect of changes in body composition and the optimal type, timing, dosage, and route of administration of GAHT for bone outcomes.

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.

And

GnRH analogues are frequently employed to provide puberty blockade in adolescents with gender incongruence or gender dysphoria. From their use in other medical conditions such as prostate cancer, their deleterious effects on the bone are well known, although these have the potential to be reversible if treatments are stopped or add back therapies can be given

And

However, Z-scores in the trans boys also showed an expected drop during GnRHa treatment. Similarly, they did not fully make up their bone loss as Z-scores at age 22 were still lower than baseline

Meaning, the authors acknowledge little is known about the lasting effects of puberty blockers. In this study, they propose some positive effect from cross sex hormones for females but ths results show that it doesn’t really make up the loss from puberty blockers.

PLUS

Just adding this piece about bone density for young transitioners here:

segm.org/the_effect_of_puberty_blockers_on_the_accrual_of_bone_mass

1st May 2021

Dr Michael Biggs (an advisor to SEGM) has been calling for the release of data from the Tavistock’s experiment since 2019. A subset of the data were finally released following the judicial review into puberty suppression at the Tavistock clinic. Biggs’ reanalysis has just been published in the Journal of Paediatric Endocrinology and Metabolism. It finds that after two years on GnRHa, the Z-scores for a significant minority of the children had declined to a level that should trigger clinical concern.

The discredited study where a Yale researcher tried to convince the world that gender treatments improve mental health of transitioners.

https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19010080

https://www.thepublicdiscourse.com/2020/09/71296/?fbclid=IwAR1qhY36S81bxLIL-Gm04MemcwA8R0OBpG5iCy_CrUM6tGttrO98Un-WLTE

A major correction has been issued by the American Journal of Psychiatry. The authors and editors of an October 2019 study, titled “Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: a total population study,” have retracted its primary conclusion. Letters to the editor by twelve authors, including ourselves, led to a reanalysis of the data and a corrected conclusion stating that in fact the data showed no improvement after surgical treatment. The following is the background to our published letter and a summary of points of the critical analysis of the study.

Two prominent transwomen clinicians, one who could led WPATH next year have stated they are against some of the current practices in trans health. Marcy Bowers and Eric Anderson. Particularly fast tracking to hormonal treatments. Article by Abigail Shrier.

bariweiss.substack.com/p/top-trans-doctors-blow-the-whistle

And finally, I missed this with the bank of countries that have declared that there is simply not enough evidence.

France - declares there is not enough evidence. The latest from National Academy of Medicine, France. They have issued a press release about treatment for gender disphoria in children and adolescents.

SEGM have translated it, but also linked up the original version.

segm.org/France-cautions-regarding-puberty-blockers-and-cross-sex-hormones-for-youth

Extract

Transgender identity is a feeling of identifying as a gender different from that assigned at birth, which is persistent and lasts more than 6 months. This experience can cause significant and prolonged distress, which can contribute to an increased risk of suicide [a].

No genetic predisposition has been found.

While this condition has been long recognized, a sharp increase in demand for medical interventions has been observed (1,2) first in North America, then in Northern Europe, and, more recently, in France, particularly among children and adolescents. A recent study of a number of high schools in Pittsburgh revealed a prevalence that is clearly higher than previously estimated in the United States (3): 10% of students declared themselves to be transgender or non-binary or were unsure of their gender [b]. In 2003, the Royal Children's Hospital in Melbourne diagnosed only one child with gender dysphoria, whereas today it treats nearly 200.

Whatever the mechanisms involved in adolescents - excessive engagement with social media, greater social acceptability, or influence by those in one’s social circle - this epidemic-like phenomenon manifests itself in the emergence of cases or even clusters of cases in the adolescents’ immediate surroundings (4). This primarily social problem is due, in part, to the questioning of an overly dichotomous view of gender identity by some young people.

The demand for medical interventions, due to the distress that this condition (which is not a mental illness per se) causes, leads to a growing supply of care in the form of consultations or care in specialized clinics. This involves many pediatric subspecialties. The psychiatric consultations are utilized first, and if the identity is authentic and the discomfort persists, endocrinology, gynecology and, ultimately, surgery become involved.

However, great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects and even serious complications that can be caused by some of the therapies available. In this regard, it is important to recall the recent decision (May 2021) of the Karolinska University Hospital in Stockholm to prohibit the use of puberty blockers.

If France allows the use of puberty blockers or cross-sex hormones with parental authorization and no age limitations, the greatest caution is needed in their use, taking into account the side-effects such as the impact on growth, bone weakening, risk of sterility, emotional and intellectual consequences and, for girls, menopause-like symptoms.

NOTE: Plenty of information on the SEGM site.

https://segm.org

It used to be the case that you had to try out the new identity for years before any life altering decisions could be made. If you are going to go down the giving examples of detransitions (a good idea) makes sure you balance it with looking at the examples where it has also worked out for people too because whether people like it or not there will also be genuine examples of this too.

Looking forward to seeing that source of detransition rates @Helpingmom1930 .

But in the ops daughter's case it was literally just a phase so.....🤷‍♀️

Does anyone even bother to read OP updates anymore?

This thread is just spam now.

😄 I am loving all the people posting without reading the update
Particularly the ones confidently stating it is not social contagion and that MN is transphobic

Yes the OP updated us about their child’s progress and I hope that their daughter is still doing well.

Do you think posting links that are useful reading for people looking for original source information, and who might find this thread due to having the same issues, is ‘spam’? I am ready to discuss any of the links posted, I have tried to post relevant information with the links.

It is sometimes hard to know where to start. And @Helpingmom1930 did say that people should do their own research!

Thanks for all the helpful links!

Discussion that is on topic and correcting misinformation is far from 'spam'. Many people read MN threads for info, sometimes long after the OP has moved on.

Well arabella, MN did remove some of the formatting I did to try to get as much info into the posts without posting one link per post, which really is spam like. And I also didn’t cut and paste it in one big long post ….

Just to assure you @Helpingmom1930 , the links are nearly all written by gender clinicians and researchers.

“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.”

I also posted just some of the country specific medical bodies stating that there is very little evidence or how poor the evidence is currently that WPATH guidelines and some clinicians are using to push for affirming only medical care for adolescents and children. So, to be honest, your posts here seem very deeply prejudiced and misinformed.

But I think it will be great that you post some evidence to back up your stated claim that posters on Mumsnet are ignoring the views of medical bodies, AND that posters want trans people to not exist.

Looking forward to it as I and I know many others including those reading along do love to read the links and learn different view points. How about you? Do you like to understand different viewpoints?

I just want to say as others have that yes my daughter is still doing really well now and much happier. I never said to her face it was a "phase" even though I definitely thought it but it did turn out to be - she admitted it herself. I obviously don't regret not letting her use a binder etc. and damaging her body when she was still so so young.

The links are still very interesting to read though.

That's really good to hear, OP. I'm gld your DD is doing so much better.

Social contagion

You can’t really believe that I know that long term studies haven’t been done but I also know that if 50% detransitioned it won’t be the same 30 people or less going around talking about how it happens to everyone.

What tell you that? And do you actually believe that even if it was a phase telling them that would make the relationship better?

You are not being horrible, you are being a normal mother. It’s no doubt a massive shock to you and it’s a big thing to get your head round. These young people are drawn into this state by online grooming, it’s a bit like a cult. Stay strong @kiwiwatermelonsugar your daughter is female and you should continue to treat her as such. Do not be drawn in. 💐

Just read your update@kiwiwatermelonsugar . Well done, good news.

@Helpingmom1930

The studies are being done in the Scandinavian countries now - Finland, for example, is moving away from the "you say you are trans so it must be true" affirmative model with children and teens and is keeping proper records and the data so far seems to be demonstrating that a majority will desist if they also have counselling for some of their other difficulties - neurodivergence, anxiety, eating disorders, self harm etc.

I get the sense that it is personal to you and you really want to believe otherwise and that children who hate their bodies really NEED gender therapies in the form of binders, drugs and surgeries. Isn't it ideal that many of them don't? Wouldn't that be brilliant if the data showed this?

Point is, many many children do - you can see this in the "missing" trans men in the generation above. There are masses of teenage girls who now think they are trans and are altering their bodies. Where are all the middle aged women who wish they had that opportunity when they were teens "if only society was more accepting"? Not nearly so many of them, are there? Women who would now be sterile, rather than having had the possibility to be mothers. If you look at the demographics of trans men, there is a huge peak at teen age, when body hatred and pressure to conform socially is highest

I am so glad to hear that your daughter is feeling so much more settled and happier now OP! That is brilliant news.

So, you have nothing to substantiate your posts at all then? Nothing to evidence your 3% claim? Not even a source?

The information about detransition rates are there in different links I posted from different countries and the rates were found in long term reviews but they were not reviews to identify ‘detransitioner’ rates, those were not the focus.

But please, just stop spreading and repeating misinformation.

There is a known link with autism, and I have a young family member in this situation. Is this something that has ever arisen with your child?