Relative who needs help with child (Canada)

[mapleleafsupport]

The DD of a member of my extended family (I’ll call her X) has decided she is male, and has been living as a boy for the last two years. X is 14, autistic, has ADHD, is apparently morbidly obese, and refused school their entire life. X also has huge distress and sobs almost every night. So I think navigating X’s autism challenges has been very difficult.

They all live in Canada (Vancouver).

X is insistent that they want puberty blockers and sex hormones. My relative has respected pronoun use and name change, but doing all they can to delay things. For example, insisting on counselling before embarking on medicalised transition (X point-blank refuses), and noting that medicalised processes involve needles (X is needle phobic).

I want to respectfully support my relative and send them resources to help them formulate a plan and navigate risks. My relative did say X had been assessed for gender dysphoria and scored extremely high on a scale. I don’t know how they assess for this in Canada or what the scale could be, and I worry there might be weaknesses as there was with GIDS services? Or it could be that X is profoundly dysphoric and transition is the necessary treatment. I’m just worried that not enough attention is being given to X's autism by health professionals.

Can anyone help with links to, for example, reports on the Scandinavians stepping back from hormone treatments, reports criticising the Dutch protocol. I want to suggest my relative asks counsellors and medics to respond directly to these reports (and other) criticisms of the affirmation model directly. I would prefer to send primary sources.

Can anyone recommend a counsellor in Vancouver that hasn’t been captured, and/or a very experienced therapist that can help with navigating autism and identity issues. My relative is wealthy and I have no doubt they’ve tried a lot already but I didn’t have time to go through the details.

Any suggestions would be appreciated.

I'm sorry OP but anything other than affirmation appears to have been banned and criminalised in Canada

https://www.loc.gov/item/global-legal-monitor/2022-01-19/canada-bill-c-4-banning-conversion-therapy-comes-into-force/

I'd suggest taking them out of the country for therapy but that seems also to be illegal.

The biggest challenge is to find a counsellor that will show respect for a child/young adult's gender confusion without completely validating, allowing them to explore gender without affirming etc etc. a neutral space.

I know many here who are gender critical haven't had contact with long term trans adults, they do exist and long before this runaway bandwagon started.

One particular issue of note is that delaying/halting puberty means that conventional surgical techniques for affirming gender are not always possible, meaning that is a genuine reason not to take blockers as a teen. Surgery and hormones in my opinion shouldn't be discussed before 18, though I'm more supportive of adults who decide to go ahead here. (I know a young woman who changed her mind after 3 years, she's now a very happy gay woman)

Sorry I can't give you any direct pointers, but here's a few links that might help you or your relative:

GETA Gender Exploratory Therapists Association

SEGM Society for Evidence-Based Gender Medicine

Rethink Identity Medicine Ethics which also links top the wonderful and insightful "Gender - A Wider Len"s podcast series from Stella O'Malley and Sasha Ayad)

Genspect (parents and relatives) also maintains Stats for Gender

Emigrate?

No amount of chit-chat will get through to a 14 year old to be honest.
Parent is going to have to parent and realise they won't be friends about it.

Kid might grow up to realise hormones and surgery are the same as getting a gastric bypass at the age of 14 i.e. completely irresponsible. Or they might not.

Being that parent when your government can incarcerate you for stopping your child from ending up on medication for life is tricky.

The good news is that as an autistic person she may well be quite open to logic and fairness as we do tend to believe that the same rules should apply to everyone. So here's my suggestions to pass along to her parents to consider if they feel they are brave enough / appropriate to share with their dd

1. Emphasise the existence of Gender Identity AND Sex and the fact they they are different words meaning and describing different things.

2. Gender Identity is how she feels, her personality, her likes and dislikes. Encourage her to describe how's she's feeling and try to expand and develop emotional vocabulary.

3. Sex is the sex of a person's body. Sex is binary and doesn't change.

A person can control a number of aspects of their appearance though. Whatever your position on makeup, haircut, dress, choice of clothes the sex of the person remains unaltered. Medical interventions do not change your sex. Some medical interventions carry substantial health risks and have be painful, intrusive and have both long and short term adverse side effects. These interventions DO NOT change your sex but can impact on your appearance.

Arguments to consider against a girl / female taking puberty blockers

Lower bone density.

Does she want to grow up to be strong and athletic? Is being weaker than the average women and /or walking on crutches an outcome that seems a sensible risk?

Less development of genital tissue, which may limit options for gender affirming surgery (bottom surgery) later in life.

Keeping your options open for a more effective and successful surgery she may well want in adulthood is a completely valid reason to decline puberty blockers.

Impact potentially permanently (lowered or absent) sex drive

Telling her that regardless of her gender identity the adults who care about her want her to grow up into (in so far as is possible) a happy fulfilled adult who is comfortable with their sexual orientation, and can enjoy fulfilling sex with a partner who loves them, is a perfectly good and valid reason to not pursue / obtain puberty blockers.

Body building / exercise can certainly have at least as much success in changing how you appear whilst being a demonstrably good impact on overall health.

4. In 2011 an estimate by GIRES said "Only 20% of the UK transgender population were likely to seek medical treatment for their condition at some stage" By 2016 Self identification had grown much more commonplace and "only 2.8% of the transgender community is undergoing any gender-affirming treatment with the vast majority 97.2% simply self-identity with no modifications to their sexed body whatsoever."

source* *https://fairplayforwomen.com/penis/

It may therefore be useful to emphasise that there is no single right way to be a trans man and whilst it is totally reasonable for her to describe her GI in the terms she feels are most helpful in explaining her feelings it doesn't follow at all that her body needs to be chemically or surgically altered to align better with that gender identity, and certainly that there is absolutely no rush to head in that direction.

Also there are two schools of thought within Transgender Activism as to whether a persons Gender Identity is inate and fixed or is actually much more fluid allowing more validity to non-binary and gender fluid feelings. Not doing anything drastic (and drugs which disrupt puberty are a drastic option from the point of view of your health) until she knows who she feels about it in 10 years time is a perfectly valid and sensible option.

Stonewall definitions below

Transgender man - "A term used to describe someone who is assigned female at birth but identifies and lives as a man. This may be shortened to trans man, or FTM, an abbreviation for female-to-male."

ALL she or anyone needs to do ACCORDING TO STONEWALL to be a trans man / transman / Transgender man is to recognise that that is the descriptor label which suits her best in her opinion. And then to 'live as a man' discuss precisely what that involves in her opinion.

Gender expression - "How a person chooses to outwardly express their gender, within the context of societal expectations of gender. A person who does not conform to societal expectations of gender may not, however, identify as trans. "

Not all men present in stereotypically masculine ways. Similarly there is no obligation for her as a trans man to be stereotypically masculine all the time. What clothes make her most comfortable and happy?

Non-binary - "An umbrella term for people whose gender identity doesn’t sit comfortably with ‘man’ or ‘woman’. Non-binary identities are varied and can include people who identify with some aspects of binary identities, while others reject them entirely."

Pip Bunce said: "For me, being gender fluid means I am non-binary, at no fixed point on the gender expression spectrum. I personally have no desire to transition — it doesn’t affect my physical makeup, whereas for others that identify the same, they do wish to transition — there really are no hard and fast rules as these are only labels." https://www.standard.co.uk/news/uk/gender-fluid-exec-named-on-list-of-top-100-women-in-business-a3942896.html

Trans - An umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth.
Trans people may describe themselves using one or more of a wide variety of terms, including (but not limited to) transgender, transsexual, gender-queer (GQ), gender-fluid, non-binary, gender-variant, crossdresser, genderless, agender, nongender, third gender, bi-gender, trans man, trans woman, trans masculine, trans feminine and neutrois.

It is unlikely that she is comfortable with all aspects of a stereotypically male existence. It is also likely that she may feel more comfortable imagining herself as possibly moving between a spectrum of non-gender conforming man, non-binary, genderless, trans masculine and agender. Suggest she'll need time to consider her options but in the meantime the priority is her health not her appearance.

https://www.stonewall.org.uk/list-lgbtq-terms

That sounds like a difficult position.

Here is my and my autistic daughter's story if it's of help (link below).

I didn't talk to her about gender identity at all, unless she brought it up. Other than to let her know that I was speaking to people who were helping me from the LGBT+ to get a basic understanding of being transgender from their perspective.

Instead I focused on the distress that her changing body brought her. I was already aware that autistic girls often present quite androgynously (short hair, "boys' clothes" etc) so I knew that this could be accidentally conflated with gender dysphoria. I also knew that having your body change can be particularly distressing for an autistic girl: the change itself (with any change being difficult, let alone the certainty of your own body) and also the sensory aspects.

I think the safeguarding approach that I took would be on the right side of the Canadian laws, though I'm not certain. It's focus is on securing an environment with no unconscious bias, not a list of things that can't be said. The approach I took regarding the contraceptive pill and sports bras may also be of help. Our story

This Twitter thread is about an important Finnish report. See if you can find the report itself from this, OP.

Leor Sapir on Twitter: "The interview highlights just how out of step the U.S. medical establishment is with its European counterparts on pediatric gender medicine. Doctors and medical groups in Finland have been willing and able to stand up to activists, including within their own ranks."
https://twitter.com/LeorSapir/status/1620448056444588033

Also Transgender Trend has some very helpful info on autism and gender identity.

Website link

What a sad situation.

I have no advice (sorry) but am mulling over the giving of puberty blockers to a morbidly obese person. I realise 'gender identity' medicine is woefully under researched with no evidence-base as far as I can see, so I can't imagine we actually have any idea of any additional risks etc to a morbidly obese person.

All surgery is way more tricky on obese people, so hopefully it would be denied or delayed on that basis alone.

Thanks for sharing your story @BonfireLady

@BonfireLady - Your story made me cry. Thank you so much for sharing it. There are sooo many parallels with what my relative is trying to cope with. I've forwarded him the link and I hope it makes him feel less alone.

I wonder if you'd be able to PM me contact details for some of the health experts you saw? If this makes you feel uncomfortable then don't worry. I know he is in Canada, but I think he really needs to talk to someone and I don't think he has found that person where he is.

Thank you all for links and suggestions so far. Hugely appreciated. I'm working through them and sharing with X's parent.

I'm glad it was of help. It's made me cry on multiple occasions too 😔 We're still on a mental health journey in relation to education and bullying (sadly this is a long journey, owing to the complexities of our education support system for autistic children 😔) and my (amazing, wonderful and complex) daughter still has violent meltdowns occasionally, but we are getting there. I cry less these days.

My husband and I have had some training in descalation techniques, plus we continue to help her to build her confidence and understanding about her own autism both at home and through support networks. Thankfully we also have a good mental health support pathway in place now too.

She doesn't talk about gender, as it's simply not on her mind, although I know it might be one day. She does believe in gender identity and describes herself as "aromantic". This is another commonality with autistic girls - where a sense of the self as sexual may not develop until later than their peers. I'm also expecting her to potentially be bisexual, which is another common factor with autism (obviously not all autistic females! Just a general pattern that is notable enough), because she sees the "whole person" rather than a specific sex when she considers friendship and emotional attachment. TBH, her sexual orientation could be straight, homosexual or bisexual. She'll figure that out when she's ready and all would be totally fine from our perspective.

When she has talked about gender, her view these days is that trans women are women and that children should not have any medical intervention - that this should only be available from 18. She is aware that I don't believe in gender identity and that, by extension that I believe trans women are not women. However, she is also aware that I will respect a trans woman's "preferred pronouns" and their gender identity belief/dysphoria, unless there is a specific reason why biological pronouns are necessary e.g. in the describing the risk of an individual such as Isla Bryson. This slow but open dialogue has also been helpful as she doesn't see me as bigoted or in direct disagreement with her gender identity belief.

Unfortunately I can't share any details of the health professionals as this would put them in a difficult position. It's still potentially career ending in the UK. The conversations that I've had with them have been in confidence and although all of us (me and them) have been very clear that we do support the fact that gender identity exists as a reality for some people (in a similar way that God exists for some people) and that gender dysphoria is real, they and I are aware that this could unfortunately be misconstrued.

However, I do have a recommendation: I read the Sue and Marcus Evans' book "Gender Dysphoria: A Therapeutic Model for Working with Children, Adolescents and Young Adults" and applied it all myself. If your relative can't find a professional that they trust to do the differential diagnosis approach that I took (i.e. I focused first and foremost on the autism and changing body aspect), then could a self-led approach be an option. At the time, I too trusted no health professional because of the high risk of unconscious bias. I channelled my inner Dr House (Hugh Laurie character and master of differential diagnosis 😁) and applied a kinder version of his approach 😁

Hope that helps.

@mapleleafsupport saw this and thought of you as they say

sex matters webinar 7:30pm (uk time) but will be on their you tube channel afterwards Yes, it will be available on our YouTube channel soon afterwards.
https://m.youtube.com/@sexmattersorg

Unfortunately Canadian medical professionals with any qualms are often refusing to see these patients, as they don't want to have their licences revoked. Which leaves the idiots behind who are willing to help these kids.

"Which leaves the idiots behind who are willing to help these kids"

I guess the question is does the help help? The evidence for it helping is not up to the standard expected elsewhere in medicine.