On the Science of Changing Sex

Getting Lost in the Crowd

Posted in Female-to-Male, Science Criticism, Transgender Youth, Transsexual Field Studies by Kay Brown on April 16, 2017

Kay Brown

Or, How the Big Tent Transgender Movement Distorts Science and Holds Back Civil Rights for Transsexuals

The word “transgender” was originally coined and used by Dr. Virginia Prince, a full time autogynephilic cross-dresser, in the early ’70s, to denote those like her/him as opposed to “transsexuals” who took hormones and had “sex change” surgery and also opposed to secretive “transvestites” who only occasionally cross-dressed, usually in private.  The term was meant to be exclusive of any other group, like drag artists or gender atypical gays or lesbians.

But…

In the early ’90s, Beth Elliott, using her nom de plume Mustang Sally, wrote an essay entitled, “The Incredible Shrinking Identity” in which she decried the social effects of subsuming transsexual people into the larger umbrella of “transgender”, which with each passing year seemed to be growing at its margins to include more and more people who just a few years before, would never have been considered to be in the same grouping.  Of course, she was mostly talking about secretive cross-dressers, “transvestites”, autogynephilic men, who as we know, are in fact in the same etiological taxon as autogynephilic MTF transsexuals.  In the ’90s, it was possible to ignore this complaint as being specious on the social level, given already rampant socially unwanted and scientifically unwarranted lumping of autogynephilic and exclusively androphilic MTF transwomen.

But what started as merely political embarrassement (for AGP transwomen) has now become a serious scientific and civil rights issue as the term “transgender” has now been stretched to the point where it has little meaning as to actual sexual, social, or gendered behavior.  It is no longer enough for scientists to differentiate between autogynephilic/late onset vs. androphilic/early onset MTF transwomen… nor even between autoandrophilic vs. androphilic FtM transmen… now we must differentiate between an ever growing host of self-defined “other” gender categories and underlying behaviors, identities that are lumped under “transgender” to the point of making the term meaningless to sexologists and social scientists alike.

Flashback, 1980:  Hanging out in the L.A. transsexual community, as it gained a political self awareness, was a teenager; let’s call her “Lee”.  Lee would tell anyone who asked that she was “transsexual”… yet caused great confusion to all who met her.  She was natal female, short even for a woman, pleasantly plump, and decidedly feminine in both appearance and manner.  She was in no sense gender atypical.  And during the time that I knew her, over 18 months, she never made any attempt to present as a man, nor even as butch.  She was always on the femmy side of androgenous to the point of being decidedly “cute” as she hung out, mostly with younger MTF transwomen whom she seemed to admire.  Had she been hanging out in this same manner in the gay male scene, they would have likely labeled her a “Fag Hag”.  The transsexual community, while leery of non-trans males who would have acted this way, affectionately accepted Lee’s non-threatening presence, while secretly rolling their eyes when she declared that she was “FtM”.

Thinking back on Lee, I’m fairly certain that she never transitioned and I’m willing to place fairly high odds that she married and had kids, probably now has grandchildren, none of which have any idea that she once hung out in the trans-scene.  At the time, we had no label for her.  Today, on the internet, the FtM transsexual community does have a label that would have applied, “tucute”, as in “Too Cute” to be trans.  If you visit the FtM pages on Tumbler, you are sure to run into a few… and will also note that they in turn, grumble about the negative feedback they get from those they call “Truscum” (“true” masculine gynephilic FtM transsexuals) for not accepting that they too are just as “trans”, even if they are in no sense gender atypical nor gender dysphoric.

Recent Events:  A couple years ago, via her facebook page, a very socially liberal, rather prominent (and wealthy) venture capitalist in my professional circle proudly announced that her teenaged child was “transgender”.  I’ve been living “mostly stealth” in that most of my professional contacts do not know of my medical history (yes, I “pass”).  But in a move to be supportive and perhaps even help her with the emotional issues that almost always come with a child’s transition I came out to her.  BAD MOVE!  Nope, upon learning more about her child, it became very clear that her daughter had always been very gender typical as a girl, was not the least bit gender dysphoric, and had no intention of legally, socially, nor medically transitioning.  No, she just wanted to be recognized as “transgender” and have everyone around her use gender neutral pronouns (cause she is they are so special, she they deserves it).

There is another couple names for this behavior, “TransTrender” and “TrendsGender”, as in it is now “trendy” to say that one is transgender, in the right circles.    Back in my college years, hanging around Stanford University, I would often hear complaints from actual gynephilic women, real lesbians, about the phenomena of primarily androphilic women taking social positions as “Political Lesbians” and “Lesbians Until Graduation”.  The “transgender” community now has the same phenomena.  It seems to have become “cool” in some comfortably well off, very socially liberal teenaged and young adult circles to be associated with the LGB and now T community, as though being associated with a marginalized group made up for their obvious social privilege.

One could well imagine the growing resentment felt by those of us who have experienced familial rejection, social disapprobation, economic deprivation, and psychic pain from a lifetime of gender atypicality and dysphoria towards those who misappropriate an identity from the protective cocoon of indulgent family, liberal universities, and the anonymity of the internet.

As one young transman put it,

“Dysphoria is the defining factor of a transgender person. It’s why they want to TRANSition. It’s why they’re called TRANS in the first place, fuckwits. It doesn’t have to be crippling “I hate my body ugh I can’t look at myself naked” (And I do know some trans people whose dysphoria is that bad). On a 10 is an “I can’t see myself naked” to 1 is a “I don’t feel right in this body”, I’m probably a 5-7. I can see myself naked but it just doesn’t feel right. Specially with my chest. That’s dysphoria. Not “omg I don’t want to be human I want to be a rabbit/sunflower/magical girl” or whatever these tucutes are on I don’t even know.   …

The more I look at it, the more I see tucutes acting like being transgender is a cute little accessory they can put on. You’re comfy with your body but you like girls even if you’re a girl yourself? Congratulations, you could be a lesbian. You like boys but you’re a boy? Good on you, you might be a homosexual man. You like the opposite gender? That makes you a terrible hetero person and that’s bad because all hetero people are transphobic and evil. 😦 Be trans instead. That’s cooler.

Except… it’s not.

It’s not cool to be trans. It’s not cool to wake up and see these parts of you that you feel so uncomfortable with having that you would wish cancer on yourself just to have them taken away. It’s not cool to have to struggle with the longing to tell your parents that you’re not the right gender because you want to trust them and want to open up to them but you’re afraid it’ll just add to the laundry list of things you’ve already disappointed them with. It’s not cool to have known you were one thing from birth but everyone else and your own body telling you you’re not and that you were supposed to be a certain way because that’s what you looked like from the outside.

It’s not cool to be trans.

If I had a choice, if being trans WAS a choice I would choose to be cis.”

If these issues had stayed on the pages of tumbler and facebook, it wouldn’t be a problem for science or those seeking better civil rights for transitioning transfolk.  But it hasn’t.

Consider a recent paper published in the Journal of Youth and Adolescence in which the authors very laudably explore the issues of safety and bathroom access for “transgender” youth.  Ah… you are probably anticipating some of the problems that this might entail and you would be right.  But let’s explore each of them carefully.

The authors cite the now popular William’s estimate of 0.7% of the population in the US as “transgendered”.  The problem with that study is the number who identify as “transgendered” because William’s did not apply any operational definition beyond asking if they were “transgendered”. Yet we know that only 0.03% of the U.S. population has actually socially transitioned, according to US Census study that cross-correlated with name/sex status changes to Social Security cards (arguably the absolute best estimate we will ever get to the number of individuals who actually transitioned).  This means that less than 5% of those who identify as “transgender” ever transition.  Thus, by definition, more than 95% of those who identify as “transgender” never transition, that in fact, they aren’t all that gender dysphoric.  So who are they?  Well, given that 80 to 90% of MTF transsexuals are autogynephilic and that an estimated 2.8% to 4.6% of men in the general population are autogynephilic, while only 0.5% of women are autoandrophilic, we can surmise that the vast bulk of those who identify as “transgender” adults are autogynephilic males, otherwise gender typical heterosexual men who cross-dress in the privacy of their homes and perhaps occasionally have a “girls’ night out” with other cross-dressers.

We know that autogynephilic males are gender typical growing up.  They are also gynephilic.  These are, save for their secret cross-dressing and sexual fantasies of being or becoming female, typical, average, run of the mill straight men.  Thus, autogynephilic males who have not transitioned are not socially visible.  Further, we know that the median and average ages of transition for autogynephilic transsexuals (the moment that they become socially visible) is 35 and 40 respectively.  In fact, in the Nuttbrook study, which surveyed 571 transgender women, only one gynephilic (and presumably autogynephilic) individual had begun transition before age 20 and of those who had begun transition before age 20, only 7% said that they were bisexual (of which a number of them are likely to be autogynephilic, as we know from other studies).

Now, compare that to the number of early onset / androphilic transwomen who transition before age 20… that number is half.  HALF.  Further, we know from study after study that such transwomen are very notably gender atypical, as well as gender dysphoric.  THESE are the kids who will be the most socially visible as youth, NOT autogynephilic “transgender”.  On the FtM side, the Autoandrophilic population similarly transition later as adults, not teens.  It will be the rare, very rare (remember, only 0.03% of the total US population transition) exclusively gynephilic, gender dysphoric kids that will be socially visible as youth, not the TuCutes and the TransTrenders.  These are the kids who are socially and personally vulnerable as youth, not the vastly larger number of individuals who will identify as “transgender”.

How badly off are the numbers?  In the Wernick study they found 86 individuals who self-identified as transgendered out of 935 students.  Seriously, 9%?  NINE &^%$#@ percent?!?  That’s more than ten times the number of adults who self-identify and three hundred times the number who actually transition.  That’s higher than the number of teens who grow up to be gay or lesbian.  Are all of the LGB kids claiming to be “transgendered”???  Or is this representative of all LGB plus all of the secretly cross-dressing and cross-dreaming boys plus the TuCutes and the TransTrenders, all balled into one?  Because, if the schools were statistically representative of the population as a whole, with only a thousand or so students, we could only expect a one in three chance of finding an actual transsexual among them, most likely an autogynephile who will transition as an adult and only one in fifteen chance of finding a transkid.

The design of this study was flawed from inception, as the numbers surveyed were never enough to find any statistically valid number of transkids, while using self report of being “transgendered” without a valid operational definition lead only to a measure of the trendiness of the label in the teenaged population.

transkids

Transkids after transition

So we see, that truly gender atypical and gender dysphoric individuals will be a very small percentage of youth who will self-identify as “transgender”.  These are the kids who social scientists and policy makers should be concerned with, not those who have yet to transition or never will.  These are the kids who, while finding more and more visibility in the press as they transition, are the ones who are getting lost in the crowd in social science studies and policy making because of the failure to apply appropriate operational definitions.

(Addendum 5/5/2017:  To reinforce my point that one needs to have an operational definition of “transgender”, we can see in another recent study (Sumia 2017) using the GIDYQ-A that only 1.3% of teenagers had any “potentially clinically significant gender dysphoria”.  Interestingly of the natal female teens, only 0.5% compared to 2.2% of the natal males had indicated such potential dysphoria.  Note that this is indeed potential, not clinically significant distress.  These numbers tally better with the hypothesis that most of these boys are autogynephilic and will likely live as secret cross-dressers.)

Further Reading:

Essay on US Census Estimate of Post-Transition Population

Essay on the Ratio of Gynephilic vs. Androphilic MTF Transsexuals

Essay on the Nature of Autogynephilia

Essay on the concordance between percentage of erotic cross-dressing adults of both sexes and measures of teenaged sub-clinical gender dysphoria

External Further Reading:

“Tucute: What it is and why its wrong”

CONSERVATIVE MEN IN CONSERVATIVE DRESSES By Amy Bloom
The world of cross-dressers is for the most part a world of traditional men, traditional marriages, and truths turned inside out. – From the Atlantic Monthly, April 2002

References:

Wernick, et Al, “Gender Identity Disparities in Bathroom Safety and Wellbeing in High School Students”, Journal of Youth and Adolescence
DOI: 10.1007/s10964-017-0652-1

Sumia et Al, “Current and recalled childhood gender identity in community youth in comparison to referred adolescents seeking sex reassignment”, Journal of Adolescence
http://www.sciencedirect.com/science/article/pii/S0140197117300155

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Who Knows Best?

Posted in Film Review, Transgender Youth by Kay Brown on January 14, 2017

Video Review:  Transgender Kids: Who Knows Best?

I just finished viewing BBC Two’s documentary on the contraversy about whether the “affirming” model is best for gender dysphoric, potential transkids.  It is well worth viewing.  It covers the full ground while (mostly) being sensitive to the transcommunity.

But sadly, it fails in several key respects.  One, it completely fails to mention that transkids are nothing like adult transitioners.  At times we catch B roll scenes of adult transsexuals, which one instantly recognizes as autogynephiles.  So this failure to distingish the two may lead naive viewers to mistakenly equate the two.

Also unhelpful, the documentary interviews one person who frankly had no idea what she was talking about regarding sexual dimorphism of the human brain. While correctly saying that one couldn’t simply look at a brain and say whether it came from a man or a woman, she fails to mention that we can see statistical trends.  But worse, she flat out states that brains only become ‘gendered’ by living in a gendered society, completely ignoring research that shows the correlation with sexual dimorphism of the brain and sexual orientation.

The areas that the documentary does cover well is the well known phenomena of desisting of gender dysphoria in most gender atypical young children by the time that they are twelve or so.  They interview a girl who had been extremely dysphoric as a younger child who desisted at puberty.  As I’ve discussed in a previous essay, 80% of such dysphoric children do desist.  The video also mentioned that most of the desisting boys will grow up to be conventional gay men and not transgender.  However, the video introduces a straw man, lumping all “transgender activists” together as saying that we all wish to sweep this inconvenient fact under the rug.  Fortunately, though it was not well show-cased, this was (partially) shown to be untrue as they interviewed an FtM transman / activist / gender therapist who acknowledged this in passing, though he also contradicted himself and made an outright lie in stating “If someone says that they are transgendered, than chances are that they are transgendered”.  We know that this is simply untrue for pre-pubescent children.

The documentary interviews both Ray Blanchard and Kenneth Zucker.  I felt Dr. Blanchard was well spoken and articulate.  But frankly, and this truly surprised me, I came away feeling far less sympathy for Dr. Zucker than before.  Perhaps the editors are partly responsible, in that they used some odd frame editing at times, perhaps they chose the quotes where Zucker was the least sympathetic?  But Dr. Zucker seemed to lack all empathy for these kids and never once affirmed that transition was a viable option that should be considered for persistors.  Further, one got the opinion that Dr. Zucker was taking credit for his treatment having lead to desisting outcomes, that from his attitude while speaking, he would consider a better one than persisting.  (As a persister myself, having been “treated” with just the type of play therapy and later direct talk therapy that he outlines, I find that attitude offensive.  For the record, I firmly hold that neither outcome is better than the other.)  He even insinuated that parents who are ‘affirming’, who helped their children transition, are homophobic, refering to a remark, that may likely be apochraphal, supposedly a quote from a parent, “Well… at least they’re not gay.”  (Most parents who are homophobic are even more virulently transphobic; like my father who begged me not transition, promissing that he would look the other way when I had boyfriends over – just like he did with his gay brother.)  What really was disturbing was his strong attempts to pathologize all gender atypical and dysphoric children as suffering from a wide range of mental illnesses, which was echoed by one of his former colleagues, specifically arguing against the oft noted concerns regarding reaction to stigma (that is, Zucker and his former colleage questioned the conventional wisdom that transkids are depressed and anxious because they are teased, bullied, and considered a dissappointment and embarrassment to family and peers).  Frankly, I was dismayed.

The real heros of the documentary are the transkids who were interviewed.  One’s heartstrings were tugged, as one would expect, but these kids also told their stories with brutal effect.

All in all… a must see.

If you are in the UK, you may watch the video here: http://www.bbc.co.uk/programmes/b088kxbw

Further Reading:

Essay on Desisting and Persisting Gender Dysphoria in Gender Atypical Children

Advice to Parents of Transkids

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When in the Course of Human Events…

Posted in Editorial, Transgender Youth by Kay Brown on January 1, 2017

Kay BrownOr, Why The Two Types of MTF Transsexuals Should Be Recognized and Treated Separately.

These past few years has been an interesting one from the standpoint that we are seeing more papers supporting the Fruend / Blanchard Two Type Taxonomy in that Blanchard’s prediction that the two types would have differential neural corralates (brain differences).  But this past year, we saw two very important papers from Hsu et al. {See previous essay} when combined with previous papers by Blanchard and Veale, lend powerful support to what a number of ‘early onset’ MTF transwomen have been saying more sotto voiced, as Velasques did,

“Teen hsts should not be required to attend support groups for older transsexuals. The two groups have nothing in common and many of us have had upsetting experiences being forced to attend meetings with people who have had a transvestic etiology as opposed to a homosexual one.”

Quite simply, autogynephilic transwomen are sexually attracted to, sexually objectify, and inappropriately romantize ‘early onset’ transwomen and our lives.  Further, they are given licence to make pruriently inappropriate comments and questions regarding such youngsters appearance, attractiveness, genital surgical status, and sexual experiences under the guise that “we are all just girls here”, comments and questions that would not occur in groups of only transkids, and certainly not from women.  As I put it in my 2009 essay on the Transkids website,

“In transsexual support groups, homosexual transsexuals are in a minority position from the beginning. It is human nature to seek out those like themselves, so occasionally an HSTS finds a support group, but soon feels out-of-place and uncomfortable, unable to relate to AGPs and the issues that AGPs most want to discuss. Unless the support group is moderated by an experienced therapist, the naturally more masculine and dominant AGPs, accustomed to male privilege, will tend to monopolize the conversations. Further, since a portion of the AGP population is strongly attracted to other transsexuals, especially to those who are physically and behaviorally more feminine, the HSTS minority may be subject to unwanted sexual advances from the AGP majority. Naturally, finding no real support for, or mirroring of, her own concerns, and made uncomfortable by sexual objectification, the lone HSTS will quickly drift away, leaving the support group to the AGPs.”

Both of these quotes actually understate the problems when ‘early onset’ transwomen are required to attend therapy with autogynphilic transwomen.  We now have laboratory and survey evidence that all autogynephiles, not just a “portion”, are strongly, in fact preferentially, attracted to gynandromorphs, that is, pre-operative, young, physically and behaviorially feminine ‘early onset’ transkids.

I can just hear my reader’s thoughts, “So what?  Lots of people find themselves the subject of attraction.  They deal with it just fine.”  Yes, but consider for a moment that we are talking about young, naive, teenagers and young adults who first attend such therapy sessions with the nearly explicit assumption that they will be in a group of transwomen “that are just like them”.  If your only model of who and what ‘transsexuals’ are is yourself, and perhaps the popular culture’s ever present mantra of “a woman trapped in a man’s body”… then one will enter that room with no adequate defences to both the sexual objectification and to the mind fuck of trying to square the rather odd differences between one’s self and one’s experiences as an obviously gender atypical and androphilic person and the presentation and experiences (not to mention implausable histories) of the autogynephilic majority in the group.  In effect, that youngster begins to ask, “If these are transwomen… then WTF am I?”  I know I certainly had this rather dizzying experience the first time I met “transsexuals”,

“During my second semester in college, I met other transsexuals for the first time, at the [Stanford] clinic. What I found surprised and confused me. They did not seem to be unaffectedly feminine, without effort, but more like men who desired to be feminine and were working desperately to appear so. I was acutely embarrassed for them. Most were much older than me. Many of them had been, or still were, happily and sexually satisfactorily married to women for years. I couldn’t understand why they wanted to live as women.  If I was surprised and confused by them, they were just as surprised and confused by me. I was asked how it was possible that I had been dating, and sexually active with, men, especially as I was pre-op. I had dated four straight boys who had been high school classmates, besides the young men that I met when I left home for college. None of the others at the Clinic had ever dated a man.”

Even this quote from my 2009 essay understates the negative consequences that occured within weeks of that first introduction to autogynephilic transsexuals in that because of it, and the fact that I was experiencing severe housing and food insecurity due to having been effectively disowned by my family, one of these autogynephilic transwomen ‘kindly’ offered to take me in… only to later demand sexual favors in return when the alternative was homelessness.  Had I known the nature of autogynephilic sexuality and mendacity… or had I not been thus improperly included in this session in which Stanford had tacitly vetted the others, this “upsetting experience” would not have occured.

Just as it is inappropriate for ‘early onset’ transwomen to be required or encouraged to attend such mixed group therapy, it is even more inappropriate to place MTF transkids in the same hospital room with an autogynephilic transsexual, as I wrote in my parental advice essay,

“Insist that your child have either a room to themselves, or with another transkid of the same social gender and sexual orientation.  Under no circumstance allow your MTF child to share a room with an adult MTF transitioner.  The hospital administration usually has no real clue about the realities of transsexuality and transsexuals, and think that we are all the same.  No one would think of asking a young lady to share a hospital room with an older straight man… but that is in effect what is happening in hospitals on a regular basis.  Autogynephilic MTF transsexuals are sexually attracted to women, and often, even especially, to young MTF transkids.  Further, a fair number of autogynephilic individuals sexualize the very act, the process of changing sex, both in themselves and in others.  Due to a lifetime of socialization as men, and only limited experience in their new gender role, these individuals often do not recognize appropriate boundaries.  Do not allow your child to be so exposed when they are at their most physically and emotionally vulnerable point in their young lives!  (I myself had a very upsetting incident when I had SRS.  A few years ago, I accompanied a transkid to that very same hospital, who had a similar experience, 28 years after my own. )”

While I do not wish to share the nature of my “upsetting incident” in the hospital, I don’t believe that these experiences are unique to me.  In point of fact, it is not hard, by scanning the web, to find accounts of others describing “upsetting” experiences either in group therapy or while at a hospital for SRS.  In one case I recall, a youngster described the older transistioning members of her group, “pervy”, while another used “skeevy”, when addressing the unwanted and inappropriate sexual attention they received.

I feel strongly, especially now that we have such strong evidence to support both the Two Type Taxonomy AND the now well documented sexual preference for ‘early onset’ MTF transkids, that including them in the same support groups, group therapy sessions, and hospital settings, borders, if not crosses into, malpractice.  MTF transkids should not have to put up with unwanted and very inappropriate sexual attention / harrassment just to get past the “gate-keepers”.

It is past time that WPATH recognize the two type taxonomy and that differential diagnostic criteria be included in the APA Diagnostic and Stastical Manual.

Further Reading:

Information for Health Care Providers

S. Alejandra Velasquez, “Treatment Recommendations for HSTS Transkids”
http://www.transkids.us/recommend.html

Kay Brown, “The Invisble Transsexual”
http://www.transkids.us/invisible.html

Essay on Autogynephiles and Gynandromorphophilia

Essay on “upsetting” experiences with an AGP transwoman

Advice to Parents of Transkids

References:

K. J. Hsu, A. M. Rosenthal, D. I. Miller and J. M. Bailey, “Sexual Arousal Patterns of Autogynephilic Cross-dressing Men”
https://www.researchgate.net/publication/308036975_Sexual_Arousal_Patterns_of_Autogynephilic_Male_Cross-Dressers

K. J. Hsu, A. M. Rosenthal, D. I. Miller and J. M. Bailey, “Who are gynandromorphophilic men? Characterizing men with sexual interest in transgender women”
http://d-miller.github.io/assets/HsuEtAl2015.pdf

Jaimie F. Veale, Dave E. Clarke and Terri C. Lomax, “Sexuality of Male-to-Female Transsexuals”
http://www.springerlink.com/content/bp2235t8261q23u3/

Anne A. Lawrence and J. Michael Bailey
Transsexual Groups in Veale et al. (2008) are “Autogynephilic” and “Even More Autogynephilic”
http://www.springerlink.com/content/u473w370g11vx758/

Jaimie F. Veale, David E. Clarke and Terri C. Lomax
Reply to Lawrence and Bailey (2008)
http://www.springerlink.com/content/cm2531l3m3148377/

Blanchard R, Collins PI., “Men with sexual interest in transvestites, transsexuals, and she-males”
http://www.ncbi.nlm.nih.gov/pubmed/8245926

Blanchard R., “The she-male phenomenon and the concept of partial autogynephilia”
http://www.informaworld.com/smpp/content~db=all~content=a789560133

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A Voice of Their Own

Posted in Transgender Youth, Transsexual Field Studies by Kay Brown on July 9, 2016

Or, What Do Transkids Think About Puberty Suppression?

transkids

Transkids after transition

In the media and especially in social media, we see lots of discussion regarding what is the appropriate standard of care for transkids.  Many adults seem to be horrified by the idea that kids should be treated at all.  Of course, anyone that thinks about it clearly will see that without puberty suppression, one is already making a decision to treat them with hormones, the ones that the body starts to make at puberty.  Thus, the justification for puberty suppression, under the notion that delaying it isn’t really making a hard and fast decision.

But what of transkids themselves?  What do they think about it all?  How about asking them?  Well, a recent paper does just that, as the paper describes them,

“They were between 13 and 18 years of age, with an average age of 16 years and 11 months, and a median age of 17 years and 4 months. All adolescents, except for one, were treated with puberty suppression. The mean age at which the adolescents started treatment with puberty suppression was 15 years and 10 months. The adolescent who was not treated with puberty suppression immediately started treatment with cross-sex hormones because she was above the age of 18 when treatment was indicated, which is in line with the Dutch protocol. Five adolescents were trans girls (natal boys with a female gender identity) and eight were trans boys (natal girls with a male gender identity).”

Note that puberty suppression was their only option until age 18, a state of affairs that I have argued, and will continue to argue, it both unnecessary and cruel, but better than nothing.  This protocol privileges desisters and indeed all non-gender-dysphoric teens in that an active or implicit decision to deliberately use endogenous hormones to masculinize or feminize (as the case may be) their bodies is socially sanctioned, actively encouraged even, but an active decision on the part of gender dysphoric teens is considered suspect and their ability to make such a decision is deemed problematic.  {Can nobody else see the double-standard?  Why, if this is all about not trusting teens to make this decision, are ALL teens not put on puberty blockers until they are adults?}  All evidence points to the age of 14 being an appropriate age to end, not begin, puberty suppression, to be replaced with conventional Hormone Replacement Therapy.  But concerns about transphobic public resistance prevents this evidence based medicine approach.

{On a personal note, I first learned about HRT at age 15, but my pediatrician recommended my mother send me to psychotherapy to “cure” me instead. I began actively requesting feminizing HRT from the Stanford Gender Dysphoria Clinic at age 17 in 1974.  I was denied this.  I had to wait until I was legally of age and began HRT very soon after my 18th birthday in the summer of ’75.  In those days, puberty suppression was not available.  I deeply regret what that delay did to my singing voice.}

So what did these modern teens have to say?  Here’s a typical comment,

“I think it is hard to set an age requirement. On the one hand I think 12 years is a good age minimum, on the other hand I think that a transgender whose puberty started earlier should have the possibility to start treatment with puberty suppression before the age of 12.” (trans girl; age: 13)

You may wish to read the rest of what they had to say at the actual paper at the link below, as it is not behind a paywall, thankfully.

Further Reading:

Essay on evidence for best age to end puberty suppression based on age of desisting gender dysphoria

Essay by Alejandra Velasquez at the transkids.us website on treatment recommendations for MTF transkids. {Note:  Ms. Velasquez was ~20 when she wrote the essay in 2004}

Essay on Advice to Parents of Transkids

References:

Vrouenraets, L. et al. “Perceptions of Sex, Gender, and Puberty Suppression: A Qualitative Analysis of Transgender Youth”
Archives of Sexual Behavior (2016). doi:10.1007/s10508-016-0764-9

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Raising Children is a Sacred Trust…

Posted in Editorial, Transgender Youth by Kay Brown on December 8, 2015

Kay BrownParental Attitudes Towards Transgender Children

Every now and then, I check the stats on this site.  I am gratified by the growing number of readers over the past six years.  I also check the search strings that are used to find this site.  I am happy that parents of transkids find my site and this much needed information.  But I am usually saddened by the search strings.  These are the most common, in order of frequency:

“How to cope with transgender children”

“How to deal with a transgender child”

“How to manage a transgender kid”

“My child is transgender”

Do you see the problem?  The terms ‘cope’, ‘deal’, and ‘manage’ indicate that these parents see their child as a dissappointent, a burden, a problem.  One ‘copes’ with emotional loss and dissappointment.  One ‘deals’ with a burden.  One ‘manages’ a problem.

I’ve known dozens of other transkids (and former transkids / adults who were transkids).  Nearly every one of them spoke of how their parents had been dissappointed by them.  Even those whose parents eventually came to support them went through a period where their parents tried to deny that they were transkids.  Many were disowned by their parents.

But every now and then, but not nearly as often as I would like, I see this search string:

“How to help a transgender child”

Today, among several like the first three, I saw this gem:

“How to protect a transgender child”

Several years ago, my husband and I hosted a lovely young couple and their two children.  Their children were around three years old, fraternal twins.  One was ‘all boy’.  He wore his favorite T-shirt sporting an image of a bulldozer that read, “I like dirt”.  The other child was a sweet natured, feminine girl wearing a yellow flowered sundress.  She gave us an impromptu ballet recital in our front parlor.  Can you see where this is going?  That sweet mannered girl is male.

This young couple loved and celebrated their children.  Both of them.  They told me that they didn’t like attending support groups for parents of gender atypical / transgender children because the other parents saw their children as dissappointments, problem children, burdens.  The other parents would spend most of the time trying to convince everyone, including themselves, that they had done everything they could to cope, deal, and manage their children.  They were apolegetic about their child’s behavior and even of their own eventual acceptance of their child’s atypicality, having done everything they could to prevent it.

Which brings me back to the search string that I never see, but would dearly love to:

“How to celebrate my transgender child”

(Addendum 2/4/2016:  Banner Day!  Today someone used this search string, “loving your transgender child”)

(3/26/2016:  UGLY DAY!  Today someone used this search string, “things to say to comfort parents of a transgender”, as though having a trans-child were a terrible tragedy.

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Child’s Play

Posted in Female-to-Male, Science Criticism, Transgender Youth by Kay Brown on February 9, 2015

critical-thinkingFor years, critics of transkids’ identities have made claims that transkids are either “confused”, “delayed”, or “pretending”.  Many papers describing feminine boys from the 1960’s would describe them as being “talented mimics”, explicitely taking the position that men and women, boys and girls, do in fact have in-born differences in behavior, mannerisms, and motor-movements, but that these feminine boys were NOT exhibiting natural behavior, but were consciously, or “subconsciously”, observing girls and women, and learning to “mimic” these behaviors.  Of course, those of us who were such and grew up to transition, have long begged to differ!

Today, we have a published paper that demolishes these notions.  At the core of the paper is the ability to determine implicit associations between concepts.  If you are not familiar with this tool, it may be useful to review the Wiki page on Implicit Association Testing .  One of it strengths is that it cannot be “faked”.  It is impervious to Social Desirability Bias or other impression management distortions.  It is also impossible for someone to be “pretending”, as the cognitive load to evaluate the test set-up, determine the “right” answer, etc. would create an obvious delay in the test.  Further, if a child were “confused” as to the meaning of sex and gender, there would be an obvious anomalous signature in the test results.

ImplicitThe study involved 32 transkids, ages 5-12, 12 FtM, 20 MTF, who have already transitioned full time, with the full support of their families.  This would obviously include “early onset” transkids.  However, and this is critical, we know, or at least suspect, that some of these kids will “desist” being gender dysphoric before puberty, if they follow the trend already seen in other studies, most especially the Steensma study from the Netherlands.  Yet, for all of that, the results of the study show that these kids are completely consistent in their implicit gender identity and preferences as their opposite sex, non-trans, controls and siblings.  They are NOT pretending, nor confused.

The folks who conducted this recent study are continuing their work, looking at these kids as they grow up.  They are looking for additional transkids to join the study.

Study on Gender Nonconformity in Children

Hi from the TransYouth Project at the University of Washington! We are researchers interested in gender development in children and have a new research project we are currently recruiting families for. The project aims to better understand gender development in gender nonconforming and transgender children.  Our new study takes 30-60 minutes and includes children ages 3-12. We are running the study all over the U.S. and Canada so please let us know if you are interested and we can let you know when we’ll be in your area. We are hoping to recruit gender nonconforming children as well as their siblings (where applicable). All data collected as part of this study are confidential. Payment is $10 per parent and $10 plus a small toy per child. There is an optional longitudinal component that we can tell you more about as well if you are interested. To sign up for the study, please visit: http://www.transyouthproject.org. If you have any questions, feel free to contact me, Dr. Kristina Olson, via email (krolson@uw.edu) or phone (206-616-1371). Thanks for considering being a part of this research or telling someone who might be!

Reference:

Kristina R. Olson, Aidan C. Key, Nicholas R. Eaton, “Gender Cognition in Transgender Children“, Psychological Science

Thomas D. Steensma, Roeline Biemond, Fijgie de Boer and Peggy T. Cohen-Kettenis, “Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study”
http://ccp.sagepub.com/content/early/2011/01/06/1359104510378303

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Researching Parental Experiences of Transkids

Posted in Editorial, Transgender Youth by Kay Brown on April 4, 2014

Here is an opportunity for the parents of transkids to give feedback to a researcher looking into their experiences,

“Researchers at Case Western Reserve University are currently conducting an online study of the experiences of families of gender variant, transgender, or otherwise non-cisgender kids ages 10-17. The study involves completing questionnaires online about your experiences with the process of your child disclosing their gender identity to you and/or the process of your child’s transition, as well as questions regarding your emotions, attitudes, and preferences for potential psychotherapy interventions for families of gender variant children. Your child will also complete several brief questionnaires about their emotions and experiences with disclosing their gender identity. To participate, you must be the parent or primary caregiver of a child or teen ages 10-17 who identifies as gender variant, transgender, or otherwise non-cisgender and you yourself must be at least 18 years of age. You will have the option of including your contact information in order to receive a $10 gift card, although providing your contact information is not necessary to participate in the study. The information gathered from this study may help us to better understand the needs of families of gender variant children and ultimately help us to design therapies to help families better cope with the changes associated with their child’s transition.”

Please participate if you qualify, as we need as many voices and as broad range of experiences as possible:

http://psychology.case.edu/research/fear_lab/lgbtq_participation.html
.
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The Age of Innocence

Posted in Female-to-Male, Transgender Youth, Transsexual Field Studies by Kay Brown on February 28, 2011

At what age should transkids start HRT?

WISHES
OH, if you were a little boy,
.  And I was a little girl –
Why you would have some whiskers grow,
.  And then my hair would curl.
Ah! if I could have whiskers grow,
.  I’d let you have my curls;
But what’s the use of wishing it –
.  Boys never can be girls.
–Kate Greenaway, Marrigold Garden, (1885)

For physicians and other health care providers, an over-riding concern is to “do no harm”.  One of the fears for such care providers is that of starting a course of treatment intended to treat a condition, only to discover that they misdiagnosed the patient and gave a treatment that not only was unneeded, but potentially harmful.

In the case of trankids, both MTF and FtM, the sooner one can begin hormonal & surgical treatment and social support interventions to allow them to successfully transition into the appropriate gender/sex role so as to take advantage of the normal adolescent physical and social maturation process along side their peers, the better the long term outcome.

But, as the very recent Steensma study, as well as many before it, shows, not all gender atypical children will be gender dysphoric, and not all gender dysphoric children will persist as such into their teen years.  Thus, the study was conducted in the hope of finding differences between persistors and desistors, so that clinical treatment decisions can be made as early as possible.  The earlier one can separate the two, the earlier one can begin to treat the transkids, while letting non-transsexual teens grow up naturally, without potentially harmful iatrogenic trauma.

Because healthcare providers have not been able to accurately predict which gender atypical / dysphoric children will persist, a number of practitioners have begun recommending and using a puberty blocking protocol, under a harm reduction model in which the persistors are protected from the harmful effects of their endogenous hormones, while refraining from iatrogenic injury from exogenous cross-sex hormones in those who will desist from their earlier gender dysphoria.  The current recommendation is that such puberty blockers be used until the individual is 16 or even 18 years old, at which time, if he/she is still a persistor, they may be switched to cross-sex hormones, while the desistors may terminate the puberty blocking protocol at any time.  (There is a built in bias for desistors and against persistors in that desistors can begin a prefered hormonal protocol, simply by stopping the puberty blockers, but persistors must wait and “prove” to healthcare workers that they are ready.)

The problem with this protocol is two fold.  First, it is not without its own potential for iatrogenic harm in that delaying puberty reduces the eventual strength of the bones in adulthood.  This may not be immediately harmful, but those children will someday be older adults, whose bones will be more prone to breaks.  Second, for MTF transkids, delaying puberty means that they will continue to grow taller, potentially reducing their ability to pass successfully as female.  This effect may however be welcomed by the FtM transkids, but their desisting female peers may not feel the same.

Another problem with this protocol is that it is very expensive, far more expensive than cross-sex Hormone Replacement Therapy (HRT). For those who live in countries who do not have a generous state provided health plan, this may be a deal breaker.

So, for health care providers and parents alike, it may be better if they can accurately predict who will desist and who will persist.  Getting this data is the object the Steensma study.  The Steensma study is short on statistics, but what they do have is remarkable:

.                                Total group       Persisters     Desisters
.                                    (N = 53)            (N = 29)       (N = 24)

Natal sex
% (N) Boys             56.6 (30)          58.6 (17)      54.2 (13)
% (N) Girls              43.4 (23)          41.4 (12)       45.8 (11)
Age at childhood
assessment
M (SD)                   9.41 (1.46)*     9.92 (1.26)    8.81 (1.47)
Age at follow-up
M (SD)                 16.11 (1.70)     16.14 (1.84)   16.07 (1.54)
Full-scale IQ
M (SD)            100.26 (12.82)    98.83 (12.28)  102 (13.50)

* Significant difference observed between persisters and desisters in age at childhood assessment (t(51) = 2.968, p < .05).

For starters, the IQ of the persistors is 98.83, essentially average.  Although this is combining FtM and MTF, the number agrees with my earlier estimate of 98.6 for the MTF HSTS population.

But, the more important data is that there is a difference between the ages of childhood assessment, the age at which their parents brought them to a clinic for evaluation.  But, the study makes it very clear that there was very little difference between the two groups in their early childhood gender atypicality.  So why is there this difference?  Why would the parents of persistors wait longer than those of desistors?

Because they don’t!  It wasn’t that parents of persistors waited longer, it was that many desistors, desisted at an earlier age, such that their parents never brought their children in for assessement.  As they get older, fewer and fewer parents of desistors would bring in their children.  But, the persistors would continue to be brought in at later and later ages.  Indeed, the authors specifically stated that from the interviews, the desistors clearly articulated that from age 10 to 13 were critical for their change in gender dysphoric feelings.  While, for persistors, that same age only confirmed and strengthened their feelings.  Thus, both interview report and the statistics agree that something special seems to be happening starting at around the age of ten or even a little younger.

Starting around the age of 10, and for the subsequent years, the persisters indicated that their crossgender preferences and behaviour and their gender identity remained stable, but that their dysphoric feelings intensified. The intensification of gender dysphoria was attributed to three factors; (1) Certain changes in their social environment, (2) The anticipation of and/or actual physical changes during puberty, (3) The first experiences of falling in love and discovering their sexual orientation.

The authors, in focusing on what the teenagers said were influential, may have missed a critical factor.  What’s so special about the age of ten?  This is well before puberty.  The authors focused on changing social factors, but could it be that biology is the important factor?  McClintock and Herdt point out that sexual attraction is first noted well before our classic definition of puberty, that of the maturation of the gonads and subsequent increase in testosterone, estrogen and progesterone.  Instead, other hormones start earlier, typically around ten years old.  And this is the age at which one’s sexuality begins to be recognizable.

With regard to sexual attraction, all persisters reported feeling exclusively attracted to persons of the same natal sex, which confirmed their gender identity as they viewed this attraction as a heterosexual attraction. They did not consider themselves homosexual or lesbian.

For the desisting boys, some came to recognize that they were gay or bisexual, essentially confirming the results of many other studies which have shown that gender atypicality in boys is highly corralated with homosexuality.  However, a number of the boys self-identified as heterosexual, even though they also recognized some same sex attraction.

For the girls, all of the desistors had become aware of the fact that they were heterosexually attracted to boys and wanted to be sexually attractive to boys.  Thus, they were the classic tomboys who grow up to be straight women.  But the persisting girls were all attracted to girls.

Thus, this study showed that the key difference between persistors and desistors among female bodied gender atypical / dysphoric individuals was sexual orientation, but among male bodied, it was not as clear cut, desisting boys included both gynephilic and androphilic sexual orientations.  However, what is clear is that persisting boys are all clearly unambiguously androphilic (HSTS).  Persistors will demonstrate same sex attraction, while desistors may or may not.  Thus opposite sex attraction is a key exclusionary sign for persistors.  Although we still would have some desistors who don’t show this sign, we have at least conclusively identified some.

Further, none of the study group was autogynephilic.

This last point is important.  Although many autogynephilic adults report having been gender dysphoric as children, it is rare, though clearly not unheard of, for them to have been noticed as such as children.  They are the “non-aparent” population as children.  However, for the HSTS population, of both sexes, MTF and FtM, their gender dysphoria was accompanied by obvious gender atypicality.  Since obvious gender atypicality is not found in autogynephilic boys, who are universally gynephilic, we can safely say that anyone who is obviously gender atypical and sexually attracted to the opposite sex is not going to be a persistor.

Another point can be clearly found in the Steensma study is that the developmental process, what ever it is, for desistors, is finished by age 14.  If a gender atypical 14 year old is still gender dysphoric and wishes to begin hormones and transition, we can be reasonably certain that he or she will not change his/her mind later.  Thus, based on the evidence, we can safely begin such interventions.  The sooner the better.

Conclusion

Transkids after transition

Transkids after transition

From the evidence, we draw the conclusion that for obviously gender atypical / dysphoric children, waiting until one is 16 or 18 years old to end puberty blocking protocols and beginning HRT is unwarranted and ill-advised.  Instead the evidence points to the age of 14 as the latest that HRT may safely be begun with little risk of iatrogenic injury to desistors.  Indeed, the evidence suggests that carefully evaluated, many of the desistors may be excluded by age ten to twelve.  Another point to come of these studies is that anatomic dysphoria (discomfort with genitalia, etc.) is correlated with persistence.  Thus, if delaying puberty is chosen, it should not be continued past the 14th birthday, and given proper screening, may be ended earlier, to switch to HRT.  For both cost and health reasons, it may be best to start on HRT for those who clearly fit the profile of a transkid, who request and understand the consequences of HRT, as soon as would be indicated for their gender of choice.  That is to say, that for MTF’s, HRT should begin at age 12, and for MtF, at around age 14, mimicking the natural maturational process for each target sex.

Addendum 2/23/2012:

If you are a young teen, finding this post:  Welcome!  To answer some questions.  Yes, you can start blockers, maybe with lose dose HRT, as young as 10 years old, but should start with very low doses, gradually increasing to the recommended level for teenagers as you reach 12-14 years old.  Of course, you would need either your parents permission, or find a youth clinic that understands transkids’ issues, who would prescribe HRT on a “harm reduction model” .  (Seriously, that’s the magic words, “harm reduction”… as in… “I’m going to get hormones on the street if I don’t get them here.”)  Good luck!

Addendum 6/1/2012:

Please read my Advice to Parents of Transgender Children

Addendum 12/29/2012:

Please read my Advice to Transgendered Teens

References:

Thomas D. Steensma, Roeline Biemond, Fijgie de Boer and Peggy T. Cohen-Kettenis, “Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study”
http://ccp.sagepub.com/content/early/2011/01/06/1359104510378303

Vicente Gilsanz, James Chalfant, Heidi Kalkwarf,Babette Zemel, Joan Lappe, Sharon Oberfield, John Shepherd, Tishya Wren, Karen Winer, “Age at Onset of Puberty Predicts Bone Mass in Young Adulthood”
http://www.jpeds.com/article/S0022-3476%2810%2900566-4/abstract

Martha K. McClintock and Gibert Herdt, “Rethinking Puberty: The Development of Sexual Attraction”
http://homepage.univie.ac.at/Michael.Berger/lit/McClintock.pdf

Annelou L.C. de Vries, Jenifer K. McGuire, Thomas D. Steensma, Eva C.F. Wagenaar, Theo A.H. Doreleijers, Peggy T. Cohen-Kettenis, “YOUNG ADULT PSYCHOLOGICAL OUTCOME AFTER PUBERTY SUPPRESSION AND GENDER REASSIGNMENT” Pediatrics (2014)
http://pediatrics.aappublications.org/content/early/2014/09/02/peds.2013-2958

Kelly Winters, “Methodological Questions In Childhood Gender Identity Desistence Research”  Blog Link

 

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