Gender Identity in Youth: A (Scathing) Rebuttal

212 is LGBT

There has been an astounding amount of attention on social media (and I cringe as I accept this platform as a medium for discourse) about an article regarding gender identity in childhood and adolescence posted by the evangelical right wing physician’s group the ‘American College of Pediatricians’ (…)
Their message is dangerously and deliberately misinformed, completely unreferenced, and hideously propagates trans- and homophobia. It’s completely unacceptable for health care professionals to endorse an agenda that is non-evidence based and motivated by conservative fundamentalism. In fact, the article is hardly even worth consideration, let alone on facebook, but the amount of attention it’s attracting behooves us to discuss the issues presented. Let’s take a closer look at the arguments the authors are trying to sell:
1. Human sexuality is an objective biological binary trait: “XY” and “XX” are genetic markers of health – not genetic markers of a disorder. The norm for human design is to be conceived either male or female. Human sexuality is binary by design with the obvious purpose being the reproduction and flourishing of our species. This principle is self-evident.
– Not only are sexuality and gender completely distinct concepts rendering this comparison null, but human, and even non-human, sexuality is anything but binary. It is widely recognized that same-sex sexual behaviour is seen across all species and that not all individuals are exclusively sexually oriented toward one gender (Bailey et al. 2009).

2. No one is born with a gender. Everyone is born with a biological sex. Gender (an awareness and sense of oneself as male or female) is a sociological and psychological concept; not an objective biological one.
– Couldn’t agree more – so we are we pathologizing the development of a gender identity that doesn’t coincide with biological sex?

3. A person’s belief that he or she is something they are not is, at best, a sign of confused thinking.
– What provocative insight… The authors then go on to misinterpret the DSM diagnosis of gender dysphoria as a form of delusional disorder. The DSM acknowledges gender dysphoria as “a marked incongruence between one’s experienced/expressed gender and assigned gender… associated with clinically significant distress or impairment in social, school, or other important areas of functioning.” The DSM authors do not comment on whether this incongruence is erroneous or somehow morally corrupt, simply that it leads to suffering (Diagnostic and statistical manual of mental disorders (5th ed.)).

4. Puberty is not a disease and puberty-blocking hormones can be dangerous.
– Puberty, indeed, is not a disease, but it can cause tremendous distress for transgender youth. Puberty-blocking hormones definitely can have adverse effects, therefore should be managed by competent health care providers, not withheld entirely. Coronary artery bypass grafting can be dangerous too.

5. According to the DSM-V, as many as 98% of gender confused boys and 88% of gender confused girls eventually accept their biological sex after naturally passing through puberty.
– From the DSM: “Rates of persistence of gender dysphoria from childhood into adolescence or adulthood vary. In natal males, persistence has ranged from 2.2% to 30%. In natal females, persistence has ranged from 12% to 50%”. Naturally, the ACP rounded to the lowest possible figure and didn’t mention how challenging it is to study an epidemiological variable such as this one. Again, for the cohort that does have persistent gender dysphoria into aduulthood, the irreversible changes of puberty can be devastating.

6. Children who use puberty blockers to impersonate the opposite sex will require cross-sex hormones in late adolescence. Cross-sex hormones are associated with dangerous health risks including but not limited to high blood pressure, blood clots, stroke and cancer.
– See point #4, just silly.

7. Rates of suicide are twenty times greater among adults who use cross-sex hormones and undergo sex reassignment surgery, even in Sweden which is among the most LGBQT – affirming countries. What compassionate and reasonable person would condemn young children to this fate knowing that after puberty as many as 88% of girls and 98% of boys will eventually accept reality and achieve a state of mental and physical health?
– This point is so ludicrous, it needs no rebuttal, but I will systematically dismantle it anyway. The Swedish study in question (Dhejne et al. 2011) did not compare the transgender cohort to one that received no cross-gender intervention; they compared them to the general population. The authors of the study concluded that “Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.” They, in fact, don’t find that gender affirming surgery leads to suicidality, but that it’s not enough to alleviate suffering and that more efforts should be taken to support transgender people!
– A recent Canadian study (woo) found that social support, reduced transphobia, and gender-affirming correction of personal identification documents, were all associated with significant reductions in suicidality among the transgender population (Bauer et al. 2015). The fact that transgender people report a 22-43% suicide attempt rate (Bauer et al. 2015) is an absolutely tragedy that clearly indicates a dire need for more support and acceptance, not further ostracization.

8. Conditioning children into believing a lifetime of chemical and surgical impersonation of the opposite sex is normal and healthful is child abuse. Endorsing gender discordance as normal via public education and legal policies will confuse children and parents, leading more children to present to “gender clinics” where they will be given puberty-blocking drugs. This, in turn, virtually ensures that they will “choose” a lifetime of carcinogenic and otherwise toxic cross-sex hormones, and likely consider unnecessary surgical mutilation of their healthy body parts as young adults.
– Just read that again, and try to conceive how this group could have any credibility left, or be worthy of any discussion. Allowing fundamentalist groups to have any kind of influence on policy makers or health professionals is utter abuse of the public. I’ll accept that there might always be a fringe minority group, intolerant of issues like gender and sexual identity, but I won’t accept that any physician, or other group in a position of authority, will allow these types of prejudice to permeate our consciousness.

References (yes, these matter)

American Psychiatric Association. (2013). Gender Dysphoria. Diagnostic and statistical manual of mental disorders (5th ed.)

Bailey et al. Same-sex sexual behavior and evolution. Trends in Ecology & Evolution, June 16, 2009

Bauer et al. Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health, June 2, 2015.

Dhejne et al. Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLoS One, 2011.

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