Desistance

Trans children, treated with surgery before puberty then assigned-sex hormones to have an assigned-sex puberty, would pass so much better. They would have skulls and skeletons consistent with their trans sex. They would need far less invasive, far more successful, surgery. The problem is children who desist. Many children referred to gender clinics as children grow up to identify as cis, often lesbian gay or bi. Reverting after surgery or such hormone treatment, after removal of genitals and needing further surgery, a person might develop a deep resentment of the medical services s/he had as a child.

Who do you protect? Not knowing whether this child will revert, do you force trans children to undergo an unwanted puberty to protect a cis person who might be caught up in the treatment? All other things being equal, people are happier with a full set of working genitalia including gonads than without. So, someone has to speak up for the genuine trans children, forced through an alienating puberty to need more surgery with worse outcomes: I am sorry that it is not me.

What matters is how many referred to gender clinics desist, and whether one can detect them before puberty. In the New York Magazine I read of two recent studies. Some of the children who desisted were just as extreme [in their gender dysphoria] as some of the children who persisted, wrote Devita Singh, a clinical psychologist. The NYMag article raises my distrust when it says that Kenneth Zucker was sacked as director of a GIC largely a result of false accusations leveled against him, after a lengthy campaign from a segment of LGBT activists who accused him — wrongly, in light of the available evidence — of harming his clients. Um. “A segment”- who? The Bad ones? So his bosses sacked him, because of lies told by bad people, rather than finding the truth? Really?

Thomas Steensma studied 127 children referred to the Centre of Expertise on Gender Dysphoria in Amsterdam. He found that eighty of them had desisted. Singh found of 139 AMAB children, 122 had desisted.

Were those children referred to the clinics for true gender dysphoria, or mere gender non-conformity? Some boys are effeminate- get over it, as they say. It is no surprise if non-conforming children become cis non-conforming adults- for it really is OK to be an feminine man or a masculine woman, and adults, who learn to navigate the discrepancies between what others expect and their own internal leadings so much better than children, can live more happily with that. A child may be more comfortable transitioned because though the new gender stereotype does not fit their idiosyncratic self, it is still more comfortable than the stereotype assigned at birth.

Can you tell the difference between non-conformity and dysphoria? I don’t know. I hope the doctors are working on it.

Would that children could be transitioned to neutral, a childhood without gendered expectations. They could be allowed to experiment- different clothes, colours, hair, names, playing without being divided between girls and boys-

Only gender affirmation- if it is not clearly harmful, it is permissible. That might be better for everyone.

New York Magazine, What’s missing from the conversation about trans kids.

Carpioni, Narcissus and Tiresias

21 thoughts on “Desistance

  1. We tried to bring up our own children in as a gender neutral way as possible, But by the time they were 5, they had clearly taken on the gender characteristics of their biological sex. This was back in the 1970s, and we were somewhat relieved that it turned out that way, primarily because they would face less problems by mostly conforming to the socially accepted norm.

    Both my wife and I had experienced problems growing up: I because I was unaware of socially accepted gender roles, probably because of my undiagnosed Asperger Syndrome, and my wife was brought up to take on a male role as head of a land owning family in a feudal society, as her younger brother wasn’t expected to survive until adulthood..

    Ideally, all children should be allowed to develop as best suits their nature without social pressure to conform, but society has a long way to go before that is possible. In the meantime, the fine line between identifying gender dysphoria, and gender non-conformity, must be tread carefully and with compassion.

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  2. the problem as I see it Clare is that some of these children might be fine without surgery if society were 100% comfortable with who they were. A recent study pointed to transgender people mostly suffering due to societal rejection rather than their condition itself and yes I myself have trouble with making the distinction between gender non-conformance and dysphoria and indeed they may in some ways overlap. I have thought at times that if society were to leave us completely alone the number of surgeries might actually go down because there would be less pressure to fit into one box or the other…

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    • That is the point. Why do children or adults want surgery, hormones, breast-binders, or hair removal? Why do we want to pass as the other sex? Is it because we are in some way trans irrespective of gendered expectations and pressures in society, or just because of those pressures? Trans women would have a great deal less acceptance as women if we were perceived as not necessarily wanting hormones and surgery. Julia Long presents quite butch: is accepting your birth gender the way ahead?

      If two children present as equally gender dysphoric, and we know that one will grow up trans and the other cis gay, but can’t tell which, we can’t risk inflicting surgery and a life-long dependence on hormones on the cis one. The potential loss is greater.

      The state of the debate is that people view us as threats or use us to make political points. Doctors wanting to make money or reputations, and imagining medicalising is the answer, aren’t necessarily on our side either.

      And. I have to insist on the validity of the choice to transition physically or socially. Whatever we do, we are the focus of hostility. Rather than transphobia, hostility to the life-choices of trans and non-conforming people is the problem.

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      • I agree there should be choice but the difficult part is knowing when to intervene. If a boy might be happier as a girl it might be harder for us to accept that truth because we think they don’t know best they are only a child. Speaking only for myself I would have been much happier being able to express myself fully as I wanted rather than follow the surgical route but I complied due to societal pressure and played the game. It is very difficult to know whether people want to change in order to be left alone and not need to fight society or because there is a primordial understanding that at their core they are truly women. But then there may be a grey zone here between non-conformance and deep gender dysphoria.

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  3. Funny, I just read this five minutes ago:

    “The stories all sounded the same too. Freshman year of high school, immense pressure to conform to a highly sexualized environment, then if your self confidence is not where the crowd thinks it should be, the name-calling and rumor-mongering. It was so bad a friend of mine told me that her daughter would come home in tears every day because the girls thought she was lesbian and the boys would too, and worse, make lewd gestures. This girl, the victim, told me that a lot of the girls that were picked on were doing this and identifying as male, she thought, as a self defense mechanism so that the rest would leave them alone…

    It is so prevalent, so ubiquitous, that the schools have just given in. The counselors and psychologists have been instructed not to question the veracity of the claim that the individual is other than what they identify themselves as. The counselors are told that they must comfort and “support” the person going through this and be nurturing. If a kid has a sexual confidence problem, they are probably gender queer according to many counselors or psychologists. I learned that there is a whole network out there actively promoting transitioning and gender fluidity and that many of the psychologists have bought into it so much that they are skipping protocol and advocating for hormone therapy after only 2-3 visits. There are networks out there for these kids to get hormones without a prescription and that these networks are referred to these kids by then psychologists themselves.”

    Kids are not competent to make these decisions. Neither it seems are many doctors and parents.

    Source:
    http://www.theamericanconservative.com/dreher/the-cult-of-transgender/#post-comments

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        • If The American Conservative wanted to ameliorate the situation, there is so much it could do. It could teĺl its readers that “Biblical manhood and Womanhood” is a totally worthless concept, having nothing to do with the way God makes humans, or even the Bible. It could oppose bullying and toxic Jock culture. It does nothing like that, preferring to tell fear-filled lies about hormones.

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          • I don’t know what ‘biblical manhood and womanhood’ refers to, sounds like evangelical language, which I don’t speak very well.
            The article is mostly about bullying: girls reacting to sexual bullying by declaring themselves boys.

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            • Well, The American Conservative is Patrick Buchanan’s rag, and he was Evangelical. If you don’t understand BMaW, you could always google it. I am unaware of conservative responses to bullying beyond hitting back harder.

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            • Buchanan is Catholic. The webzine was founded as a counter to the pro-war neocon movement, something I would think you could appreciate.
              Hitting back harder is actually a very effective way to deal with individual bullies but with the situation described in the article of an entire culture there is really nothing you can do but find a different school.

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  4. The doctors have already been working on it for a while. As Kelley Winters points out (http://transadvocate.com/the-new-york-magazine-lies-to-parents-about-trans-children_n_18875.htm), the 80% desistance statistic is a result of a clear (and deliberate) problem in the DSM-IV, where it was possible to base a gender dysphoria diagnosis entirely on social gender non-conformance. The criteria in the current DSM-5 (and ICD-10) are not nearly as problematic in this respect.

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    • Welcome, Ana, and thank you for commenting.

      Here are the DSM IV criteria, taken from that article:

      DSM 4 criteria

      Here are the DSM V criteria:

      Gender Dysphoria in Children 302.6 (F64.2)
      A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following
      (one of which must be Criterion A1):
      1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender).
      2. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing.
      3. A strong preference for cross-gender roles in make-believe play or fantasy play,
      4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.
      5. A strong preference for playmates of the other gender.
      6. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities.
      7. A strong dislike of one’s sexual anatomy.
      8. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender.

      Before DSM V, children did not need that desire or insistence. I will need to dig into this further, and consider the thesis. Do you think the whole desistance rate is caused by a lack of criterion 1? If not, what proportion do you think is caused by that?

      I want to protect trans kids from puberty if possible. The questions are,

      Can this be done without damage to cis kids?
      If not, which is the more important loss to a child, the trauma of the wrong puberty, greater difficulty passing and more invasive surgery, or loss of functioning genitalia, impotence and infertility?

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      • Quite frankly, I don’t know the research well enough to be able to say exactly how much the DSM-IV criteria distort the results cited here, only that it’s pretty clear that they do.

        If one looks at this from another angle, Van Caenegem et al. (Prevalence of Gender Nonconformity in Flanders, Belgium; Archives of Sexual Behavior, 2015) found a prevalence of gender ambivalence of 2.2% in people assigned as male and 1.9% in people assigned as female, with a prevalence of gender incongruence as 0.7% and 0.6% respectively. From these figures, simple arithmetic would suggest that abut 24% of the gender non-conforming people actually have gender incongruence to some degree. This is quite close to how the original article states that 20% eventually transitioned happily.

        The numbers are consistent with a hypothesis that DSM-IV was unable to see the difference between a child’s social gender non-conformance and transsexuality. Just how much better the current criteria are remains to be seen, but the changes in criteria are not all we have: from what I’ve understood, modern gender-affirming treatment attempts to take into account the uncertainties and to help both trans and cis children who are trying to make sense of their gender.

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  5. Interesting discussion. I don’t envy kids dealing with any of these questions in their lives, given the way society is currently structured. A lot of pressure, a lot of options, a lot of uncertainty, and a lot of prejudice. It seems a bit safer for kids in this country that at least there is profit angle to consider on the part of the medical professionals dealing with them. It must be difficult to trust private health providers in this kind of context, especially when a profitable industry is building around the demand for services.

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    • I would not bring private v public health-care into this. Given the tabloid reaction to funding for trans services, possibly private is the way ahead: very wealthy people getting the best care, and so finding what that best care might look like.

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