“Rapid Onset” Gender dysphoria

The parents’ stories are heartbreaking. These usually involve a teen who was anxious, depressed, socially isolated, or suffering from PTSD coming to identify as trans after internet binges on social media sites. These parents report that mental health professionals are validating the self-diagnosis of transgender after a handful of therapy sessions, without any exploration of prior mental health issues, trauma, sexual orientation, or history of gender nonconforming behavior. This clearly violates APA recommendations, which urge special caution in treating adolescents who present with sudden onset dysphoria.

This is the basis of a great deal of hatred of “trans activists” and opposition to transition. So, is it true? There are stories of young women who went through a phase in their teens of desiring top-surgery, but their parents help them avoid that- and these young women feel they have had a lucky escape. Of course they are young women, not trans men. And here is a story of “wreckage”, where the child is distanced from their parents, who feel the diagnosis is wrong.

After a 30-minute consultation with a physician’s assistant, Molly was given an appointment for the following week to begin testosterone injections. There was no exploration of her other physical and mental health issues, and whether these may have influenced her belief that she was trans.

Testosterone can have a serious effect on a female body, even at the first injection. These are the stories feminists tell each other. I found it after an ill-advised attempt to find common ground on Mumsnet: the comment thread referred us to it, calling it “a heartbreaking tale of social contagion”. It contravenes the World Professional Association for Transgender Health (WPATH) guidelines

(pdf)

which state,

The criteria for hormone therapy are as follows:
1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country (if younger, follow the Standards of Care outlined in section VI);
4. If significant medical or mental health concerns are present, they must be reasonably well-controlled.

Dysphoria here is clearly not “well-documented”, arguably not “persistent”, and the mental health concerns should be assessed.

The PA (physician assistant) also suggested that Molly schedule top surgery – a double mastectomy – within a few months.

No wonder people are shocked, reading this sort of story. The WPATH guidelines say many people find comfort with altered gender expression without surgery, and qualified mental health professionals must make an assessment before surgery, and Assess, diagnose, and discuss treatment options for co-existing mental health concerns. Chest surgery may be carried out after one year of T and ample time of living in the desired gender role.

The parents said they wanted time to think and research, and at first the child agreed, but at college without telling the parents started T. The child- or young adult- kept repeating that she didn’t want to see us, that we were the reason she had been hospitalized because we didn’t support her transition.

Max “did not blossom into his true self”. He was more anxious and isolated than ever and rarely left the house, spending most of his time online.

I tell people you don’t get hormones easily or quickly, especially as a child. This story, contradicting the WPATH guidelines, says differently. I don’t believe it. T after half an hour with a physician assistant? A PA’s qualification takes less time than a medical degree, and they practise medicine supervised by a physician. They may diagnose and treat. I saw a consultant psychiatrist on the NHS.

The post alleges that teenage girls identify as trans because of social contagion, from visiting websites which valorize being trans. Other conditions allegedly spread in the same way: Bulimia was virtually unknown until the 1970s, but once described there was a common language for it, and it spread into culturally remote enclaves following the introduction of Western media sources. NYMag confirms that, and Lisa Marchiano quotes the researcher NYMag interviewed. Fiji first got television in 1995, and shortly after the first teenage girls there showed symptoms of eating disorders.

What do you think?

Partly it depends on whether being trans is acceptable. It could be unacceptable for conservative reasons, that God made us male and female, or for radical feminist reasons, that there is no necessary connection between sex and gender, and both sexes exhibit a wide range of gendered behaviour. It seems possible to me that I transitioned because of social pressure.

The stories are out there. People are angry. If girls imagine that transition is the answer to their problems, though they could have lived as normal women within the freedom of gender expression which other women carve out for themselves, perhaps they are right to be angry. You only learn that medical transition is not the answer to your problems when you have completed it, without robust gatekeeping.

In the comments, someone suggests autistic girls might find boys easier to grok than female teens, and it’s easy to see how a young woman who has no interest or patience for make up and complicated hairdos, who hates frilly clothes (too uncomfortable for those who are “sensory”), and who has a blunt communication style can come to wonder if she is “really” female or “actually” male instead, especially as adolescence brings on an increase in gender differences. Speculation becomes feverish.

Talk to me.

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