Gender dysphoria in children

Far too many children are accused of “cross-gender behaviour”. This could lead to lasting damage. The Gender diversity and Transgender identity in Children factsheet of the American Psychological Association says 5 to 12% of girls and 2 to 6% of
boys exhibit cross-gender behavior
. With numbers that high, the definition of “normal gendered behaviour” is the problem, not the children. Let them play, experiment, be who they are!

It is hard to estimate the numbers of lesbian and gay people. Do you survey how many have ever had homosexual experience, or who have had homosexual experience in the last year? And people are still scared of saying they are gay rather than straight, and will identify as heterosexual despite gay experience. But asked to place themselves on the Kinsey scale, with six boxes rather than two, only 72% of British adults identified as exclusively heterosexual. Wikipedia is interesting on this, and that is as far as I have gone- I am not an expert, merely trying to form my own understanding of the best way to treat children. People are far too complex for either/or, gay/straight, trans/cis. My personal interest is in beta males with viragos, derided so long as not real men, as pussy-whipped. Such beta-males can be very feminine.

So I love the APA’s position now:

There are three main approaches to psychological intervention with gender diverse children including a “gender affirmative” approach, a “wait and see if these behaviors desist” approach, or actively discouraging gender non-conforming behavior. The gender affirmative model is grounded in the evidence-based idea that attempting to change or contort a person’s gender does harm. Psychological interventions should aim to help children understand that their gender identity and gender expression are not a problem. Providers should aim to non-judgmentally accept the child’s gender presentation and help children build resilience and become more comfortable with themselves, without attempting to change or eliminate cross-gender behavior. Children who experience affirming and supportive responses to their gender identity are more likely to have improved mental health outcomes. Gender identity is resistant, if not impervious to environmental manipulation. Moreover, attempts to change a child’s gender may have a negative impact on the child’s well-being.

Parents and schools are the problem. Most of the therapeutic work is with the parents, to prevent them suppressing the child’s harmless but surprising behaviour: Often, the most important intervention is helping the family to cope with and live for some time with the uncertainty about the child’s gender and sexual identity development. They need to be advocates for their children. Providers should advocate for children to be safe in schools while exploring gender diverse expression. Pardon me while I scream at the floor- “Children should be safe in schools”! It needs to be said!!!!!!! If children’s natural, harmless gender expression is not tolerated by parents, schools or peers, they may exhibit the usual extreme stress reactions of children, such as “Oppositional defiance” or “ADHD”; or depression, rocking, cutting…

The fact sheet at first appears to distinguish “gender diverse” children, who express their gender in ways that are not consistent with socially prescribed gender roles or identities, from “transgender” children, who consistently, persistently, and insistently express a cross-gender identity and feel that their gender is different from their assigned sex. Later, though, it conflates the two: Fully reversible interventions such as a social gender transition including changing clothing, name change, new pronouns, or changes in haircuts may be indicated for some gender diverse and transgender children. And why not exploration? Let little Stephen come to school as Clare occasionally, if s/he wants. Let Clare be boyish and Stephen girlish. We need to know which the child is at the time that hormone therapy is prescribed, and not before.

APA fact-sheet pdf.
beta males.
Wikipedia on demographics of sexual orientation.

Gender psychiatrist

I am one person. This is not immediately obvious.

Penny Lenihan, at Charing Cross, is my eighth psychiatrist. I liked her practical manner, and she shook me up, so that I don’t want to go where I am going this weekend. Cos it ain’t competent me that is going, but shit me, shit me who does fuck all and whom I despise. She observed me communicating calmly and well, and me weeping in anger frustration and sadness, and said “You compartmentalize”.

And I think that’s a bad thing, and I should stop, and I don’t even know what she means by it, particularly. One of my thoughts was that this is a good experience, because however unsettled I feel now I might get to better ways of coping. And now I think that I might bring things to consciousness: see what I am doing, see I have choices.

I got a different view of Serra Pitts. Dr Lenihan has some familiarity with my case, because she has been supervising Serra, who was a trainee and is no longer working with the clinic. I was unaware Serra was a trainee. It is “contrary to protocols” that trainees work with patients privately after sessions at the clinic end. Dr Lenihan will see that the new trainees are aware of the protocols, she says drily. And now I see, yes, that is appropriate; and Serra just not turning up for work does not mean Serra having great difficulty but Serra doing something any employer would object to.

We started by discussing what hormones I was on. She saw no reason for me to be on norethisterone, and did not think my emotional issues were anything to do with hormone doses, though she did want me to see the endocrinologist.. This morning I have been entirely miserable about that: so much of what I have done over the last four years to get my head together has been at best useless. So we were off to a bad start: I thought I would be discharged. She asked if I had been offered group therapy. Well, no; I would be willing to attend but needed it sold to me: what might I gain? So the offer of groups appeared rescinded, because I was insufficiently enthusiastic, and I was confused.

Like many group patients, I like to imagine I am better than the people I would meet in the group; and perhaps fear opening up to them.

Serra told me that the clinic is under great pressure to put patients through, and achieve desired outcomes. I should come knowing what I wanted to get out of it.

So because my emotional issues are not particularly related to transsexuality, she will refer me to my local CMHT. Yes, I do know that means Community Mental Health Trust. I know what they will say: “Sorry, we have no funding”. Well, I am not a risk of killing someone, and if I were they could always leave me to the prison system.

So I gave myself permission not to go to the AM clerks’ conference, and considered the possibility that I would be still tearful, there, and actually disrupt it, rather than merely gain nothing and give nothing to it; and decided that the risk was worth it, and that I could get there without undue difficulty, and would just go.

Antoine Caron, The Triumph of Winter

At the Gender clinic IV

At Charing Cross Gender Identity Clinic, Serra the psychotherapist grants me absolution over something which puzzles and shames me- or helps me find it for myself, which is better.

At the election, I felt it would be good to campaign for the Green Party. It seemed like a desire: to put leaflets through doors, to support our candidate, her motivation and her activity. Yet I did not, when others were doing it or on my own. I wondered at this. I have read that the best liars are the ones who believe their own lies, and wondered if this was me, pretending to a moral position others would find attractive without the reality of it. Nor was I certain how to distinguish a real desire from a fake one like this: I would like to place some reliance on conscious judgment as well as what I unconsciously do. I would feel more in control, even if that feeling was an illusion.

She called it the difference between what I want and what I feel I should want. It is alright to rebel against the Shoulds, to be myself. I am not conflicted, not really.

The day before, I saw Dr Lorimer, and asked him about the colo-vaginoplasty, which I had thought of asking since I first saw him twenty months ago. He said he might refer me to a surgeon. Oh! What do I feel about this? It is not the same as my previous surgery, as what I have now is so much better than what I had before that. Yet my opening scarcely accommodates two phalanges of a finger. It brings up old stuff, of the horrors of dilation and my sense of shame at failure.

I Want an opening in me, though I do not understand, though I am entirely gynaephile. It cannot be social pressure. I remember my mother’s adhesions after her bowel operation, for the removal of a cancer, and how sick they made her- but surgery has moved on a great deal in twenty years. Serra can help, giving me ideas about how to contact people who have had the operation. She herself has heard both good and bad experiences of this op from her patients.

I had expected Dr Lorimer to discharge me, and instead he referred me to his colleague Dr Lenihan. I thought, why should I see her, what good would that do me? My appointment is in November, and I may not attend. But I love to see Serra, who says lovely things, making me glow-
Because I believe them, she says-
and because I feel I am growing and changing and she helps.

I also asked him why take hormones, and he said, to avoid osteoporosis. Again, that makes little sense to me. People report a huge gain in energy on HRT, and it has seemed to affect my emotional lability. I should have challenged him, perhaps. Perhaps it is true.

I noted after that I said about that, how our unnamed understanding is real. (Today, Saturday, I feel such happiness having had a text from her.)

I make connections, I talk to people in the street, and that day I tried a high risk one: a woman, talking on her phone by the pedestrian crossing, said “He likes me!” I turned to her and said “Congratulations”. This merely confused her, it was not a good connection, and it will not put me off.

I told Serra of the Oresteia, and she said “I love hearing you on that play.” It was the right play at the right time for me. It made me understand it better.

Zhao Mengfu

Disagreements

A man died in an industrial accident in a car factory. The machine was referred to as a robot, and because it was first tweeted by Sarah O’Connor, a journalist, the angle was that it was a death like in Terminator. I read of this over Naz’s shoulder, and commented that it was ridiculous. He agreed, and was happy to chat.

It is an industrial accident. We only hear of it because they have an angle to horrify us. Our conversation moved onto Greece, with whom he has no sympathy- “They have maxed out their credit cards. They want to continue spending on their credit cards.” I mentioned Keynes, and he said it was a balance. Greece should sort out its tax system. Our in-work benefits were too generous: simply take people out of tax, which is better than one system to take money off people then another to give it back. He knows people who have lived on benefits for decades, and he thinks it wrong.

I started talking about my experiences in Oldham, but when I mentioned arranged marriages he cut me off. He has an arranged marriage with someone from India, it is just his culture. He is a successful businessman, his brother has a business, his father has a business. Other people should be self-reliant.

Disagreeing, I do not want to convert him but hear why he feels this.

At Charing Cross I listened to an obese man stating quietly but determinedly what he would do, and bemoaning being 26 next day- so old! Then Lucy and Nick sat down. Lucy is cis. Nick is painfully thin, flat chested but petite, with a feminine face. He needs T. She does group work, art with mental health, dementia and learning difficulties among other client groups. She bemoans how difficult it is to get everyone’s name, and how important.

-What do you do?
– I connect with people. Like I’m talking with you now.

She accepts that, not everyone might. Our conversation moves to wild swimming and how lovely it feels, so I tell her of Loch Caolisport, how it is so shallow so that it warms in the sun.

Oh, that is so lovely! Lucy starts to rhapsodise. Imagine how beautiful, to just relax into the water, out in the open in the sun, far from the shore yet able to stand up… Nick, how do you think swimming outside would differ from being in a pool?

Nick grins shyly but says nothing, and I realise she is here as a paid escort rather than a friend.

Stuart Lorimer is quite friendly. He orders blood tests, and I am typing now having waited forty minutes for a phlebotomist and anticipating at least another hour, at the rate they are going. I thought he would discharge me, as I do not need surgery.

I want to know why would I be taking hormones, now. He says purely to stave off osteoporosis. Perhaps I should have challenged him, because they seem to have an effect on energy and lability. He refers me to Penny Lenihan, when I thought he would have discharged me. I quite like coming into London, but am unclear why I would want to be here. He gave me a feedback form, and I wrote that everything was lovely.

Rubens, the descent from the cross

Serenity

The Hungarian woman I talked to on the train shocked me. “I like talking to people on trains,” I announced, and she had no objection. “Do you like yourself?” Well, it is what I want to know.

She thinks she does. She notices that people in England tend to be unhappy in their twenties and thirties, taking on their parents’ neurotic fears. “The sins of the fathers are visited on the children” I quote, and she assents. In Hungary too. Even for people born after 1990? Yes, because the school system is the same as it was before. She blames the politicians. It is better now she is forty. She has degrees in biochemistry and nursing, and was head of department, yet earned £300 a month when the prices were the same as here. She was living on toast.

So she came to England, and worked cleaning ten hours a week, because she spoke no English. She refused to claim any benefits. Now she works as a nurse: her accent is noticeable but comprehensible, and her vocabulary fluent.

She finds the politicians here too lax on immigrants. That shocked me. People born here should be able to claim benefits because their parents and grandparents paid in, but immigrants should not.

At St Pancras, I always check out the policemen’s weapons. I have not seen guns lately, but today they are in black rather than hi-vis, and the clubs at their belts seem bigger than normal. Then I saw two men with rifles. I asked why. One, well over six foot, replied courteously enough that they were there to disrupt criminal or terrorist activity, hoping not to use the guns but able to if necessary; the other faced away from us in an alert pose. I don’t like it.

I went to see Stuart Lorimer at Charing Cross. I told him of Essence, and he said I appeared serene. I told him of wanting to clean my teeth because I wanted to, and he assented. So now I stay at home, I will have coffee with friends two times this week, I join the Quaker meeting and the Green party.

“Both lovely organisations”, he assents. “It sounds a lovely lifestyle. Stress is overrated. I am on my first day back from three weeks away. I was reclining by a pool, and I thought that I could go to museums and archaeological sites, and I did not want to. I just wanted to stay by the pool.”

I don’t feel I am suppressing emotion- he says that is not how I appear. I wonder if there could be more to life. I don’t want anything particularly. It is not that I feel dissatisfied as that I assess intellectually that most people aged 48 would want more.

He suggested seeing a clinical psychologist for counselling when I first saw him, and this has not transpired. He will chase them up. What would I want from these sessions?

I want to know what I want.
-An existential question.
-Is it an appropriate question?
-Yes, I think so.
-I saw a counsellor in Marsby. She wanted me to set goals.
-Goals are also overrated, he says.

He would like to see if this serenity persists. I believe it will, I say. I am in truth telling mode, knowing the truth of it as I say it. Actually, given that my inner critic was nagging me to get a job continually to November, and I was in my sulk, perhaps merely accepting and enjoying my quiet life is worthwhile.

Clanking back slowly on the Piccadilly Line, I feel absolved. It is OK to be doing what I am doing. It is a lovely feeling. It has been quite a pleasant day, on the buses, trains and tube.

He is compassionate, and I bloom. Just like then.

Monet haystack, white frost, sunrise

Testosterone deficiency

The ViolinistI have had a completely lovely day. After the Matisse exhibition, I went to see my psychiatrist.

After we last met in October, he lost my notes, and has only just written to my GP. He will copy me in. “Incompetent” is not a judgment I am qualified to make, but this is disorganised. He sees my testosterone level is 0.4, which he considers a bit low, and it may be worthwhile for me to use a topical gel. He explains that women have testosterone too, produced by the adrenal gland- that is why I still have testosterone- and that it may help with the motivation. I am quite happy to take testosterone, counter-intuitive though it may seem, I say. I am happy to take your recommendation.

As if he had not heard me, he explains that we are used to seeing testosterone as the enemy, but lack of it may indeed cause a lack in motivation, and women’s levels are typically 1-3. The gel would raise mine to 1, say. He will get me an appointment with the endocrinologist. My oestrogen level is still a little high- I must be particularly good at absorbing it.

I see the problem as this. After a number of painful experiences- Quakers, CAB, the German woman etc- and suffering emotional lability which he confirms may be partly hormonal, I retreat from the world in order not to get upset any more than I can help. Reading in the morning and watching pre-recorded telly in the afternoons- if the benefits office, or you, told me that was not much of a life, I could not but agree- and yet I don’t want anything else. I thought I would be found not entitled to ESA, but rather than doing something about it I battened down the hatches. He agrees that the motivation may be partly seasonal.

He is impressed that I passed ATOS. I didn’t exaggerate, exactly- he says that everything they ask is geared to finding one able to do things, so you have to push back against it. He would be happy to help with a letter if it becomes a problem at the next assessment. I explain the CAB incident to him- aspects which are more clear fact rather than interpretation- and he says I was victimised.

In the train, and now, I am nearly in tears thinking of this. It is such a relief. I thought I was swinging the lead, really- I thought everyone would think that- and the expert is supportive. I had come thinking that my oestrogen was reduced, and that was it, he could probably help me no more, and he thinks my hormones may profitably be adjusted.

I rushed back to the tube, got on just as the door was closing, and as the train jerked away I fell in a man’s lap. Embarrassed, I apologised, and he said quite kindly “as long as you’re all right.”

I expect a curse and a kick. Yet here I am-

not being kicked

Charing Cross

KlimtMy business in London was not The Solution, but it may do some good, eventually.

-It is rare for us to see someone at your stage in transition. Why are you here?

-About two years ago, my GP, knowing that one stays on HRT for a limited time, stopped my hormones, and my emotions went wild, I was shouting and weeping in the office and in the car. I went back on them within six weeks, and back on the full dose within six months, but my lability continued. At the time, I asked to see an endocrinologist here, to see if there was something to do with hormones- there are no double-blind studies, but you get to know your patients- and finding myself at last referred to a gender psychiatrist, I am here to see what good we can do together.

-OK.
He is concerned that I will think the way he uses the consultation a waste of time, but I am in his hands. Insisting on my own way of using the time cannot be better than merely co-operating. He takes a history.

-What is your earliest memory related to transgender?

This one confuses me, because it is not a five-year-old’s memory, but a 47 year-old’s. I know we reconstruct memories every time we consider them, and twist them for our own satisfaction, but- I envied my sister’s party dress. It was yellow velvet.

Apart from that, I did not fit The Script- know there is something wrong aged 2, know I am a girl by aged 5.
-If they are honest, a lot of people do not fit that, he says.
I self-identified as a fetishistic transvestite. And, here cutting my long story short, when I was 35 even though I was terrified of transitioning and thought I would be sacked and ostracised for it, I knew it was what I had to do.

-How did you feel about the changes of puberty?
-Growing body hair really pleased me. I wanted to fit in, then, I was ashamed at how slight my arms were.

Giving my history reminds me that I had several times off with depression while in Oldham, the longest six weeks. My emotional problems were before I came off the oestradiol.

He suggests it would be good for me to talk about these things, so suggests counselling, at his clinic in London as local counsellors can get hung up on the gender issue. OK. He sends me to the phlebotomist, and thinks it would be useful for me to see an endocrinologist there. He makes me another appointment with himself: May is the earliest possible.

There, I see a woman aged 19, who is diffident with the receptionist, one hour early, and who huddles in the corner staring down at her phone, the picture of our extreme meekness; and an older woman, with a male voice, helping a trans man with registering as the man cannot manage the forms. She explains to him, possibly inaccurately. Having nothing better to do in London, I take the train home, and phone Jayne to meet for coffee. She tells me all about the hassle of organising a lunch for a group of which she is now vice-chair. I would have told her of the GIC had she asked.

The next visit to Charing Cross GIC is here.

Altercations

French cased duelling pistols, Nicolas Noel Boutet, single shot, percussion, rifled, .58 caliber, blued steel, Versailles, 1794-1797 - Royal Ontario MuseumI waited for my appointment in the garden. There was a beetle meandering over the paving slabs. The azaleas were particularly beautiful. Much nicer than the waiting room, with its “Aggression towards staff will not be tolerated” notices. There was a policeman waiting too, for a partner-agencies meeting. “It’s been all go in your patch” he said when the social worker came in. Yes, there has been a murder in Marsby. Something to do with drug dealing. I joined the conversation. I may be one of the nutcases- “service users” is the preferred term- but I still look like a professional, more or less.

Normally Bob (I read his name badge) works in Zhuzhkov, but he was in Swanston at the weekend. It was a nightmare. There had been a fight at the club, and so the manager had closed it down, and there were all these people hanging around outside, resentful at not carrying on drinking. Bob thinks they are idiots, they should just go home. Would it be better to keep the club open rather than pour people onto the street all at once? No, the manager was right to shut, and when it closes at four in the morning people hang around outside for ages. Idiots.

Banksy: Kissing Policemen- detailHe rather fancies the idea of working on commission. He would arrest everyone. “Dropping litter, crossing the road in a dangerous way?” He grins.

There was a man shouting outside the bus the next day, and then he got on the bus and hit a man sitting at the back. He shouted something about don’t try to burn down my mother’s house. Two men about twenty, maybe younger. The bus driver, sixty with a pronounced South Efrican eccent barrelled down to deal with them. He would not let the assailant off. The assailant phoned his mum to say that she should come to the police station, and the bus driver would not let him off the bus. “He had me by the throat”, he said, an exaggeration. The bus driver phoned the police, and the bus company. An older woman stood by the assailant gloating. “The police are coming. You’re in trouble now.” I thought this unhelpful. He seemed a child. He waited quietly.

I got off, thinking the police might want witnesses, not wanting to get involved. I understand the instinct is to look away in these circs. A man told me that in London they would put them off the bus and deal with it on the pavement, and the bus could go without delay. He had moved out to Marsby when he retired and his wife died. He tells me of Barnet, where he lived. Well, you can get a much bigger house in Marsby for the same money, but the place is not quite so lively. Later I saw him on the bus, gesturing right and left and talking, as if to another person.

The police took away both lads, and we drove off, fifteen minutes late. Getting off, several people thanked and congratulated the driver.

Thinking and feeling

File:Loke og Sigyn by Eckersberg.jpg

Seeing the gender psychiatrist was one of the most painful things ever to happen to me, and perhaps my greatest moment of growth.

Before I saw my GP in November 2000, I was concerned how I would persuade her to make the referral, and I phoned the Beaumont Trust helpline to discuss it. “Tell her how you feel” said the volunteer, and in the end I told her how unhappy I was. But when I saw Dr Dalrymple, I was concerned to persuade him intellectually. It appeared to me that I was TS, for particular reasons. So I made my arguments, and he dismissed each one. All he left was that I feel happy female. He took away all my myths. I woke in the night weeping, and the next day I could not go to the office, because I was crying, and so I visited Margaret, my best friend, and cried and she sympathised.

I lay in my bath and thought I feel happy- the more I remove my body hair, my voice working towards alto from baritone. I like my nails long and varnished. I express myself how I want to express myself, and called that “feminine”. It did not seem the hot panting joy of a pervert or the fanatic enthusiasm of a Convert, it felt quiet and peaceful and harmonious. It was my feeling, from my heart. So I did not need my myths. However, seeing Dr Dalrymple had been so painful that I could not see him again, and I went private.

Ever since, I have thought of this incident as putting me in touch with my feelings more than ever before. I have thought I am naturally more disposed to Feeling, but grew up in a milieu where feeling was devalued in favour of thinking. Only thinking was useful. This now seems impossible: how may I decide what to do, other than by what I Want, by feeling?

So Jung as explained by Robin Robertson makes sense to me. If Thinking rather than Sensation or Intuition is my “Primary Function” then Feeling is  my “Inferior function”, the “Royal Road to the unconscious”. I would agree with him that balancing these two, using each for its proper purpose, is best, and I suppressed feeling, driving it into unconsciousness. This is common- consider the man shouting “I am Perfectly Calm!!” And- I remain primary Thinker: I still am perplexed that I cannot explain intellectually, why I want to express myself female. Feeling happier is not enough for me. My whole search for the “Real me”, trying to think it through, is Thinking rather than feeling. Feeling might have me there already.

Since reading that book, I have been remembering my dreams. I dreamt of David Mitchell last night, specifically of performing comedy with him- not remembering my lines, not having rehearsed enough, you know the type. Wish fulfilment, and Robertson explains this as dreaming of a God- celebrities are the closest thing we have to Gods these days. Perhaps a comedian represents clever and mischievous trickery, as Loki would have done at one time.

When we need to relate to the world in a new or different manner, writes Robertson, our dreams produce a God or Goddess who possesses the abilities we need. The Animus figure evolves into someone we can be comfortable with in a human way.