An open letter to my MP, about the British Government’s threat to trans rights

I write to you because I am extremely concerned about recent ministerial statements about gender recognition. The ministers show a lack of understanding of the law and of medical understanding of gender dysphoria. In particular, gender recognition on the basis of the trans person’s self-declaration will pose no threat to women’s single-sex services, as English law already recognises trans people in our chosen gender for most purposes. I am concerned that the ministers’ misunderstanding threatens a restriction of my rights in law as a trans woman. The ministers propose to restrict medical treatment for trans children, and so do not show proper respect for medical expertise or children’s needs.

On 3 March 2020, in response to a written question, Elizabeth Berridge said in the House of Lords,

Those seeking to rely on the protections and exemptions contained in the Equality Act 2020 [sic] must be able to do so with confidence and clarity. The Equality and Human Rights Commission’s statutory codes of practice on the Equality Act 2010 explain the provisions of the Act and the EHRC is responsible for updating these codes as necessary.

This Government has been clear that we must take the right steps to protect safe single-sex spaces for women and girls; their access should not be jeopardised. Some women’s organisations have expressed concern that predatory men may abuse the gender recognition system, intended to support transgender adults. We have heard these concerns and are considering carefully our next steps.

On 22 April, in a speech to the Women and Equalities Select Committee, Liz Truss said,

The final point I’d like to make, Madam Chairman, in this initial part, is on the issue of the Gender Recognition Act. We’ve been doing a lot of work internally, making sure we’re in a position to respond to that consultation and launch what we propose to do on the future of the Gender Recognition Act. We will be in a position to do that by the summer, and there are three very important principles that I will be putting place.

First of all, the protection of single-sex spaces, which is extremely important.

Secondly making sure that transgender adults are free to live their lives as they wish without fear of persecution, whilst maintaining the proper checks and balances in the system.

Finally, which is not a direct issue concerning the Gender Recognition Act, but is relevant, making sure that the under 18s are protected from decisions that they could make, that are irreversible in the future. I believe strongly that adults should have the freedom to lead their lives as they see fit, but I think it’s very important that while people are still developing their decision-making capabilities that we protect them from making those irreversible decisions. Of course some of these policies have been delayed, Chair, by the specific issues around Covid but I can assure you that alongside the Covid work, our officials continue to do those things to make them happen.

Both ministers refer to the protection of single-sex spaces, and Elizabeth Berridge specifically states “concern that predatory men may abuse the gender recognition system”. This misunderstands the way the Gender Recognition Act 2004 and the Equality Act 2010 work, and how psychiatrists understand gender dysphoria. For almost all purposes, we have self-declaration of trans people already.

The International Classification of Diseases provides a definition of gender identity disorders including transsexualism, which is defined as,

A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one’s anatomic sex, and a wish to have surgery and hormonal treatment to make one’s body as congruent as possible with one’s preferred sex.

The Diagnostic and Statistical Manual of the American Psychiatric Association defines gender dysphoria as follows:

A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by at least two of the following:

1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics).

2. a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics).

3. a strong desire for the primary and/or secondary sex characteristics of the other gender.

4. a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender).

5. a strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).

6. a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender).

In both definitions, the patient’s desire or belief is paramount. I am a trans woman because I believe I am. There is no other way of diagnosing: only what the person says and does. We transition, because we cannot avoid it, because we want it more than anything else in the world.

In terms of using single sex spaces, the presence of trans women was tolerated long before either Act. When I saw my psychiatrist in 2001, he gave me a card stating that I was undergoing treatment for transsexualism and it was part of the treatment to dress female and use women’s spaces. I never had to show it to someone. Before I saw the psychiatrist I spent a long time preparing to transition, because I was scared, and felt the need to check out whether I could bear the hostility and discrimination. So I expressed myself female and went out- to the supermarket as well as the gay pub, including women’s loos. People tolerated me. I only wanted to pee. I am not sure what law applied, then.

The law now protects people as soon as we decide to transition. It is in the Equality Act 2010 s 7:

A person has the protected characteristic of gender reassignment if the person is proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning the person’s sex by changing physiological or other attributes of sex.

So as soon as a person decides to transition they are protected, and for purposes of changing rooms and toilets we go to those of the gender we are expressing. We self-declare: I am a trans woman, because I say that I am. I should not be discriminated against as a trans woman, whether or not I have a gender recognition certificate. I express myself as a woman, and so should be treated as a woman.

But we can still be excluded from women’s spaces, under the Equality Act 2010 schedule 3 paragraphs 28-30. We can be excluded if it “is a proportionate means of achieving a legitimate aim”.

Elizabeth Berridge echoed concerns about predatory men, but Layla Moran MP answered those concerns comprehensively, in 2018. In a debate she said,

Let us assume that someone wants to go into a women-only space for nefarious purposes. That [gender recognition] would be quite a stupid thing to do because, apart from anything else, if an offence was committed it would show evidence of premeditation, which would increase the person’s sentence. Also, had the certificate been gained for the sole purpose of entering such a space to commit a crime, that would be a separate crime under ​the Fraud Act 2006. If someone was intent on harming women, that would be one of the stupider ways of doing it.

Gender recognition does not affect any of these matters. Section 9 of the Gender Recognition Act states the person’s gender becomes the acquired gender, as does the sex, but this is “subject to provision made by this Act or any other enactment or any subordinate legislation”. That includes the Equality Act.

Before the Gender Recognition Act, I got a passport saying that my sex was “F”, and a driving licence indicating in the driver number that I am female. The guidance now on passports is here, and on driving licences here. A transgender person only needs a letter from their doctor to change their passport, and a statutory declaration or deed poll changing their name to change their driving licence. We do not need a GRC.

So, why do people get gender recognition certificates? In 2004, a friend got one because it entitled her to claim her state retirement pension early, and at the time it affected whether people would enter a civil partnership or a marriage, but after the Marriage (Same Sex Couples) Act 2013 that no longer applies. I got my gender recognition certificate because it was there. The law could officially declare that I was a woman, so I wanted that. However the current procedure is generally recognised as intrusive and expensive.

Because the junior minister is echoing groundless fears about “predatory men” and the Secretary of State refers to “checks and balances” I fear that my rights to be treated as a woman may be reduced. The law helps mold society’s response to trans people. Discrimination law protects me, and creates a moral injunction to treat me decently. Talk of how my rights may endanger women reduces that. Because of the campaigns against trans women I have suffered personal abuse and threats on line.

I want you to express these matters to the ministers, explaining that their fears are groundless, and ask them to assure me the rights of trans people will not be curtailed. I would like you to express your personal views to me, and answer these questions: would you oppose any diminution of trans rights under law? Would you support reform of gender recognition, to dispense with the requirement of evidence beyond the trans person’s word, formally sworn or affirmed, as Theresa May promised in 2017?

I am particularly concerned about the Secretary of State’s remarks about the treatment of children. She says that she wants to protect under 18s from irreversible decisions. This shows a fundamental misunderstanding of treatment for trans children and young people.

It should not be for the law or the government to interfere in medical decisions for children. These decisions should be made by doctors, parents and the children themselves according to Gillick competence in the best interests of the children. Irreversible decisions are not made by children. The NHS can treat under 18s with puberty blocking hormones, which are reversible. For evidence of this, for example consider the Australian standards of care and treatment guidelines.

Social transition of transgender children, not necessarily involving any hormone treatment, improves their mental health.

Please may I see you about this. During the lockdown, are you holding surgeries by video conference?

Transitioning as a child

When child H, then aged three, was brought to school dressed as a girl, the school referred the family to social services, alleging that the foster carers may be fabricating and inducing mental illness in the children. Eighteen months later in June 2017, when H began attending, the school requested that she wear a boy’s uniform, but H and the foster parents did not comply. In July 2018, social services started care proceedings, and the social worker Lisa North alleged the foster carers had a “preoccupation with an encouragement of gender dysphoria”. On 9 May 2019 the judge completely exonerated the foster carers, praising them as child-focused.

Social Services, seeking evidence for care proceedings, commissioned a consultant paediatrician, Dr Gupta, to consider the account of events they had prepared and assess whether there was “factitious or induced illness”. That is a defined category, with a developed theory of what it is and how it may be established. The theory gives twelve factors establishing FII, all of which Dr Gupta said applied in this case, even though she did not see the children. Social Services then issued care proceedings, alleging that the foster parents have manipulated children’s gender and diagnosis of additional needs, which is considered the highest division of emotional abuse. The children remained at home while the courts obtained expert evidence.

The foster parents had three of their own children, and were caring for five more. Though not related by birth or adoption, the children saw themselves as brothers and sisters. One of them, R, aged 12, had been referred to the Tavistock gender identity clinic and was living transitioned to female. R had ADHD and autistic spectrum disorder. H and C, H’s six year old brother, had both suffered abuse and neglect from their birth parents. C had had several injuries in falls while in foster care.

A psychiatrist, Dr Hellin, assessed the foster parents and found the mother had no sign of personality disorder or mental illness, but that her identity and sense of self and of competence is very much based on her role as a mother carer and the proceedings have attacked this making her feel very insecure vulnerable, self-doubting and frightened. The father was psychologically resilient, and involved with the family, and there was no sign of FII. Both were “reflective” about the issue of gender dysphoria.

Another consultant paediatrician, Dr Ward, considered the children’s medical records though did not see the children herself. She concluded that R, the elder trans girl, and another child had no inappropriate referrals or medical treatment but that H’s brother C had had accidents because of inadequate supervision.

Of H, she used male pronouns, saying H required consistent, positive and nurturing care because of trauma and physical abuse by the birth parents. The foster-carers were over-anxious about H’s health and development, and sought second opinions. With hindsight, the investigations were not clinically indicated, and there is evidence that the foster-carers had given misleading information when they suspected cerebral palsy: if the court agreed, that would be fabrication, not merely the behaviour of an anxious parent.

H had not yet been referred about gender dysphoria. Dr Ward wrote, a significant proportion of pre-pubertal children who display differences in gender identity revert to their biological gender in adolescence. Failure to seek medical support and opinion leaves H at significant risk of emotional harm as a result of being presented in school as a girl. Failure to seek medical attention in relation to this problem represents neglect of H’s emotional and physical well-being. However the gender specialist who reported on H disagreed.

Dr Ward thought K, a girl aged 4, who had also been abused by her birth parents, was normal and healthy, but that the foster-carers interpreted her response to the abuse as mental health problems, and there was “concern” that they overinterpreted, exaggerated or misreported behaviour, which led to referrals. The foster-carers seemed focussed on potential diagnoses, which might lead to K falsely perceiving herself as disabled.

I will quote the judge’s summary of Dr Pasterski’s introduction in full.

“Dr Pasterski is a chartered psychologist and gender specialist with 23 years of experience in conducting gender identity assessments in children and adolescents. In her report she identifies that there have been recent changes to the diagnostic criteria for gender dysphoria and that research on mental health and transgender children have shed light onto critical historical misunderstandings related to clinical presentation in gender dysphoria. Firstly, that children who present with gender dysphoria are likely to desist in their cross-gender identification and secondly that gender dysphoria is inherently associated with high rates of comorbid psychopathology. She notes both have been shown to be false. She identifies that these misunderstandings arise from two particular factors. Firstly earlier studies which showed that up to 80% of children desist in gender dysphoria included children who presented with gender incongruent behaviour but did not necessarily state the wish to be or that they were the other gender. Thus children displaying gender variance may have been wrongly diagnosed with gender dysphoria. As a result of this treatment protocols previously incorporated a watch and wait approach which had prevented truly dysphoric children from transitioning which had likely resulted in increased rates of depression and anxiety. As Dr Pasterski puts it ‘Put simply, many who have shown to desist were likely not dysphoric and psychopathology in those who persisted was likely due to forbidden expression of their true gender identity.’ Current guidance suggests that supporting a child who clearly and consistently states that they wish to be the other gender in their preferred gender role is associated with improved mental health and well-being.”

Dr Pasterski thought gender dysphoria could not be fabricated or induced. R was content to present as a girl, consistent with a diagnosis of gender dysphoria. It was appropriate to support her in her authentic, preferred presentation.

H appeared to be a content, alert and socially engaged little girl. She identified herself as a girl. It was right to allow her to present as she wished, even though she had not seen the GIC: there is a risk of harm from unnecessary gender related investigations (para 59 iii). The children were free to be themselves, and removing them from their loving, settled and engaging home would harm them.

The independent social worker reported that the children were well-cared for, that the foster parents worked well with social services and health professionals, following professional advice. The children were fully integrated as a family. She thought the foster-mother was closed to the possibility of H or R reverting to male, and that early transition made it more difficult to explore gender identity- that is, she disagreed with the gender specialist.

The local authority requested permission to withdraw the court proceedings. The foster-carers objected that simply withdrawing proceedings, without the court finding the facts of the case, might lead to an unjustified cloud of suspicion over them.

The law says that where it is clear that there is no basis for care proceedings the court should allow social services to withdraw their application, but where it is arguable that there should be an order about care the court should find the facts. Court proceedings create a cloud of uncertainty, intrusion and stress, bad for the welfare of the children.

The judge concluded that it was so obvious that care orders were inappropriate that no further factual findings were necessary, and in the interests of the children the court proceedings should end. This is a complete exoneration of the foster parents. To the extent that there may be individual examples which either do amount to, or could be construed as, examples of inaccurate reporting, or over medicalisation or lack of supervision they are isolated outliers in comparison to an otherwise overwhelming evidential panorama of appropriate parenting. The children are prospering, and the foster carers are good, child-focused parents.

He decides, at para 75 iii, that concerns about the early social transition of the two trans girls were “compellingly rebutted” by Dr Pasterski. Dr Ward only gave isolated examples of over-medicalisation, but the “overwhelming weight” of evidence shows the foster carers are good parents.

So this is an example of trans girls properly cared for by loving foster carers, having to undergo court proceedings because of social workers and school staff taking concerns about the trans girls’ transitions too far, though at para 81 the judge could not condemn them: they were merely less well informed than Dr Pasterski. The judge says “The concerns were comprehensively dispelled”.

The Daily Mail’s headline about this is grudging, giving undue prominence to the social workers’ concerns: Judge backs parents who allowed their four-year-old son to live as a girl and sent him to school in a girl’s uniform – despite social workers accusing them of ‘actively encouraging’ their child’s transgender identity. Note the misgendering.

The judgment is available here.

A Mermaids training session

Mermaids is the charity caring for trans children and teens in the UK. Recently, their training session was recorded, so you can listen to it and hear how reasonable it is. There are also transcripts.

The man who clandestinely recorded it clearly thought he was being so brave going undercover, challenging the trainer. There was a shock, horror article about it in the Times. When you listen to it, you can see that any gender critical person who was not prejudiced about trans people, would find it unobjectionable. The Times article is a complete distortion of what is said.

The trainer, who is lesbian, proves the Times wrong. “Trans ideologists are spreading cod science,” says the headline- no, her statistics are clear. She starts by talking about “gender reveal parties”. We find out what is between the foetus’ legs, and it becomes he or she, and so we get pink or blue clothes. “Lots of children don’t fit those boy and girl boxes.” Lots of things are on a spectrum. People have different heights and skin colours. On a scale of 1 (Princess Barbie) to 12 (GI Joe) the trainer puts herself as a 5. Yet the Times claims the two extremes are the only alternatives given. It is a deliberate misrepresentation of a subtle argument that gender varies between everyone, not just trans people; and some people are gender fluid, being one style at one time and one style at another. “We’re not all one thing,” she says.

The Times mocks talk of jelly babies, but it would help participants become playful and so permit them to think in less rigid ways. As the audience shows, everyone knows the extreme stereotypes, which are strongly emphasised by the culture. Gender identity is different from sexuality, but neither may be controlled. Some people are intersex.

Jan tells her own experience. She had no problem being a tomboy, but in the early seventies was terrified of people knowing she was lesbian, as a child, but being a boy who likes “girlish” activities is different. GI Joe is a stereotype, cultural not innate, but “when people buy into it it becomes real”. She began to define trans and cis, but the interloper interrupted, and put her off track. Then she defines non-binary and gender fluid. Some people identify as queer, and some people hate the term. People can socially transition without transitioning medically. No-one need know a trans person’s operation status. Trans women can be gay or straight- a straight trans woman is attracted to men. Younger people are far more comfortable with gender fluidity.

She speaks movingly of when she internalised homophobia. “There are places where I would be in danger, and people… who hate me because of who I am.” That is, lesbian. It’s like carrying a heavy weight. She wants being queer, or trans, to be not an issue any more. She explains pronouns and misgendering, how painful it can be.

She gets gender incongruence slightly wrong. It’s not a psychological condition in the draft ICD, but that ICD has not yet been approved. There is evidence of a biological underpinning to trans. There are positive role models visible in society, lesbian and trans. She refers to brain research, and googling I found this. Always there is new research. 1% are trans, she says, though not how many of them transition.

She explains the history of Mermaids, supporting trans children and their parents. 40% of those children cannot be out at home, so schools should support them. She explains the Equality Act and the difficulties LGBT people can face from family and society. Maybe 10% of the population are bigoted against us, so the rest should be mindful of that and speak up for us.

When a child is fully supported to lead their own transition, their mental health is the same as their peers’. When the child is prevented, their mental health suffers. Because parents are resistant, and GPs may be unsympathetic, schools can refer people to the Tavistock and Portman clinic, the Gender and Identity Development Service for under 18s. After a long series of assessments, where medically indicated, a child may be given puberty blockers. Low doses of cross sex hormones are not given to children under 16, and rarely to older children. The youngest child seen is 4.

Attendees should research further, at the Tavistock website and Stonewall. They should challenge stereotyping, and be able to tell children about available support. Children can change their name officially, and choose a name to be known as in school. Staff should be told of transition on a need-to-know basis, and it should be treated matter-of-factly: just as a woman may change her name on marriage, so a child may change gender presentation. Mermaids can help schools with any necessary policies.

Janice Turner in the Times clearly finds all of this unobjectionable, as she attacks things Jan the trainer did not say. The man making the recording tried to challenge the trainer, claiming that her suicide statistics were wrong, and that she had based them on a survey of 27 self-referred people, though she had referred to the Stonewall School Report, which says at page 7 that 45% of more than 592 trans people had tried to take their own lives. He claims that the suicide statistic is used to put pressure on schools, and minimises the evidence of suicide attempts. He is not an honest reporter. The second recording ends abruptly, and it is not clear what happened after that.

Similarly, the transcripts are made by anti-trans campaigners, and are littered with inaccuracies. For example, where the anonymous recorder spoke of “dysmorphia” the transcript records it as “dysphoria”. There are also sarky asides- where the trainer is assertive, it calls her “really really cross”. It says [long, looooooong pause for us all to reflect on whether it’s wise to challenge Mermaids woman further. Clearly no one else is prepared to take her on] Actually, it is at most five seconds.

The transcripts are misleading. They put in headings which are not on the audio, such as Help kids to socially or even legally change their name. You don’t need to tell the parents. In fact, feel free to ignore their authority! You would think a feminist would have heard of Gillick competence: children can decide whether their parents should hear about their medical treatment. Mostly, though, the transcripts do not seriously distort the message of the trainer, if you ignore the headings.

Audio recording part 1 part 2.

Googledocs transcript part 1 part 2.

Suddenly disclosed gender dysphoria

Just because someone has only just noticed signs of a person’s gender dysphoria does not mean that it has had a “rapid onset”. A parent might report that the child had appeared happy and gave no sign of gender dysphoria, but the child might have had distress which s/he could not name, or even known their own gender identity for years. A child might suddenly disclose because they have decided to take action on their gender dysphoria, which they had concealed because they did not know what they could do about it. And just because someone has not noticed signs of gender dysphoria, does not mean they were not obvious to anyone open to seeing them. Some children repress their gender identity when they know they will gain only grief for it.

There is the suggestion that teenage children, especially those assigned female at birth, may suddenly decide that they are trans and seek treatment. There is a conviction where there was no sign of it before. Those asserting this tend to find the thought revolting.

Those who assert that “ROGD” is a thing, rather than a name for childhood gender dysphoria, say that it might be a social contagion brought on by suggestion, as some say anorexia can be. There are pro-ana groups promoting anorexia as a lifestyle, though it can threaten health and stop menstruation, just as testosterone might. If transition revolts you, you might be prone to see it as a way of fleeing independent adult womanhood akin to anorexia. These feminists know that womanhood, and fertility, can be very scary. Men come on to teenage girls, follow and assault them, do not take “no” for an answer- only “I have a boyfriend”, perhaps, claiming to be some man’s property rather than being entitled to decide and refuse in my own right- and this is dangerous. Claiming to be a man is a way of escaping that.

So they claim that teenage “girls” are “mutilated and medicalised”, rather than treated. The child wears a binder, which constricts breathing, and craves chest masculinisation surgery (“mastectomy”). This revolts the ROGD theorist. Why should you want a healthy part of yourself cut off? We are sad for women who have to suffer lumpectomy for cancer, and the NHS offers reconstructive surgery. I sympathise. I like my breasts and would not want to lose them. But I can empathise: chest-masc surgery changes the way others look at you, and I can understand someone might want it. I have seen the delight people have in it.

If there were a theorist who believed that ROGD was a thing, a phenomenon distinguishable from other types of childhood gender dysphoria, who was not also repulsed by current surgical treatment for female to male gender dysphoria or gender incongruence, I would be more likely to believe in it.

There is a place for people who want to resolve the distress of gender dysphoria by some means other than transition, hormones and surgery. A patient might explore their personality and character with the aim of casting off restricting inhibitions and accepting themselves. Transition is not the only treatment for people who find “femininity” constraining. However, transition alleviates distress and enables people to accept themselves, in a way they could not before.

Those who advance the hypothesis are revolted by “girls” transitioning. They think the “girls” should be supported into accepting womanhood, and supported in subverting restrictive feminine roles as women. They are not fit to research their idea, unless they can accept that sometimes transition is right for a person. Rather than supporting a teenager in becoming an adult, they want to restrict the way the teenager knows he can thrive.

I am told that gender dysphoria can have a rapid onset, where someone with an intersex condition receives a new hormone treatment. That is not what the transphobic campaigners are exercised about.

Trans children and adolescents in Australia

Australian doctors affirm trans children, and show why affirmation works: Trans or gender diverse children with good health and wellbeing who are supported and affirmed by their family, community, and educational environments may not require any additional psychological support beyond occasional and intermittent contact with relevant professionals in the child’s life, such as the family’s general practitioner or school supports. Others need a skilled clinician working with the family, to help them support their child. Where there are other mental health problems, they should be treated together with GD.

Parents who do not support their child’s transition may make their mental health worse. “Do no harm” does not mean refusing gender-affirming treatment:

Withholding of gender affirming treatment is not considered a neutral option, and may exacerbate distress in a number of ways including increasing depression, anxiety and suicidality, social withdrawal, as well as possibly increasing chances of young people illegally accessing medications.

Social transition improves emotional functioning. It should be the child’s decision, and may be just at particular times or particular places. Social transition brings trans children’s depression, anxiety and self-worth to the same level as cis children’s. Doctors may need to be advocates, telling schools this is what the child needs. An endocrinologist should see the child before puberty starts.

Children referred in adolescence need different treatment. The child may have spent a long time coming to understand their gender dysphoria, and considering how to explain it to parents, so will want immediate support and medical help, but a parent might see this as sudden, and have difficulty adjusting. The child needs a comprehensive exploration of the adolescent’s early developmental history, history of gender identity development and expression, emotional functioning, intellectual and educational functioning, peer and other social relationships, family functioning as well as immediate and extended family support.

Once there is significant breast growth and menstruation in a trans boy, puberty suppression is not recommended. Gender dysphoria around menstruation can be reduced with norethisterone. Testosterone in trans boys may produce irreversible facial and body hair growth and scalp hair loss. Deepening of the voice is irreversible. Clitoral enlargement and vaginal atrophy may be reversible, but this is unknown.

Oestrogen in trans girls will reduce muscle mass and strength, soften skin, and decrease libido and spontaneous erections. These effects are probably reversible. Breast growth is irreversible. The testicles will shrink, and sperm production decrease: it is unknown if these effects are reversible.

Teenagers vary in their maturity, and ability to make decisions with complex risks and benefits. However delaying hormone treatment in trans girls means increased masculinisation of face and body, and suppressing puberty without starting stage 2 treatment (gender-affirming hormones) can weaken bones. Refusing treatment reduces an adolescent’s sense of their own autonomy and agency.

GPs should give an initial assessment, including of the family support and functioning, and advise on the effect of treatment on sexuality, sexual pleasure, and fertility.

A trans boy may have chest masculinisation surgery as young as 16. There should be a joint decision with child, parents and clinicians coming to consensus, taking account of the child’s maturity. However the guidelines advise delaying genital surgery until adulthood, because it will make the patient sterile, and may reduce sexual pleasure and interest.

The New Zealand Adolescent Health Survey suggested that 1.2% of adolescents identify as transgender. The guidelines suggest that this means referrals will continue to rise. Only an atmosphere of support and acceptance will enable a child to make a proper decision.

Guidelines pdf.

TERF propaganda

In a Youth Drama group a 17 year old boy at the start of their transitioning journey informs you that you must refer to them by their chosen female name and only cast them in female roles and that on an upcoming residential they would expect to be sleeping in with the girls. If not they would report you and the young person quotes their rights at you. Parents always insist that their teenage sons and daughters would sleep separately and under safeguarding you need to ensure separate sex accommodation. In addition two of the girls in the group are survivors of sexual abuse.

It starts by referring to the child as a boy. She’s a trans girl. Then it uses innuendo. It implies a threat, of unwanted sexual conduct by the trans girl, but does not spell it out. If you spell it out, you render it ridiculous, but the writer seeks to inflame fear and suspicion so leaves the reader to imagine what might but probably won’t happen.

It raises an issue without any context. How long has the teacher known the pupil, and the other pupils involved? What dormitories or rooms are available at the residential centre? What do the other girls think?

It implies that the survivors are vulnerable. Survivors respond in a variety of ways. All the children here are entitled to the support of the staff, tailored to their individual needs, and as a teacher you would know those needs. A teacher positive about the gender change could create acceptance in the group.

It demands an instant response. A teacher should certainly agree that the pupil should not take male roles, and would use her chosen name, but could reasonably request time to discuss the residential. That teacher would be aware of transitioning children and possibly of the ways schools supported them.

Well, I would not want to play a man, either. The girl quotes her rights and threatens to “report” her teacher. We can be fearless in enforcing our rights, but generally when transitioning we do not want to adopt a defensive posture from the off. We want to make transition work, and to maintain good relationships. Has the teacher shown hostility in the past?

It is ignorant of the law. Schools have various ways of coping. A residential fee-paying girls’ school in London has a protocol on allowing pupils to identify as male or non-binary. We consulted the pupils to find out what the issues were. Their main preoccupation has been to look after people who don’t want to identify as one gender or another, said the head teacher. So the pupils want to be supportive, and the teachers do too. There isn’t the problem insinuated by that writer.

Another fee-paying school put a trans boy in the boys’ boarding house. The Telegraph report misgenders them as “girls”, but they play in the boys’ football team. It quotes as reasonable a head teacher claiming trans is “a hysteria”, and as ridiculous a head teacher who does not use gendered language for pupils. Any problem would be immediately reported, so there is none.

The propaganda ignores the law. Wrigleys solicitors suggest that as sex and gender are different, and because of exceptions in the Equality Act, it may not be discriminatory for a boarding school to refuse to admit a pupil to a single-sex boarding house and its facilities because of the pupil’s sex or gender reassignment.

A little time critically analysing the propaganda shows the fear it seeks to insinuate is unfounded. The propaganda is dangerous, though, as readers might be affected emotionally by it, lacking the tools to analyse it. It is fear-mongering, and therefore reasonably called transphobic.

“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.

Puberty blockers

No-one transitions on a whim. It is so difficult to transition that anyone who does probably is trans. That includes children.

There are 12.4m children aged 0-15 in the UK, and 1.4m 16-17 year olds. So 800 children on puberty blockers is a tiny fraction. Help, help, the sky is falling! cries the Daily Mail. They reported the fact, and sensationalised it- “Huge growth”- from what? Is not 800 out of 12.4m a tiny number? Then they interviewed and photographed a 17 year old trans woman who said puberty blockers saved her life, as she would have been suicidal suffering male pubertal changes. And then they started quoting transphobes. A spokeswoman for the Grassroots Conservatives campaign, who could be assumed to have no expertise whatsoever, said, This drastic notion that we should change our gender should be a last resort, as if a handful in a hundred thousand showed mass poisoning of children, or even the possibility that anyone who had the treatment did not need it. The children are diagnosed with life long gender dysphoria. The doctors predict that these are the children who will never regret their decision.

A woman speaking for Transgender Trend, a parents’ group speaking against transition, said These kids are not old enough to make life-changing decisions as if they were not diagnosed by doctors who were clear the treatment was appropriate. A doctor said the treatment relieved suffering, and three doctors said it was unsupported by rigorous scientific evidence, as if control groups could ever be ethical.

The treatment is puberty suppression. It gives children and families more time to make the final decision to transition surgically, before puberty changes the child’s body to appear irrevocably of the gender assigned at birth.

There were 2016 referrals of children and adolescents aged 3-18 in 2016 (yes, it is an odd coincidence). Children may remain under the care of the clinic for several years. Help, help, the sky is falling! said the Daily Telegraph. Chris McGovern, chair of the Campaign for Real Education so not obviously a medical expert called this a “politically correct agenda”. The Telegraph blames feminists! Feminists were attempting to reshape school policies on gender… children were being forced to “unlearn” the difference between boys and girls. If children did not know the difference, they would not know they wanted to transition. Liberating children from rigid gender roles would reduce the pressure to transition.

I feel that not all children who are trans will have been able to convince their parents, even if they have had the courage or desperation to try. I feel the children who are referred will be the strongest-minded and most certain trans children. And only a minority of those referred get any treatment. They are encouraged to transition and live in role, including at school, but most do not get puberty blockers, leave alone surgery.

Before puberty blockers, trans girls have their sperm frozen so that they might have children later in life. The Daily Mail opposes this. Storage costs £300 a year, and the Mail says the money should be spent on people with sympathetic health problems, not these weirdos. The article put “trans girls” in scare quotes, and referred to them as boys who believe they are female.

“Shouldn’t be allowed at all” was one of the highest rated comments. Consider the hostility to transition! No parent would accept it unless completely convinced. The barriers to a child’s transition are so great that children who do are trans.

I feel that schools which prevented gender indoctrination and permitted children to experiment with gender would produce more balanced adults. I am ambivalent about transition in children. What if it is wrong for them? I understand the worries- but surely all those involved are doing their best, for the best interests of the child.

Toilets in Texas

The Texas House of Representatives, which had previously blocked Texas Senate attempts at a Bathroom Bill, has now passed one. Schools must provide single-occupancy toilets, changing rooms and locker rooms. Schools which now allow trans children to use the locker room for their gender would have to revert. Separate does not mean equal.

The Bill goes to the Texas Senate, which will likely pass it, as the Senate had a much wider Bill requiring all people in Texas government buildings, including schools, to use toilets matching their “biological sex”. The wider Bill was blocked by the House Speaker, who refused to refer it to a committee.

The Texas Governor endorsed the legislation as a priority, and the lieutenant-Governor threatened to block periodic legislation which re-authorises some State agencies, unless it was passed. Without that legislation, those agencies would be shut down.

SB 2078 regulates school districts’ “Multihazard Emergency Operations plans”, considering things like school shooters, natural disasters, and now trans children. The right of each student to access restrooms, locker rooms and changing facilities with privacy, dignity and safety [shall be accommodated by] requiring the provision of single-occupancy facilities for use by a student who does not wish to use the facilities used by persons of the student’s biological sex.

This section may only be enforced by the state Attorney General, but nutcase objectors will still demonstrate against trans children, to force him to act. It does not require or authorise a school to disclose intimate details about a pupil, but using a separate locker room will be noticed.

The stalled SB6, applying to all government buildings, is longer than the Bill concerning emergencies. The Texas Senate discerned an “utmost moral obligation” “to protect the safety, welfare and wellbeing of children… and all Texas residents”, and found that schools providing access to restrooms, showers, and dressing rooms based on an individual student’s internal sense of gender is alarming and could potentially lead to boys and girls showering together and using the same restroom prejudicing a safe and secure learning environment. It is wearying to read of trans children being seen as so dangerous. Trans boys are called girls. The cubicles which prevent me ever embarrassing others in a bathroom are ignored- I am in the presence of others in a state of undress.

All government buildings should require that each multiple-occupancy bathroom or changing facility located in the building be designated for and used only by persons of the same biological sex.

“Biological sex” means the physical condition of being male or female, which is stated on a person’s birth certificate. My birth certificate says I am female, and Texas allows amendment of sex on a birth certificate if ordered by the court.

The Bill which is to be passed makes monsters of children.

Report in Texas Tribune.

Not transgender: a tomboy.

A mother writes in the New York Times of her daughter, who wears track pants and t-shirts, who aged seven affects a Luke Skywalker hair cut, and who, having been told she is a “tomboy” identifies as that, though she asks why it is a tomboy. She is quite sure she is a girl and not trans. Wanting freedom and respect for children who identify as trans, we surely want the same for children, however they identify.

The mother has read up on puberty blockers, and is quite willing to accept if her child decides she is a trans boy; but the child does not say that. The mother accepts her child’s decisions, as when aged three she wanted clothes like her father’s. By her own words she is the model parent for a trans child, accepting and backing up her child, though the child does not identify as trans; I believe her.

Why would a child identify as trans? Would a child who is reassured that they can behave as they like, as far as gender roles go, never consider that they were really trans? If a boy wants a princess dress from the Disney store, does that make him a girl? Would a boy imagine he was a girl, because he picks up from the culture that those things are for girls?

That is, is there a gender identity or just motivation towards certain behaviour?

Parental support needs to be self-sacrificial, like Billy Elliot’s father scabbing during the miner’s strike to support his son’s ballet ambitions. Even then, the family need some support and recognition from outside, or the child may go along with their peers’ ways. They have, after all, to know they can survive in the world.

The mother criticises the teacher in the after-school club, who asked, Your child wants to be called a boy, right? Or is she a boy that wants to be called a girl? Which is it again? The implication of the article is that if the child is non-conforming, there is pressure on the family to transition. People understand transition now, and the mother implies some think it appropriate for non-conforming children. I hope a teacher or doctor would want to ensure that the parent was not moulding a child to prevent transition, and such moulding could be done subtly- of course the child can climb trees, or wear what s/he likes, but must never talk of being a boy. Children can read their parents, what is approved or disapproved.

The mother writes of her objection to the child being asked- but it is the child’s decision, and a question is not a demand. Properly used, questions can help a child understand the range of her/his options. They had not known it was possible until they heard of it.

More generally, if gender roles are not enforced on anyone, will anyone transition? Commenters talk of when they were girls, or children they know, in the 1950s or 1970s playing with a pedal car marked “Police” or feeding ants to spiders. Others talk of now. I am a woman; I love fashion and am considered attractive. And yet I am a scientist, an atheist, and a science-fiction nerd. I despise romances and chic lit. I am not warm, supportive or nurturing. Another says Speaking as a short-haired, slacks-wearing adult woman working in a male field who nevertheless feels feminine, I think it’s important to keep looks/roles separate from deeper identities. She feels the feminine makeup skirts heels look is expensive and uncomfortable.

Trans folk need freedom for everyone. In a society where gender roles are rigid, trans people will be excluded. It seems to me that adults are freer to express themselves as they wish; and yet the numbers transitioning increase. This is because trans is real for people, not just adjusting to circumstances.

New York Times article.