Contra the Fearmongering Atlantic Story, Trans-Affirming Care Is Great for Kids

A child with long hair blows bubbles.
Current research supports a flexible approach that does not push children toward any particular outcome. Thinkstock

This post is part of Outward, Slate’s home for coverage of LGBTQ life, thought, and culture. Read more here.

As transgender acceptance has grown, so has worry in certain quarters about gender dysphoric or gender nonconforming kids being influenced by nefarious forces to identify as transgender. Many progressive people seem to express tolerance for transgender adults, while fearing that children and teens are being turned transgender in large numbers by too much acceptance of trans people in the culture or the press. There have been countless articles written giving voice to these fears; one writer who has perennially sounded the alarm is Jesse Singal, who did so again in a lengthy and controversial cover story for the July issue of the Atlantic.

Given all this hand-wringing over the children, it feels necessary to say, unambiguously, that such fears are overblown and can lead parents astray, guiding them toward decisions that may permanently harm their kids and endanger their relationship with them for the rest of their lives. Contrary to the fears of Singal and his ilk, current research supports a flexible approach that does not push children toward any particular outcome, and best practices put the needs of seriously distressed children first.

Despite the intense debate over trans kids in the public sphere, there’s actually mostly agreement in the field about the research and treatment of gender dysphoria in youth. Experts largely agree that gender nonconforming dress and behavior are common among young children, and that only a minority of such children will grow up to be transgender adults. (Estimates of the desistance rates—the measure of how many gender nonconforming or dysphoric youth desist, or do not grow into transgender adults, vary, but newer studies have found a lower rate of desistance as more experience with gender nonconformity in children and tightened clinical guidelines for diagnosing dysphoria have resulted in fewer false positives.) The experts also agree that it’s not possible for professionals to tell for sure which children will desist—they can’t say for certain which kids will grow up to be transgender adults.

However, adolescents who experience gender dysphoria are likely to become transgender adults, and the only proven, effective treatment for persistent adult gender dysphoria is for patients to undergo transition and live as the gender they know themselves to be. Researchers and clinicians agree that there’s no need for medical interventions in prepubescent children, regardless of how strongly they experience gender dysphoria. And, they agree that social interventions such as using a different name or pronouns can be helpful for some children with severe gender dysphoria, and that all measures (social and medical) should be decided on a case-by-case basis, taking the individual needs of the child or adolescent into account.

Singal’s piece downplays these areas of consensus, which, if explained, would tend to reassure parents that seeking the help of an experienced clinician is the right move and will not lead to the immediate, unconsidered advice that the child should transition socially, much less medically. Instead, he uses isolated examples and unsupported statements to paint a picture of girls being influenced by peers, online videos, or even sexual abuse into the false belief that they are transgender boys. Singal writes: “Trauma, particularly sexual trauma, can contribute to or exacerbate dysphoria in some patients, but again, no one yet knows exactly why.” Although one or two individuals have linked their histories of abuse to their detransition journeys, Singal provides no scientific support for the idea that sexual trauma leads to gender dysphoria, and to my knowledge no evidence of such a connection exists.

Singal’s focus on adolescent girls is confusing because research by Thomas Steensma of VU University Medical Center in the Netherlands, who Singal interviewed for his piece, has found that adolescent gender dysphoria is much less likely to go away than dysphoria in young children and that patients presenting with dysphoria who were assigned female at birth are more likely to go on to become transgender (male) adults. No one disputes that more research is needed, but the current research picture does not suggest or even hint at an epidemic of confused, sexually abused girls who have been influenced into thinking they are transgender by friends, online celebrities, or LGBTQ groups. There are groups who believe this is happening, without evidence, and Singal interviewed Jenny (the mother of a teen called Delta), who is a member of one of these groups, without discussing the connection, their agenda, or the lack of evidence supporting their paranoid fears.

Like Singal, I’ve also spoke with Steensma, who is the leading expert on desistance in children with gender dysphoria. Here’s what he had to say when I asked him how parents should think about his research, especially when they read about it in the press: “With extreme gender nonconformity, the chances of a non-normative development path is very high. Most will have a non-normative gender presentation in adulthood, and/or identify as gay, trans, etc. Parents need to ask: What is the best decision to make now, that will benefit the child now, but won’t confuse them or make things more difficult later?

Johanna Olson-Kennedy, medical director for the Center for Transyouth Health and Development at Children’s Hospital Los Angeles, also spoke with me about best practices for treating gender dysphoric youth. She stressed the ways attempts to ward against regret may backfire. In a system where experimenting with a new name or pronoun at school, or wearing some different clothes, first requires a teenager to pretend to have complete certainty that they’re a different gender (and assert this for months), they’re hardly being given room to explore doubts or change their mind. Olson-Kennedy explains:

Transgender care models often result in requirements that trans patients must meet in order for their providers to feel comfortable and guard against this idea that we might accidentally make someone trans. Trans people and youth need room to have their own uncertainties, but instead we force them to make everyone else feel OK. I think cis people envision gender as a landing spot, while trans and gender nonconforming youth experience gender as a journey. In my experience, the small number of individuals who start and then discontinue medical intervention more often do not regret it, but rather consider this decision-making a part of the journey they had to take for themselves. If we could talk about the journeys of trans and gender nonconforming folks we’d do a lot better by them.

No one is suggesting that children who declares they are boys on Tuesday should be given testosterone on Wednesday and surgery on Thursday. Parents can and should consider all possible explanations for their child’s distress—if their child has been sexually abused, for instance, it makes sense to prioritize therapy aimed at resolving that trauma over other concerns. But, adolescence is a time when young people are differentiating from their parents, and this is difficult for parents who may truly believe they know their child better than the child knows themselves. Disappointment, worry, and feelings of failure are all common responses to children maturating and becoming their own people, and can lead parents away from listening to their children and accepting them for who they are. Parents of gender nonconforming youth are hardly alone in this, but the consequences for youth whose burgeoning self-conception is undermined or prohibited from being expressed can be particularly tragic.

Affirming care means giving youth the space to experiment and explore, trusting that the young person won’t be irrevocably damaged by the exploration process itself. Parents who follow the current guidelines and seek out qualified experts should have no fear of their children being harmed by too much acceptance of trans youth.