Sticks and Stones

Another week, another article on transgender children and their “crazy” / “abusive”/ “attention seeking” parents. Even when articles are not actively offensive and transphobic (as so very many are), they retain a heavy tone of scepticism and judgement. And then I get down to the comments section…

I know I shouldn’t look. I know there’s nothing there I want to see. I know I will leave in tears. But somehow, I can’t help myself. Partly, I want to learn what views are being shared, to try to understand what people are saying and, once I start, I’m so horrified, I’m unable to look away. A bigger driver though, is the knowledge that in a few years’ time my child will be the one on the internet. She won’t be able to look away, and I won’t be able to protect her. And the hurt I feel now will be nothing compared to the hurt she will feel when she realises how the world views her. It breaks my heart.

Parenting a transgender child seems to be a particularly lonely road. The vile and vicious comments under Daily Mail articles about transgender children and their families, are matched on the Guardian, on Mumsnet, even on supposedly LGBT friendly sites like Gay Star News. Parents of transgender children are harshly judged and attacked from the right and from the left. From traditional conservatives and from radical feminists. From religious fundamentalists and sections of the LGB exclusionary parts of LGBT+.  At times it feels overwhelming. Hopeless.

Sometimes, when I’ve pulled myself up from despair, I wonder whether, if I could just find the energy to respond to the thousands of hateful comments, perhaps I could open a few minds. Help move society a few tiny millimetres in the direction it needs to go in for my child to be happy, to be accepted, to be safe. I know I won’t overcome some people’s strongly felt prejudice, but maybe if I could explain a bit more, try a bit harder, maybe there are some people who could learn that my child is not a threat, that I am not a failure as a parent, that we just want our daughter to be left alone to enjoy the childhood she deserves without this constant stream of vitriol.

I decided to take another look at the comment sections (the majority from a recent Guardian online article), to try to understand what drives people to write such hurtful things. To break through the insults and hate and try to gain an insight into why so very many people find accepting my child so intolerable. Then to give a personal response to those comments, away from the collective pile on which often occurs when someone is brave enough to try to confront, explain, or simply give examples of their lived experience. (I’ve purposefully tried to give a personal response, rather than lots of sources, however if you are looking for more examples of evidence or reading then please do look for examples in our last blog post: GIDS.NHS.UK All the support a parent needs….)

I take a big breath, and leave a warning to parents and transgender individuals who are having a tough day. If you are feeling a bit vulnerable today, have a hug, watch this video of a ninja cat instead,  move on and smile and know that some people are so very firmly in your corner and the world is slowly moving in the right direction. I strongly believe that all those haters are on the wrong side of history.

And for those of you who are feeling up for it (or who, like me, find it impossible to look away), here we go:

‘I was a tom boy when I was a child’. ‘My brother borrowed my dresses when he was a child’

  • This is not relevant. ‘Tomboy’ usually describes girls who are perceived to enjoy stereotypically male activities or toys or friends. This is not being transgender, and nobody is claiming it is. Being transgender is not about what toys you play with, or what activities you prefer, or how you behave or how you dress or who you play with. It is about the identity that these children feel deep inside. I know this is a very difficult concept to grasp and it may not make sense to anyone who does not themselves feel any particularly strong gender identity, but to these children it is more important than anything else. It can become the driving focus of their life (right up until they are accepted, and then they often become like any other child). The thing that matters more than anything else to them is to be acknowledged and accepted as the gender that they know themselves to be.

‘I was a tom boy or a not very macho boy – If this had been around when I was young I would have been made to be transgender.

  • I don’t think that is at all likely. Girls who are ‘tom boys’ and boys who do not conform to stereotypically male ‘norms’ are not likely to be referred to a gender identity clinic – and if they were it would be pretty quick to find out how they identify. Unless you felt very strongly that you were a boy and were desperately sad about being called a girl over a prolonged period of time, your experience is not relevant to this topic. The children who transition tend to be ones for whom gender identity is the main thing that dominates their happiness. They also tend to have a deep feeling of sadness around their gender identity. Unless you were a child who was extremely sad every night saying ‘I am a boy’ or ‘I am a girl’, it is not likely you would be being supported to socially transition. The young children who socially transition have really fought for this, against a world that tells them they are wrong. They have insisted over a long period of time that this is who they are.

‘I used to want to be a boy’ ‘I used to call myself a boy and I’m not transgender’

  • For children who are potentially confused, counselling can help them work out whether they are thinking life would be easier as a boy because of their frustration about limited gender roles or limited society opportunities for women, or suffocating expectations of what it means to be a women (and vice versa for boys who do not fit into the masculine ‘norm’). For anyone to feel that they do not fit in is very sad. I hope any such children can be met with kindness and understanding. There is no fixed destination. There is no conveyor belt. What all gender non-conforming children need, like what transgender children need, is more love and openness and acceptance. Of course we don’t want gender confused children to be pushed into a path that is not right for them. But to protect gender non-confirming and gender confused children, we do not need to stamp out the rights and the hope and the wellbeing of children like mine who are not one tiny bit confused, who know who they are and just want acceptance and room to exist.

‘It is a money making scheme for big pharmaceuticals and profit hungry doctors – keeping patients on drugs for life’.

  • My child has not heard of big pharmaceuticals. She does not yet understand about hormones or any medical interventions. She does however know that she is a girl.

‘It is a trend’. ‘These children think this is a way to be famous and cool’

  • Transgender children are very likely to get bullied or socially isolated. Many are victims of hate crimes. Most transgender children desperately want to fit in and be accepted as one of the other children. This is not a path to being famous and cool  My child genuinely though she was the only child in the world to have felt this way. She had never heard of transgender. She didn’t know what being cool or famous meant. (Though as a proud parent, my child will always be cool to me).

‘Parents are doing it for attention’

  • I can’t imagine many parents wanting this type of attention, by which I mean constantly being judged and shunned and told you are a terrible parent. Losing friends and family members and feeling very alone. I certainly would never in a million years have chosen this. In fact the opposite is true, many parents shy away from attention, close their social media, try to avoid the inevitable and frequent difficult conversations. The majority of stories in the press are not self-serving, they are from parents who feel duty bound to raise awareness with the intention of de-stigmatising transgender children to make society a safer place for their child. Our family couldn’t do it, but I thank them for being brave enough to speak out for us all.

‘My child once or twice told me they were a girl when they were little. I said ‘don’t be silly Billy you are a boy. Aren’t I an amazing parent? If only these stupid parents/mums had followed my example’

  • Many parents of transgender children spend months and years telling their child, ‘no you are not a boy you are a girl’, often until the child shuts down and stops raising the issue (while still feeling miserable inside). In our house this was a daily conversation for over 6 months. Please don’t bring your crappy example of having told your child a handful of times and insinuate that we have somehow failed. Your child is not transgender. My child was so fixated on asserting their gender identity that it dominated and damaged their life for that time. The guilt of not supporting her then is on us. The children that continue to vocally (insistently and persistently) assert a transgender identity do so against a huge heap of societal and family pressure telling them they are wrong.

‘So-called trans-women are really men who are pretending to be women so that they can invade women’s spaces to rape women’

  • I’m always taken aback when I read this, and it comes up time and again in spite of a complete absence of credible evidence that this has ever occurred. My child is young. My child is not invading women’s spaces to rape women. This is not only absurd, not only deeply offensive and hurtful, it is also incredibly damaging. It conjures up the idea that ‘normal’ people should be afraid of transgender people. That they are different and can’t be trusted and our children (and women) need protecting from them. Well, my beautiful child, who is one of the kindest sweetest children you could meet, needs protecting from this kind of hate.

‘If gender identity can’t be seen, defined or objectively measured then it can’t be real or need supporting’

  • So emotions or feelings or thoughts don’t exist either. Or anything to do with identity or who you are. None of these are valid. I can’t define the fact that I like smarties, therefore that can’t be true. I can’t see whether you feel happy, so happiness isn’t a real thing. We don’t understand consciousness, so that doesn’t exist either. This argument is highly flawed.

‘This is body mutilation’

  • Thanks for that sensationalist statement. Why can’t people choose want they want to do with their own bodies without you getting so outraged? There are no operations related to transitioning before the age of 18, when they are adults, and can choose for themselves. Many transgender people do not choose to have surgery. Many non-transgender people change their bodies (eg tattoos, plastic surgery, breast augmentation/reduction etc) for a variety of reasons some aesthetic, some medical. I’m scared shitless about my daughter potentially having surgery one day, but I’d be anxious about any surgery. I’m going to do my very best to try to support her being comfortable in her own body without the need for surgery but I’m not naive, and know that for many transgender people, surgery is vital treatment for their gender and body dysphoria. I will support her in whatever she may choose to do.

‘Children naturally grow out of it’

‘80% do not persist as they mature’

‘It is just a phase’

  • When talking about transgender children the statistic of 80% of children not ‘persisting’ is often repeated but total and utter nonsense. The few studies underpinning it, have been thoroughly debunked. The key thing these studies have in common is that they grouped gender non-conforming children (the majority surveyed, highly unlikely to be transgender, often grow up gay) in with cross-gender identifying children (a small minority of the surveyed group, highly likely to be transgender, no more or less likely to be gay). The Meta analysis of these studies are also intrinsically flawed as they simply collate all the previous rubbish studies. This means the numbers we have are meaningless for predicting the future path for children like mine who, from a very young age, has consistently and very persistently stated that they are a different gender to the one assigned at birth. The most recent evidence finds that children who very strongly identify as a different gender will continue to do so and will not grow out of it. Yes more research is needed, to give a better steer on ‘persistence’, but the 80% figure should be treated as a research phase that we have naturally grown out of as we’ve matured.

 ‘Let them decide when they are 18’

  • Comments like this actually helped me decide to accept my daughter as a girl. She was miserable for years before we supported her. She felt extremely rejected by us and by others in her life. She cried every single day. Since we accepted her as a girl, and helped her be acknowledged by others as a girl, she has been so happy. So very happy. Every day. Why should a parent force their child to be miserable every day for years (for 15 years if you were to have your way!). A parent needs a very good reason to keep their child in a state of sadness and rejection, when the only thing you need to do to support your child to say ‘I love you whatever’ and to change the name, pronoun and noun that you use. We have not yet got to puberty, and making decisions then will be tough. But if our daughter at puberty still feels like she has since age 3, then she will have our full support to help her avoid the wrong puberty and have the right puberty for her gender.

‘why would a parent make this decision. Crazy’

‘Just wait’

‘The best course of action would be for parents not to make any decisions at all’

  • This shows little understanding of what it is like to parent a transgender child. Life is full of decisions. Before making the extremely difficult and heart-breaking decision to support my child, for months I made the decision to say ‘I love you, but no, you are not a girl you are a boy’ and watched their sad face. For months later, when they said ‘I am a girl’ I decided to change the subject or look away. For months further I avoided directly calling them a boy but decided to sit in silence as others called them a boy and I watched their shoulders hunch in and the sad look of rejection on their face. For months further I sat with them at bedtime as they cried and listened to them say ‘but I am a girl’ and I decided not to say ‘that is ok, we love you whatever’. Life with a very insistent transgender child is full of difficult and painful and troubling decisions for a parent who cares deeply for their child. Making a decision finally to say ‘that’s ok, we love you whatever’ was the latest in a very long line of decisions. Which eventually moved on to ‘ok, we’ll call you a girl’, and ‘ok, we’ll help others to call you a girl’ and ‘ok, we’ll help others to understand you are a girl’. We do not wake up one morning and think, wouldn’t it be fun to choose this incredibly hard and traumatic path for our children.

‘Just teach them to be happy as they are’

  • I really, really tried. It didn’t work. They got sadder and sadder. And feeling rejected by your parents is very tough. Feeling that your parents love you, but the way you feel is so unacceptable that your parents cannot bring themselves to properly accept you, is very tough on a child. We all want our children to be happy. We all want our children to have an easy path in life. This is not an easy path. But my child is now so very happy, long may it remain so. The main thing that threatens my child’s happiness is not potential future medical interventions, but the hate and anger that they receive. I wonder if, in a world of greater acceptance for transgender people, would fewer transgender people choose medical interventions? If it was more feasible to have a non-typical body and still be referred to by the pronoun and identity that a person feels. I can’t see that acceptance happening any time soon. If you care about my child’s happiness, please stop denying their existence and trivialising what it has taken us to get to this point.

‘Don’t label children’

  • Our world and our language is full of labels. If you genuinely want a world without labels, then please put your energy into trying to avoid these boxes and labels everywhere, don’t focus your energy on a very powerless and vulnerable group of children who just happen to not fit into the boxes and traditional labels that the world is accustomed to.

‘It’s all because of gender segregated parenting. The parents had too fixed ideas of what boys and girls could act like or play with’

‘It’s all this gender neutral parenting. They haven’t taught their child what gender they are’

  • Parents of transgender children get hit with contradictory accusations. Either we were parenting with too rigid stereotypical gender norms, or our parenting was too gender neutral. We hear this all the time and everyone seems very happy to share their opinion with us. The one thing that is quickly obvious when you get a group of parents of transgender children together, is the huge diversity. It is a bit like jury service. There is no common denominator between the parents. The weight of scientific evidence is also clear, including the Lancet, no less, that there is no evidence of a link between parenting and whether or not a child is transgender.

‘Young children can’t make a decision to change gender’

‘How can a young child know about transgender. What on earth are you teaching them?’

‘I wouldn’t trust a 5 year old to choose what to have for dinner let alone their gender’

  • People really don’t understand this at all. My child had never heard of transgender. They never made a decision to change gender. They always, from the moment they could speak, said they were a girl (they were presumed male at birth). They knew they were a girl before they knew most things about the world. They knew it instinctively. They knew it, despite the fact that their parents, and everyone in the world told them they were a boy. They knew it, and insisted upon it time after time, despite being told in no uncertain terms that they were wrong. They never decided to change gender. They never have changed gender. The change has not been within them, the change has been the rest of us, coming to understand what their truth is, and coming to accept it. Our child has not changed, we as parents have changed and reset our understanding of our child. How our child developed a strong gender identity that they were a girl, I really do not know. But the thing is, hundreds of children up and down the country and thousands world-wide have had the same experience. There have been transgender people throughout the world, throughout the centuries, and many of those transgender people recall having known their gender identity from a young age.

‘These are mentally unwell children, we shouldn’t fuel their delusion’

  • For many decades transgender people were classified as mentally unwell. Enormous pressure was put on them to conform, to change their view. This has led to some particularly awful outcomes for some transgender people who have had very tough lives. Lives far tougher than anyone would wish on their child. The medical consensus is that attempting to persuade people to identify as the gender they were assigned at birth is both unethical, and ineffective. Being transgender is being taken out of being classified as a mental health issue. Unsurprisingly, there is now increasing evidence that when transgender people are accepted, loved and supported, they have normal levels of mental health and wellbeing.

‘This is backward, we should be breaking down gender barriers and stereotypes’

‘Instead of supporting these children, let’s overthrow gender norms instead’

  • Breaking down gender boxes and stereotypes will be a great thing for very many children, including for transgender children. If this is what you care about, focus your attention on breaking down gender boxes and stereotypes in society at large, don’t focus your attention on a marginalised group of vulnerable children. And if in your vision for a freer society you agree that people should still be free to describe themselves as a girl, then allow transgender children this freedom as well.

‘Those parents are senseless liberals inflicting horrendous damage on their child with this trendy transgender ideology’; ‘those parents were far too liberal letting their child call the shots when they should have been more strict’; ‘Those parents were far too strict, couldn’t relax and let their children play with any toys they wanted to play with; ‘I bet the child is being abused’; ‘I bet these children are from a broken home’; ‘I bet the mum hated men so much the child wanted to be a girl’; ‘I bet one of the parents are in a homosexual relationship’; ‘Those parents must be homophobic and preferred a trans daughter to a gay son’; ‘I bet one of the parents is transgender’.

  • We hear all of these charming comments. Parents of transgender children come from all walks of life. And whatever walk of life they happen to come from, accusations like this are thrown at us as the reason why we are in this situation. The more I see these accusations (once I get beyond my own thin skinned shock and upset at how people view us) the more clearly ridiculous these accusations appear. Try to ignore.

‘It is disgusting’. ‘It makes me sick’. ‘It is vile’. ‘These children should be taken away from their abusive parents’. ‘These horrendous narcissistic parents should be locked up’

  • Yes we hear a lot of this too, some things aren’t worth the effort of engagement, try to ignore.

‘Children should be able to play with any toys – you shouldn’t force your child to be a girl or a boy just because they like toys associated with the other sex’ ‘Your inability to let children play with any toys or choose what to wear is what has caused this’

  • In my view children should be able to play with any toys that they want to play with. Our child has always been able to play with any toys. For our child, this is a question of identity, not of toys or interests or behaviour or preferences. I know it is hard to understand that a child can have a clear gender identity at a young age. But you have not lived my life. Don’t judge us (and make my child’s life harsher and more filled with hate) just because you find it hard to logically understand.

‘You shouldn’t have let your child play with opposite gender toys or choose what to wear. This is what has caused this’

  • Look, I think you have some weird ideas about toys. I disagree with you on this one. But I know plenty of families who have had fairly clear gender segregated expectations and upbringings for their child, and they have also found themselves with a transgender child. So although on a case by case basis it is easy to throw insults at us parents and say ‘this is what you have done wrong’, if you met a large enough group of us, you would see that we have very little in common in terms of our parenting styles, apart from perhaps a fierce determination to try to help and protect our wonderful children. The recent Lancet review concluded there is no evidence of parental upbringing having an influence on children being transgender. So give us a break from your mean accusations.

‘There are 2 fixed genders that are very clear cut, and it is scientifically impossible to ignore this.’

  • People who quote ‘science’ in this way have a very limited understanding of science. ‘Gender’ and ‘Biological sex’ is made up of a wide variety of different elements. Sex chromosomes, which are often XX or XY, but can come in other formations. Internal sex organs (eg ovaries). External sex organs. Intersex people can have different combinations of these (eg having ovaries and XY chromosomes). Hormone levels – some people are have raised testosterone or oestrogen. Some women are unable to process androgens and have levels of testosterone typically found in males. Biologically speaking the world is much more complex than people would like to believe. The world is full of variation, it is humans (and our language and our need to classify and define) that try to put things in neat strict boxes. Some people think there is a physical aspect to gender identity, potentially linked to levels of hormones in the foetus, but like much of the brain and human development, much remains to be discovered. Beyond this, gender consists of gender identity (who you feel you are), gender expression (how you choose to dress), gender roles (how you conform with or do not conform with stereotypical gendered expectations). Life is complicated, and for some of us, that is ok.

‘My child said they were a dog for a year’ ‘My child thought they were Spiderman’ ‘My child asked us to call them an airplane’ etc.

  • Were they playing? Were they having fun? For my child, asserting that they were a girl was not a game. They would say ‘I am a girl’ with tears in their eyes. When called a boy they would hunch their shoulders with sadness. This did not pass, this did not end. Please don’t bring your glib example of your child who played at being a dog, or Spiderman or an airplane. One other reason why this is not comparable –my child’s experience matches that of a small but not tiny number of other children who have the same experience. It also matches the experience of many adults who continue to identify as transgender, and are happy to be able to find acceptance in that identity. There is no comparison with the flippant dog/ Spiderman /airplane example.

 

Phew. Made it to the end. And this time feeling a bit stronger. The same comments seem to come up time and time again with little variation no matter the publication or source.

If you are a parent of a trans or gender non-conforming child, a trans person or a trans ally and feel your eye drifting down to the comments… If you are feeling strong and want to try to educate, challenge, or simply stand up to the haters, then please do copy/paste content or link to this post.

This is the defining civil rights battle of the 21st Century. We can rise to the challenge. We can stay strong. Our children, our society needs us to.

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GIDS.NHS.UK All the support a parent needs….

The UK’s specialist Children’s Gender Identity Service, GIDS Tavistock, launched a new website this week. A website that has the potential to become the first source of guidance for people interested in issues relating to gender identity in children. A website that can help dispel the many inaccuracies and distortions about transgender children that appear in the media. A website that can be the first port of call for parents of gender questioning and transgender children.

I was very excited to see the updated website, as the old one did not provide the information and support that parents like myself so badly need, particularly in the early days when it was so hard to sort through confusing and contradictory information to find out how best to support our child.

Instead I found myself disappointed.

I’m hoping however, that the people at GIDS Tavistock have good intentions, and in the process of quickly rolling out their new site, simply overlooked the stage of consulting with parents and interested parties on what content would best support transgender children and their families.

I saw on the main Tavistock and Portman site the statement that:

issues around gender is changing all the time. If you see anything on the new site that you think is either incorrect or out of date, we’d love to hear from you. Please contact us via gids@tavi-port.nhs.uk

So I thought it would be helpful to feed back my comments on the site’s content and add a few thoughts of easily implemented changes that can be included to update the site. It is pretty long so I’ve added some scores for each of the key sections.

First up: The ‘Parents’ section:


http://gids.nhs.uk/parents

Why does my child feel this way?

The parents section starts by presenting different opinions on why children might end up transgender. It does this in a very biased way. When summarising the view that there is a physiological causation to gender identity it presents this as “Some people think”. It would be more genuine and accurate to say “X leading scientists and gender specialists have found X Y Z evidence for a physiological element to gender identity”. Presenting this view point as the vague “some people” gives little credence to this view, despite this being the conclusion of a wide number of credible gender identity specialists.

It seems to contrast this with the statement that “others argue that current research hasn’t found a major difference between boys and girls brains”. It seems to give this alternative argument greater credibility by reference to an “academic psychologist” and directly linking to a book (that outlines a lack of scientific evidence to support gender stereotypes about women being innately better at map reading or worse at parking). You may be aware that this text is popularly cited by a minority who claim that (trans)gender is a social construct and therefore argue that trans people don’t exist. This is not helpful GIDS Tavistock.

It is inappropriate to present these two (gender identity having a physiological element and male and female brains not being completely different) as alternative options. It is easily possible for both to be true.

There is clearly growing evidence backing up a physiological and pre-birth element to gender identity, and though this evidence is limited, it is misleading to ignore it or dismiss it as “some people think”.

It is entirely possible for there to be some tiny physiological element to gender identity, without there being two binary and totally distinct ‘male and female brains’. The concept of a ‘male’ brain, as completely distinct and separate from a ‘female brain’ is clearly nonsense, but I don’t see anyone arguing this. Yes, some trans people use the phrase ‘female brain in a male body’ or vice versa, but most people are using this as a short hand vernacular way of explaining that they identify as the other gender.

Most people I know who are deeply interested in this subject view gender as a complex spectrum and a complex interplay of identity, culture, expression, interests, preferences.  To introduce this strawman (or rather scarecrow!) debate on the first page is highly disingenuous, and appears to discredit those who feel that they have ‘been born this way’.

Nowhere does this section give the view of the recent Lancet report which clearly states “to date, research has established no clear correlations between parenting and gender incongruence”

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00683-8/fulltext

This section is actively unsupportive GIDS Tavistock: 1/5

Where can I get help for myself?

This section does not provide any links to the main organisations that are able to provide support to parents. Mermaids (http://www.mermaidsuk.org.uk/) is clearly an important organisation in this space, though there are also other groups that can support. This section recommends parents get support from their GP. If you had consulted properly with parents when developing this website we would have informed you that a GP is not a reliable source of advice. There is no systematic training for GPs on gender identity issues, especially for children, and many of us have encountered GPs who at best are ignorant and dismissive.

This section needs to acknowledge that GP knowledge and awareness of gender identity issues is patchy, and needs to provide clear alternative sources of support. This is critical both due to the long waiting lists to see GIDS, and also as often a GP referral is needed to even get on to the waiting list – parents needs support in these early stages, especially if their GP is un or ill-informed and refuses to refer.

This section is not at all helpful GIDS Tavistock: 1/5

 

When is the right time to ask for professional help?

This section states that “if a young person is demonstrating distress at any time we would encourage you to initially seek input from local services such as CAMHS”. Many parents that I know have been turned away from CAMHS if their child’s distress is purely down to gender identity. The advice on this website should match up with the reality of what CAMHS sees as their role in supporting children who are distressed ‘just’ about their gender identity. The advice to seek support from the mental health service should also be prefixed with the consensus that being transgender is not in itself a mental health issue..

One other concern with advising parents and young people to contact CAHMS, is this will add significantly to the already very long wait (with a waiting time to see CAHMS, and time for CAHMS to refer on to GIDS). If your child is in severe distress about their gender identity the last thing you want as a parent is additional barriers to reach the help they need.

Could do better GIDS Tavistock 3/5

Should I use my child’s preferred name and pronouns?

Well done GIDS Tavistock. This section is written with kindness and understanding of what parents are dealing with at its heart. This tone of emotional support is so important in supporting gender questioning and transgender children and their families.

Good work GIDS Tavistock 5/5

How do I know whether or not this is a phase?

You say: “it is a fact that whilst many young people retain the gender identity they develop in childhood or adolescence, some do not”. This is helpful, although you place the emphasis on the children who do not continue in the gender identity they develop in childhood. It would be helpful if your acknowledgement that “many children retain the gender identity they develop in childhood” came across more clearly in both your publications and in the media articles with which you collaborate (the recent Times article quotes you as having stated that 80% do not continue in their childhood gender identity – this is further discussed below).

In your communications, it often feels as though your priority is on the few children who might not retain the gender identity they develop in childhood, at the expense of clearly supporting the many young people who do retain that gender identity.

Pretty good here GIDS Tavistock 4/5

How can I help my younger child?

You state: “During this same time of life, children learn about gender roles and what is expected from each sex in their community i.e. ‘things that boys/girls do or like.’”

And:

“Our ideas of what ‘boys do and like’ or what ‘girls do and like’ changes over time”.

And:

“There is nothing ‘wrong’ with any child who explores interests and activities outside of the current gender stereotypes.  Indeed, it is probably helpful for all children to be encouraged to play with a range of toys, friends, activities and emotions in order that they can find out what works best for them as this will likely help them grow into rounded and accepting adults”.

More of this:

“parents may want to influence how a child plays or behaves in order to protect their child from stigma, but it is important not make the child feeling like they are doing something wrong”

And this:

“When a child’s interests and abilities are different from societal expectations, he or she can be noticed or even discriminated against by others”

Come on GIDS Tavistock, you were doing so well! A transgender identity is not about gender roles or things that boys or girls do or do not like or dislike. Why can’t you unpick this? Why not say “a boy liking dolls or dresses and a girl liking football or trousers does not mean they are transgender. These children do not need to be supported by a service like GIDS Tavistock.

GIDS Tavistock is to provide support to children and young people with a gender identity that is different from the gender identity they were presumed at birth. This service is for children who state “I am a girl” or “I’m not a boy” (when assigned male at birth), or “I’m neither”. Of course there are more complicated situations, and it can be hard for parents and children when gender identity is not clear or when there is confusion about whether the underlying issue is one of gender identity or expression / gender roles, and the GIDS Tavistock can support young people to explore these issues. But for a child who feels that they are a boy, and is a boy who likes playing with stereotypically girls toys, or likes stereotypically girls’ clothing or who has a more gentle play behaviour or is perceived to be more feminine, this is not a relevant service.

This service is surely for the small percentage of children for whom gender identity has become a critical issue in their development, not for children who might prefer non-stereotypical play or dress.

Gender isn’t all that matters.

You say: “Try and get a balance between paying attention to a child’s gender-related preferences whilst not allowing gender to become the only way in which you understand your child.  Allow your child access to all sorts of toys, friends and activities, associated with both boys and girls. “

What? Oh come on GIDS Tavistock. How is this relevant to children like mine who feels that they are a different gender. For children (assigned male at birth) who do not give a damn what toys or friends or activities they play with as long as they are acknowledged as a girl. Gender IS all that matters when you have a child who is severely distressed about their gender identity. Are you aiming this advice towards parents of transgender children (surely your target audience?), or aiming it at parents of ‘gender non-conforming children’. If the latter, please put this in a different section. Sure, gender non-conforming children may get bullied for non-stereotypical behaviour, activities, friends, clothing preferences. Sure parents who have very fixed ideas about gender roles and norms may need reassurance about what toys their child can play with, but this is not advice for parents of transgender children.

Even worse, this may lead some parents of gender non-conforming (but not transgender) children to question whether their child is transgender – making your near eternal wait times even longer. How is this helpful GIDS Tavistock?!

Woeful GIDS Tavistock 0/5

Social transition? 

You say: “Based on knowledge of child development and our experience of working with families, we know that some younger children benefit from a period of ‘watchful waiting’ when they appear to be questioning their assigned gender.”

GIDS Tavistock have you read the latest US American Academy of Pediatrics publication “Supporting Caring for Trans Children”?

http://hrc-assets.s3-website-us-east-1.amazonaws.com//files/documents/SupportingCaringforTransChildren.pdf

supporting-trans-children

This is a fantastic publication that actually helps parents of transgender children with some really clear advice. In this, they rightly clarify the term ‘watchful waiting’ as ‘delayed transition’. It would be more honest if the term ‘delayed transition’ was used here.

More broadly – please take a look at this US publication. This is the kind of material I was hoping to see on the GIDS Tavistock website. Clear and informative.

Some further reading needed GIDS Tavistock 2/5

Looking after yourself

You say: “Some parents tell us that they wonder whether they are to ‘blame,’”.

This would be a good place to reiterate the recent Lancet article conclusion “to date, research has established no clear correlations between parenting and gender incongruence”.http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00683-8/fulltext

Well done GIDS Tavistock for acknowledging the difficulties parents face trying to support their children within a sometimes hostile society 4/5

Evidence base: http://gids.nhs.uk/evidence-base

I don’t really know how to start here GIDS Tavistock. The section on ‘evidence base’ is extraordinarily biased, selectively sourced, and lacking in evidence. The NHS GIDS Tavistock should think harder about which pieces of evidence to present in a section entitled evidence base. Such a section should also include proper referencing so that people can read the source material.

Further, the only GIDS publication that is referenced in this section is a presentation (not a peer reviewed publication) that does not seem to be publically available. This section should honestly present and weigh up a cross-section of the evidence that is available. It should acknowledge areas in which evidence is lacking, and should not overstate the case in areas where the evidence base is weak or contested.

How many people continue with their transition?

Oh come on GIDS Tavistock. In a section titled “evidence base” you present a very one-sided view of a subject that at very best can be described as contested (I would describe these statistics as discredited).

“In the majority of cases these feelings seem to discontinue either before, or early in, puberty (Steensma et al, 2013).“

This often repeated assumption appears in NHS, NICE and WPATH guidance, yet the evidence base is extremely weak and the supporting literature e.g. (Green, 1987; Money & Russo, 1979; Zucker & Bradley, 1995; Zuger, 1984, Drummond, Bradley, Peterson-Badali, & Zucker, 2008; Wallien & Cohen-Kettenis, 2008, de Vries et al 2010, Steensma et al 2011), have multiple flaws e.g. self-selecting participant groups, small sample sizes, outdated definitions of gender roles, philosophical underpinnings which have been criticised as homophobic or misogynistic, lack of follow-up. Findings have been used to make sweeping unsupported conclusions.

“Across all studies approximately 16% continue with their gender identification (Steensma et al, 2013).”

These statements are simply not supported by recent scientific literature. The few studies that give rise to similar statistics have been criticised roundly as flawed, and most importantly, they include gender non-conforming as well as transgender children. They include boys who like playing with dolls, alongside natal males who say ‘I am a girl’. These are clearly two different categories, and putting both in the same pool is clearly meaningless – the fact that boys who like playing with dolls end up being men is not in any way relevant to the question of whether natal males who say ‘I am a girl’ will continue to identify as female into adulthood.

The quoting of this cross study % figure is irrelevant and confusing given the admission that “It should be emphasised that most studies did not use the fairly strict criteria of DSM-5, and children might previously have received a diagnosis based only on gender-variant behaviour”. A cursory reading of the studies looked at by Steensma & Cohen-Kettenis reveals that many (all?) were flawed, and lacked basic rigour for cross comparison.

It would perhaps be more appropriate to simply state as in the WPATH guidelines that

“The current evidence base is insufficient to predict the long-term outcomes of completing a gender role transition during early childhood” and that “additional research is needed to refine estimates of its prevalence and persistence in different populations worldwide”.

Where evidence is weak, this should be stated. See for example the following for summaries of problems with the evidence:

 

You should not be self-selecting which pieces of evidence to present in a section on “evidence base”. This section should honestly present and weigh up the evidence that is available and honestly state where evidence is weak or contested.

Where evidence is weak it would be very reassuring to see you acknowledge this. Better still, to help all of us, it would be good to see your commitment to GIDS data being used properly by researchers to improve the evidence base. It is not helpful that one piece of evidence that you list in this section ‘GIDS Audit: Retrospective Look at Cases Closed at GIDS, presented at WPATH 2016’ does not appear to be available. If data is not made available, it cannot enhance understanding of this important topic.

This is a complex and contested subject. An honest review of the evidence would acknowledge this. Must try harder GIDS Tavistock 1/5

Social transition age

You say: “Quantitative and qualitative follow-up studies by Steensma et al (2011; 2013) present evidence to strongly suggest that early social transition does not necessarily equate to an adult transgender identity.  The qualitative study reports on two girls who had transitioned when they were in elementary school and struggled with the desire to return to their original gender role.  Fear of teasing and feeling ashamed resulted in a prolonged period of stress. One girl even struggled to go back to her previous gender role for two years.”

Reading the Dutch studies I found it difficult to reach this conclusion. This hinges on the use of the term ‘transition’, though as Steensma & Cohen-Kettenis (2010) state:

“None of the boys completely transitioned, that is they did not live in the preferred gender role on a daily basis (including a name change and change in pronouns). The boys were still treated as boys (be it a different type of boy) by other children. In contrast to the boys, the girls reported wearing boys’ clothing all the time. Most of them also had boyish haircuts. None of the girls ‘officially’ transitioned by changing their name or informing other children that they wanted to be referred to as ‘he’. However, as a result of their appearance and behaviour, virtually all the girls were largely perceived and treated like boys.”

To be clear, none of these children had transitioned including the two children on which such strong conclusions are made. This is very very weak evidence on which to base any conclusion on social transition. In your conclusion, for this section on social transition, you again talk about gender roles not about identity:

You say: “As such, in our approach, we would encourage exploration of gender roles in this younger cohort, with a view to keeping options open and not having any pre-conceived ideas as the longer term outcome. This could be summarised as a ‘watch, wait and see’ approach”.

This ‘guidance’ contrasts very strongly with the actually useful guidance in the new American Academy of Pediatrics publication which is worth quoting at length:

“Competent clinicians generally can tell transgender kids apart from other gender expansive children. Many delayed-transition advocates say this is impossible until a child reaches puberty, but their own studies contradict them, identifying early characteristics that predict whether gender dysphoria will continue. Persisters in these studies had more cross-gender behavior and more intense gender dysphoria during childhood, as measured on various psychological tests. Interviewed later, they also described their childhood experiences with gender differently. For instance, persisters recalled insisting that they were the “other” gender, while desisters had said they wished they were that gender.”

And:

“It is clear that many children who are gender-expansive or have mild gender dysphoria do not grow up to be transgender — but these are not the children for whom competent clinicians recommend gender transition”.

Further:

“As in most areas of medicine and life, there is no perfect test to predict what is best for each child. But delayed-transition advocates treat unnecessary or mistaken gender transition as the worst-case scenario, rather than balancing this risk with the consequences of the delay. There is no evidence that another transition later on, either back to the original gender or to another gender altogether, would be harmful for a socially transitioned child — especially if the child had support in continuing to explore their gender identity. More important, untreated gender dysphoria can drive depression, anxiety, social problems, school failure, self-harm and even suicide. Delayed-transition proponents have few answers for children and families in the throes of these symptoms. What’s more, we know little about the long-term consequences of prolonging gender dysphoria.”

You would also be recommended to look to the American Academy of Pediatrics publication for a helpful summary of ‘Gender Affirmative Approaches’.

Your ‘evidence’, GIDS Tavistock, appear to be entirely ignoring the recent studies on the gender affirmative model see for example:Hidalgo et al (2013)  The Gender Affirmative Model: What We Know and What We Aim to Learn  and,

Hill et al (2010) An Affirmative Intervention for Families With Gender Variant Children: Parental Ratings of Child Mental Health and Gender

You are falling out of touch GIDS Tavistock. Please keep up with more recent research and publications GIDS Tavistock 1/5

Case studies of young people

I’m not going to review these in any detail, but would like to feel more confident in how you’ve selected which case studies to include. It might be helpful to present these each in the same way unlike the current site in which a story of a girl who did not continue to transition is presented differently to the case studies of four trans boys. I was struck by the fact there is not a single case-study of a trans girl. Is there any reason for that?

Conclusion: 

I added up your marks GIDS Tavistock- you got 22/40 so 55%.

It is a good start but I do feel you are letting yourself down in a few areas. We know you can do better and would love to help you improve to be the best you can be.