"Bound by law to offer gender affirming advice."

[Fan_of_Meehl]

I would find many of the arguments against gender-affirming care more palatable if it came with an attitude of "These procedures aren't easily reversible so let's just make sure we are erring on the side of caution with youth while still respecting their feelings and fully supporting their desire to live life as they choose once they become adults."

While I'm certain there are people out there with that attitude, I have seen extraordinarily few opponents to gender-affirming care in children who are truly supportive or welcoming of adults transitioning. It certainly makes me question their real motives.

I have that attitude. That is, I think it is prudent for clients to be cautious about committing to irreversible surgeries (or even hormone treatments, by the way...I have worked with a veteran who decided to de-transition due to adverse health effects some of which may be permanent according to the medical folks...weight gain, breast enlargement, muscle atrophy, low T, difficulty with erections and even when achieved, painful erections, genital atrophy).

I am not ideologically 'against' anyone transitioning nor am I 'for' anyone transitioning. I am 'for' my clients making up their own minds and charting pathways of recovery consistent with THEIR deeply held beliefs, values, goals, etc.

Fortunately, I don't work with the kids. I think that's a whole 'nother kettle of fish. I am neither 'pro' or 'con' this area...to me this is such a complex and emotionally-charged topic I feel like I need to get a whole lot more information on it and also need to think very deeply about all the ethical/moral and legal issues involved. But, as far as adults are concerned? They're free to do as they wish and I would support them pursuing any path they think would allow them to thrive. However, I think it would be irresponsible for me to encourage them to transition or not to transition based on my particular beliefs or values. I also think it would be irresponsible for me (as their therapist) not to ask open-ended Socratic questions or encourage them to think critically about their choices or for them to receive true and comprehensive informed consent including known or possible risks/benefits, alternatives, etc. But this feels like the one area of clinical practice where you're expected as the therapist to somehow just 'agree with' and endorse/encourage clients to transition vs. being more impartial and Socratic and measured. It doesn't feel right to me and I'm pretty sure I'm not alone in that and I don't believe it makes me bigoted; I believe it makes me adherent to some of the most central and sacred tenets of responsible delivery of psychotherapy, but people are sure to differ on this. I'm more comfortable considering my approach to be 'client-affirming' or 'person-centered' rather than 'gender affirming.' The term 'gender affirming' could imply that if a biological/natal male comes to you saying that they are considering transitioning to female that you are supposed to immediately strive to 'affirm' that 'choice.'

Here's what really concerns me about these discussions, though. We used to be a profession that celebrated and encouraged dissent, controversy, and debate in the field. However, all too frequently in this area, any dissent, differing opinions, questions, hesitations, doubts, Socratic questions or basically anything other than full-throated support for a particular position puts the person raising the questions at risk of being labeled any number of negative labels either explicitly or by insinuation, joke, remarks, etc.

If we're ever going to be able to truly establish any scientific consensus in this (or any other) area in the field, we're only going to be able to get there via embracing questions/critiques, dissent, 'controversy,' debate, and alternate theories or ways of trying to understand the clinical phenomena or the research database.

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[Ollie123]

I have that attitude. That is, I think it is prudent for clients to be cautious about committing to irreversible surgeries (or even hormone treatments, by the way...I have worked with a veteran who decided to de-transition due to adverse health effects some of which may be permanent according to the medical folks...weight gain, breast enlargement, muscle atrophy, low T, difficulty with erections and even when achieved, painful erections, genital atrophy).

I don't know you, but I would wager you also aren't out there vocally advocating in support of the anti-trans bills!

I would wager > 95% of those advocates fall somewhere on the "This isn't a decision to be taken lightly" spectrum. Random TikTok videos that may or may not be real aside, I'd wager nearly all people considering surgical transition do take it seriously.

RE: Socratic questioning, I think it really depends on the provider and where they are coming from. A provider you have a strong rapport with who says "I will wholeheartedly support you and advocate for you whatever direction you decide to go, but this is a big decision. Let's talk about it." socratic questioning is going to be perceived very differently than the one with a crucifix on the wall who immediately starts peppering the person with "Whether they really think this is a good idea, have you read about all the side effects, Tucker Carlson told me everyone who gets the surgery ends up regretting it and burns in hell for eternity, etc." socratic questioning.

We can discuss nuance, ideal phrasings for responses, etc. for the former, but looking at the big picture I don't think most in the psychology community are likely to take major issue with such an approach if done in good faith in a believable way (even from a provider with strong religious leanings). 99% of things take place in varying shades of grey, that's just not where the public debate takes place.

 

[Fan_of_Meehl]

I don't know you, but I would wager you also aren't out there vocally advocating in support of the anti-trans bills!

I would wager > 95% of those advocates fall somewhere on the "This isn't a decision to be taken lightly" spectrum. Random TikTok videos that may or may not be real aside, I'd wager nearly all people considering surgical transition do take it seriously.

RE: Socratic questioning, I think it really depends on the provider and where they are coming from. A provider you have a strong rapport with who says "I will wholeheartedly support you and advocate for you whatever direction you decide to go, but this is a big decision. Let's talk about it." socratic questioning is going to be perceived very differently than the one with a crucifix on the wall who immediately starts peppering the person with "Whether they really think this is a good idea, have you read about all the side effects, Tucker Carlson told me everyone who gets the surgery ends up regretting it and burns in hell for eternity, etc." socratic questioning.

We can discuss nuance, ideal phrasings for responses, etc. for the former, but looking at the big picture I don't think most in the psychology community are likely to take major issue with such an approach if done in good faith in a believable way (even from a provider with strong religious leanings). 99% of things take place in varying shades of grey, that's just not where the public debate takes place.

Serious question, though...how many doctoral-level psychologists do you think there are who are 'anti-trans' (however that is defined)?

Crucifixes on walls? Really? Clinical psychology is just about the most politically liberal and low percentage orthodox religious profession around.

And considering the observation that 'This isn't a decision to be taken lightly' to be a 'spectrum' (of 'pathology?') which is abundantly populated with rabid 'anti-trans' (politically ultra-conservative) activists just strikes me as silly. If a careful clinician makes the observation that these things aren't to be taken lightly then he/she is on a slippery slope towards arch-conservative fascism? LOL. This is exactly what I'm talking about.

 

[Ollie123]

Think I might have explained myself poorly if that was your takeaway.

I think there are very few doctoral-level psychologists that are "anti-trans" (however defined, I agree this is amorphous). However, I also think there are very few doctoral-level psychologists in the "You played with your sister's barbie once so let's get you in for surgery tomorrow" camp. In general, we're varying shades of reasonable, intelligent people who care about others. Gun to my head, I'd still guess there are substantially more transphobic psychologists than there are ones encouraging people to impulsively get bottom surgery, but I don't have numbers to back that up.

My point wasn't that a clinician who says "This isn't a decision to take lightly, let's talk about it" is on a slippery slope to fascism. Actually quite the opposite. My point is I think that's the overwhelmingly modal response and some version of that (nuance TBD) is probably the "correct" response.

Now politicians and activists are another matter entirely. That's where my original comment came from. I very, very sincerely doubt the prototypical politician sponsoring/advocating for these "protect the children" bills springing up all around the US right now would be supportive and respectful of an adult deciding to transition.

For what its worth, I have known multiple clinicians who had crucifixes in their office. I have lived in the bible belt for some time now.

 

[Psychstudent!721]

Any source for 99% of these kids having ROGD? Fwiw, again, no one’s giving any medical transition treatment to kids, where the treatment is largely social transition. Adolescence gets a bit hairier, because the hormonal effects of puberty start coming into play, but the ROGD proponents I’ve seen rarely say “let’s hold off on medical treatment but I’ll totally support my child in dressing and identifying how they want and socially presenting in their preferred gender” but rather “my child could never be trans! I refuse to acknowledge it!” I’ve read ROGD perspectives to better understand them, and I have to say, the vast majority essentially boil down to transphobia when you scratch the surface even a bit, because they aren’t saying “let’s take a cautious approach with initiating medical treatment” (which has pros and cons with anything you treat medically, especially something with emerging literature like this), but rather, “no way are these people trans! Nope! Never!”

Im sorry, "no one is giving medical transition to kids" is just not correct. The evidence is clear from whistleblowers and verified reports that there are places prescribing hormone treatment and puberty blockers or pushing parents on surgical transition despite the lack of evidence of benefit. You literally have medical professionals telling people if we dont transition kids they will commit suicide. How can you say "ROGD boils down to transphobia?" Its not transphobic to be against transitioning kids and teaching young children that sex is generally fluid which is false. This was not an issue until kids became the subject. I agree with you, there exists people that hide their bigotry behind platitudes but to use that as a broad brush is not correct. We have almost a 100 year diagnostic history of gender dysphoria and gender confusion, its not new. What is new is the rates at which children, young children mostly teens are out of the blue saying "im trans" at 12,13,14 ,15 with ZERO signs or gender related distress until then. In some cases, children are in the midst of puberty with no added stress. You cannot say that a girl who developed large breasts during early puberty but doesn't experience any additional distress related to puberty is really GD. We do have studies pointing to GD having a social contagion component like eating disorder, especially in young girls. The research hasnt been invalidated its just been criticized for being insensitive . GD has for a very long time been something we've seen in young boys 2-4 adamant in not wearing boy clothes or playing with boy toys (which is something that is not socially constructed but largely related to the amount of testosterone or estrogen they get in utero and is cross cultural). I said "likely have". Given the incredibly low rate of individuals who remain trans into adult hood vs those who grow out of questioning their gender (which is a big issue for vulnerable populations like those with ASD) and those who just grow up homosexual the number is certainly 85-90%+. Well have to respectfully disagree here

 

[zestyzigzagoon]

Im sorry, "no one is giving medical transition to kids" is just not correct. The evidence is clear from whistleblowers and verified reports that there are places prescribing hormone treatment and puberty blockers or pushing parents on surgical transition despite the lack of evidence of benefit. You literally have medical professionals telling people if we dont transition kids they will commit suicide. How can you say "ROGD boils down to transphobia?" Its not transphobic to be against transitioning kids and teaching young children that sex is generally fluid which is false. This was not an issue until kids became the subject. I agree with you, there exists people that hide their bigotry behind platitudes but to use that as a broad brush is not correct. We have almost a 100 year diagnostic history of gender dysphoria and gender confusion, its not new. What is new is the rates at which children, young children mostly teens are out of the blue saying "im trans" at 12,13,14 ,15 with ZERO signs or gender related distress until then. In some cases, children are in the midst of puberty with no added stress. You cannot say that a girl who developed large breasts during early puberty but doesn't experience any additional distress related to puberty is really GD. We do have studies pointing to GD having a social contagion component like eating disorder, especially in young girls. The research hasnt been invalidated its just been criticized for being insensitive . GD has for a very long time been something we've seen in young boys 2-4 adamant in not wearing boy clothes or playing with boy toys (which is something that is not socially constructed but largely related to the amount of testosterone or estrogen they get in utero and is cross cultural). I said "likely have". Given the incredibly low rate of individuals who remain trans into adult hood vs those who grow out of questioning their gender (which is a big issue for vulnerable populations like those with ASD) and those who just grow up homosexual the number is certainly 85-90%+. Well have to respectfully disagree here

So…no source. Got it.

 

[zestyzigzagoon]

"In the three years ending in 2021, at least 776 mastectomies were performed in the United States on patients ages 13 to 17 with a gender dysphoria diagnosis, according to Komodo’s data analysis of insurance claims. This tally does not include procedures that were paid for out of pocket."

"At least 14,726 minors started hormone treatment with a prior gender dysphoria diagnosis from 2017 through 2021, according to the Komodo analysis."

Number of transgender children seeking treatment surges in U.S.

About 42,000 U.S. children ages 6 to 17 were diagnosed with gender dysphoria in 2021, nearly triple the number in 2017, a unique data analysis for Reuters found.

www.reuters.com

The original assertion was that 99% of these kids have ROGD. No one is denying that there are more children using gender-affirming care services than in previous years.

 

[zestyzigzagoon]

"In the three years ending in 2021, at least 776 mastectomies were performed in the United States on patients ages 13 to 17 with a gender dysphoria diagnosis, according to Komodo’s data analysis of insurance claims. This tally does not include procedures that were paid for out of pocket."

"At least 14,726 minors started hormone treatment with a prior gender dysphoria diagnosis from 2017 through 2021, according to the Komodo analysis."

Number of transgender children seeking treatment surges in U.S.

About 42,000 U.S. children ages 6 to 17 were diagnosed with gender dysphoria in 2021, nearly triple the number in 2017, a unique data analysis for Reuters found.

www.reuters.com

"In 2021, about 42,000 children and teens across the United States received a diagnosis of gender dysphoria"
U.S. patients ages 6-17 with a prior gender dysphoria diagnosis initiating hormone treatment in 2021: 4,231
4231/42000...AKA 90% of children who were diagnosed in 2021 did not receive hormones and far less got chest surgeries.

 

[zestyzigzagoon]

GD treatment isn’t one size fits all. HRT reduces dysphoria (primary outcome). It’s also expected that suicidality, anxiety, and depression will decrease in turn but it’s not always that simple. I agree more robust data is needed. But it’s foolish to imply that if a trans person undergoes medical transition and still experiences symptoms of mental illness, that the transition was unnecessary when their continuing symptoms could just as easily be a result of the increasingly focused attacks on trans people in America by the media

 

[ClinicalABA]

I think you'll find that most reasonable folks around here, regardless of their personal feelings on this issue, would and have acknowledged that the rates of GDD and related issues are increasing, including in younger populations. Additionally, there are relatively low, but certainly non-zero rates of medical interventions with minors. To deny so would be misinformed, at best, and potentially disingenuous. Most of the same reasonable people would agree that any medical intervention should be undertaken cautiously, after appropriate counseling and social transitioning. Are there cases of minors being prescribed potentially un-reversible medical interventions after a few sessions, with clinicians threatening parents that it's this or suicide? I, as would most (all?), Reasonable folks around here would definitely see this as highly problematic. If that is the norm in a clinic or with a specific practioner, that clinic/clinician is, imho and probably that of most reasonable people around here, unethical. The evidence for that happening has, as far as I can tell, been alluded to as coming from "whistleblowers" by a poster who expressed concerns that trans men are often just pretending to be women so as to assault women and girls in restrooms, as well as stating that 80-99% of people de-transition (both assertions without evidence, even after having been asked directly for sources). You have provided statistical data on one issue, while other reasonable folks are asking for evidence of something else entirely. Careful- lie down with dogs...

 

[ClinicalABA]

Just to clarify some terms, I think some posters are using "kids" to represent all minors, while others are distinguishing between adolescents (near or at puberty), teens, and children. In an exchange above, @futureapppsy2 states "no one is giving medical transitions to kids," It is clear that that by "kids" they mean "pre-adolescents," as in the next sentence they say "Adolescence gets a bit hairier." @futureapppsy2 's post is then challenged first by a poster who says that the statement "no one is giving medical transitions to kids" is incorrect, but then goes on to reference "12, 13, 14, 15", referring to this group as "young children mostly teens." This creates confusion about which specific population the posters are arguing about, and creates a situation where both sides of the argument could be correct. @futureappsy clearly make the distinction between "kids" and "adolescents", while the other poster seemingly lumps the groups together.

@borne_before then provides a journalism piece. The main body reports data on hormone therapies in minors aged 13-17, The article, overall, looks at a population between ages 6-17. In some summary statements, they say "A total of 17,683 patients, ages 6 through 17, with a prior gender dysphoria diagnosis initiated either puberty blockers or hormones or both during the five-year period." As all the data they previously presented specifically on hormone therapy was for the 13-17 age group, this can be a bit misleading, implying that children as young as 6 are undergoing hormone related therapies.

I also think there is some vagueness in the term "transition therapy" . Some may lump together MH therapy and social transitioning with medical interventions. Furthermore, if you separate out non-medical interventions from the meaning of "transition therapy," I think it is still important to make the distinction between puberty blockers, other hormonal therapies, and surgeries, as these involve different levels of intrusiveness, risk and irreversibility. For example, saying "there is evidence of transition therapies being used on children" is not specific enough, and some would construe this (or at least disingenuously use it) as meaning, "potentially harmful or irreversible medical transition therapies are being used with 8 year olds."

 

[ClinicalABA]

I don't think anyone who has honestly looked at the issue think a six year old is getting medical treatment. I do think that the general public see a kid socially transition at six, or before age six, and conflate the two. But, also there narrative on the pro puberty blocker side is that "they have no side effects."

Agreed, but some (maybe one) are not honestly looking at the issue. Also, if that narrative is incorrect.

 

[ClinicalABA]

Is anyone else over this, yet?

it can be tedious, but i think it's a good topic for looking at not only what we take as evidence, but also for checking our own professional/scientific views against what we feel more personally/emotionally about an issue. For me, it's a challenging endeavor and a a nice diversion from the more mundane research I'm typically reviewing (usually titled something like "The differential effects of picture vs. model prompts on blah blah blah"). Also, being a heathen myself, I am not encountering situations where prevailing wisdom or scientific evidence is going against any of my own spiritual beliefs (of which I basically have none!). I imagine that can make this issue difficult for some, and I think it's helpful to keep it going.

 

[Psychstudent!721]

So…no source. Got it.

What would you like a source for exactly? Considering you're not rebutting anything with valid evidence of your own. If you would like evidence of medical transitioning of minors, just read the American college of pediatrics take on the manner and its incorrect to say "oh thats not happening."

 

[ClinicalABA]

What would you like a source for exactly? Considering you're not rebutting anything with valid evidence of your own. If you would like evidence of medical transitioning of minors, just read the American college of pediatrics take on the manner and its incorrect to say "oh thats not happening."

Any chance you could provide a URL? I've tried searching their website, but the search function links to multiple position pieces and it would be difficult to go through them all and try to interpret/identify which you are talking about.

 

[zestyzigzagoon]

What would you like a source for exactly? Considering you're not rebutting anything with valid evidence of your own. If you would like evidence of medical transitioning of minors, just read the American college of pediatrics take on the manner and its incorrect to say "oh thats not happening."

Once again…I’m NOT saying that trans kids taking hormones isn’t happening. I’m just saying that ROGD and social contagion are not valid explanations when studies use convenience samples of parents who already don’t accept their child’s gender identity. If you believe social contagion is why kids are trans and it’s a fleeting phase, then the burden of proof falls on YOU

 

[smalltownpsych]

I personally think that there have always been a variety of people who don’t identify with their biological sex for a variety of reasons. For some it’s more about gender roles and for some it is more about physiology and every shade in between. When I talk to these individuals, their thoughts on it and their perspective on how to address it is highly individualized. I attempt to take a non-judgemental stance and try to help them understand their own experience of this and validate that. I think questions on how to treat this from a medical standpoint should not be in the hands of politicians and the only way for us to discover best practices is to continue to treat each patient individually and then see what happens. It is a societal experiment that is completely uncontrolled and that is obviously scary and risky, but the only thing scarier is to act as though we have a solution from either political side when we really don’t and can’t since we can’t experiment on people and especially not kids.

 

[Psychstudent!721]

Im not saying that YOU are saying that hormones isnt happening, that was to another person. This thread is getting out of hand in the sense its hard to follow. I don't believe that was a valid critique of litmans study but other studies show around 80% of kids who identify as gender confused grow out of it or simply identify as gay when adults. The fact that we are seeing teenagers, mostly girls, one day identify as trans without ever exhibiting other symptoms as young children (when we have a very long diagnostic history of gender confusion) also suggests theres more to it. Studies also show that there is large overlap between those who identify as trans and autism (no I am not saying trans people are autistic). Yes, genuine trans people exist and deserve respect full stop. However, these activists and parents who are championing toddlers and teenagers as trans is wild and should not be encouraged by professionals. Even older members of the community say as such. It is poor practice of any field, especially the medical field to do such experimentation on kids.

 

[Psychstudent!721]

Any chance you could provide a URL? I've tried searching their website, but the search function links to multiple position pieces and it would be difficult to go through them all and try to interpret/identify which you are talking about.

You are being redirected... This is my reference to medical interventions being harmful for kids. Even the UK and Nordic countries are starting to move away from such treatments as hormone therapy for kids.

 

[WisNeuro]

I'm not sure I would use the AC Peds group as "evidence." Multiple researchers (e.g., U of Minnesota) have called them out for misrepresenting their work to push their fringe agenda. I wholeheartedly agree that a broader discussion should be had and further research is needed, but this group is a shady activist organization also tied to debunked antivax claims.

 

[zestyzigzagoon]

If most “gender confused” children grow out of it, then gender affirming therapy should theoretically detect that. If their gender incongruence persists, then medical intervention is taken. At our current level of understanding, there is no better way to address this issue without risking putting genuine trans children through further distress

 

[ClinicalABA]

You are being redirected... This is my reference to medical interventions being harmful for kids. Even the UK and Nordic countries are starting to move away from such treatments as hormone therapy for kids.

Thank you. Is your evidence the link page, or one of the articles referenced on that page? The page you link to is appears to be a blog, with no byline indicating authorship and no references. Doesn't really meet any basic definition of "evidence" as far as an academic debate/discussion is concerned.

 

[WisNeuro]

Thank you. Is your evidence the link page, or one of the articles referenced on that page? The page you link to is appears to be a blog, with no byline indicating authorship and no references. Doesn't really meet any basic definition of "evidence" as far as an academic debate/discussion is concerned.

Well, this is the same group that claims conversion therapy has good evidence, among many other demonstrably false advocacy pieces. Apparently the cure for inadequate research in an area is to just find the opposing side and accept that, despite even worse academic rigor.

 

[ClinicalABA]

Well, this is the same group that claims conversion therapy has good evidence, among many other demonstrably false advocacy pieces. Apparently the cure for inadequate research in an area is to just find the opposing side and accept that, despite even worse academic rigor.

I'm totally aware of what the American College of Pediatrics is all about, as I suspect that poster is.

 

[ClinicalABA]

Well, this is the same group that claims conversion therapy has good evidence, among many other demonstrably false advocacy pieces. Apparently the cure for inadequate research in an area is to just find the opposing side and accept that, despite even worse academic rigor.

In other news, the earth is flat! Here's the evidence: The Flat Earth Society

 

[Freud’sMommy]

You people are so anachronistic speaking about "gender-affirming" care when we should all be practicing identity-affirming care. Gender is an important component of a person's self-concept, but so are race, SES, height, ableness, ancestral memories, nationality, etc. If a seemingly white American with caucasian parents identifies as a black man from Sichuan, then we are ethically obligated to treat that as a fact. Objective reality does not exist, and it's more clinically relevant to attend to a patient's "truth" or subjective reality.