Factchecking Jason Wong & Mohd Khair’s “377A: Putting Children First”

In their Straits Times opinion piece “377A: Putting Children First” (3 Aug 2022), Jason Wong and Mohd Khair asked: “How can people with vastly differing viewpoints coexist side by side in Singapore society, without resulting in clashes or conflicts over deeply held values?”

I believe most of us share those values. We yearn for a united Singapore that strives for justice, equality, happiness, prosperity, and progress for our nation, not one where conflict and anger dominate public discourse and society is divided by distrust and hatred.

Unfortunately, the op-ed included many factual inaccuracies and misrepresentations of the LGBTQ community, so I’d like to take up their request for civil dialogue with this response to their points.

1) “Foreign news reports tell of young children being made to learn that gender confusion (an often conflicting and painful experience) is not just normal, but should be celebrated and accompanied by irreversible treatment from a very young age.”

Transgender children are not confused. They are as certain about their gender as their cisgender (non-trans) peers, and indistinguishable from them in how they think about their gender. A trans girl “feels” like a girl in the same way that any other girl does, and is just as distraught when people insist she is a boy.

Psychologically, the damage done is the same as if you were to force any other child to live as a gender they say they are not. Mental health issues like depression and anxiety were almost universally observed in transgender populations up until very recently — and what changed was trans people being able to transition at younger ages to live as the gender they say they are.

For children, this may mean changing clothes and hairstyles, perhaps names and pronouns as well. None of those things are irreversible, but can bring significant relief.

Studies of transgender children supported in their identities found “developmentally normal levels of depression and only minimal elevations in anxiety”. Researchers noted the contrast to the high rates of psychopathology typical in children with untreated gender dysphoria.

2) “These practices may be harmful to children. For example, Sweden has largely banned the use of puberty blockers to treat gender-confused children, owing to harmful side effects”

This was not a ban but a recommendation to restrict puberty blockers to trans youths experiencing gender dysphoria during puberty, fearing that doctors might give them even to trans youths who did not want or need it.

Their justification was the “Rapid Onset Gender Dysphoria” theory, which suggests that most trans youths are lonely gay or lesbian teens convinced by social media that coming out as trans would help them escape homophobic bullying, look cool and get friends.

These claims were based on posts by parents on online forums. Yet even from those testimonies it’s clear that many of those youths (now adults) were perfectly happy with their transition, even if their parents were not.

ROGD was heavily denounced as lacking scientific evidence in a statement by 122 professional healthcare organisations including the American Psychological Association. Follow up studies in 2021 and a larger one of 197,374 trans youths in August 2022 found no support for its claims.

Instead, they found that trans youths experienced significantly more bullying after coming out as trans, and many identified as gay or lesbian after transition, debunking the theories that they transitioned to avoid homophobia or social ostracism. Another claim was that there has been a worrying increase in the proportion of transmasculine youths seeking transition. The 2022 study found this was due to a reduction in transfeminine youths; transmasculine numbers had remained stable.

The Swedish National Board of Health and Welfare’s recommendation ends with (translated): “It is important that young people with gender dysphoria continue to receive care and treatment within the healthcare system. It concerns both hormonal treatments in cases where they are deemed justified and, for example, psychosocial interventions, child psychiatric treatment and suicide prevention measures when necessary.”

3) “the United States authorities have recently warned of side effects such as symptoms of brain swelling.”

The US Food and Drug Administration has a database for people to log side effects of medications. If a statistically significant number of people experience it, it will be listed as a potential side effect of that medication.

The FDA noted six instances of children experiencing brain swelling on puberty blockers. Only one of those six was transgender.

They found the data inconclusive due to the small sample size. Nonetheless, they recommended that patients be monitored for symptoms. This is standard for any medication with potentially serious side effects.

Here, it may be helpful to explain more about puberty blockers.

80–90% of prepubescent children who express gender atypical behaviour or interests (e.g. tomboys) do not grow up to be trans. Some were classified as gender dysphoric children under diagnostic criteria in the 80s and 90s, despite having no desire to be another gender or experiencing any distress over their sex.

However, after puberty begins, any persisting (and especially increasing) gender dysphoria is expected to be permanent. Waiting any longer only prolongs their distresss and will not change their gender identity, any more than a gay teen who waits long enough may end up turning straight.

Many of those youths find social transition is enough. For others, worsening dysphoria may make them suitable for puberty blockers. Assessments are done by a team of experts across medical disciplines working closely with the family, and considering the child’s circumstances (medical conditions, family support, history of dysphoria, etc). This includes accounting for the risks of puberty blockers.

Not everyone approved for treatment goes ahead with it. For those who do, puberty blockers buy them time to grow up before making the irreversible decision — typically around age 16 — of whether to go through a male or female puberty.

The alternatives are either:

1. prolonging their suffering while their bodies irreversibly develop as a sex they do not identify with and are very unlikely to. This will also affect their ability to blend into society in the high likelihood they transition, putting them at greater risk of stigma and violence; or
2. allowing them to go on cross-sex hormone therapy, which is more likely to lead to a happier outcome but also has irreversible effects.

Puberty blockers are only recommended due to concerns that a non-trans kid may mistakenly think they are trans and end up looking like a sex they do not identify with. Unfortunately, the same concern is not offered to their trans peers.

Gender dysphoric trans youths on puberty blockers have had overwhelmingly positive outcomes. A pioneering study in 2014 found them to have mental health slightly better than their non-trans peers.

This January 2022 review of 27,712 trans people found that the earlier they started puberty suppression or HRT, the better their mental health outcomes compared to those who wanted to but were unable to do so:

• From age 14–16: 222% decrease in past-month severe psychological distress and 135% decrease in past-year suicidal ideation
• From age 16–18: 153% decrease in severe psychological distress, 62% decrease in suidical ideation
• After age 18: 81% decrease in severe psychological distress, 21% decrease in suicidal ideation

This discussion is however moot in Singapore. Puberty blockers are not approved for treating gender dysphoria here, where public healthcare establishes a minimum age of 18 for HRT with both parents’ consent and 21 without. (It was previously 16, but possibly raised in response to controversies where schools had difficulties accommodating transitioning students.)

4) “Children are also taught that mothers and fathers are completely interchangeable, and encouraged to be sexually experimental since all sexual behaviours are equal, despite the science showing that some behaviours are riskier than others.”

It is unclear where the first claim comes from, and the only people who encourage children to have sex are sexual predators seeking to abuse them. If any children are having sex, that should be a much greater concern than whether or not they are doing it safely. Many LGBTQ people are survivors of sexual assault and agonise alongside others who are similarly abused; it is unthinkable to believe they would encourage more abuse.

6) “In Singapore, we already have local examples of school-going children encouraged to use gender pronouns in controversial ways and young teenagers identifying as “pansexual”

The writers might be referring to trans youths coming out to their friends and teachers in schools. But this rarely ends well for the student.

TransgenderSG’s 2020 survey of 242 trans people in Singapore found:

• 77.6% of openly trans students reported negative experiences in school including bullying, public humiliation, sexual abuse, and being sent for conversion therapy against their will
• Under a third agreed or strongly agreed that they felt safe at school
• Under a quarter had a staff member they could go to for support

Many trans students in Singapore — including top performers in elite schools — dropped out of school because they could not cope with the hostility, mostly from teachers and school administrators. TransBefrienders launched their Study Support Scheme to help mentor such students who wished to still sit for their GCE N, O or A levels as private candidates, giving them a chance to continue their education.

7) “[377A is the only law that] restrains advancing LGBTQ activism that contributes to a hyper-sexualised environment and a disproportionate focus on sexual and gender identities. If Section 377A is repealed, the ground will only become further divided and civil dialogue harder to achieve.”

It is not LGBTQ people who have been disproportionately focusing on sexual and gender identities in Singapore.

Many of us have been harmed by the onslaught of these discussions in the past weeks. They have put a strain on our relationships and between us and the people we work, live and learn with who are being taught that we are a threat to their children, their families and our country. We are exhausted and drained from having to constantly prove our right to exist, often in the face of rampant, uncivil anger. We gain nothing and will lose much from any further division of society.

9) “Decades of social science show that the best conditions to raise a child are when the child grows up in a healthy family with both a biological father and mother, who are in a stable and lasting marriage.”

The writers might be thinking of this 2012 study by Mark Regnerus.

It compared children raised by their married biological parents to children whose parents had divorced after one of them came out as gay and found a same-sex partner, or where one of their parents had had an affair or past relationship with a same-sex partner. Some of those children had never actually lived with a same-sex couple.

It is well established that infidelity and divorce enact a heavy toll on the wellbeing of children. It is not a fair reading to assume that the negative outcomes were instead due to one parent having had a same-sex relationship. The same negative effects on children are observed in divorce and infidelity cases where all parties are heterosexual.

Alternatively, the writers might be thinking of this 2014 paper comparing the outcomes of children raised by their married, biological parents to those whose parents divorced. It concludes: “Consequently, society should make every effort to support healthy marriages and to discourage married couples from divorcing.” The study makes no mention of same-sex couples. It is a misuse of data to assume the same results would be observed.

What they are right about are the benefits of stable, lasting marriages on children — and in fact, legalising same-sex marriage has been found to bring similar benefits.

For more studies of children raised by same-sex parents, you can refer to this meta-analysis by Cornell University. 75 of the 79 studies on the topic found they fare no worse than other children, while 4 (including the Regnerus study) found disadvantages, particularly linked to parental distress, stigmatisation and family instability.

Ironically, by pressuring gay men and lesbians into heterosexual marriages doomed to failure, refusing to legally recognise same-sex marriage, and perpetuating prejudices against the LGBTQ community, we are only increasing the number of children who will be impacted by divorce, and failing to provide them with the security and stability they need to thrive.

So many in the LGBTQ community have been estranged from their families and denied the ability to create our own. We know, more than anyone else, how precious and important families are. We have no wish to weaken them or rip any more families apart, which is why we want to speak out against the widespread disinformation in op-eds such as these that only foster unwarranted paranoia, fear and distrust within families, friends and communities. That is what harms families, and it is what harms children, especially LGBTQ children made to feel unloved by the people who are meant to love them most but have so often failed in that task.

Family means so much more than merely sharing DNA. Our families are the people who love us and create home for us, whether or not we are related by blood or whether that resembles the nuclear family structure. So many children in Singapore and around the world are raised not just by their parents but also by their grandparents, siblings, cousins, aunts and uncles, domestic helpers, neighbours, daycare centres, schools, churches, mosques and temples. It takes a village to raise a child. It always has.

So if we truly care about the children and the future of Singapore, we would work to build a country where every child is supported, no matter who they are; where they never need to feel alone or afraid to embrace the fullness of their selves; and where we, the adults around them, strive each day to model and live out lives of integrity, honesty, kindness and love.