In ‘Detransition, Desistance, and Disinformation: A Guide for Understanding Transgender Children Debates’ Julia Serano has written at huge length, but really added nothing to the issue stated in the title. This seems due in part from her own experience not being quite relevant to that of the children in question — having been able to wait until well into adulthood before transitioning — and the rest due to not really being clear and consistent about the terms she uses, even when saying she is clarifying them.
For this issue — the children who need medical assistance with puberty in order to live the best possible life in line with their gender identity — we need clarity about whether they have a permanent gender identity, and whether they need medical intervention. For the former it is counter-productive to keep using “gender” in contradictory ways, as in:
“For many decades (e.g., back when I was a child), if a parent brought their cross-gender-identified or gender non-conforming child into the medical/psychiatric system, the predominant form of treatment was (what is now typically called) “gender-reparative therapy” — that link takes you to a blog-post in which I describe such therapies in more detail and offer additional links for further reading. This approach is based on the presumption that young children’s gender identities and preferences are still fairly flexible, and it utilises positive and negative reinforcement strategies — specifically, encouraging or restricting certain types of play, or play partners — in an attempt to make the child behave and identify in a more gender-conforming manner.”
The children in question have a fixed gender identity from the earliest age. It is very likely practically inborn, with characteristics often observed by family even before it is expressed as soon as the infant has words. That is their gender. They are not “gender non-conforming”, they are seeking to express their gender. They are not cross-gender identified”, but firmly identified as their own gender. The “reparative therapy” (not usually called “gender reparative”) does not seek to make them “gender-conform” but instead fear to express their own gender, which is why it is so very harmful.
Watch these children in documentaries and you can see that the gender expression visible is natural to them, they are liberated — normal children — when people stop trying to restrict that expression.
OK, so why are these children so firm in their gender when a woman like Julia could suppress hers, and almost be happy as a male for decades? The answer lays further up in the article where Julia defines Transsexual. Much she says there is right, but transsexualism is about changing sex, about changing the genitalia, about the prime reproductive and sex drive being that of the other sex from that of the organs formed on the body in the womb. It isn’t limited to people who have that surgery, but includes the many who dream of it, to different degrees, but may never act on those dreams.
It isn’t about hormones, or facial, throat, voice, or chest surgery. Those are about gender presentation, and perhaps social dysphoria, and can go quite easily with people being very happy with their sex organs, or not bothered. Transgender was originally coined as the term for people who wanted to live, part or full time, as “the other gender” whilst retaining their original sex organs. It was in contrast to transsexualism. Its original proponent — who herself lived that way — believed hormones, or sex reassignment surgery, were very harmful for such as her, causing suicides. As Julia says, 1990s transgender activists sought to expand the term, make it without limits, a self-definition, which makes it imprecise, and unsuited for legal and medical use. It is becoming sometimes used as a third gender identity — neither girl nor boy — too. The Indian government is proposing exactly that now — transgender as an official documentation gender for people “neither fully male nor fully female”, with “man” and “woman” only available to those registered as such at birth.
Incidentally, Julia wrongly echoes transphobic “experts” who says transsexualism covers those who have completed such a transition. It is defined as wanting or needing such surgery, and most who have achieved that no longer feel such a need — duh! — and so are cured. To say that they continue to suffer from that medical condition of needing to transition, lifelong, despite their experience, is transphobic — based on their identity, and their need not having been real, nor their experience of being wholly the gender of their identity. Instead we tend to say we have a transsexual medical history, or simply a trans history.
The children who are so clear on their gender are transsexual. As they realise the physical differences between the sexes they express rejection of those of their registered sex, or strong demands for those of the other sex, or both. Those born with a male organ — external and active at the youngest ages — very often talk of removing it, or take sharp tools to it. If those born with female organs are forced to experience female puberty then similar actions may be taken again breasts. Such children are in fear of the wrong puberty, of the wrong adult bodies. How could such firm needs, over many years, ever change?
Parents have expressed horror at transsexual including the three letters s, e, and x, saying these are children and their gender identity has nothing to do with sexuality. One hopes the same delicacy doesn’t lead to their offspring being denied cross-sex hormones, or sex reassignment surgery. What if they had Intersex, or sextuplet children, or lived in Middlesex, Essex, Wessex, or Sussex?
Let us be clear though, no one is to be asking 2 or 3 year-olds if they want to cut off their dangly bits. The brain develops in its own time, and what matters is the “consistent, persistent, and insistent” needs a child spontaneously expresses, in their own time. A therapist might, after hearing of a child expressing such needs to family, bring some anatomically-correct dolls to a patient’s attention, and ask which is like her (or him). A child might answer “this is how my body is, but it should be like this other one”.
Experts such as Prof. Cohen-Kettenis (head of the Netherlands children’s gender clinic in the 1990s when it led the world) have long known that this is the distinguishing characteristic. In 1995 Cohen-Kettenis said on film that such children are clear cases and never change their minds. Recent surveys of teens at her clinic who had persisted with their gender through puberty found that physical dysphoria linked them, and distinguished them from those who had expression cross-gender identity but not physical dysphoria. Pubertal hormones (actually probably the year-earlier hormones of adrenarche too) affected them differently mentally to physically — in the same way as would hormones to cause the correct puberty. The “desisters” found themselves liking the sexuality that kicked in at puberty that matched their genitalia, the trans teens hated their genitalia even more. Transsexual girls at 11 or 12 start to experience female sexual desire — as do other girls. The sexual organs on their body are the opposite of what they need to eventually fulfil that desire; they are literally “in the way”, the “wrong body”, but sex reassignment surgery is unavailable — withheld for years, and perhaps forever where there is no provision; suicide figures rocket. Trans boys’s experience is obviously different, and so intense dysphoric children form at least 2 distinct diversities.
People whose gender dysphoria crystallises in adolescence, or later, form many different diversities again — some passing through identifying as lesbian or gay, some non-binary, gender queer, third sex, etc.. Later life events crystallise it for others — although many recount “something wrong” as a child, and some may be those who insisted on “being a girl” as a child, but desisted at puberty, only to realise the pleasures of their “original plumbing”, realised at puberty, paled after some years. There is no hierarchy, or superiority of trans diversities, but the intense children are most likely to wish to be known only as their true gender, and seek to disappear from view, and be less visible, and unheard as adults. Julia says theirs is the dominant narrative, but perhaps she felt that because it was not her own. Aside from “shock news” reports of such children, the bulk of media stories are of other diversities — the transition in retirement of Caitlyn Jenner, and ‘Transparent’, the non-binary media stars, the serving military and veterans.
A relevant point Julia misses in all this “80% of trans children desist, so no such children must get the right puberty until adulthood” is that almost all the experts agree that gender identity expressed at, into, or after puberty, is pretty reliable, and the “persisters” are expressing it at such a point, just as are fresh patients. It is just a transphobic distraction from the clear-cut need of some adolescents — the most dysphoric patients too — to continue to “doubt” them simply because they first presented in the same sort of age-range as children who have ceased to meet the critieria of a deliberately badly drawn diagnosis. It is also medically unethical — each patient is supposed to be treated individually, according their clinical need, not as some badly drawn group.
It is unlikely to be coincidental that “experts” who have long being trying to escape calls by patients and families to provide timely medical intervention have fuzzied out this clear distinction. They often still talk of it as just “the most intense dysphoria”. Even though physical dysphoria was one of the possible diagnostic criteria for ‘Gender Identity Disorder’ it was easy to receive that diagnosis — and be swept into the cohorts that eventually produced the 80% desist figures — without having that symptom. Instead stuff about clothes, toys, play mates, and “insisting is a girl or will be girl” sufficed. The clinic of the prime “expert” had their records audited and it was found they kept no record of whether patients had that symptom, or if they were ever asked. That list of symptoms was compiled by people pushing the “most desist, and we cannot predict which that will be, and so it unsafe to medically intervene with any” line, who pushed that children should equally not be allowed to socially transition until their teens, or used various techniques — in addition to the non-affirming undermining, which of course extended to families, and schools, and media, just mentioned — to attempt to change children’s gender. The most sadistically cruel being forcing irrecoverable physical changes of the wrong puberty by withheld intervention, hoping the minor will feel that the life they need has become impossible.
Why did they do this? To avoid peer or social conservatives’ condemnation; to facilitate the possibility of fame and fortune from achieving “cures”; to have larger numbers of patients, and the fees, and job security they bring; to provide material for published papers that boost careers; to please powerful patrons or peers; out of religious belief. Guidelines preventing assistance were pushed through professional bodies, and doctors who instead did what was best for their patients were dragged through years of “disciplinary” hearings, and their careers ruined. Sometimes it has to be transphobia, as Julia says — seeing a happy trans life as a bad outcome, regardless of evidence. One sees the pressures even now faced by those actually providing medical intervention.