Gender Health Query (GHQ) is a new organization started by Justine Kreher (@thehomoarchy on Twitter). Its focus will be research and political action from the perspective of gay, lesbian, bisexual, and trans-identified people who question the current LGBT zeitgeist around youth medical transition. GHQ is also on Twitter @genderhq.See the last section of this article for how to join and/or support this important new effort. Your support can be as simple as signing this statement.

Justine Kreher is a 50-year old bisexual woman who is happily married to the woman she has been with for the last 21 years. She believes, from personal experience, that one’s feelings about gender and sexuality can change drastically from the tweens to young adulthood. This reflects her own experience as someone who didn’t understand her own same-sex attraction until age 22, as well as the experiences of people in the LGBT population she has been around for years. Her personal philosophy is influenced by stoicism, Taoism, Enlightenment values, and most importantly, skepticism.

 This 4thWaveNow interview with Justine was conducted via email.

Justine, why did you form Gender Health Query?

I started researching the subject of increasing numbers of children and teens being socially and medically transitioned for gender dysphoria, under the now popular affirmative model, about four years ago. I had noticed that gay men and lesbians were beginning to express worries and even outrage about this. Their worries were not surprising to me and shouldn’t be to anyone who has spent time among LGBT people. Gender dysphoria has always been a part of the gay and lesbian community and has existed without medical transition, even though medical transition has been an option for a few decades now.

Justine’s wife Tara in her girlhood (on left)

To take a very personal example, my spouse was very masculine-identified as a child, including using male nicknames, and having exclusive “male-typical” interests. As for myself, I was a tomboy. I don’t claim that I would have been diagnosed with DSM-5 gender dysphoria, but I had some gender dysphoria as a small child and again as a tween. At the time, it felt very depressing I wasn’t born a boy, but I grew out of what was really a female inferiority complex and now have no desire to be male. Understandably, some older lesbians/gay men are actually horrified by what is happening now because they feel that this would have risked their own journey to self-acceptance without being permanently medically altered.

GHQ will be a medical and censorship watchdog organization focused around the increase in minors being socially and medically transitioned for gender dysphoria. It’s also intended to be a platform for the increasing numbers of LGB, and even trans people, who feel there are serious risks involved with this. This is happening under the now popular affirmative model that states a child’s/teen’s expressed gender should simply be supported, and any attempt to help the youth avoid or delay hormones and surgery is considered unethical. This is also happening in the context of postmodern ideologies about gender being widely promoted in many areas of society. GHQ also critiques this relatively new gender ideology in the way it affects how LGBT youth–and society at large–view identity, sexual boundaries, and trans versus female rights.

Most of the existing research on gender dysphoric youth, as well as gender clinician observations, has found that children with even serious gender dysphoria may outgrow it and are more likely to grow up to be gay or lesbian. And now more stories are accumulating (partly thanks to 4thwavenow) about lesbian, as well as increasing numbers of bisexual and heterosexual youth, who are desisting from trans-identification. Some are also detransitioning after being medically altered.

There is an activist mantra that gender identity and sexual orientation are two different things. This is repeated by affirmative model MDs and PhDs. However, if you look at this closely, the line between gender-nonconforming same-sex-attracted people and trans in minors is blurry.

What is your opinion of the affirmative model, which validates trans-identification in children and teenagers, and defines encouraging coping skills and waiting as “conversion therapy”?

At this point people can’t deny there are going to be young people who will be medicalized unnecessarily with the rise of what I call the “child/teen medical transition movement.” This begins as young as nine or ten years old with hormone blockers or even cross-sex hormones. This also includes unnecessary sterilization, loss of sexual function, castration, and double mastectomies. It’s already happening and there is historical precedence for harm arising to young people even in environments with less lax gatekeeping than what we are currently seeing in the United States.

I initially thought that people’s worries were likely overblown. I assumed there would be a lot of concern and caretaking by the mental health and medical professions to ensure a proper screening process. I was wrong. In fact, I now believe this isn’t a priority among many of these professionals or even organizations like the APA or AAP. This may sound like hyperbole, but it is my opinion, as someone who has read most of the relevant research, attended gender conferences, listened to hours of presentations, and read all the articles by affirmative model advocates. In my view, it has simply already been decided that false positives are morally acceptable collateral damage when it comes to trans-positive social support and access to medical treatments.

I actually support the right of people to make this argument and I point to positive data (de Vries 2014), (Olson, 2016) around the affirmative model on the GHQ website to try to be fair. Decisions involving collateral damage are made all the time in society. There are trans youth who self-harm and seek hormones on the black market if not treated by doctors. I don’t think it’s helpful to deny the seriousness of this by saying things like “there is no such thing as gender” or this is all just the result of “social constructs,” easily abolished by cultural changes. Affirmative model advocates sincerely believe they are doing more good than harm by promoting early social and medical transition. I believe the hormone-blocker protocol is child abuse regardless of what the youth’s adult identity will be. I view any unnecessary alterations providing hormones and surgeries to cognitively immature minors as child abuse.

Others believe standing by and not helping a distressed youth who may be sure they want to transition is child abuse.

This view is being reinforced by inducing suicide terror in parents and the public, by avoiding mentioning desistance altogether in articles about trans youth, and by removing links, (something done even by research universities), to information that reveals data that looks disturbing. And by extremist activist behavior that prevents people from questioning the affirmative model.This is why Gender Health Query is necessary. If LGB people want someone to be invested in caring about the negative impacts of this on immature LGB youth, they will have to take responsibility for caring themselves. There is already harm happening from the affirmative model. It’s only a matter of what the extent of it will be. And I believe there will be a concerted effort to ignore it, or even suppress it, in liberal media, by LGBT organizations, by universities, and by people in the mental health and medical professions in the United States. I expect increasing numbers of desisters and detransitioners to be treated horribly within the “queer community,” where gender and sexual fluidity are now esteemed, and you’d better not interfere with anybody’s easy access to hormones and surgery or else. They already are.

Our site also addresses risks to heterosexual youth (with more seeking transition now) who may be on the autism spectrum, have BDD or BPD, or be victims of trauma.

So, GHQ will mainly be tracking harm arising from the increase in minors transitioning and the ramifications to youth who are harmed. What about the young people who will medically transition, no matter what?

I can’t object to people arguing that good things are coming of the affirmative model or that making a young person wait to transition may be very distressing to them. I try to make data-based arguments and there is data to support these positions.

But “false positives” (for lack a better word) are an inevitability of the affirmative model or “child/teen medical transition movement.” Transition is starting in childhood now, at age nine or ten, not even the tweens. Studies on regret rates are generally of poor quality, with many lost to follow-ups, and mental health issues persists. While reported regret rates are very low in research on adult cohorts who transitioned under a gatekeeping model, they still are not zero. But adult regretters are adults with agency.

Young people cannot truly consent to the serious consequences of these actions until around age twenty-five. This means that affirmative model advocates, LGBT organizations, and now society as a whole, are making a conscious decision to perpetrate a major human rights violation on at least some children and teens, by drastically subverting their maturation process. This could be considered an atrocity if a youth has been sterilized and/or has their sexuality permanently destroyed. It’s just as bad as what has been done to intersex babies and those who’ve undergone surgical genital mutilation. The level of harm to over-medicalized minors could possibly dwarf what was done to intersex babies via surgical “correction,” in terms of sheer numbers, as thousands of children are being put on hormone blockers (and other medical interventions) in the western world.

As more and more people who transitioned as minors start to express regrets under this new approach, as things are going, society will put the responsibility for that on the child or teenager (now an adult), as the affirmative model necessitates a “let the child lead” narrative. This creates another ethos: It absolves adults of moral responsibility. We are seeing affirmative-model advocates make statements to the public that detransition is “no big deal” or just part of their “gender journey.” In my opinion, this is being done to acclimate the public to this coming new reality of sterilized youth, with destroyed sexual function and pointless double mastectomies; to make it morally acceptable. Detransition is not a harmless ordeal based on the multiple accounts I have read from people who transitioned as minors or young adults.

Justine (left) with wife Tara.

There is also a risk this protocol may be used to “correct” effeminate pre-gay boys and masculine pre-lesbian girls in homophobic countries like Iran, China, and Russia, once the child medical transition movement is fully normalized in the West. Dismissing this worry as paranoia is very naive. Much worse has been done to LGB people. Iran already prefers transgenderism and forces homosexuals to transition. And accusations of homophobic parents fueling a child’s transition have already been made in relatively gay-friendly England.

Affirmative model advocates should be upfront about all this, in my opinion, rather than make lengthy red herring arguments about how methodology has inflated desistance statistics. It’s possible that they may have been inflated. But these arguments do nothing to prove the numbers are so small they are irrelevant.

Johanna Olson-Kennedy has argued that regretters shouldn’t stop all youth from transitioning. If a confused, likely same-sex attracted young person, who transitioned as a teen has regrets, she can “just go and get” fake breast implants later.

But our grief over watching detransitioned, medicalized young people, who haven’t even reached full-cognitive development, matters. We are no less justified than the trans activists whose angry protests against Dr. Ken Zucker caused USPATH to cancel his lectures. Those of us who are concerned should not apologize and anyone who tries to intimidate us out of it is acting oppressively. We aren’t trying to shut anyone else down. But until affirmative model advocates prove early social transitions and early medical treatments only rarely prevent desistance, this is as much a homosexual/bisexual human rights issue as it is a trans rights issue.

If they are going to argue that perpetrating a human rights violation (sterilizing and creating other permanent changes) on other vulnerable minorities (as children and teens) such as LGB youth, autistic youth, and traumatized girls, they are morally obligated to justify these acts with much better data than they have now, because in all other cases, these medical interventions would be considered highly unethical.

GHQ will demand data that justifies this and a right to know what the costs are specifically. “Apples. oranges, and fruit salad,” Diane Ehrensaft’s diagnostic explanation, is not acceptable proof in my opinion. Control groups are considered unethical but there are probably back-end ways to determine social influence. For example, a researcher could study a population of trans-identified children and teens in a country where giving youth hormone blockers isn’t occurring. Or how about recruiting some of the desisters (and perhaps their parents) who have begun to speak up on social media and personal websites?  But at the same time, I reject the idea that any type of control group not employing enthusiastic transition is unethical, which affirmative model advocates argue. Parents could lovingly raise their dysphoric children to view themselves as an outlier “third gender” type of male or female, rather than lying to them that they are literally biologically the opposite sex. There are already parents who treat transition as something that will be safer if done when older. Children have no understanding of the ramifications of transition at that age, and there are ethical questions around promoting harsh medical treatments as a panacea to their struggles.

There currently appears to be a culture of apathy throughout the affirmative-model mental health and medical professions about the impact of their approach on grey-area nonconforming children and teens. This is despite the fact that there is a lot of information that demonstrates gender dysphoria is influenced by the environment and culture. These influences include homophobic bullying, family stability, trauma, and what appears to be social contagion.  Environment and culture now are extremely pro-medical transition.

This apathy permeates much of liberal society, media, and all other LGBT organizations, despite the fact the data to support all of this is minimal. In fact, I would say there is open hostility towards LGB youth and other teens with issues who may be harmed. There is an explosion of trans-identified females. Many are promoting the idea this is due to positive increasing acceptance. They are refusing to acknowledge some of it looks very disturbing and similar to other body dysmorphia contagions. Brown pulling down the link to Lisa Littman’s ROGD study is just one example.

The abuse the journalist Jesse Singal has received, enabled by actual liberal media outlets, is another example. His articles are perfectly reasonable and well-balanced, and there is much evidence on the GHQ site to support the validity of the issues raised in them. There are leftists who are criticizing all of this (I am center-left). But many liberals appear hostile towards the concept of caring about youth who may be hurt because they are used to “hurt the trans community,” something Johanna Olson-Kennedy said at a 2017 Gender Odyssey conference I attended. It’s why I believe my argument that affirmative-model advocates view LGB youth simply as morally acceptable collateral damage to trans-positive healthcare is a very fair opinion to have of them.

You have mentioned that the site will also critique postmodern influenced gender ideology, a subset of “queer theory.” So, the site is more than just a medical watchdog site?

I originally wanted it to be a dispassionate analysis of desistance statistics but realized all of this is happening in a larger cultural context of society beginning to believe biological sex is irrelevant; even to the point that school teachers and scientists are repeating these ideas.

The GHQ site actually includes data that supports biological explanations as to why trans people, as well as gays and lesbians, have some characteristics that align with cross-sex controls. So, in this regard a “gender spectrum” argument is not totally unreasonable (but only for a very small percent of the population).

Unfortunately, the current way this ideology is playing out in this time and place is actually doing some harm. And I believe this harm is tragic and totally unnecessary, but currently very real. LGBT people have been completely turned against each other over it. Women have been turned against each other over it. And people on the left have been turned against each other over it. I believe support for the “LGBT community” is going down significantly because of it, as recent polls show a decline.

LGBT youth culture has become very obsessed with pronouns, labels, body dysmorphia, and identities to the point of being unhealthy. There are many people who agree with me, particularly GenX LGBT people, like myself, who believe current “queer youth” culture seems angrier, more sexually confused, and more gender confused than ever. Some young people cannot tolerate people deviating from their views on gender even slightly. They have difficulty functioning without the validation of the outside world, which is now increasingly bowing to demands for pronoun verifications before all social interactions. Research by people like Jonathan Haidt points to harms coming to young people from identity-politics-obsessed environments. Yet affirmative-model advocates, and I mean psychologists and doctors here, actually are encouraging these problems.

Also on the GHQ site, there is anecdotal evidence that queer/gender identity politics doesn’t promote positive mental health. There are some studies that show people with non-binary identities have poorer mental health than binary trans as well. There isn’t even really proof all of these non-binary-identified youth, mostly females, really have gender dysphoria and not some other mental health issue or body dysmorphia.

And disturbingly, some people are acting as if others owe them emotional and sexual access to validate their gender identity. LGBT organizations and mental health professionals, in some ways, enable this by uncritically pushing the idea that your sex is merely what you declare it to be and that multiple genders are real. I would expect these people to be more critical and assess possible externalities or even negative impacts on these individuals. And I would expect them to prepare young people for the real world of genital-preference-centered sexuality, and to teach them respect for others’ sexual orientations, which these professionals increasingly don’t respect themselves.

I cannot stress enough the harm this has done within the LGBT community and particularly between lesbians and trans people. I don’t think large numbers of lesbians, who previously embraced the rainbow, will ever trust any concept of an “LGBT movement” ever again. Starting in 2015, I tried to warn lesbians in LGBT media how destructive this would be. And I am a latecomer compared to other women who were smart enough to anticipate these problems years before I even knew they existed. I disparaged some of them and now have to apologize and give them credit.

Your organization is trans inclusive. Why did you choose to make it an LGBT organization, since trans people are front and center everywhere else?

At this point all LGBT people need to have some stand-alone organizations. The issues are all actually different in many ways. Gay men need HIV prevention outreach programs. Bisexual women(and LGBT organizations expend almost no energy on bisexuals), have higher abuse rates than gay men or lesbians. Sometimes specific groups have a better understanding of their particular issues and more motivation to address them. Trans activism may be hurting aspects of the homosexual rights movement that has nothing to do with surgeries on minors or pushing girls out of winning sports positions. Lesbians definitely need their own activism as that tiny population is getting overtaken by trans and “queer” activism that values gender and sexual fluidity.

But I have tried to raise concerns about the overmedicalization of gender nonconforming young people and some of the negative fall-out from gender ideology with hundreds of LGB people in academia, in LGBT orgs, and in LGBT media. And I have watched other gay men, lesbians, and bisexuals attack, and viciously at times, other LGB people for raising perfectly reasonable concerns. I’m not going to blame everyone in the trans community for the toxic discourse around this whole issue any more than I am going to excuse some lesbians who I have seen abandon their own youth in ways I think are really appalling and profound.

Trans people are not a monolith and GHQ is ideologically-based, not identity-based. Youth medical skeptics, postmodern gender ideology skeptics, and other acknowledgers of biological sex are welcome. The current extremism in trans activism may have unintended consequences for trans people too. Some trans people don’t believe that early transition, without emphasizing patience and coping skills, is ultimately the healthiest outcome for all youth who will go on to transition. You can find serious consequences to that here. People may be feeding into an obsession addressed with quick fixes and “passing” at the expense of desistance, proper brain development, fertility, bone health, and cardiovascular health. Many trans people have children or say they want them or never even get bottom surgery. The ethical questions of medically transitioning youth who will have a trans-identification no matter what are just as relevant as the effects of all of this on desisters.

Certain trans people–some dub them as “truscum”–are not supportive of concepts of multiple genders and resent being lumped in with people who don’t medically transition. They receive a lot of abuse and get censored by the most powerful social media companies in the world like Twitter and Facebook. They are reasonable people and we all share in common some harm from this. I hope that we can all find a way forward.

There is so much censorship around these issues on the left. Some people opposing aspects of gender activism are turning to right-wing venues and right-wing activists. Do you plan to do that?

From what I have seen, I don’t blame people who feel so desperate that they are aligning with the right-wing around fall-out from gender activism. Sometimes dialogue can actually increase tolerance if people avoid existing in these increasingly cult-like ideological states. So I don’t condemn that.

But I make it clear on the website that this is a place that supports inclusion of LGBT people in family and public life. I’m not interested in enabling people who want to enforce bible or conservative ideology-based gender or sexuality norms on people. In fact, they are part of the problem at times, in my opinion. I sometimes tell them that when I engage with them superficially. I reserve the right to be quoted or write something for a conservative newspaper, since there is a liberal media blackout on these issues. But I don’t want GHQ to ever coordinate activism with the right-wing in any official capacity. I’m too concerned it endorses some of their motivations that I oppose. And beyond that, alliances with the Right upsets people I care about and want to be a part of the discussions around the safety of all of this.

There is 4thwavenow and Transgender Trend and other child/teen transition skeptic orgs. How is GHQ different?

Information from these sites have been instrumental in increasing my understanding of some of the downsides to what is happening with more young people transitioning. I think the GHQ site spends more time highlighting pro-transition arguments for context than some other youth medicalization skeptics sites and discourse. In addition, it is specifically geared towards the LGBT perspective on the issues. That said, although I spent a lot of time launching GHQ, I consider my efforts a community project as my knowledge, analysis, and viewpoints have been helped immensely by the whole community of LGBT people, parents, desisters, detransitioners, therapists, social scientists, and doctors who are discussing this and how safe it is.

The GHQ site is also organized systematically for easy access to multiple areas of interest. There are 17 topics with multiple subtopics. So if parents, or journalists, or LGB people, or whoever, wants to access information such as medical consequences, gender clinician quotes, science article quotes, and the references that go with them, they can read things based on subject matter listed in a long outline you can find here. The information in these sections is pretty extensive and should contain most of the important information that has come out over the last few years. As more news comes out, it will be tagged at the end of each of these topics. That way people can access information accumulated from a few years of data collection, as well as any new information that comes out, and this will be updated regularly.

For example, this blog post on a recent Swedish documentary that features transition regret was tagged to the GHQ “regret” topic, as well as the topic of increasing numbers of female teens coming out as trans. Opinions will also occasionally be featured if they can be supported by evidence, real-world observations, or personal experience.

Comments won’t be open on blog posts. It’s a better use of our time as activists, at least for GHQ, to spend energy in raising awareness among LGBT organizations and media, than moderating comments for trolling, brigading, or hateful comments. We are on Facebook and Twitter so plenty of commentary will happen there. But anyone can contact us with comments, questions, or blog post ideas anytime. In fact, I would like to encourage that now.

Can you summarize your activist agenda?

This is a huge issue with so many unintended consequences that need to be addressed. Initial main goals will be as follows:

1) To be a database of extensive information, including peer-reviewed research and real-world observations, to support rationally defensible reasons for concern, coming from the perspective of LGBT people. The site will also cover the increasing numbers of heterosexual youth who are dysphoric. And to show LGBT support for educators, mental health professionals, and doctors, who are frankly terrified for their jobs to express any skepticism about the affirmative model.

2) To spread this information, particularly to LGBT organizations, mental health entities, and educators. There is a real lack of awareness that first and foremost needs to be addressed through outreach and face to face interactions whenever possible. This will be done via mail campaigns, press releases, requests that these entities meet with concerned individuals, communications via organized speaking panels, and if the current refusal to address harms here continues, organizing protests.

3) To try to create dialogue with other LGBT organizations, such as the Trevor Project, about downsides to youth medical transitions, and the harmful effects of blurring the lines between sex and gender that all of these organizations participate in. They need to reiterate respect for sexual boundaries with young people, who are increasingly feeling entitled to sexual access to others (as well as being targeted themselves, sometimes by older people).

4) To create an activist push, as many trans activists have done to achieve their goals, to remind the mental health and medical professions that the onus is on them to prove they are not harming grey-area, dysphoric youth. And to address the damage when they do harm. The first priority should be to find ways to collect data that prove early social transition and use of hormone blockers don’t increase persistence. If it does, as some gender clinicians fear, the affirmative model has a side effect, unfortunately, of also being an unintentional gay and lesbian eugenics movement. In teens, the picture is more complicated. There is little evidence these entities in the United States will care that much unless they are made to care through activist pressure (our area) and ultimately lawsuits (not our area).

5) LGBT organizations such as GLSEN and entities such as the LGBT centered Division 44 of the APA need to include people who handle and study detransition. There will be more detransitioners. These entities enthusiastically encourage youth transition. We are going to demand they help when it goes wrong.

How can people join your organization? Are you looking for other LGBT people to help you in your efforts?

There is a statement on the site for people to sign if they agree with our mission. This isn’t a petition and will be ongoing. It helps demonstrate support for raising these issues from people who are not generally against basic LGBT social inclusion and rights. The statement can be found here. There will be a mass email statement sent out to many LGBT organizations, medical organizations, mental health organizations, and media soon. So, adding your name will be helpful.

Please contact us if you have a blog post idea you would like to contribute if the information can be supported by science research, an informed opinion, real-world observations, or personal experiences.

Also, please contact us if you would like to get more directly involved in public outreach, research, or anything else that is relevant or have any ideas to contribute.

I can travel to speaking events and can present this issue with arguments that can be morally and rationally justified. The same can be said for appearing on a podcast or YouTube channel. There is a plethora of issues not delved into in this interview that are very interesting and currently relevant. I can discuss this issue from most angles; the medical consequences, issues regarding affirmative model health professionals, desistance statistics, gender activist extremism, and the conflicts around identity politics within the LGBT community.

Lisa Marchiano is a writer and therapist in private practice.She has been in contact with hundreds of parents of trans-identifying young people.You can find her on Twitter @LisaMarchiano. Lisa creates monthly audio content on Patreon for parents of gender-questioning youth.

by Lisa Marchiano

Say you’re a mom.

Maybe you’re also a lawyer. Or a doctor or nurse. A biochemical engineering professor at a research university. Or maybe you’re just a mom. You never wanted kids, or you always knew you wanted them, but when they got here, your life was turned upside down. They became the thing that mattered above all else. You had a baby girl. You chose her name carefully. Maybe something traditional, with a family connection. Maybe something unusual, to communicate how special you knew she would be. You adored her.

You nursed her on demand, carefully attending to her cues. For two years running, you didn’t sleep eight hours straight. She was colicky, or she wasn’t. Maybe she had inexplicable crying jags after you nursed. No one believed you that anything was wrong. Your pediatrician was dismissive, but somehow you knew. So you researched it. You read articles and asked questions of other moms. And you watched her. You paid close attention to what happened whenever she nursed, the way she pulled off the breast and arched her back and wailed. It turned out that she was allergic to the dairy in your breast milk. There was a test that proved it. So you gave up dairy, and things got better. For the next two years, you ate no milk, no yogurt, no ice cream. You made your own baby food. You bought only organic.

Maybe she had serious medical issues right from the beginning. Maybe she was a preemie, or had a rare disease. Or maybe it all went smoothly. She spoke her first words. She walked. You delighted in her smiles, talked to her, sang to her. You were diligent and attentive, reading research about infant-parent attachment. You wore her in a sling. You co-slept with her. Or you didn’t and she slept in a crib.

As she grew, you learned the intricacies of each cry. You struggled to understand what she needed, and to do your best to provide it. You knew she had a fever before the thermometer registered it. When she vomited for eight hours, you wondered if you should take her to the emergency room. Your husband said you were overreacting but something didn’t feel right. You insisted on taking her. She was admitted for dehydration.

You bought educational toys. You read to her extensively because you knew the research about language development and how important parental interaction is. When it came time to send her to pre-school, you chose carefully. You read the reviews, talked to other moms.

You didn’t care about your daughter being girly. You didn’t paint the nursery pink. You never pierced her ears or put a headband on her when she was a baby so everyone would know she was a girl. You were proud she liked dinosaurs. You made sure she knew that girls could do anything and be anything they wanted.

Maybe your husband was a great dad. She adored him and he adored her. Or maybe he wasn’t in the picture. There had been a divorce. Maybe he was angry, or even violent. Maybe he was just passive. Whatever the case, your top priority was your daughter. You wanted her to have a good relationship with her dad.

By the time she was five, you knew she was a little different from other kids. She was more intense. She would read chapter books at lightning speed. Teachers loved her. They always gushed about how bright she was. Or, they disliked her. She could be difficult, moody. Maybe she had tantrums, or had difficulty reading social cues. She could be disruptive, with her passionate feelings about things.

You taught her to eat well. You wanted her to be healthy, and to take good care of her body. If she was a little heavy, you gently encouraged her to be more active without shaming her or drawing attention to her weight. You knew the dangers of eating disorders.  You bought organic meat, or at least the kind raised without hormones. You limited refined carbohydrates and processed sugar. Sodas were not allowed in your house. You were careful about what she put into her body.

She obsessed over bugs. Or ballet. She was tall and lithe – a dancer’s body. She went on pointe a year early. Or she was always heavy. Kids teased her. She was happiest playing at the creek with the boys next door. She was a talented singer. When music played, she saw colors. Or she played ice hockey. You watched her grow and were proud. She was the most important thing.

She was a girly girl who always wanted to wear dresses and loved the “gown” she got to wear at her cousin’s wedding. Or she was a tomboy who wouldn’t wear a dress even at her kindergarten graduation. You didn’t mind at all. You admired her fierce, independent spirit.

When she seemed to struggle with reading in the third grade, you sensed something wasn’t quite right. You did hours of research on the internet. Why was your bright child struggling? Teachers said you were being ridiculous to suspect anything. They implied you were one of those moms. She was just lazy and needed to apply herself. Had you considered putting her on medication for ADHD? She’d always been a classroom management challenge. But you knew. You believed in yourself – that you knew your daughter better than anyone. You weren’t going to shame her or give her unnecessary drugs. You found the top specialists. You got the learning disability diagnosed. You paid thousands of dollars for specialized tutoring to remediate the difficulty, and the struggles ceased. You were relieved and proud of yourself that you listened to your gut.

Then puberty hit. She withdrew. You didn’t understand at first. She spent more time in her room. She was moody and distant. You listened outside her door. Was she okay in there? You knew she needed more independence. You gave her some space, but you were vigilant, watchful. You did what you could to know her friends. You talked to her teachers.

You gave her a smartphone for her 12^th birthday. This was how kids communicated, how they stayed in touch. Not having one would make it difficult for her to have friends. She kept her computer in her room, and sometimes you discovered her on it in the middle of the night. You worried about how much time she was spending online, but this was what kids did. And she needed it – all of her homework was done online.

She went to public school. Or private school. A small, progressive school for the gifted. The teachers had face piercings and were called by their first names. Or maybe you homeschooled. You allowed her to follow her own lead, crafted a custom curriculum that reflected her unique gifts and challenges.

She became more withdrawn. She stopped talking to you. Maybe she gained weight. Or lost weight. Or started cutting. You saw the marks on her arm. You didn’t hesitate. You found a therapist. She had depression and anxiety. Maybe talking to someone would help.

Or maybe she just seemed insecure, more anxious. She had just started high school, and her friends were changing. The “alpha” in her friend group cut her hair off and came out as nonbinary. You saw that your daughter worried about not fitting in. Then three more friends came out as something, you found out later. One said she was a demi boy. Another announced she was pansexual. Another said she was really a boy. They all got the same haircut. They were fourteen.

She started spending time on DeviantArt when she was 11. She was always a talented artist. How great that she had a place online to share this interest. Or maybe she opened a Tumblr account. Or Instagram. Her other friends were on there too, and it seemed like such a female-friendly space. Maybe she watched a lot of YouTube videos. She liked ones about cooking and funny reaction videos. All of these platforms were somewhat unfamiliar to you and they seemed harmless enough.

Your daughter comes out to you.

Maybe she said she was gay. Maybe you weren’t surprised. You have kind of always known. You tell her you are glad she told you, and that you love and accept her no matter what.

But a few weeks or months later, she told you she got it wrong. She wasn’t actually a lesbian. She was pansexual. She was gender fluid. She was trans. She told you this one night while you were fighting over her slipping grades. This was the reason, she explained. She’d been depressed because she couldn’t be her authentic self.

You found out that the idea first occurred to her after a school assembly on transgender issues. Or after her guitar teacher came out as trans. Or after spending hours and hours online watching YouTube transition videos. She’d been going to the GSA meetings at school. You were relieved to know she was receiving support while coming to terms with her sexuality, but then you found out that all of the kids in the GSA identified as trans.

Or maybe she wrote you a letter. The style was unlike hers. You suspected she may have copied it from the internet. The letter announced her new male name and asked that you use male pronouns. It mentioned that she wanted to start testosterone right away.

You told her you love her, that her happiness mattered, that you didn’t want her to suffer. Then you started researching. Because that is what you do. It’s what you’ve always done. You paid careful attention to her. You’ve known her as well as one human being can know another. But you also researched.

You looked up the effects of testosterone on female-bodied people and learned that long-term risks are unknown, but that a hysterectomy is indicated after five years on “T” because of the increased risk of cancer. You discovered that there is a growing community of detransitioners who felt that they weren’t helped by transition. You read reports of other parents who also had smart, quirky teen daughters who suddenly decided they were a boy. Their stories were remarkably similar to yours. Some researchers spoke of social contagion.

You learned that there were few therapists who would help your child explore these questions in an open-ended way. You heard stories about children being greenlighted for hormones and even surgery after one, two, or three visits to a gender clinic.

Meanwhile, you could see that she was suffering from anxiety. Or an eating disorder. Maybe she was diagnosed a while ago with ADHD. Or autism spectrum disorder. It’s a complicated picture. The doctors at the gender clinic told you there was only one problem with only one answer, but you knew it wasn’t that simple.

Your child came out at school. She went to the principal and asked that her name and pronouns be changed, and the principal complied without consulting you. It was a small school, maybe 100 kids, but there were at least fifteen who identified as trans. Your daughter’s teachers were eager to support her. Her English teacher chose her essay to be read aloud at the school-wide literary salon. The essay was about being transgender.

You couldn’t speak about this to anyone. Your extended family reacted to her coming out post on Facebook with “likes” and encouragement. When you tried to talk to your cousin about your concerns, she said you were being old-fashioned, that things were different now and you just needed to support “him.” When you called a meeting with the guidance counselor and the principal, they were condescending. It was clear they thought you were a bigot.

You were living in a progressive neighborhood that featured Hillary lawn signs in the fall of 2016. There was a small independent bookstore and a food coop. At your Unitarian church, fellow parishioners who’ve known your daughter since she was a baby came up to you and squealed their congratulations. They were so excited your son had found his authentic self!

You couldn’t say what you were really thinking. You couldn’t let them know that this wasn’t your child’s authentic self, that your child was in fact doing this to fit in, to claim an identity. You couldn’t say this because no one would understand. They would think you were one of those parents, the ones who couldn’t accept their trans child. Your loneliness and isolation were crushing.

You had to bear this alone. If you were lucky, your husband saw things the same way you did. You and he were a team. If you were unlucky, he accused you of overreacting, of being hysterical. Maybe he even undermined you. Maybe your marriage ended.

You weren’t close with your daughter anymore. You knew that it was normal for teens to have conflict with parents, but this felt like something more. You walked on eggshells. She seemed unhappy and irritable all the time. Identifying as trans was supposed to be the answer, but she only became more depressed, more difficult to reach. She blamed you for not being supportive. She called you transphobic. If you really cared about her, you would help her transition, she said.

The activists characterized you as an anti-trans hater who didn’t care about her son. But you know your child. You’ve known her since she came out all tiny and perfect. You’ve been there every step of the way, encouraging her, striving to understand her unique challenges. You know that her belief that she was trans came about only after friends declared their trans identity, after hours of watching trans YouTubers. You know your child.

You tried to walk a line of supporting her as a person without supporting her belief that she was a boy, but family and teachers affirmed her, so your efforts to help her keep an open mind were undermined. She became deeply invested in the belief that she was trans. You found out that she had a transition pact with on online friend. They were planning on moving into together when they were 18 and starting “T.” You knew this wasn’t an idle threat, because your daughter would be able to access “T” as soon as she turned 18 without any therapy or assessment at an informed consent clinic.

So you wait. You wait for the mainstream media to start covering the story, so that people realize what is going on and you can speak about this without sounding crazy. You wait for the lawsuits to come, for reports to surface of the rising tide of detransitioners. You wait for therapists and doctors to realize that we are living through another mental health contagion such as we saw with multiple personality disorder in the 90s.

Say you’re a mom. A good mom. A mom who is fighting for her daughter.

You wait.

by Helena

Helena is a 21-year-old woman who identified first as nonbinary, and later as a transgender man, from 2013 through 2018. In 2016, she began medical transition by taking testosterone, and detransitioned two years later. During her teen years, Helena was an avid member of several Tumblr “communities”: trans/gender identity, eating disorders, and self-harm.

This piece is the second in a series of articles that analyze aspects of Tumblr Helena has observed as detrimental to the massive numbers of youth who call the site their virtual home. The focus of this article is the self-harm and pro-anorexia Tumblr worlds. Part 1 is here.

Helena can be found on Twitter @lacroicsz and is a member of the Pique Resilience Project, a group of four detransitioned/desisted women creating multimedia content about their experiences.

In Part 1, I described a few elements of Tumblr’s design that compromise the perception and communication of its users. Now we will take a look at some of the ways Tumblr’s unique atmosphere has given life to dangerous subcultures that have engulfed the lives of countless young people, mostly girls, in the last decade.

Introverted, angst-ridden, struggling adolescents across the globe are now faced with the risk of becoming inundated with content from self-harm blogs, pro-anorexia blogs, social-justice blogs that encourage self-diagnosis of mental illness, the use of mental illness as social currency, and gender identity ideology that is even more logically flawed and emotionally driven than in the mainstream. In this piece, I will discuss the self-harm community, and the pro eating-disorder community, both of which I have had personal experience belonging to. The community surrounding gender identity and dysphoria, the one with which I am most familiar, will be discussed in depth in Part 3.

Self-Harm Tumblr

The community of bloggers that filmed and shared photos, gifs, and written glorifications of self-harm behavior, often called “self-harm Tumblr” or “self-harm blogs,” was nearly eradicated when Tumblr prohibited the practice in 2012, but the long-term impact of such a dark and abnormal presence on the character of the site–and the teenagers who use(d) it–are still very evident. During their heyday, these blogs permeated Tumblr with graphic, slow motion, black-and-white gifs of razors slicing through flesh or dramatic quotes about suicide that were available simply by typing “self-harm” or “suicide” into the search bar.

Here’s how it worked: Imagine you’re a sad teenage girl circa 2012. Maybe you hate your body, or you’re conflicted about your sexuality, or you don’t fit in with your peers, or your home life is disordered. You’ve started using Tumblr a lot; you love that you can search anything you’re thinking of in the moment and instantly be gratified with awesome fan art of your favorite characters or updates on your favorite TV shows. But on this day, it’s not your teen idol or some BBC show that’s on your mind. Instead, it’s painful thoughts of self-hatred or even suicide. Maybe it’s the crushing feeling that your parents don’t love you. Maybe they’re too busy fighting to reassure you they probably do. Whatever it is, it’s not good, and like with everything else, you don’t have many places to turn to with this kind of thing. Your parents won’t understand, you don’t want to bother your best friend with your complaining for the umpteenth time that day, and listening to emo songs isn’t hittin’ like usual. So you do what you always do when you’re lonely and stimulated: you go on Tumblr. You type “depression” in the search bar, and a thousand posts like this come up:

Feels good. Feels validating. All that energy vibrating in your chest is matched by the black-and-white moving picture on the screen in front of you. You scroll down, and what do you know, there’s more. An infinite supply, always updating, because thousands of people just like you are posting more and more of these depression-aesthetic memes every day.

Now let’s say that at some point you do begin to self harm. Maybe you saw it in a music video, or your best friend started doing it, or you even saw it in a Tumblr gif, but through whatever means, the thought of venting your feelings into your own skin with a razor blade finds its way into your head. Or maybe you want to self harm, the desire is burning within you, but you’re scared. Not to worry, go back to Tumblr and type in “self harm” or “cutting.” You’ll get another infinite supply of addictive, dopamine machine guns. But this time, they’re bloody. A lot of them are matched with captions that strike you as relatable. The gore is mesmerizing, you can’t look away. There’s something about watching blood pour or ooze (whether from your own self harm or from one of these gifs) that feels analgesic. Before you know it, you’ve been lying there in your bed for hours, body limp except for your thumb stroking your smartphone’s screen as you scroll through these countless images.

If you’ve never self harmed before, this might make you wanna try. Click here to view some examples of Tumblr self-harm posts, but be warned–they are graphic. These images, and the act of self harm, will make you feel better for a moment by flooding your body with endorphins as it resonates with and then tries to cope with the  stinging pain, but the second another stressor, another hopeless thought comes your way, you have to go back again. It’s a deal with the devil, but there’s a reason so many kids have been seduced into shaking his hand.

No one is born with the desire to slice their flesh every time they feel upset, and previously, self-harming behavior was seen only in the most severe psychiatric cases. Ordinary teenage girls were not cutting themselves to the point of hospitalization a few generations ago, and the statistics reflect that. According to a study released in 2017 which evaluated ER visits for nonfatal injuries amongst adolescents from 2001 to 2015, rates of ER visits among youth “showed no statistically significant trend until 2008, increasing 5.7% annually thereafter and reaching 303.7 per 100 000 population in 2015. Age-adjusted trends for males overall and across age groups remained stable throughout 2001-2015. Overall age-adjusted rates for females demonstrated no statistically significant trend before 2009, yet increased 8.4% yearly from 2009 to 2015. After 2009, rates among females aged 10 to 14 years increased 18.8% per year—from 109.8 per 100, 000 in 2009 to 317.7 in 2015. Rates among females aged 15 to 19 years showed a 7.2% increase on average per year during 2008-2015.” (Mercado et. al.)

Note the statistic that the rates of female self-injury hospitalizations were stagnant until 2008, when they suddenly began increasing. Keep in mind that correlation does not equal causation, and cultural phenomena seldom have one clear explanation, but the fact that Tumblr was launched in 2007, and really picked up speed in 2008, should not go ignored in this discussion.

These self-harm blogs were not simply the online diaries of depressed teenagers, but a thriving community in which mental illness became identity. The images, and the captions that accompany them, often reinforced depressive ruminations, such as: No one cares about the self harmer, the self harmer will be depressed forever, and suicide and self harm are justifiable ways of coping with negative emotions. It is this way of thinking, this immersion in depressive thought, and the resentment and alienation that results from suffocating yourself in this maladaptive coping mechanism on a constant basis, that paved the way for later subgroups surrounding mental illness.

Pro-Anorexia Tumblr

“Pro-Ana” culture existed years before Tumblr, with the first pro-Ana websites emerging in the 1990s, when the already existing real-life pro-Ana movement moved online. The issue was brought to public attention in 2001 when Oprah Winfrey discussed it on her television show, and the world was shocked to learn that not only was anorexia a prevalent threat to young girls, but that many of these girls seemed overjoyed to be suffering from it.

Since the pro-Ana movement has been so widespread for so long, there’s actually quite a bit of literature and research on the topic of social contagion and eating-disorder “symptom pooling,” that is, when sufferers of the same mental illness band together and form an echo chamber that exacerbates the symptoms of the illness. This article from the Social Issues Research Centre gives a good introduction to the inner workings of popular pro-ED websites, and much more information is available online. Pro-Ana culture is known for its users’ belief that they are not sick, but simply being themselves and making a lifestyle choice to be more “disciplined” than people who do not choose to be anorexic. The name “Ana,” as opposed to using the terms “anorexia” or “eating disorder,” personifies the illness almost as a goddess to be worshipped.

Pro-Ana ideology is one contradiction after the next, with users glorifying the illness, how it has empowered them, how in-control and serene they feel when they starve, how much better their life is since finding their pro-Ana friends, and how they “trigger” each other to victory–yet, in the next breath, advising that “if you don’t have an ED, turn away now. You don’t want to be like me.” It is a highly addictive formula of community, purpose, coping mechanisms, and a simultaneous god and victim complex.

While all of this is pretty standard for pro-Ana communities, the Tumblr pro-Ana community is unique. It doesn’t (and never did) have the same degree of vitriol, and has always been heavier on victimization. While some pro-Ana communities see themselves as a quasi-political class who have the right to starve themselves because that’s what they believe is right for them, the Tumblr pro-Ana community treats anorexia more like the mental illness it is. This doesn’t come close to solving the problem, though, since Tumblr has some twisted attitudes towards mental illness in the first place. Whereas other pro-Ana communities focus on the sheer act of starvation as fulfillment through self-mastery, the Tumblr pro-Ana community sets its sights on the end goals of the perpetual diet. Many of them view it less as a lifestyle choice for the rest of their lives, but more as a necessary evil to achieve a standard of living that is tolerable to them. They focus on what they will be able to do when they are thin, how they will look, and how much better life will be. Then, they can stop starving (or so they believe)– almost as if their anorexia is a transition to a different existence, a new body, a new life (the parallels with the trans/gender dysphoric Tumblr communities are quite obvious here).

There is a heartbreaking air of hopefulness in the anorexic community on Tumblr. They are not pro-Ana because they chose it to feel superior, they are pro-Ana because they feel they must be. They cannot survive another day seeing their reflections, and the fat they see on their bodies (even when there is none left) is more than aesthetically displeasing to them: it contains the very cause of all of their suffering. Every moment of pain since birth has been because they are too fat, they eat too much, they’re too out of control–as if losing a dangerous amount of weight would resolve the mental patterns that drove them to take such self-destructive measures in the first place.

Tumblr pro-Ana is a much more hopeful, naive pro-Ana culture than others online. It was born of the original culture in the 1990s, but influenced by the unique attitude Tumblr has developed towards self-harming behavior and mental illness. Users will repeat again and again, “no one chooses to be anorexic…” “if I could stop being this way I would…” and to a certain extent, this is true. No one can “snap out” of an eating disorder, but the Tumblr culture goes beyond acknowledging the difficulty of recovery. Anorexia is viewed not as a lifestyle choice, like in other pro-Ana communities, but as an inescapable battle bestowed upon these girls that they must fight, else they will never be happy. They were born to be redeemable failures, out-of-control gluttons, and every miserable moment traces back to the pounds that could be lost. Their only hope at survival is to beat their bodies into submission to rid themselves of the visible, tangible, evidence of their curse: fat. This is how anorexia ceases to be defined as a mental illness, ceases to be defined as a “lifestyle”, and begins its definition as an identity. It transcends the material and becomes spiritual. Some people are just born to suffer like this, and they have to learn to love it.

To an outsider, it seems convoluted. Unbelievable, even. It is so far removed from sanity that it is difficult for me to explain in a way that will convey even a fraction of the many ideological layers that have developed within Tumblr’s pro-Ana community. But to them, at least to the extent they are able to convince themselves, it’s not that crazy. It makes sense: you’re a fat ugly failure and you have to do something about it! Extreme normalization of this truly dangerous behavior has always existed in pro-Ana circles, where anorexics even go so far as to see their path as superior to a non-anorexic existence. On other pro-Ana sites, this looks like intense competition, purposefully “triggering” others by being heartlessly demeaning and catty, and exchanging tips on how to hide the severity of their illness from parents, friends, and doctors (including within inpatient psychiatric facilities).

On Tumblr, the approach is similar but less aggressive. “Meanspo” (meaning something to the tune of “mean thinspo,” a type of post in which the writer purposefully writes triggering, mean, messages but warns the reader beforehand) is distinguished from other posts, because as opposed to other communities’ competitive, vicious nature, the Tumblr pro-Ana community is soft and friendly. They understand themselves as a large congregation of friends, helpless in the face of the symptoms they share, and the only way to help each other is to be very sweet and lose as much weight as possible, to stave off the demons.

And if you’re not in the mood to be called a fat pig, don’t worry, there’s “sweetspo”: thinspo that is kind and loving, something these girls might not usually experience. Or if they do, they don’t feel worthy of accepting this love from anybody but Ana. But don’t get it twisted, Ana is only nice in the context of getting you back on track to lose weight. No “you don’t deserve to do this to yourself,” no “you don’t have to torture your body to avoid suffering.” There is no option presented by the pro-Ana community that does not fit within the confines of the ideology; rather, comforting sentiments are used to strengthen the sense of emotional isolation and dependency members of the community feel.

Something that has always been intriguing about the pro-Ana movement is its propensity for viewing itself almost as a minority group of sorts. On the original forum platforms for pro-Ana discussion, this manifested in members believing anorexia is a “lifestyle”, and that their choices deserve to be respected. A “good Ana doesn’t die”, and doctors or loved ones who attempt to intervene are violating the autonomy of the anorexic. With this came a militancy designed to keep girls in line and constantly living and spreading the lifestyle, because an easygoing, accepting atmosphere would not achieve results. This is why the pro-Ana social contagion reached the levels it did in the 1990s and early 2000s; it was a fierce battleground where the narrative proclaimed that only the strong survive, and the strongest will place first. But really it was the resulting group belligerence that emerged from this narrative, rather than the any truth to the narrative itself, that carried so many young women and girls through years of self destruction.

Other ideological groups on Tumblr are also popularly associated with a similar militancy, but the core dysfunctions of these groups, including the Tumblr pro-Ana community, are unique in the way they create psychological dependence. Other pro-Ana communities would create this dependence by fostering a competitive atmosphere in which it would be unacceptable to fall behind. Members were expected to display their starting weight, current weight, progress, and goal weights on every post and comment in the form of a signature. There would be daily threads requesting Anas to post their food intake diaries, and it would be an absolute disgrace to answer that you had Granny Smith apple slices, chicken breast, and 2.5 tootsie rolls when other girls only drank cucumber icewater all day. If you couldn’t run with the Alphas, the whole pack left you behind, it was that simple. In contrast, emotional dependency is created on Tumblr more through curating the pro-Ana community as a (conditionally!) loving and accepting oasis where everyone can feel “included” as an Ana, even if they aren’t underweight and even binge sometimes! Isn’t that nice?

Like pathological groups elsewhere on Tumblr, everyone is valid and included. You don’t need to lose any weight to be anorexic, it’s the thought that counts.

Now, don’t get me wrong, you can have a pretty severe eating disorder and not be stick-thin and struggle to lose weight as quickly as you would like, but it wouldn’t clinically be anorexia. Combinations of symptoms from anorexia, bulimia, avoidant/restrictive food intake disorder, and binge eating disorder are considered an Eating Disorder Not Otherwise Specified (or, EDNOS), and the concept used to be reasonably acceptable on other pro-Ana sites. Being hardcore anorexic (avoidant of food) or, to a lesser extent, bulimic (compensating for food not avoided by purging) was preferable (as long as it showed results), but the attitude that everyone must be included or else they won’t feel like they have a real eating disorder fundamentally contradicts the competitive nature of the ideology. On the non-Tumblr pro-Ana sites, girls who were overweight were encouraged to take up the lifestyle, but they were essentially second-class citizens compared to the veterans who had managed to maintain a low or underweight BMI, and they would not be considered sufficiently anorexic until they had proven their disorder. On Tumblr, young girls have managed to reconstruct mental disorder into a family just as complex, passionate, and loving as any real one can hope to be.

As of this writing, the self-harm and pro-ED cultures online have been forced to withstand quite a bit of censorship. Tumblr blogs that post gory content are deleted, and pro-Ana content is monitored, though to a lesser extent; explicit pro-Ana content can still be found. To evade Tumbler censorship, users employ special tags to find each other, like #not pro just using tags, or #anarexya. The culture has morphed to encompass “thinspo” that is less about skeletal, sickly bodies and more about conventionally attractive, slim Instagram models, and lots of memes (see the tag #proedmemes). Memes and aesthetically pleasing photos of pretty women (and in some cases, trans men) motivate this new generation of eating-disordered females, without showing off the glaring red flags of past generations, where the disordered behavior was purposefully exaggerated, rather than hidden away for preservation. When explicit visual content is impermissible, the disordered females must rely more heavily on emotionally based community interaction to motivate themselves to engage in painful, unnatural behavior like starving or purging; in way, it makes these communities even more inviting.  For more examples, see the below gallery of current pro-Ana content.

I hope everyone is now sufficiently disturbed by the goings-on in the online communities comprised of teenage girls, and the disorders they have manifested in our society. The risk of being devoured and digested by these poisonous digital chambers and their respective ideologies extends to your daughters, sisters, granddaughters, and cousins. They lie open in waiting for any unsuspecting, naive young girl whose emotional terrain is still unknown and unfamiliar. The similarities between the self-harm, eating-disorder, and gender-identity ideological communities cannot be overstated, and we would be fools to ignore the role of Tumblr.com in the shocking and drastic increases in adolescent female gender dysphoria that have presented over the last five or so years.

In Part 3, I hope to do some measure of justice to the labyrinthine ideological shenanigans of this virtual community. Something in our culture has created the perfect storm for the explosion of gender-identity ideology, and as a detective would prioritize searching a suspected criminal’s bedroom, Tumblr may as well be the first place we look for clues.

by William J. Malone, M.D., endocrinologist (Twitter: @will_malone).

with contributions from Colin M. Wright, Ph.D., (Twitter: @SwipeWright), biologist and Eberly Research Fellow at Penn State University;  and Julia D. Robertson (Twitter: JuliaDRobertson), journalist, award-winning author and Senior Editor of The Velvet Chronicle.  

1. Many health care professionals and mainstream medical organizations endorse the concept of an innate gender identity.[a] They define gender identity as the “internal, deeply held” sense of whether one is a man or a woman (boy or girl), both, or neither, and report that it can be reliably articulated by children as young as 3-5 years old.[b]

2. A growing number of scientists, philosophers, and health care professionals reject this concept, or at least the above definition.[c] First, developmental studies show that children have only a superficial understanding of sex and gender at best.  For instance, up until age 7, children often believe that if a boy puts on a dress, he becomes a girl.[d]  This gives us reason to doubt whether a coherent concept of gender identity exists at all in young children. Additionally, the concept relies on stereotypes that encourage the conflation of gender with sex.

3. However, starting at a young age, children do tend to exhibit preferences and behaviors that we associate with sex. For example, male children display more aggressive behavior than female children.[e]  It is also known that “cross-sex” behavior, or more accurately cross-sex stereotypical behavior, is often predictive of later same-sex attraction.[f]  Can all of these findings be integrated?

4. To start, just as sex influences the development of bodies, it also influences brains. There are in-utero differences in hormone exposures (male testosterone surge at 8 weeks gestation for example) and distinct developmental pathways are triggered based on the XX or XY chromosomal make-up of neurons.[g]  The integration of these sex-related processes with environmental pressures gives rise to an individual’s personality and preferences.

5. It follows then that population-based studies have demonstrated small, but measurable, sex-related differences in personality and preferences that are independent of social influences.  When social influences are weakened (in more egalitarian societies), the sex-related differences in personality and preferences increase.[h] [i] This suggests that as environmental pressures become relaxed, innate sex-specific preferences surface.

6. It is important to note though, that while our species exhibits sexual dimorphism, the measurable differences between the sexes are often small, meaning there is a large (approximately 85%) overlap of most traits, including personality, behavior, and preferences.[j] The differences are so small that for most of the population they are negligible and cannot be used to predict the behavior of any individual with much accuracy.  It is wrong to ascribe population-level phenomena to individuals.  Of note, small differences can be very significant in sports competition, a topic I will not cover here.[k]

7. To expand further, the distribution curves below demonstrate the dimorphic split in clinically measurable sex-related differences in personality traits. Notice the significant 83% overlap (Cohen’s d ~ 0.4).[l]

The consequence of this overlap is that adolescent males who fall on the left end of the male pattern (blue, “masculine”) curve, and adolescent females who fall on the right end of the female pattern (pink “feminine”) curve, are going to have personality traits that are different than the majority of other members of their own sex.  In fact, due to the significant overlap of personality traits between men and women, the personality traits of some women will be more “masculine” than those exhibited by some, or even most men, and vice versa.

8. Consequently, an adolescent female may find her behavior, personality traits, and preferences more “masculine” than most girls and most boys. This could lead her to incorrectly believe that she is the opposite sex.  That child’s parents could become confused as well, noticing how “different” their child’s behavior is from their own, and/or from that of their peers.  That child simply exists at the end of a behavioral spectrum, and “sex-atypical” behavior is part of the natural variation exhibited both within and between the sexes. Personality and behavior do not define one’s sex.

9. There would be less confusion if the distributions completely overlapped. It would simply be understood as the norm that males and females display overlapping personality traits.  It appears that there is just enough difference to create confusion at the ends of the distributions.

10. This could explain studies showing a 28% concordance of a transgender identity in twins.[m] Identical twins have identical chromosomes, and likely have similar sex-related behaviors as well as environmental influences on their behavior.  Using twin adolescent males as an example: if their behaviors are at the “feminine” end of the male-typical bell curve, they could both become confused as to what their behaviors and preferences mean about their sex.  Whether they develop gender dysphoria as a consequence of that is another issue.  In the event that gender dysphoria does develop, 85% of the time it will resolve with uninterrupted puberty.[n]

11. What is being called “gender identity” is likely an individual’s perception of how their own sex-related and environmentally influenced personality compares to same and opposite sexed people. Put another way, it’s a self-assessment of one’s stereotypical degree of “masculinity” or “femininity”, and it’s wrongly being conflated with biological sex.  This conflation stems from a cultural failure to understand the broad distribution of personalities and preferences within sexes, and the broad overlap between sexes.
    

12. When a girl reports that she “feels like a boy” or “is a boy”, that sentiment may reflect her perception of how her personality and preferences compare to the rest of her peers. Also, if she has concrete thinking characteristic of an autism spectrum condition, she may not be “sex-atypical” in her behavior, but may be falsely perceiving herself to be.  These scenarios don’t apply to all cases of gender dysphoria, as many other triggers have been described.[o]  Counseling can help gender dysphoric adolescents resolve any trauma or thought processes that have caused them to desire an opposite sexed body.[p] [q] [r]

13. To summarize, there is a lack of understanding when it comes to the significant overlap of relatively small, but still present, sex-related personality and behavioral differences (that are additionally influenced by environment). This lack of understanding has led to confusion.  That confusion impacts children who fall at the extreme tail-ends of the distribution, who are statistically more likely to grow up to be gay, lesbian, or bisexual adults if allowed to experience uninterrupted puberty.ⁿ  Additionally, telling a child that he or she was born in the wrong body pathologizes “gender non-conforming” behavior and makes gender dysphoria less likely to resolve.^a

14. In conclusion, no child is born in the wrong body. Adults should expand their understanding of what normal male and female behavior and preferences look like.  They should understand that being male and being female both come with a wide range of personalities, preferences, and possibilities.
    

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[a] Hembree, Wylie, T, P., Louis, Hannema, E, S., . . . G, G. (2017, September 13). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society * Clinical Practice Guideline. Retrieved from https://academic.oup.com/jcem/article/10

[b] Gender identity. (2018, May). Retrieved from https://www.caringforkids.cps.ca/handouts/gender-identity

[c] Byrne, A. (2019, January 10). What Is Gender Identity? Retrieved from https://arcdigital.media/what-is-gender-identity-10ce0da71999

[d] Martin, Carol. “Cognitive Theories of Early Gender Development.” Semantic Scholar, 2002, pdfs.semanticscholar.org/69e9/67157a01cb0af9252650195e7adb99578364.pdf.

[e] Harbin, S. J. (2016). Gender Differences in Rough and Tumble Play Behaviors. International Journal of Undergraduate Research and Creative Activities,8(1). doi:10.7710/2168-0620.1080

[f] Childhood Cross-Gender Behavior and Adult Homosexuality. (n.d.). Retrieved from https://www.tandfonline.com/doi/abs/10.1300/J529v12n01_03

[g] Wheelock, M., Hect, J., Hernandez-Andrade, E., Hassan, S., Romero, R., Eggebrecht, A., & Thomason, M. (2019). Sex differences in functional connectivity during fetal brain development. Developmental Cognitive Neuroscience,36, 100632. doi:10.1016/j.dcn.201

[h] Giolla, E. M., & Kajonius, P. J. (2018). Sex differences in personality are larger in gender-equal countries: Replicating and extending a surprising finding. International Journal of Psychology. DOI:10.1002/ijop.12529

[i] Archer, J. (2019). The reality and evolutionary significance of human psychological sex differences. Biological Reviews. doi:10.1111/brv.12507

[j] Eight Things You Need to Know About Sex, Gender, Brains, and Behavior: A Guide for Academics, Journalists, Parents, Gender Diversity Advocates, Social Justice Warriors, Tweeters, Facebookers, and Everyone Else.

[k] Comparing Athletic Performances: The Best Elite Women to Boys and Men: Duke University School of Law. (n.d.). Retrieved from https://law.duke.edu/sports/sex-sport/comparative-athletic-performance/

[l] https://sexdifference.org

[m] Diamond, M. (2013). Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation. International Journal of Transgenderism,14(1), 24-38. doi:10.1080/15532739.2013.750222

[n] Ristori, J., & Steensma, T. D. (2016). Gender dysphoria in childhood. International Review of Psychiatry,28(1), 13-20. doi:10.3109/09540261.2015.1115754

[o] Gender dysphoria is not one thing. (2017, December 07). Retrieved from https://4thwavenow.com/2017/12/07/gender-dysphoria-is-not-one-thing/

[p] Zucker, Kenneth & Wood, Hayley & Singh, Devita & Bradley, Susan. (2012). A Developmental, Biopsychosocial Model for the Treatment of Children with Gender Identity Disorder. Journal of homosexuality. 59. 369-97. 10.1080/00918369.2012.653309.

[q] Vries, Annelou & Cohen-Kettenis, Peggy. (2012). Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach. Journal of homosexuality. 59. 301-20. 10.1080/00918369.2012.653300.

[r] Clarke, Anna Churcher, and Anastassis Spiliadis. “‘Taking the Lid off the Box’: The Value of Extended Clinical Assessment for Adolescents Presenting with Gender Identity Difficulties.” Clinical Child Psychology and Psychiatry, vol. 24, no. 2, 2019, pp. 33

by Worriedmom

Third in a series. Part 1 is here. Part 2 is here.

4thWaveNow contributor Worriedmom has practiced civil litigation for many years in federal and state courts.

Since our last coverage of medical malpractice litigation against renowned phalloplasty surgeon Curtis Crane, M.D., we’ve received frequent inquiries about the current status of the lawsuits and his practice. Research has revealed some interesting facts and circumstances about Dr. Crane.

First, as of this writing, there no longer appear to be any open civil cases against Dr. Crane in the state of California. All eight of the malpractice cases that had previously been pending in the San Francisco Superior Court have now been “dismissed with prejudice” (read on to understand the meaning of “with prejudice” in the settlement context, since this doesn’t mean what some folks may assume it does).

Specifically:

Doe v. Crane, CGC-16-550630 was dismissed April 5, 2017.

Carter v. Crane, CGC-16-554254 was dismissed December 10, 2018.

Raynor v. Crane, CGC-17-556713 was dismissed November 8, 2018.

Carson v. Crane, CGC-17-556743 was dismissed October 10, 2018.

Doe v. Crane, CGC-17-557327 was dismissed November 8, 2018.

Davis v. Crane, CGC-17-557363 was dismissed December 10, 2018.

Shepherd v. Crane, CGC-17-559294, dismissed October 3, 2018.

Doe v. Crane, CGC-17-560690 was dismissed March 15, 2019.[1]

A ninth malpractice case, Hansen v. Crane (CGC-18-571442), brought in November of last year, was also dismissed on January 14, 2019. As with the other actions listed above, this lawsuit also alleged malpractice in connection with genital surgery:

Interestingly, the plaintiff in that case alleged that at the time he consulted Dr. Crane, Dr. Crane told him that “none of his patients had ever had a serious complication from phalloplasty, that it was a safe procedure, and that only 5% of his patients have needed surgical repairs.”

As of the writing of this article, however, all of the malpractice litigation filed against Dr. Crane in San Francisco has now been dismissed. What does this mean? It’s impossible to know.

What we do know is that none of these dismissals appear to have been the result of a jury or other type of fact-finding proceeding that evaluated Dr. Crane’s conduct and made any findings about negligence or malpractice. In other words, it does not appear that an independent arbiter has reviewed the facts of these cases and ruled on whether the care provided either complied, or did not comply, with established “standards of care.” This is not surprising, since over 90% of all medical malpractice cases never go to trial.

One might reasonably conclude, then, that all of these actions have been settled out of court. For what amount of damages? We can’t know. It could be zero, it could be $10 million. The amount paid in settlement of such a claim is confidential virtually 100% of the time. The medical liability insurance carrier is, in most cases these days, the party that decides whether or not to settle a case, and this is a “business decision” on the carrier’s part.

From interrogatory answers filed in the Raynor case, cited above, we do know something about Dr. Crane’s professional liability and medical malpractice coverage in 2016, the date the malpractice alleged in that case was claimed to have occurred (see Motion for Relief from Waiver of Discovery Objections dated April 16, 2018, Declaration of Corban J. Porter and Exhibit D thereto):

Private settlement agreements also typically include “NDA” (or non-disclosure agreement) provisions, in which the parties agree to keep all terms of the settlement confidential, and further agree to the payment of damages in the event of a breach. These NDA provisions have, of course, come under public scrutiny as part of the “MeToo” movement and the Stormy Daniels affairs. Some commentators argue that keeping medical malpractice settlement amounts confidential hurts the public:

Secret nondisclosure agreements also affect patient safety by allowing bad doctors and other dangerous medical providers to continue to harm patients because their incompetency is hidden from their present and future patients and employers.

Finally, these litigations were also dismissed “with prejudice,” which means that the plaintiff cannot bring another lawsuit based on the same facts. This makes sense, because otherwise no defendant would ever pay money in settlement of a litigation if he or she knew that the plaintiff could simply re-file the same lawsuit another day.  So, it’s important to understand: When dismissal “with prejudice” is entered as part of a settlement, it does not indicate that anyone has ruled on the merits of the case.

That’s it for our legal update, but for those of us who are interested in Dr. Crane and his business model, there have been some additional developments.

Most important, it appears that Dr. Crane may no longer be performing surgery in the state of California (although his medical license is still current in that state). His prior practice, Brownstein & Crane Surgical Services, seems to be out of business. Any internet searches for brownsteincrane.com result in a re-direct to “Crane Center for Transgender Surgery,” a practice operating in California and Texas.

In and of itself, this is not surprising. According to the Crane Center’s Facebook page, Dr. Brownstein retired in 2013, after having performed “thousands of FTM chest surgeries” and passing this extensive knowledge along to Dr. Crane.

What is notable is that, as of the time of our earlier article in 2018, Brownstein-Crane was a thriving California transgender medical practice. According to the Wayback Machine, which is the only source for information on the practice, back in March of 2018, Brownstein-Crane, in addition to Dr. Crane, employed:

• Thomas Satterwhite, M.D. (plastic surgeon);
• Heidi Wittenberg, M.D. (OB/GYN, surgeon);
• Michael Safir, M.D. (uro-genital reconstructive surgeon);
• Ashley DeLeon, M.D. (uro-genital surgeon);
• Charles Lee, M.D. (micro-surgeon);
• David Chang, M.D. (surgeon);
• Gabriel Kind, M.D. (plastic surgeon); and
• Michael Parrett, M.D. (plastic surgeon).

A photograph that appeared on Brownstein-Crane’s now-defunct website.

Of all those doctors, today only Drs. DeLeon and Safir remain affiliated with Dr. Crane. Dr. Crane now appears to practice in Austin, Texas, and has been joined there by Dr. Richard Santucci (together with Dr. DeLeon); Dr. Safir holds down the fort in San Francisco and has been joined by Dr. Angela Rodriguez. Dr. Crane’s website indicates that information about the Crane Center’s doctors is “coming soon.”

It’s not clear when Dr. Santucci joined Dr. Crane’s practice, but he does not appear to have been part of the earlier Brownstein-Crane incarnation:

Source.

Not to worry, though: Dr. Safir remains busy in San Francisco.

 Source.

The Crane Center has wasted no time in accessing potential new patients, sending attractive representatives to attend such conferences as Gender Odyssey in San Diego and the Philadelphia Trans Wellness Conference, and sponsoring art festivals and pride events.

For an added bonus, prospective patients may even be able to receive a free initial surgery consultation, right there at the conference!

What is the story behind Dr. Crane’s relocation to Texas?

It’s impossible to know. Perhaps some of his current or former patients will enlighten us.

[1] Interestingly, on March 7, 2019, Crane’s defense counsel in this case was ordered to pay a $1,800 sanction for “misuse of the discovery process.”

In response to our most recent article about Dr. Curtis Crane, we have been contacted by one of Crane’s former patients, who asked us to share this video.

Be aware that the video contains graphic images and video footage pertaining to the phalloplasty surgery and complications experienced by this person.

We thank this former patient for reaching out to us, and for having the courage to speak out.

In recent months, there has been a marked increase in the number of both trans-identified and detransitoned people speaking out on social media and YouTube about the harms they say they experienced from a variety of medical-transition procedures. It should be obvious that the testimonies of these regretters don’t somehow cancel out the positive transition experiences others report. In fact, many regretters who speak out do so not to deny others the right to access medical transition, but to provide information about possible unwanted side effects and/or sequelae of surgical and/or hormonal interventions.

Yet the typical response from trans activists can be summarized succinctly:

Regret and detransition are vanishingly rare. You’re an outlier, so don’t fearmonger.

As many detransitioners have pointed out, no one actually knows just how many regretters (some of whom continue to identify as transgender) and detransitioners there are. Regretters are not systematically tracked, and the few studies that have looked at regret rates typically report that many subjects have been lost to followup.

Most importantly, many regretters never return to their gender clinics once they’ve detransitioned (or discontinued further medical intervention). As Carey Callahan remarked in her recent interview with a detransitioner who did return to talk to her former gender doctor,

She’s exceptional for doing so- in my circle only a handful of detransitioners have gone back to inform their doctors about their detransition.

But regardless of how rare regret or detransition may ultimately be, why wouldn’t adult trans people and their supporters want others to learn everything possible about both the positive and negative impacts of medical transition–particularly when it comes to young people? Further, if a young person resolves their dysphoria and thus avoids the rigors of medical transition, how is that not a good outcome?

These questions (which we have posed many times in the past) inspired this recent tweet thread from the 4thWaveNow Twitter account.

You can also read this thread here.

by Juliette van Steensel

Juliette van Steensel is a 19-year-old woman who identified as transgender for a brief period in her earlier teenage years. She wrote this piece particularly for parents who may be wondering how to best support and respond to their trans-identifying daughters, based on her positive experiences with her own parents during that time in her life. Juliette is originally from the Netherlands and now lives in the UK, where she is studying for a degree in linguistics. She is available to interact in the comment section of this post, and can also be reached on Twitter @jvsteensel.

Cases of young teenagers claiming to be transgender out of the blue seem to be on the rise. Though there are plenty of opinions and discussions on this to be found online, some voices are hard to hear: those of parents reluctant to give in to their children’s wishes to transition, and those of people who once identified with the transgender community and no longer do. I myself identified as transgender for a short time in my teens, but grew out of it. As I was looking for people with similar experiences, I came across 4thWaveNow. I recognise myself in many of the stories shared here, and I feel very sympathetic towards the parents sharing their struggles. I hope that sharing my experience with transgenderism and the ways in which my parents supported me in this will provide some insight to other people going through this.

When I was 16, I came out to my parents as genderqueer. This was following a coming-out as gay, which followed a coming-out as bisexual. At the time, I viewed this as a logical progression: I was breaking out of the heteronormative, cis-centric mold imposed on me by society. As a final step to complete this progression, I decided I would start hormone treatment when I turned 18, and start university ‘as a man’ — or at least, not as a gender-conforming woman. It never got that far, though: some six months later, I had started to grow out my hair, wear dresses and skirts again and didn’t think twice about ticking the ‘female’ box on my university application forms. Now, I have many other things to concern myself with outside of gender: I have recently finished an internship in linguistics in Singapore, and I look forward to earning my bachelor’s degree in linguistics at Cambridge University over the next three years. Rather than spending my free time obsessing over gender, I spend it on art, playing the violin, and going out with my friends.

Sometimes, though, I think back to when I identified as transgender. Mainly, I think about how it affected my parents, and my relationship with them. My parents never rejected me outright. However, when talking about this period later, I learnt how sceptical and worried they were. Now, I admire that they were able to keep most of this to themselves and trust me to figure myself out. Thankfully, I did manage to do just that, and I am now very glad I never made any permanent changes to my body. Looking back now, the reasons for my so-called gender dysphoria and wish to transition, followed by acceptance of my biological gender only about half a year later are painfully clear. They have little to do with gender beneath the surface.

As most teenagers do at some point or other, I started questioning my sexuality in high school. I was around 15 years old at this time and often turned towards the internet to share my thoughts and find like-minded people. The internet offers a wealth of stories and experiences from others on this topic and I spent a lot of time reading through these. In particular, I spent a lot of time on a blogging platform called Tumblr. On Tumblr, the LGBT community is particularly active. People share their personal experiences, as well as thoughts and opinions on sexuality as it relates to society, culture and politics. At the time I was discovering this content, I was young, impressionable and curious. Discussions about inequality, sexism and homophobia were a cause for me to be passionate about. Of course, in many places around the world people of non-traditional expression and sexual orientation aren’t considered equal, which ought to be discussed. However, rather than encouraging change and communication, many of the activist blogs I frequented on Tumblr encouraged a victim role. It was not unusual to see posts demonising people who identified as heterosexual or cisgender. In these communities on Tumblr, respect was earned not by showing strength, but rather by demonstrating the highest degree of victimhood. This means that the person with the most complex, unique and marginalised identity has the most authority — the unspoken rule was that someone who has not had the ‘lived experience’ could never understand, and could never have a useful word to say about an issue. Looking up to others in this community, I felt very tempted to immerse myself in these alternative identities. Besides, not identifying as heterosexual, I already felt like I fit in. It was a small effort to delve deeper.

As a teen, I struggled with identity and often found it hard to express myself. On Tumblr, the biggest discussions around self-expression usually centred around gender. This is how I became interested in dressing androgynously and rejecting traditional femininity. There were countless blogs of young people, mostly biological females, with boyish haircuts, wearing masculine clothes and asking to be addressed with gender neutral or masculine pronouns. Many spoke at length about their dislike of stereotypical femininity, their perception of heterosexual relationship and their discomfort with their female bodies. This struck a chord with me. As a young girl, at many points in my life, stereotypes and expectations felt forced upon me because of my being female: my family often asked me if I had a boyfriend yet, when I would finally grow out my hair beyond my shoulders, how many kids I wanted. These pressures made me insecure, partly because I didn’t want to fulfill some of these expectations, and partly because I was worried I wouldn’t be able to. I saw the experiences of non-binary, genderqueer and transgender-identified people on Tumblr as an escape from these pressures of traditional femininity.

However, none of this explains why I considered something so drastic as hormone treatment to change my feminine features. A much-used term on these gender-related blogs on Tumblr was gender dysphoria. Many people on the blogs I frequented described feeling trapped in their body and uncomfortable in their skin; they described being unhappy with their breasts and their hips, and feeling unattractive. On these blogs, these feelings were considered symptoms of gender dysphoria, and a sure sign that transitioning to the opposite sex with the help of hormone treatment and invasive surgery was the right course of action. At no point were negative side effects of these procedures discussed, nor was the possibility considered that these feelings might not be related to gender in the first place. At this age, there was much I disliked about my body, and combined with my need to reject traditional femininity, it seemed logical that gender dysphoria was the explanation for these feelings. I was convinced: I now had a way to experiment with self-expression and reject stereotypical femininity with masculine haircuts and clothing, and the term gender dysphoria to explain my bodily insecurities. After this, it wasn’t difficult for me to convince myself that transitioning was the key to happiness and security.

For me, the road to wanting to transition was a slow one. Initially, I simply enjoyed experimenting with more androgynous fashion and hairstyles. But over time, gender became an obsession. Relevant to my experience is the rest of my life at this time. My family had recently moved from the Netherlands to Scotland, where I started a new high school. At 15 years old, this was a very big shift for me and I struggled to make friends during my first year at school. On top of this, about a year after moving, my parents divorced. Perhaps as a cry for attention, an act of rebellion, or simply as a distraction, I became obsessed with all things gender identity. Everything around me reminded me of the biological and societal differences between the sexes. I became obsessed with hormone treatment and surgery, with disguising the feminine parts of my body and with ways to disassociate myself from femininity in all manners of expression. I was convinced that when I finally transitioned, and had the acceptance of my friends and family, I would be happy.

But every step I took — cutting my hair, wearing men’s clothes, adopting ‘masculine’ mannerisms — only made my insecurities worse. I felt like I didn’t fit in, I felt unattractive, and I felt like I would never be happy being in the body I was in, even more so than before I began presenting as male. I felt entirely dependent on outside validation that I came across as masculine —validation I didn’t often receive. For a while, I didn’t talk to my family about these feelings. But at some point, I felt so unhappy that I decided to talk to my mum about my wish to transition. I didn’t have to bring it up, but one day when I was in a particularly gloomy mood, my mum asked me directly if I wanted to be a boy. She’d noticed that I’d started wearing masculine clothes, cut my hair shorter and shorter, and had put the puzzle pieces together. That question allowed me to share the thoughts and feelings I had about gender and my body. During this conversation, my mum mostly allowed me to talk without interrupting, until I brought up the topic of transitioning.

I don’t believe I ever fully intended to transition; when I talked to my mum about hormone treatment, I had already decided I would start it only after finishing high school, so I would be able to start my ‘new life’ at university. I could tell my mum was hesitant: she expressed that she wasn’t convinced that hormone treatment was the right course, and she was very happy to hear that I wanted to wait a couple of years before starting treatment. Still, though, my mum was very understanding, and clearly wanted to fix my unhappiness as best she could. That reaction helped me step outside of my own head a little: it helped me realise the gravity of the decision I wanted to make. However, I was less receptive to my mum’s admission that it would be difficult for her to think of me as anything other than a daughter. I understand this now, and I am sure many parents here feel the same. At the time, though, this wasn’t something I wanted to hear: it made me feel pressured to fit an image my mum had of me.

We reached a compromise, though: my mum agreed to contact a gender therapist for me. We had one visit with this therapist — who didn’t push treatment, but simply wanted to look further into ways of self-expression without the constraint of labels — but when trying to book a follow-up appointment, we never heard back. My mum only received a response to her emails a few months later because of an issue with the therapist’s e-mail, and by this time I was no longer interested in transition. I wonder from time to time if I would have gone through with transition had I had more appointments with this gender therapist. It’s a scary thought, since I no longer have any desire to be male. However, I do feel like the appointment was helpful. It made me feel valid, but at the same time, it made the situation feel very real all of a sudden. It helped me to see how big of a change transitioning would be, and perhaps this was ultimately the first push for me to grow out of this phase.

Altogether, I identified as genderqueer and later as transgender for only about six months. I don’t remember exactly what led me to grow out of these feelings of gender dysphoria, but I think the most vital step was settling in at school. Making more friends and finding other ways to express myself, as well as feeling more at ease socially helped build my confidence. Around this time, I also started exercising, and this was a great way to relieve stress and learn to feel more at home in my body. By the time my fifth year of high school rolled around, I was too busy with friends, crushes and university applications to think much about gender.

Throughout all of this, my relationship with my parents was vital. My parents never rejected me — they expressed at times they didn’t agree with my self-diagnosis, but at no point did they make my insecurities feel invalid. My dad in particular was open to however I chose to express myself, and encouraged me to experiment. He complimented me on both my feminine and masculine clothes. He even took me to a male barber to get a haircut. I didn’t experience this affirmation as encouragement to transition; rather, it boosted my confidence and showed me my relationship with my dad wasn’t dependent on how I expressed myself. Both my parents made it clear that things like the way I dressed, the way I labeled myself, or who I loved would never make them reject me. Knowing I had their support and trust made it easier for me to return that trust, and kept me from feeling a need to rebel.

Now, I know how difficult the whole ordeal was for them, and I feel some guilt for worrying them as much as I did. The topic of gender doesn’t come up a lot in conversation: I feel too embarrassed to bring it up, even though I know my parents don’t think any less of me for it — though my family doesn’t shy back from making fun of my haircuts. At the time though, they took me seriously, for which I am very grateful. It allowed me to grow out of this phase of my life without need for intervention and before taking any drastic measures.

My view on these gender-related issues has changed gradually over the past few years. I see this sudden gender dysphoria that some teenagers express as symptomatic of other problems, rather than as a problem on its own. I interpreted my insecurity as gender dysphoria and my dislike of stereotypical femininity as a wish to be male. Frustrated with my situation — feeling alone at a new school, feeling insecure about my body, having to deal with my parents’ divorce — gender became an obsession. It functioned as an escape and as a problem to fix. I convinced myself that everything in my life would improve if I transitioned. I believe this might be the case for other young people claiming to experience gender dysphoria: obsession with gender serves as a way to avoid dealing with more complex, underlying issues with confidence, identity and security. These need to be dealt with first, before transition can even be considered. I also believe that the sudden increase in cases of gender-confused teens can be explained in part by the internet. I was introduced to these concepts of gender identity through the internet. It is also very easy to find people online that will affirm your feelings and encourage you to transition, even though these people are not nearly familiar enough with your real life to make these judgements. Validation is easily found online, which is why some teens might withdraw there to avoid confrontation instead of talking to family and friends in real life.

Despite my scepticism towards claims of gender dysphoria from teenagers, I would still urge parents of teens going through this to act with empathy before anything else. I don’t believe many teens would act this way on purpose, or to be manipulative: for me, it wasn’t in any way enjoyable to constantly deal with these obsessive thoughts and insecurities. For that reason, I would encourage parents not to view this as an act of rebellion from your child, but rather as a cry for help. What was by far the most helpful for me was knowing that my parents’ love for me was not lessened by how I chose to express myself, and that all their scepticism came from a place of concern. I also believe it is important not to reject your child outright, and to trust them to figure things out in their own time. Allow them to experiment with their fashion and hairstyle, and allow them to try out a different way to express their identity. Many children and young teens expressing gender dysphoria at some point in life later find they are gay, or that they simply feel more comfortable dressing like the opposite sex. If this turns out to be the case for your child, it is important that you support them — your acceptance will likely mean a lot to your child. Remember that for your child to share these thoughts and insecurities about their identity and body in the first place shows they trust you and are willing to talk, and this trust is something to be treasured.

by Carey Callahan

Carey Callahan is a family therapist, writer, and organizer advocating for responsible healthcare for gender dysphoria. You can find her writing at medium.com/mariacatt42 (where this piece was first published), and she tweets at @catt_bear.

This piece is an intro to a series Carey will be writing in the coming weeks.

One of the sadder parts of being detransitioned and public about it is that the parents find you. They’ve been told by a doctor or a social worker that the only route forward that protects against suicidality is to affirm their kid’s trans identity. That they need to be open to the possibility their kid may need their pubertal process disrupted, may need to begin what could within a couple of years turn into a life time commitment to cross sex hormones, and could need surgeries to socially function. They’ve been told asking questions about the impact of their kid’s peer group, internet use, drug use, co-morbid diagnoses, internalization of sexism, or family dynamics is transphobia. They’ve been told, no matter what their authentic emotions are, to celebrate their child’s transition.

I’m in the novel position of being both a detransitioned lady and a family therapist. I am not, and probably never will be, your family therapist. At this point in time I won’t work with families with a gender dysphoric young person because I’m scared of the risk to my license. In the past few months activists have filed complaints to the licensing boards of two therapists I’m connected with, both of whom have been public in their defense of the research into Rapid Onset Gender Dysphoria. To trans activists, promoting and enforcing “affirmative care” as the sole available clinical response to youth gender dysphoria (“GD” for the rest of this essay) is a battle so righteous that the ends justify the means. Those means include punishing mental health professionals by threatening their livelihoods, calling DHS on non-compliant parents, slandering youth GD researchers whose research documents majority youth desistance, harassing researchers whose research suggests the existence of a new cohort of youth GD diagnoses that may have vastly different outcomes than previous cohorts, or slandering and harassing even the reporters who acknowledge these events are happening. There is a group of activists within the trans community who truly believe that doubts about a child’s ability to understand and consent to the long term consequences of medical interventions whose long term consequences are a matter of intense controversy among adult patients can only be motivated by transphobia.

Pediatric transition has always been a troublesome topic for me. My efforts to advocate for resources and training for detransition mental healthcare have consistently put me in positions where I have to pick a side about pediatric transition. My choices have been: critique pediatric transition, be labeled a transphobe and be cut off from opportunities within the trans healthcare community to build an infrastructure for supporting detransitioners OR focus only on detransition care, and endorse pediatric transition.

Carey Callahan

At the end of the day, if I had a kid, they’d have to wait till they were 18 to get themselves on hormones and pursue surgeries, so I don’t feel right recommending parents do anything different. It’s not that I don’t believe I could have a kid who, in order to have a good life, truly did need to move through life in a gender role I didn’t expect. I know trans adults like that, and their medical transitions reduced their GD to such a level that they could function well, with loving partners and meaningful work. But my doubts about the ethics of pediatric transition are not based on assuming a trans kid’s identity isn’t going to be stable and long-lasting. (Although it’s worth remembering in 2009 hardly anyone had heard the word “nonbinary,” so I don’t think we can even can speculate about the gender schemas that will be popular in 2029.)

My insistence that any kid I raise be a legal adult before making these choices is based on knowing trans adults who have been surprised by the challenges of their long term healthcare. I am not going to create a situation where my kid is 25 and gets to blame their mom for pain when they orgasm, fusion of their uterus and cervix, reduced mitochondrial function, or straight up never having an orgasm. No way am I running the risk of allowing my kid to halt their puberty with Lupron shots and create a future spending big bucks at the dentist, rheumatologist, and endocrinologist. I didn’t have steady health insurance till my mid-thirties, so I don’t have faith that if my kid had chronic symptoms like the people in the Lupron Survivors Facebook group do that they’d be able to access specialists without sliding into inescapable medical debt.

Once I told a prominent psychiatrist and affirmative care researcher that there’s no way I would let a teen take testosterone because there’s a high likelihood they’d end up needing a hysterectomy in their twenties. After a hysterectomy you are dependent on HRT for your lifetime and need to prioritize having health insurance both for the HRT and the complications following the hysterectomy. It’s normal for Americans, especially in their twenties and thirties, to have long stretches of time where they can’t afford to see a doctor. The psychiatrist, appearing deeply perplexed, replied (this is a paraphrase), “But you can’t make decisions about your identity based on fears you won’t be able to access healthcare.”

The trans community is pretty clear you don’t need to take testosterone to identify as a trans man. Thus, testosterone isn’t actually a choice about your identity, it’s a choice about body modification, and yes you can absolutely choose to avoid body modifications that create risks to your health you fear you may not be able to manage. But if a Harvard educated psychiatrist can’t keep that distinction clear, can a teenager? Do the teenagers in your life know about co-pays, or how to get a referral to a specialist, or what COBRA is? I’ve had a fair amount of the letters of the LGBT alphabet soup confidently explained to me by teenagers, but I’ve never met a teen who knew how to apply for Medicaid benefits.

All this to say, if you are suspicious of the increased prevalence of youth GD referrals and the righteousness of activists who believe minors know what they’re getting into when they medically transition, I’m there with you. But if parenting teens were just about creating sane rules and explaining how the world works, teen boys could be trusted to shower regularly, teen girls could be trusted to use school bathrooms without putting fights on Snapchat, and Smirnoff Ice would have a significantly smaller market share.

The reality is that in many states on your teen’s 18th birthday they can walk into a Planned Parenthood and have the first of the two appointments it will take for them to get HRT. You have the power (although only if you and your coparent are on the same page) to keep your kid from initiating medical transition until that day. That day will roll around quicker than you think.

What this means is that cultivating a positive relationship in which you have credibility and influence with that person you made is paramount. From my work as a family therapist I can tell you being able to do that, when that person is in their teens and twenties, is a spiritual triumph. Young people’s psyches are built for separation, independence, and risk taking. But you, passionately loving parent, with the privilege of both your life experience, and fully formed pre-frontal cortex (boy howdy I’m hoping you can fully access all that emotion regulation) are gonna love that kid into some wise choices.

How do you do this?

The short answer is:

1. An unconditionally loving relationship demonstrated by you giving them feedback that is intentionally overwhelmingly positive
2. and lots of offering them your reflective listening skills;
3. bounded by clear and explicit, age appropriate boundaries
4. which are backed up by logical and consistent consequences.

Doesn’t strike you as that short of an answer, does it? But in actuality that answer above is the recipe for every successful relationship- kids, spouses, friends, coworkers. Having children hit puberty is a fantastic way to find out all your weird personal myths about how relationships should go and how exactly they do not work.

Here’s the basics of any human relationship: People love to be liked. People love to be understood and most people love to talk about themselves. People are most relaxed when rules, roles, and boundaries are clear, and people love to be relaxed. People absolutely don’t love logical consequences for their behavior. But the least painful way to learn about the process of considering logical consequences is from navigating logical and consistent consequences doled out by your parents.

Over the next two months I’ll dive into those 4 components of building a positive relationship with your kid, and how your kid’s gender dysphoria and trans identification interact with these components. I am NOT saying you can detrans your kid. I am absolutely saying that if you build a positive relationship with your kid, you can be both a valuable sounding board and a source of information for them. I know from my own experience the sources of information and the sounding boards (i.e. gender therapists and online community) available to gender dysphoric people who are discerning their medical choices tend to put forth a very rosy view of medical transition.

If you’re a parent, and you’re feeling desperate, the very best thing you can do before this series gets going is to get SERIOUS about your self-care. Having a child begin a clearly inappropriate medical transition is a specific level of hell, and I would never want to minimize how bad that situation sucks for parents. But in the midst of that hell you need to bring your parenting A game. You have to take up running, yoga, meditation, prayer, Xanax- whatever can chill out your emotional lizard brain so that you can access your logical, strategic, patient pre-frontal cortex. If you’re not giving an hour each day to chilling yourself out, you won’t be able to stay non-reactive when that baby you nursed tells you they’ve got a surgery date. An hour of self-care is the minimum, and I don’t want to get any emails from you if you wrote them before 2 hours.

Check back in about a week for Part 1, the deep dive into positive feedback for your endlessly confusing child.

For preventing the biological sex of children [aka penis-babies and vagina-babies] in American households, from being a burthen on their exploration of gender identity, and thereby benefitting the publick.

by Aubee Djinn, MD

In the 1720’s, Ireland was suffering under a disastrous famine.  Jonathan Swift, Anglo-Irish author, was horrified at how British politics unfairly exacerbated the suffering of the Irish.  Having made several unsuccessful appeals to Parliament to enact policies to relieve the famine, he turned to writing.  “A Modest Proposal” called attention to a social ill by proposing an outrageous solution: eating Irish children.

Aubee Djinn (a pseudonym) is an American OB-GYN amazed at how social trends are obscuring scientific fact. With a nod to Jonathan Swift’s 1729 essay, this contemporary social ill is met with an equally outrageous Modest Proposal.

It is a melancholy object to those, who walk through our great hospitals, or travel in their maternity wards, when they see the hallways, the corridors, and the newborn nurseries crowded with infants whose differentiated genitalia are at odds with their undifferentiated gender identity.  These infants instead of being allowed to naturally discover their gender identity as they mature, are forced to endure the suggestions of their parts and pieces, and of the external socializations that follow.

It is common knowledge that gender identity is separate from biological sex, yet the correlation of anatomy and identity is unfortunately strong enough to imply effect to the unenlightened mind.  Infants attached to penises usually become men, and those with vaginae usually become women.  However, any good scientist knows that correlation does not equal causation.  If a parent is likewise woke, they will know that genitalia are not predictive of gender.  In the absence of social constructs and family influence, penis-babies would be just as likely to discover they are girls as boys, and vagina-babies can likewise grow up to be men or women.  However, when parents are not enlightened, they will assume that sex predicts gender identity, and risk irreversible damage to their offspring.

Witness the homunculus with neither penis nor vagina, and yet both simultaneously, that almost universally develops one or the other. As with embryology, gender identity is undifferentiated at creation, and takes form later in life.  It is inconvenient that despite their variety of shapes and dimensions, genitalia lend themselves to neat dichotomous categories that the uninformed parent will naïvely extrapolate to the gender of their child.  It is even more inconvenient that gravid women are told of these fetal bits during a sonographic exam at mid-gestation, and use the information to inform absurd celebrations of the implied gender of their fetus.  Cupcakes, balloons, confetti, even an empty ale-can filled with colored powder and placed on a fence post for a musket ball … all of these rituals are celebrating the revelation of a child’s gender identity, when only its genitalia are known. Therein lies the rub.

Society is burdened by the downstream effects of such confusion. Parents impose social constructs upon their offspring based upon their genitalia, and allow stereotypes and misunderstandings to hamper their children’s natural development.  Children see and even touch their genitalia and will naturally wonder what their genitalia means.  They struggle to understand themselves in the context of this biology and the associated social construct.  This explains the phlegmatic and bilious humour of today’s youth.  It contributes to their melancholy, lethargy, and isolation, and is evidenced by high rates of substance abuse and, indeed, of suicide.

Our impaired youth are a scourge on society and threaten our future as a productive member of the global community.  As a good and just society (which we have never been and yet strive to be), we should endeavor to abolish the horrific consequences of biological sex biasing the pure development of gender identity

But my intention is very far from being confined to provide only for the children of unenlightened parents: it is of a much greater extent, and shall take in the whole number of infants born in our country.  Since all children are born with undiscovered gender identity, then they should be permitted to develop without the influence of biologic sex.  Other members of society are encouraged to change their appearance to match their gender identity, so I know no reason why infants should not be accorded the same basic human right.  Since their gender identity is undetermined, so then should be their apparent biology.

My modest proposal is that all infants be unburdened of the external ornaments of their biologic sex, so that their gender identity may develop without the influence of parental expectations or societal norms.  The first step is the outlawing of ultrasound to visualize the fetal bits, far less to hazard a guess at the gender (this has worked well in China and India).  In the delivery room, this will necessitate the immediate but temporary separation of mother and child so that the mother remains unaware of whether she has birthed a penis-baby or a vagina-baby.  Fortunately, the existing medicalization of childbirth should make this separation basically unnoticeable to the modern parturient.

For penis-babies, all the genitalia are external, and will be removed by phallectomy, scrotectomy, and orchiectomy.  Urination will be by a urethral meatus remaining on the perineum.  Some may argue against the expense of two million such operations per annum, but my calculations confirm that these costs will be offset by savings from the absence of circumcisions and also by the elimination of urinals from all elementary school restrooms.

For vagina-babies, the vaginal orifice may be narrowed by creating a smooth covering of skin, created by cutting and appositioning the labia minora and labia majora, and by clitorectomy.  Sadly, American surgeons are not properly trained to perform such a complicated surgery, especially on an hours-old newborn.  Fortunately, there are many expert surgeons in Africa and the Middle East, where these procedures are frequently performed.  In the West, these surgeries are known as Class 3 genital mutilations and they are currently banned for their cruelty.  Foreign surgeons would be glad for the opportunity to come to the West and rebrand their skills as gender-identity-neutralization surgeries, simultaneously reeducating our medical community and earning a handsome living.

Newborn ovaries and corpus uteri may be left in situ through childhood because in their quiescence they are irrelevant and invisible both to the individual and to society and would not influence exploration of gender identity, and also because they will be needed for the continuation of the species.  Of course, by the age of 10 or 11, all children will need to decide on a gender identity, start on estrogen or testosterone, and embark on a gender-creation surgery, including choice of mastectomy or augmentation, phalloplasty, hysterectomy, or neovagina creation.  After a genderless childhood, the choice of a gendered adolescence and adulthood will be a cause for celebration, in line with other coming of age ceremonies like bar/bat-mitzvahs or quinceañeras. In the event a child chooses no gender at all, they would have a smorgasbord of available medical options ranging from a clean perineum to, perhaps, both a penis and a vagina.

Unfortunately, some of these surgeries (especially the phalloplasty) do not currently yield the best results, neither cosmetic nor functional.  In the event that we have not discovered how to manufacture sperm out of whole cloth by then, we will need to remember to keep our sperm vaults properly powered and staffed, lest the electricity fail and our species go extinct.  It is my humble hope that by the time today’s newborns reach the age of decision, our scientific and surgical talents will be the equal of our enlightened minds.  Even better, by then we will have perfected the uterus transplant and will enjoy a large supply of unwanted natal uteri to transplant into transwomen who desire to breed.  Of course, this also requires that the fetus be exposed to anti-rejection medication and be delivered by cesarean section, and that the parturient eventually have the uterus removed once breeding is complete, but these are small sacrifices compared to the benefits of experiencing the full potential of one’s chosen gender identity.

For those readers who remain unconvinced, I offer some additional benefits for their consideration.  Firstly, our society is plagued by masculine toxicity, presumably mediated by testosterone.  Since all penis-babies will be castrati, the only testosterone in our society will be distributed by pharmacies.  Therefore, we will have the opportunity to titrate the dosage of testosterone to prevent toxic masculinity.  No more rape-culture.  No more me-too. No more manspreading on the subway.

Secondly, we will no longer be confused by pronouns.  Children in their first decade will be ungendered and will all be referred to as they/them/theirs.  By the end of adolescence, every individual will have chosen their gender, and will have had bespoke chemical and surgical treatments so that their external appearances exactly match their gender identities.  Third parties will not have to wonder whether the biological sex matches gender-identity, and won’t have to ask what pronouns to use.  Gender identity is laid bare for all to see!

Thirdly, we will no longer be plagued by sexism.  Because all women will have chosen to be women with full knowledge of what it means to fully be a woman, they should not resent any lack of opportunity, pay disparity, or what not.

Lastly, this modest proposal is only a beginning.  Once we successfully sever biology from gender, we will have made the first big step towards a wondrous post-biological human existence where anybody can be anyone, and we are all equal in the eyes of our Creator and in the eyes of each other.  There will be no reason to argue, struggle, and fight for our natural rights and deserved equalities … what the Creator has not provided, science will.  A Brave New World awaits us!

I Profess in the sincerity of my Heart that I have not the least personal Interest in endeavouring to promote this necessary Work having no other Motive than the publick Good of my Country, providing for Infants, and curing gender dysphoria. I have no Children who might be directly affected by this proposal; the youngest being fifteen Years old, and my Wife past Child-bearing.

“A Modest Proposal,” by Jonathan Swift

On December 11, 2019, the 4thWaveNow Twitter account was disabled. That morning, we received an email from Twitter, claiming we had engaged in “hateful conduct” with this tweet:

Presumably, the “hateful conduct” was our use of the term “natal male” in the tweet’s concluding clause. In its Rules and Policies document, Twitter says a tweet that engages in “hateful conduct” will “promote violence against, directly attack or threaten” someone on the basis of their identity.

Did this tweet engage in hateful conduct?

Let’s let the founder’s daughter speak for herself, shall we? She belongs to a population of young lesbians who once believed they were trans—a population Katy neither advocates for (yes, we do) nor understands from personal experience, being a natal male.

The now-unavailable tweet also included a link to an article by the daughter of 4thWaveNow founder—a 22-year-old lesbian and cofounder of the Pique Resilience Project—wherein she describes her former trans-identification and subsequent desistance.

We appealed the false claim that the term “natal male” is “hateful” (more on that terminology shortly). Our appeal was immediately denied, and two subsequent appeals have been thus far ignored. Our only option appears to be deleting the tweet to end our total account lockout. Right now, this is what Twitter users see where the tweet originally appeared.

But the plot quickly thickened. On the day our account was frozen, the journalist Jesse Singal wrote an email to the Twitter press office, inquiring whether mention of biological [in this case, “natal”] sex was now against the Twitter rules. Singal expressed concern that such suspensions might affect his own work.

Singal received an email response from Twitter employee “Liz” which he posted on his Twitter feed. Liz couldn’t have been more unequivocal in her mea culpa on Twitter’s behalf:

“This was our mistake and shouldn’t have been actioned….We work quickly to make [it] right.”

Case closed? Evidently not.

It has now been 6 days since the lockout, with no responses to our appeals, no unfreezing of the account, no emails from Twitter…nuttin’. Since “working quickly” is highly unlikely to mean almost a week (especially given the use of past tense in Liz’s email), we can only surmise that the Twitter representative–clearly someone with significant authority–either lied to prominent journalist Jesse Singal (to what end, exactly?), or something else happened behind the scenes that caused “the team” to ignore Liz’s very clear admission of fault on Twitter’s behalf.

Our only option continues to be deleting the tweet (and taking an undeserved “strike” against our account–something we’ve not had in five years of tweets), but given Twitter’s self-admitted “mistake that should never have been actioned”—why should we delete it?

Since it’s unlikely Twitter suspended the 4thWaveNow Twitter account for anything other than referring to birth sex, let’s look a little closer at the term “natal male” and whether (and how) it should be interpreted as “hateful conduct.” This is of particular interest, since the very next morning after our account was frozen, another report against us turned up in our email—this time for using the term “natal boys.” But this time, Twitter rightly concluded the tweet broke no rules.

Putting aside the obvious inconsistency in Twitter’s “hateful conduct” policy, “natal male” is not, in fact, “misgendering,” a Twitter policy we are well aware of:

How does using the term “natal” in reference to birth sex “dehumanize, degrade or reinforce negative or harmful stereotypes”? The Diagnostic and Statistical Manual (DSM), version 5 (DSM-5) uses the term at least six times in its latest rendition—including in its definition of “transgender:”

The DSM-5 defines “gender assignment” thusly:

And it’s not just the DSM-5: Natal [sex or gender] is a term used by many trans-supportive sources, websites, and scientific studies. It’s a standard term often used as a synonym for “assigned sex at birth” or AMAB/AFAB.

Be that as it may, whoever(s) reported our tweet clearly thought the term “natal male” was offensive. Fair enough: They could have (instead of tattling to the Twitter Thought Police) engaged an argument here, and there are at least two we’ve seen routinely before: (a) a trans woman has always been female, and/or (b) just because someone was “assigned” male at birth doesn’t mean they don’t understand the experience of lesbians born female [leading us back to (a)].

Mature adults who approach matters in good faith engage in discussion, usually hoping their conversation partner can, at the very least, see their point of view (if not agree with it). But that’s not what people who tattle to Big Tech censors do. Instead—like the authoritarians they are—they try to shut down those who don’t conform 100% to their point of view.

Mass reporting, gaming the Twitter terms of service, playing “gotcha” on Twitter—what, exactly, do the trans-activist scolds think they have achieved? When, in fact, has the suppression of dialogue resulted in changing anyone’s mind?

If “natal male” is a term of offense, can it be long before the term “transgender” itself is verboten? Because “trans” or “transgender” explicitly refers to transitioning from one state to another state. Why allow the term at all, since it points to the inconvenient truth that a person was at one time something different?

Perhaps that is the end game: Make any and all terminology that would differentiate a trans person from a “cis” person unsayable (oddly, “cis” is not on the Twitter Thought Police list of bannable Crime-Words, given that many of us take offense at it), and you’ve achieved at least one Orwellian goal:

“It’s a beautiful thing, the destruction of words.”—George Orwell, 1984

The key point here is of greater import than one Twitter account (of many) being muzzled by this absurd but ominous censorship. The real issue is the chilling of everyone‘s discourse, the right to be exposed to many varied opinions on (like it or not) the social media platform most used by those with power to influence policy and public opinion.

To stay afloat on the platform, we are forced to write and converse with each other in coded, sanitized language; to paraphrase and obfuscate meanings. Orwell’s Big Brother couldn’t have thought of a better medium to control the masses.

When you silence someone by misusing the (already censorious) policies of one of the most powerful social-media companies in the world, you’ve tainted thought itself.

“But if thought corrupts language, language can also corrupt thought.” — George Orwell, 1984

Is it any wonder so many people now question the motives and tactics behind (what many of us originally thought was) the Next Civil Rights movement–a movement we started off supporting?

Stay tuned for updates.

Last week, we wrote about Twitter’s lockdown of our account for use of the scientific term “natal male.”

We filed a complaint with the Northern California Better Business Bureau. That complaint was today rejected, with Twitter [in its boilerplate response] doubling down on its defamatory claim that we engaged in “hateful conduct,” specifically: threatening, directly attacking, and promoting violence.

If we continue in this “abusive behavior,” so sayeth our Twitter Overlord-bot, we are risking our account.

Once again, below is the tweet Twitter claims to be “abusive behavior,” worthy of the potential forfeiture of over 13,000 followers (including many prominent journalists, politicians, and others who wield political and public opinion influence) and five years of substantive information shared with the public.

Were we surprised by Twitter’s automated response? Of course not; it’s par for the course in the current zeitgeist, where totalitarian-minded scolds running the most influential social media platform in the world believe it is their solemn duty to serve as Reeducation Nannies for the teeming masses.

In the two weeks since our lockout, other thought criminals have also been Twitter-jailed or perma-banned for their “abusive behavior” (otherwise known as telling truths certain trans-activist tattletales don’t want you to know). Fellow inmates include reasonable trans people like MarsBruh, a trans man who goes out of his way in his interview series to feature diverse viewpoints, and detransitioned lesbian activist and Youtuber gnc_centric, who as of this writing has also filed a BBB complaint--to no avail–to reverse her permanent suspension from Twitter.

There have been many more before us, and there will undoubtedly be more to come who’ll be ejected from the 21st century public square and condemned to Big Tech thought-crime prisons.

Nevertheless, despite our cynicism, we believe it’s important to keep telling our truth, and that now includes rejecting Twitter’s libelous edict:

Since our previous post on the matter, our Twitter lockout has been written up in a very good article by Libby Emmons in the Canadian Post Millennial, and the journalist Jesse Singal confirmed via Twitter that “simply describing what being trans is could lead to you losing your account.”

And as everyone not living in a cave now knows, just a few days ago beloved author of the Harry Potter series, JK Rowling, has come under international fire (including ridiculous propaganda pieces in major US outlets such as NBC, CNN, and the onetime paper-of-record) for tweeting her views about biological sex in regard to the recent UK court case against Maya Forstater.

The 4th_WaveNow Twitter account is fairly well known, but is puny by Twitter standards. Banning JK Rowling (and others with 1M or more followers) from the public square for her past or future thought crimes might be a bridge too far–but for how long?

Maybe Rowling and other celebrities with adequate financial wherewithal and intestinal fortitude should put their heads together and try pushing that biological (aka “natal”) sex envelope a wee bit further on Twitter.

Just a thought. You know, just to see what might happen…

by Benji, gnc_centric

 Benji/gnc_centric—in the words of her now-suspended Twitter profile—is a “socially detransitioned dysphoric female,” a “homoSEXUal not homoGENDERal” lesbian.  Benji, a Canadian activist, writer, and YouTuber, writes here about how she was recently suspended from Twitter and subsequently Medium for (she believes) referring to the biological sex of a certain UK trans woman. Benji joins many other women whose voices have been censored by Silicon Valley tech companies. (4thWaveNow is also currently under a Twitter lockdown for similar reasons.)

Despite being silenced on some platforms, Benji is still very much active on the Internet. See the bottom of this article for ways to contact her and to see her work.

 4thWaveNow is pleased to host the below article, originally published in a slightly different form on Benji’s now-suspended Medium account.

Benji wrote another piece for 4thWaveNow earlier this year, about her less-than-supportive experiences in a Toronto trans-teen support group.

We will continue to offer 4thWaveNow as a platform for others who find themselves in a similar situation; please let us know if you would like to be published here.

 My Twitter Suspension

On the morning of December 11th, I was tweeting away as usual when at 11:40am, I tried to reply to a tweet and this is what I saw:

I went to check my account and saw this:

I had just recently reached 4000 followers so I was very upset. I checked the hashtags where I posted most, #TransTheGayAway #DiscussingDysphoria #Detrans and #QueerRapeCulture and all my tweets have been erased from Twitter.

I was confused, so I checked my email to see what offence I had committed and found this:

I can only assume that this happened because I referred to a trans woman, Katy Montgomerie, as a male. If she wasn’t a male, she wouldn’t have dysphoria and wouldn’t have anywhere to transition from; the whole concept of “Male to Female”. I struggle to see how this tweet is “hateful”.

Context

On December 7th, 4th Wave Now tweeted a thread about an affirmation-only parent support group on Facebook, specifically about a thread in that group that had developed on the topic of families with multiple trans children.

Katy Montgomerie replied in the thread, claiming that families with multiple trans kids are statistically likely and nothing to be concerned about. Katy then went on to say that the parents who run 4th Wave Now are anti trans; desperate not to have trans kids. The reality is, that the daughter of one of the founders of 4th Wave Now is a 22 year old, detransitioned lesbian.

The tweet that is missing from this thread is here:

This tweet is not visible because it violates Twitter’s rules, as “hateful conduct” for a similar reason to mine; referring to a Katy, a trans woman, as a “natal male”. 4thWaveNow explains their current situation here and here.

Here’s where I responded to Katy, after being tagged into the thread by 4thWaveNow, the missing tweet is the one I was suspended for because it was ruled “hateful.”

The missing tweet is at the top of this article but I’ll put the text here so you don’t have to scroll up. I tweeted:

“This is nonsense. Where are you getting this? A 4000% increase in females transitioning in the UK isn’t just because ~acceptance~. You presume to know the female motivators for transition when you are in fact male. What do you base this on?”

Here’s one source for the 4,400% increase in female minors in the UK being referred for transition that I was referencing

On Twitter, Katy says she has detrans friends and wants to help detrans people, but I’ve only ever seen her dismissing detransition as so rare that it’s not relevant enough to merit a change in the way transition is prescribed. She says she is a friend to detrans people but attacks one of the few websites –4thWaveNow– that will amplify our writing about our experiences. She says she supports detrans people but calls any resource we use “anti-trans”. Obviously, she has her own ideology to propagate and this is her method. I would advise detransitioned people to steer clear of her on Twitter and Medium.

Appeals

As soon as I understood that I had been suspended, I appealed to Twitter. Predictably, they said they were looking into it but (initially) did not respond beyond that. I don’t have much faith in Twitter or their review process, so on December 15th, I filed a complaint with the Better Business Bureau. I know a few women who’ve had their Twitter accounts suspended and were able to reverse this using the BBB, so I was cautiously optimistic.

This was my appeal to them:

I have been using twitter for many years, mostly for lesbian activism. A few days ago, my account @gnc_centric was indefinitely suspended for “hateful conduct” which is shocking because the tweet that is cited is not at all hateful. I believe that this is the result of targeted reporting by homophobes who do not like what I have to say. I appealed to Twitter but they have not explained why my tweet was hateful or why it rises to the level of an indefinite suspension. I am appealing to you because for me, Twitter is a powerful networking tool and I need it to stay in contact with journalists and other professionals, as part of my activism.

They immediately replied, saying that they were looking into it. On the morning of December 23rd, I awoke to find this response in my email.

It’s true I’ve been put in Twitter jail a few times. If I recall correctly, I’ve had my account locked twice, for 12h and had it locked once, for 7 days (thanks @AidanCTweets ). As you can imagine, I did not wish violence on anyone or say anything cruel or tweet with malicious intent. I would love to be able to go through how I “violated Twitter rules” each time, but I can’t access my old tweets now and I didn’t keep track of it as it happened.

This was my reply to this result:

I am rejecting this response because: if you were to review the history of all the times I’ve violated the twitter rules, you would see that the tweets in question were all just as innocuous as this one. I have never tweeted anything violent or hateful but because of mass reporting, I’ve had my account locked several times. I thought the BBB would see I’m not using the Twitter service in hateful or violent way and see the reality of the situation; those who oppose me will find ways to disrupt my use of Twitter, regardless of the reality that I’m not hateful or violent. Twitter is woefully unable to screen reported tweets and as a result this has happened to me repeatedly.

This was the response I received on December 24th:

I can’t believe the irony of this response. I would really, really, REALLY like to know, who experienced “targeted abuse” by me. Not to be too narcissistic, but am I not the one in this situation who is unable to “feel safe expressing diverse opinions and beliefs” on Twitter? I’ve had multiple short suspensions for expressing my beliefs, is that not “abusive behaviour” on the part of those who see me as a threat? “This includes behaviour that harasses, intimidates, or uses fear to silence someone else’s voice”. I can’t believe they sent ME this message, when I’m the one who has been continuously harassed and now, silenced on Twitter.

What makes me so angry is that extremist ideologues know this is how Twitter works, and they are meticulous in their reporting. Their goal is to get the most vocal women who question gender ideology off of the platform and they know exactly how to do it.

Medium Suspension

On December 25th (Merry Christmas!) I checked in to see what people on Twitter were saying about GNC Centric… and they were saying my Medium account (where this article was originally posted on December 23rd) had been suspended. I suspect that this happened because I mentioned Katy Montgomerie– and the fact that they were male–in my Medium piece.

I searched for my Medium on incognito and found this:

So I checked my email and found this:

Since Medium has very similar policies to Twitter, I will not bother attempting to appeal this suspension. When I was first suspended from Twitter, I planned to post much more on Medium; what I used to post as Twitter threads I would now format as short articles.

Since this is obviously now impossible, I’ve made alternate plans. For the time being, I will be guest posting on other sites like here on 4thWaveNow and Graham Linehan’s blog. I’m now in the process of building my own website (finally!) where I can’t be censored and I’m very much looking forward to that! I’m also going to start posting YouTube videos more regularly now.

In 4thWaveNow’s first article about their concurrent Twitter suspension, they have two quotes from Orwell’s 1984. They seem relevant as ever, so I’ll add them here as well.

“It’s a beautiful thing, the destruction of words.” — George Orwell, 1984

“But if thought corrupts language, language can also corrupt thought.” — George Orwell, 1984

Contact

Now that I’m no longer on Twitter (though I’m keeping an eye on what’s going on there ) I’m spending more time on other social media. The most direct way of contacting me now is through email.

Social Media
Email ► GncCentric@gmail.com
Tumblr ►https://gnc-centric.tumblr.com
Reddit ► https://www.reddit.com/user/GNC-centric
Spinster ► https://spinster.xyz/@GncCentric
YouTube ► https://www.youtube.com/c/gnc-centric

Fourth in our series featuring Dr. Curtis Crane, phalloplasty surgeon. Part 1 is here. Part 2 is here. Part 3 is here.

4thWaveNow contributor Worriedmom has practiced civil litigation for many years in federal and state courts.

by Worriedmom

These days, the world (or at least the media) certainly does not seem in short supply of telegenic, winsome, and appealing “transgender children.” One recent example is Jacob LeMay, pictured here, who as a nine-year old prompted Presidential candidate Elizabeth Warren to commit to seeking Jacob’s input and guidance on her choice for Secretary of Education.

This wasn’t Jacob’s first time in the spotlight, either. As a transgender five-year-old, Jacob’s story was featured on NBC Nightly News and the Today Show. Because at the age of four, sensitive to what they interpreted as gender distress on his part, Jacob’s parents offered “a number of choices,” one of which was whether to start life anew as a boy.

Jacob’s parents have been generous with their transgender parenting expertise, sharing insights with Harvard’s Graduate School of Education,  Good Morning America, New Hampshire Public Radio, “Here and Now” on Boston’s WBUR, and MSNBC, among others. Jacob’s mother, Mimi, has already written her memoir chronicling the family’s journey.

Some might find the idea of a memoir just a bit premature given that Jacob’s transgender journey is, at this point, only five years in duration, but honestly, you’d have to be a real meanie to object. Jacob is an undeniably cute kid, the entire family is good-looking, relatable, and well-educated, and they certainly seem to care a great deal about Jacob, as well as Jacob’s future well-being.

And while one might envision a series of memoirs, detailing Jacob’s life of fulfillment, it’s also entirely possible that this will be the first and only installment.

Even in the few short years since the “transgender child” became the media’s go-to story, several stars have skyrocketed to prominence, only to disappear. Remember Coy Mathis’ brave fight to use the little girls’ room at age six? No word on Coy’s doings since Coy was featured in a 2016 documentary film, “Growing Up Coy.” Similarly, Willa Naylor, the transgender eight year old and author whose sympathetic story motivated the entire country of Malta to change its laws, has been radio silent since 2016.

Even the most famous transgender child of them all, Jazz Jennings, whose entire life has been lived in the glare of the media spotlight, has in the past 18 months undergone no fewer than three grueling and painful surgeries, and has postponed matriculation at Harvard University, allegedly due to mental health issues, and at this point may well wish for just a little bit less of the world’s focus.

It may be that Jacob’s transgender story will, at some point, go dark. We may never know whether Jacob, who like the others has been frequently lauded as “brave” and “inspirational,” will have the happy ending that early childhood transition, we are told, is guaranteed to produce.

Stories are important, but unfinished stories can be deceptive. Before we can confidently predict that Jacob, and peers will live “happily ever after,” we should take a look at another story.

This story received no media attention. There are no soft-focus interviews, picture books, or product tie-ins. This is the story of M.

The only reason we know about M’s story at all is because M was one of at least nine former patients of Dr. Curtis Crane, late of San Francisco and currently of Austin, Texas, who filed medical malpractice or other personal injury cases against Dr. Crane. M’s case (CGC-17-560690) was, like the others, filed in the civil division of the San Francisco Superior Court under the pseudonym “John Doe.” (Note: Although M was repeatedly “doxxed” in the court records by the attorneys on all sides, we retain his privacy here, as we have no interest in shaming or causing further sadness to M [we use M’s preferred pronouns for the same reason].)

The court file reveals M’s journey to manhood, which, in his own words, entailed “many surgeries.” M’s transition journey is detailed below and all of the information is taken directly from the court file:

• According to his attestation, M’s efforts to become a man began in late 2003 with a “social transition.” According to medical records, M was born in 1977, which made him 26 years old at the commencement of the transformation process.
• In 2004, about six months after his social transition, M began treatment with male hormones.
• In 2005, M received a bilateral mastectomy.
• In 2006 M received a total abdominal hysterectomy with bilateral salpingo-oophorectomy (which meant that M’s uterus, cervix, fallopian tubes and ovaries were all surgically removed).
• In 2009, M received a metoidioplasty, an operation that uses tissue from the clitoris, which has typically been enlarged from testosterone use, to form a “neo-penis.” This operation was performed by the famous Dr. Miroslav Djordjević of Serbia, which was in the process of becoming an international hub of transgender surgery.

Alas, M’s gender journey was far from over.

• In 2011, M underwent his first phalloplasty or surgical construction of a penis, with Dr. Toby Meltzer. This operation was not planned to, and did not, include construction of a functioning urethra. (We note that Dr. Meltzer has also been widely panned by at least some of his SRS patients.) The tissue to form the neophallus in the 2011 surgery was apparently taken from M’s back, and left behind a “dog ear.” During the 2011 surgery with Dr. Meltzer, M also received a vaginectomy (surgical removal of the vagina) and a scrotoplasty (construction of an artificial scrotum).

After all of this, M continued to suffer from gender dysphoria. In 2014, M came under the care of Dr. Curtis Crane. The surgical consent form indicates that M was to receive:

The plan for this surgery was to remove the “old” phallus from 2011, and to re-construct a new one, this time with tissue from M’s left forearm (M underwent electrolysis and laser hair removal on the forearm area for six months prior to the surgery to prepare the skin for transplant). The new penis would have a functioning urethra. The lawsuit against Dr. Crane arose because, while M alleged that he repeatedly told Dr. Crane and his staff that he did not need a vaginectomy and a scrotoplasty, those having already been performed by Dr. Meltzer in 2011, M stated that Dr. Crane over-rode his instructions and both cut into the area where M’s vagina had previously been, and damaged and dis-placed M’s scrotum (as discussed more fully below).

The legal papers contain another interesting and tantalizing suggestion that is never developed in the record. Specifically, M alleges that when M complained to Dr. Crane that vaginectomy and scrotoplasty were listed on M’s informed consent document, when those operations were not supposed to be performed, Dr. Crane reassured M that they were listed on the document either as a typo or for billing purposes [emphasis added]. A curious fact, if true.

According to court records, M’s lawsuit against Dr. Crane was dismissed on March 15, 2019. As is customary, there is no indication whether Dr. Crane, or his insurer, paid any damages to M.

Following the 2015 phalloplasty and other procedures with Dr. Crane, incredibly, M required at least three additional surgeries. In April 2016, M underwent a “phallus shortening” procedure, which involved “telescoping entire phallus into suprapubic area.” In November 2017 M went to Cedars-Sinai Hospital in Los Angeles and received a urethroplasty in a two-stage procedure, to close the neourethra which was placed by Dr. Crane. Then, in March 2018, Dr. Garcia and another surgeon again performed surgery on M, this time to “re-place” the existing penis (which was also displaced), and to re-orient M’s scrotum. In his lawsuit against Dr. Crane, M alleged that during the 2015 surgery, Dr. Crane had “displaced” his scrotum by three centimeters, leaving it immediately adjacent to his anus. Moreover, M claimed, Dr. Crane had moved M’s testicles from their customary “side by side” position and re-placed them one in front of the other.

In March 2019 (following the three post-Crane surgeries), M stated that he still had an abscess in his pelvis where his vagina had been. Moreover,

At this point, words cannot really begin to describe M’s ordeal.

M was forced to take off work from September 2015 through February 2016 (5 months), then returned to work in March of 2016, but had to stop working again in November 2017. It’s unknown whether he ever returned to full-time work (in a court filing dated March 2019, M stated that he had been out of work for “the majority” of the past three years). The filing also stated that, because of the surgeries he had undergone, M had to assume a new job for which he was paid 50% less, and was then living “paycheck to paycheck.”

M alleged that his out of pocket expenses for the September 2015 surgery with Dr. Crane were approximately $6,500, while his out of pocket expenses for the November 2017 surgery with Dr. Garcia were approximately $4,000, and he expected to spend about $4,000 more for the “last” surgery in the spring of 2018.

M’s out of pocket expenses pale in comparison to the price tag for the surgery performed by Dr. Crane, however, which was approved by the Ontario Ministry of Health and Long-term Care in the amount of $126,508.  Given that fact, the total financial cost of M’s gender journey is no doubt somewhere north of a million; the personal cost is, of course, incalculable. And yet M’s gender dysphoria endures.

So returning to the celebrity trans kids at the beginning of this article: What do you suppose young Jacob, and Jacob’s transgender peers, are hearing about their likely futures? Do you think that, being young children after all, they expect that one day the Gender Fairy will pay a visit? Or do they believe that, as Diane Ehrensaft claims, “God got it wrong,” and someday they will return to the womb and re-emerge as their correct gender? After all, nobody is better at magical thinking than young children, and raising a girl as a boy, or vice-versa, is implicitly, if not explicitly, affirming the child in the belief that one day her wish will come true.

M’s phalloplasty story isn’t suitable bed-time fare, at least not for Jacob. But for Jacob’s parents, and their many peers, perhaps it should be. After all, the Gender Fairy could someday deliver a real-life nightmare.

Did you know that JK Rowling’s and Harry Potter’s birthdays are coming up soon?

Many of us have felt heartened and grateful for JK Rowling’s recent contributions to the discussion around gender ideology. Rowling shares a birthday with her beloved literary progeny – July 31. Harry Potter fans will recall that the boy wizard receives his first Hogwarts’ acceptance letter a week before his 11^th birthday. When his Aunt Petunia and Uncle Vernon refuse to let him see the letter, more and more “letters from no one” begin to arrive, finally inundating his aunt and uncle.

The Hogwarts’ motto is Draco Dormiens Nunquam Titillandus (Never Tickle a Sleeping Dragon), but sometimes sleeping dragons do indeed need to be tickled. We thought we would show our support for Joanne on her birthday by sending “letters from no one” to The Guardian, the BBC, and The New York Times. All we are asking for is constructive dialogue in the mainstream media. Please download the letter, print it three times, and send it to the New York Times, the BBC, and the Guardian in time for it to arrive around July 31. Alternatively, you may copy the text (printed below) and paste it into an email. Or better yet, do both! You may feel free to sign it and give a brief description of yourself, or you may simply send without signing.

Once you’ve printed your letter, please take a picture of it and post the photo on social media using the hashtags #ItsNotHateToWantDebate and #HappyBirthdayJKR. Tag in the journalists and the outlets. And please help spread the word!

Let’s send as many letters to each of these media outlets as Hogwarts sent to Harry at Uncle Vernon and Aunt Petunia’s house.

Looking forward to seeing you at Hogwarts!

For a downloadable PDF of the letter, click here.

To copy and paste the letter into an email, see the text of the letter below.

To the BBC, The Guardian and The New York Times:

We are writing to request that you widen your scope when reporting on gender diversity. A progressive society is characterised by a respect for thoughtful discussion and we hope that journalistic outlets of your stature could explore multiple perspectives on these important questions rather than stifling debate by covering only one side.

In her recent personal essay, J.K. Rowling outlined her concerns that extremist ideology was negatively impacting vulnerable groups. She highlighted several pressing aspects of this issue that have received scant coverage in the liberal media. The international reaction to Rowling’s essay demonstrated both the lack of public awareness about these issues and the urgent need for honest and respectful dialogue.

In Harry Potter and the Philosopher’s Stone, Harry begins to receive numerous copies of his Hogwarts’ acceptance letter a week before his birthday on July 31 – which is also Rowling’s birthday. These letters marked a new beginning for the fictional boy wizard. We hope these letters that you are receiving will signal to you that there are many from across the political spectrum who wish to have a good-faith discussion about gender ideology and its impact on women, children, adolescents, and also on lesbian, gay, and bisexual people.

It is our hope that together we can help to usher in a new beginning where we can have important conversations that until now have been substantially ignored by the liberal mainstream media. Given our mutual desire to support gender non-conforming individuals, we believe that it is vitally important for leading media to cover these crucial and under-reported stories.

• The extraordinary growth in the number of adolescents with gender dysphoria
• The link between increasingly rigid gendered expectations and gender dysphoria in childhood
• The social pressures on lesbian, gay and bisexual youth to conform to sex role stereotypes and/or change their bodies
• The complex issues facing the growing number of detransitioners
• The potential impact the enshrinement of gender identity has upon sex-based rights, single-sex spaces, and sports for women and girls

 After receiving his letters, Harry travelled to Hogwarts on September 1. We would like to follow up with you in early September to see how we might bring more nuance and depth to the current coverage about gender issues.

Hope to see you at Hogwarts!

#ItsNotHateToWantDebate                #HappyBirthdayJKR

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by Grace Williams

On February 27, Algemeen Dagblad, the second-most widely read newspaper in the Netherlands, published an astonishing article. Written by Berendien Teteleptal, the author reports that “more research on sex changes in young people under the age of 18 is urgently needed. Doctors who provide transgender care in Nijmegen and Amsterdam say they know too little about the target group and the long-term effects.” (See here for an English translation of the article.)

What makes this article surprising is that it was a Dutch team of researcher-clinicians (one of whom is extensively quoted in the piece) who pioneered the use of puberty blockers in children with gender dysphoria; this practice is now widespread in the western world.

VU University Medical Center, Amsterdam

After reading this article, I went back through some of the posts on 4thWaveNow that have mentioned Dutch research. One of the posts dates back to November 2015, not long after Denise, the founder of 4thWaveNow, started blogging, entitled “Skeptical ethicist: ‘A medical doctor is not a candy seller’.”

In the post, Denise describes an article published in June 2015 in the Journal of Adolescent Health. Published by a group of  Dutch gender dysphoria researchers, the authors report on a qualitative survey of 17 gender clinics in 10 Western countries. The survey revealed that quite a few professionals on these teams (pediatric endocrinologists, psychologists, psychiatrists, and ethicists) have reservations about early medical treatment. “The article concludes in a way that makes me feel a whisper of hope for the future.”

Several professionals mentioned that participation in the study made them think more explicitly about the various themes, and it encouraged them to discuss the issues in their teams. In the Dutch teams, we therefore introduced moral deliberation sessions to talk about these ethical topics. The first reactions of the professionals were positive; the sessions made them rethink aspects of the protocol.

That the top Dutch researcher-clinicians are now openly discussing their concerns in the mainstream media shows the prescience of Denise’s whisper of hope from almost six years ago. Does their concern stem from these “moral deliberation sessions” they started after the 2015 empirical ethical study? Could another factor be the  recent ruling in the Keira Bell case by the British High Court, limiting the use of puberty blockers in gender-dysphoric children?

Thomas Steensma

Quoted in the aforementioned article by Tetelaptal, Thomas Steensma, one of the lead researcher-clinicians at the Center of Expertise on Gender Dysphoria in Amsterdam, asks some critical questions that U.S. “affirmative” clinicians largely ignore. Teteleptal writes:

Because what is behind the large increase of children who have suddenly registered for transgender care since 2013? And what is the quality of life for this group long after the sex change? There is no answer to those questions. And that must happen, think Steensma and colleagues from Nijmegen.

“We don’t know whether studies we have done in the past can still be applied to this time. Many more children are registering, and also a different type,” says Steensma. “Suddenly there are many more girls applying who feel like a boy. While the ratio was the same in 2013, now three times as many children who were born as girls register, compared to children who were born as boys.”

Steensma also raises questions about the effect of early medical intervention on future fertility:

It is still unclear whether these administered hormones affect the fertility of boys and girls. “We just don’t know,” says Steensma. “Little research has been done so far on treatment with puberty blockers and hormones in young people. That is why it is also seen as experimental. We are one of the few countries in the world that conducts ongoing research about this. In the United Kingdom, for example, only now, for the first time in all these years, a study of a small group of transgender people has been published. This makes it so difficult, almost all research comes from ourselves.”

Not only does he lament the lack of research, Steensma expresses frustration that some practitioners are applying Dutch research without adequate assessment of their patients:

We conduct structural research in the Netherlands. But the rest of the world is blindly adopting our research. While every doctor or psychologist who engages in transgender health care should feel the obligation to do a proper assessment before and after intervention.

The Dutch have always exercised more caution

The Dutch have always been more careful in their use of interventions like puberty blockers, taking care to conduct thorough assessments before proceeding. Many Dutch clinicians have practiced what has been characterized as “watchful waiting,” in contrast to the affirmation approach promoted by the most prominent gender clinicians in the United States.

It’s worth noting that it’s not just medical transition for which the Dutch have urged a slow and deliberative approach. As reported in this 2016 4thWaveNow post, the Dutch have also advised caution when it comes to social transitioning of young children. In a 2011 journal article, Steensma et al. write:

As for the clinical management in children before the age of 10, we suggest a cautious attitude towards the moment of transitioning. Given our findings that some girls, who were almost (but not entirely) living as boys in the childhood years, experienced great trouble when they wanted to return to the female gender role, we believe that parents and caregivers should fully realize the unpredictability of their child’s psychosexual outcome. They may help the child to handle their gender variance in a supportive way, but without taking social steps long before puberty, which are hard to reverse.

A 2013 study conducted by Steensma et al. found that social transition was one of the factors associated with the persistence of gender dysphoria. “Childhood social transitions were important predictors of persistence, especially among natal boys,” the authors write.

No medical consensus

Recently, at about the same time the article discussing Steensma’s concerns were reported in Algemeen Dagblad, transgender woman Rachel Levine appeared before a US Senate committee in a hearing to confirm Levine as President Biden’s assistant secretary of health. During the hearing, Senator Rand Paul asked Levine this question: “Do you believe that minors are capable of making such a life-changing decision as changing one’s sex?”

To which Levine responded: “Transgender medicine is a very complex and nuanced field with robust research and standards of care that have been developed, and if I am fortunate enough to be confirmed as the assistant secretary of health, I will look forward to working with you and your office and coming to your office and discussing the particulars of the standards of care for transgender medicine.”

Never mind that Levine failed to provide a public, direct answer to the senator’s question; note how differently Levine describes transgender medicine from how Steensma characterizes it. Levine refers to “robust research” and “standards of care.” Meanwhile, Steensma, who conducted the very research on which many US “affirmative” clinicians are basing their treatment protocols, tells a reporter: “Little research has been done so far on treatment with puberty blockers and hormones in young people. That is why it is also seen as experimental.”

If you had heard only Levine’s testimony on this matter, you might be excused for concluding that there is widespread medical consensus for the use of medical interventions in gender dysphoric minors, but you would be wrong. As Dutch researchers noted in the 2015 journal article mentioned above, “in actual practice, no consensus exists whether to use these early medical interventions.” This was true in 2015, and it remains true in 2021.

It would, of course, be going too far to suggest that Steensma no longer believes that puberty blockers and cross-sex hormones should ever be used in the treatment of adolescent gender dysphoria. Clearly he believes it’s appropriate in certain cases. In fact that’s the hallmark of the Dutch approach: individual assessment, tailored to each unique case. According to  this article published by the same author on February 28 in de Gelderlander, another Dutch publication,

Steensma does not endorse the judgment of the British court. According to him, there are children who can oversee the consequences. “But that’s an individual process. You can’t compare individuals with one another. We are not saying that hormone treatments are good for everyone. We would also never say that they are not good for anyone. We make the assessment per person.”

Again, though: In contrast to the “Wild West” of pediatric transgender medical care in the United States, where minors can get puberty blockers, hormones, and sometimes even surgery with very little assessment, the Dutch approach has traditionally been considerably more cautious and nuanced. In the de Gelderlander piece Teteleptal writes, “Steensma is perturbed by the method of some clinics and practitioners in America, for example, where puberty blockers seem to be the solution to everything.” ( English translation here.)

Annelou de Vries

Steensma is not alone amongst Dutch clinicians. Annelou L.C. de Vries   a psychiatrist with the Department of Child and Adolescent Psychiatry at Amsterdam University Medical Centers, who, like her colleagues, has published widely on pediatric gender issues for many years. In a commentary published in the October 2020 issue of Pediatrics, de Vries writes:

According to the original Dutch protocol, one of the criteria to start puberty suppression was “a presence of gender dysphoria from early childhood on.” Prospective follow-up studies evaluating these Dutch transgender adolescents showed improved psychological functioning. However, authors of case histories and a parent-report study warrant that gender identity development is diverse, and a new developmental pathway is proposed involving youth with post puberty adolescent-onset transgender histories. These youth did not yet participate in the early evaluation studies. This raises the question whether the positive outcomes of early medical interventions also apply to adolescents who more recently present in overwhelming large numbers for transgender care, including those that come at an older age, possibly without a childhood history of GI [gender incongruence]. It also asks for caution because some case histories illustrate the complexities that may be associated with later-presenting transgender adolescents and describe that some eventually detransition.

Given their stated concerns, we can hope Steensma, de Vries and their colleagues, as well as researchers in other countries, will design studies to explore why there’s been such a dramatic increase in the number of gender-dysphoric adolescents with no history of childhood gender dysphoria, as well as why some of these young people later detransition. Lisa Littman’s 2018 paper based on parental reports is a good first step, but much more research is needed. Social contagion, along with other potential factors such as internalized homophobia, sexual trauma, autism and other neuro-atypical conditions, deserve careful and ongoing investigation by gender-dysphoria researchers.

On April 7, 2021, the UC San Francisco Child and Adolescent Gender Center offered a Zoom “training” entitled “Fertility Issues for Transgender and Nonbinary Youth.” Advertised widely on Facebook, the session was led by well-known gender therapist Diane Ehrensaft and a colleague, and was attended by over 100 people via Zoom. A recording of the session was provided to 4thWaveNow by an attendee. This article will draw on a few excerpts from the session, available for viewing here and here.

There’s a lot to unpack in the nearly two-hour long session, and we hope to address it more fully in future writings. For now, this piece will focus on one key theme explored in the session:

Future reproduction is pretty much foreclosed as a possibility for children who have been puberty-blocked and who subsequently continue on (as nearly all do) to cross sex hormones, but the “benefits outweigh risks” to move the child from, as Ehrensaft puts it, “gender dysphoria to gender euphoria.”

The fertility-wrecking aspect of the blockers>cross-sex hormones regimen isn’t new ground for those of us who’ve been closely following the accelerating trajectory of pediatric transition in the last few years. Indeed, gender clinicians themselves have known and talked about it for years. The issue is that biological reproduction depends on full maturation of gametes (sperm and ova), and gamete maturation depends upon a person completing their natal puberty.

But what may be new to our readers is that Ehrensaft–a developmental psychologist by training– herself recognizes a concern that child-transition skeptics have repeatedly pointed out: tweens and young teens undergoing these treatments are not developmentally mature enough to comprehend the full magnitude of irreversible sterilization. (Interestingly, she also discussed this three years ago at the 2018 WPATH conference in Buenos Aires.)

Although Ehrensaft (as you might guess) continues to recommend these treatments, in her Zoom presentation, she explains in detail that clinicians, parents, and other adults involved in the child’s care shouldn’t overburden a child with “TMI” –too much information—too many details– about the momentous decision to undergo interventions that result in permanent chemical sterilization.

Now is as good a time as any to dispense (again) with a typical reaction expressed when anyone talks about fertility and trans kids. Many trans activists routinely pooh-pooh the idea that people should be concerned about the loss of future fertility in medically-transitioned children. “You just think women should be baby machines! Not everyone wants to have babies!” Again we state (as we have previously): The issue is not whether a child should ever want “genetically related” (to use Ehrensaft’s term)  offspring when they reach adulthood. It is that it is a human right to make the decision to reproduce–or not–when one has reached adulthood.  Stated more plainly: Sterilizing children is a human rights violation. Until quite recently, these statements would not have been considered remotely controversial—but here we are.

Before delving further into yesterday’s Zoom session, let’s briefly review some of Ehrensaft’s previous remarks on the sterilization of trans kids.

Regular readers and followers of the 4thWaveNow Twitter account will be aware of Ehrensaft’s now-infamous presentation at a 2016 conference in Santa Cruz, CA, perhaps best known for the segment on barrettes and onesies. Less well known perhaps is her opinion, expressed in the same venue, that parents who might want to protect their children’s foundational human right to decide (yea or nay) about reproduction as adults (as opposed to middle school-age) are wrongly interfering with their children’s “dreams” and only balk because of a selfish desire for “genetically related” grandchildren.

“We have to work with parents on—these aren’t your dreams, we have to focus on your child’s dreams, and what they want.”

It appears Ehrensaft has not changed her views much on this in the last 5 years. In the April 7^th 2021 Zoom session, Ehrensaft again appeared to relegate any worries or ethical concerns about sterilizing an 11- or 12-year-old child to nothing more than a self-centered parental desire for grandchildren.  Note that in the slide reproduced here, the 11-year-old “assigned female at birth” identifies as “genderqueer.”

Back in 2016, Ehrensaft waxed enthusiastic that many of the puberty-blocked trans kids she has worked with are mature beyond their years, capable of choosing adoption over biological offspring, just as a thoughtful adult might do after careful deliberation. (Interestingly, Ehrensaft seems to have moderated her opinion on this somewhat. In last week’s session, she cautioned clinicians that such pronouncements could possibly be “almost a reflexive response” from some young clients who just want to obtain blockers or hormones, an “overblown altruism”.)

But Ehrensaft’s key point back in 2016 was that puberty blockers and cross-sex hormones are directly analogous to fertility-robbing chemotherapy treatments for children with terminal cancer, since both are “life saving” and urgently required interventions. The message is powerful (whether accurate or not) and more than enough to chasten any loving parent: Denying your middle schooler blockers and hormones is tantamount to letting a child with terminal cancer die for lack of treatment.

We have, of course, heard the life-saving claim many times before: that dysphoric tweens require these treatments for survival, despite risks to not only their future fertility, but also potentially to their sexual function. There is no historical evidence for this claim (in fact, child and youth suicide rates have increased since the advent of pediatric medical transition).(A thorough examination of the flaws in the “suicide or transition” orthodoxy would require another 3000-word article, but for those interested, see here, here, and here for some more reading on the subject.)

Now let’s take a closer look at Ehrensaft’s April 7^th Zoom presentation.

You may have heard that puberty blockers are supposed to “buy time” for the dysphoric child to decide whether to proceed further with medical intervention. Indeed, that was the original intent when puberty blockers were first prescribed to gender dysphoric children in the Netherlands.  But there’s a reason why the original Amsterdam clinician-researchers were (and still are) cautious about recommending social transition for younger children: Their goal was to prevent those children who might outgrow their gender dysphoria from embarking on lifelong, unnecessary medicalization; to avoid concretizing what is for some a transient gender confusion. The Dutch engaged in lengthy evaluation and recommended blockers for a carefully assessed cohort of their young patients. Even then, the blockers were meant to buy time.

But Ehrensaft and other “affirmative” clinicians have turned the more cautious “watchful waiting” approach on its head in the last decade or so. No longer is a child encouraged to leave the question open as to whether they will become lifelong medical patients; now they are “affirmed,” often as young as toddlerhood; and at the first sign of puberty, in Ehrensaft’s words, they urgently desire blockers to

 “ward off an unwanted puberty that they’ve been thinking and worrying about for years…These kids who have socially transitioned many years prior, they don’t NEED more time to explore their gender. They’ve known from an early age what their authentic gender was…they’ve been living their affirmed gender for many years by the time they reach puberty.”

For these children, blockers (and the cross-sex hormones which nearly inevitably follow provide “continuity of care in gender affirmation and discontinuity in potential capacity to ever create progeny with their own genetic material.”

So common is social transition (in the US at least), Ehrensaft reported on April 7^th, that US researchers have found upwards of 90% of kids requesting pubertal blockade have already socially transitioned. The full ramifications of this increase in social transition (encouraged by affirmative therapists like Ehrensaft) have never been explored in a controlled study. It’s interesting that affirmative clinicians readily follow the Dutch protocol for the use of puberty blockers, while utterly dismissing their cautions about early social transitions.

So if children “affirmed” (and therefore socially transitioned) since early childhood are now justifiably candidates for blockers and then cross hormones, what is the responsibility of clinicians and parents in consenting to these interventions, given that (in her words) “blocking puberty takes away options for fertility for most?”

Ehrensaft acknowledges that a child at Tanner stage 2 (that is, the earliest sign of puberty— “as early as 8 or 9 years old”) is not emotionally or psychologically equipped to understand sex or reproduction, beyond much more than a simple, concrete description of sperm + egg. What’s more, she says, asking a child to consider the mechanics of sex and reproduction at this age may actually be psychologically harmful!

“Fertility considerations about blockers followed by hormones brings on the storm before the lull is over”… So we now have a child who could be as young as 8, 9 who has to think about sex, babies, and future roles rather than games and game playing, which is where we situate development at this period…it’s a developmental stretch and it can create emotional stress.”

She calls this “the disruption”– the “developmental disarray” which could result from informing a child still interested in games and make-believe (and though she doesn’t say it, at an age when some may still believe in Santa Claus or the Easter Bunny):

“So we’re needing to acquire the child’s assent for medical interventions and that requires asking a child prematurely to take on sex and drugs but no rock and roll.”

So what to do if you don’t want to stress out the child with TMI when they are at the “just the facts” stage of development — when you “may get a lot of squirminess about sex or around sex”?  Do you talk about how the jaunty boy sperm meets the cute girl ovum (like the slide picture shows) but stay silent on the icky stuff about sex? After all, they’re not ready (and may even be disgusted by) the “rock and roll” older adolescents become intensely interested in with full-on puberty and sexual maturation.

Pretty much, says Ehrensaft. Instead of “giving them more information than they need or can handle,”adults should limit themselves to simplistic explanations about reproduction but not sex.

The question arises: If a child as young as 8 or 9 years old “can’t handle” information about sex, how can they handle deciding whether they are OK with losing the right to reproduce (or not) as an adult, when given “just the facts”?

Ehrensaft buttresses her points by highlighting the developmental framework popularized by the late Erik Erikson (one of the 20^th century’s most respected developmental psychologists), which rests on the notion that successful and healthy maturation and adult identity consolidation occurs in stages. She notes that children being asked to decide about their future fertility are “two or three” stages behind the age when they would be better equipped to comprehend the gravity of that choice.

It’s not surprising she would be familiar with the giants in that field; though best known as a gender therapist, Ehrensaft, as mentioned previously, is a PhD developmental psychologist. (It’s much less widely known that in the 1990s, she also had some involvement, as a psychotherapist, in the widely-discredited “satanic ritual abuse” preschool controversy.)

But very unlike Erikson, Ehrensaft’s analyses & recommendations always stem from an untestable confirmation bias: that “gender identity” is a native, fundamental property of the human brain, present from birth (as she said in that 2016 talk, babies “probably know their gender as early as the beginning of the second year of life…they probably know even earlier but they’re really pre-pre verbal”).  In contrast, Erikson’s work made no mention of innate gender. Rather, he emphasized identity development as a long process, involving an essential “crisis” that is often not resolved until one’s 20s. In fact, Erikson posited that a person might not attain healthy adult psychological integration if they did not experience an identity crisis. Another question arises:  Could gender dysphoria, for at least some children and adolescents, be something that needs to be struggled with for successful resolution and maturation, instead of ameliorated (short-circuited?) as Ehrensaft and other affirmative clinicians now do via social transition and hormone blockers?

After warning her audience not to burden tweens with TMI, she rather abruptly notes that

“Those of us who provide this care have been accused of sterilizing children. And what I would say is, we are not sterilizing everybody—[quickly revises] anybody.”

Yet this is precisely what Ehrensaft has told her audience affirming clinicians are doing, just with different words (e.g., “they won’t be able to have a genetically related child”): These treatments WILL permanently take the choice to reproduce away from a child who has been puberty-blocked and then moves to cross-sex hormones. A dictionary definition for that is sterilization.

Not missing a beat, she continues:

“I would encourage us to hold this in mind: That when people—when adults—confront medical infertility it is a very very difficult road and there are certainly and people may go through some really hard times but there’s not a high suicidality rate for infertile people facing medical infertility. But we do know there are alarmingly high rates of self harm and suicidality and suicidal thoughts among both adults and youth who experience extreme gender dysphoria. And I will say that one of the things I’ve read recently while reading a research study it struck me one youth talking about fertility preservation. I have to decide between saving myself and holding the option of someday having a child…to me it’s a choice between that potential child and my life.”

What research study? Who conducted it? And why would children believe (or be encouraged to believe) they must make a “Sophie’s Choice” between their own lives and that of potential future offspring?

“But as we communicate the fertility information to youth, hold in mind, not many people become suicidal about medical infertility, but many do about gender dysphoria.”

Where are the references for this statement? Where are the studies comparing the “not many” infertile adults who never become suicidal, with adults who were sterilized at the dawn of puberty? Where is the NIH-funded research looking at how chemically sterilized trans kids subsequently feel at 20, 35, 40 and later (much later for males) about having their reproductive choices foreclosed when they were 10 or 12 years old?

To her credit, Ehrensaft does acknowledge there are real ethical issues to ponder here. She even poses the same question many pediatric transition skeptics regularly do:

 “Is a child really able to foresee into the future and foreshorten fertility … And how can a child two or three stages behind Erikson’s stage 7 anticipate what they will feel two or three stages later?”

She provides no answer to her own question; in fact, she simply poses more questions, and says it’s “for us to start [emphasis added] finding out. And we are.”

How can this not be seen as an admission that the entire “affirmative” pediatric-transition enterprise is, in fact, an experiment–with unknown future consequences?

Ehrensaft wraps up this part of the Zoom session with an anecdote she says she heard from another gender clinician, Scott Leibowitz, MD:

“I want to mention one intervention I learned from Scott Leibowitz. Which is, in making these decisions with youth about fertility and their future fertility, once they’ve made the decision, he invites them to write a letter to themselves at age 30, and write their present-age self to their 30-year-old self explaining to them what process they went through to make the decision they did that may have implications for future fertility at age 30 or 25.:

What does Ehrensaft (and Leibowitz, assuming she has represented his views accurately) think this letter-writing exercise will accomplish “after [the child has already] made the decision” that they will never reproduce? Is this meant to serve as an apology of sorts to the regretful adult? That 30-year-old future self, with a 30-year-old brain and all its more nuanced and experience-tempered understanding of the world, its fully developed frontal lobes, will see this letter by his or her child-self and feel — what? Does any 30-year-old look upon the writings or thoughts of their 12-year-old self and see wisdom? They will likely “forgive” their 12-year-old self, but …

Ehrensaft presents this anecdote as if it’s some kind of a solution to the question she posed: How can a child at an early stage of emotional, psychological, and intellectual development make a decision several years before they are equipped to fully comprehend it?

To sum up the 4thWaveNow reaction to the main message imparted in this Zoom “training”: Ehrensaft’s use of (accurate) developmental psychology to justify the impossibility of obtaining informed consent from minors, with only the emotional blackmail of suicidality as a rationale, is nothing short of mind-blowing.

But maybe this is all much ado about nothing. After all, as Ehrensaft’s colleague Jen Hastings, MD told her Zoom audience, maybe none of this will matter in a future when reproductive tech and genetic engineering liberate us from our biological constraints:

“Gametes may soon be irrelevant.”

The complete April 7, 2021 Zoom training can be viewed (in two parts) here and here.

Seven years on, 4thWaveNow founder Denise (also known as Marie) made her first public appearance in a conversation with YouTuber/podcaster Benjamin Boyce on April 9, 2022. The lively interview is available on YouTube (full video) as well as Spotify.

The central theme of the “calmversation” was the US federal government’s embrace of “affirmative” care for gender dysphoric minors–whether their parents are onboard or not.

Denise and Benjamin also talked at length about the organizations currently engaged in promoting gender-identity instruction in US schools, a practice that has been in place for many years. In addition, they touched on some rather controversial topics, including the choice of some “affirming” parents to purchase fake penises (“packers”) and tucking underwear for their small children.

The day after her chat with Boyce, Denise added some more detail and clarifications about the topics they discussed. You can find them in this Twitter thread, also compiled here.

The first weekend of November 2023, 4thWaveNow and Transgender Trend founders Denise and Stephanie met in person for the first time at the Genspect:The Bigger Picture conference.

Though they’ve been in touch since 2015, Stephanie and Denise had a lot more to say when they finally got to spend time together in the mile-high city. They talked politics, gender and–best of all–cemented their relationship as friends and colleagues as they hiked the Rockies and talked nonstop.

Since a video is worth way more than 1000 words, we’ll let you see what they had to say in this interview recorded when they were together at the Denver conference.

Please click the link below to view a PDF of the slide presentation 4thWaveNow founder Denise Caignon presented during her speech at Genspect’s The Bigger Picture conference in Denver, Colorado, November 4, 2023.

Denise only had time to present a subset of the slides you’ll see in the PDF, so even if you attended the conference, there is more content here than you saw there.

Please note that the slides are rich with clickable links to public content, including videos, Twitter threads, and more. Simply hover over text and/or images to view.

Genspect 4thWaveNow slide presentation November 2023. Click to view PDF