UNDERSTANDING TRANSGENDER ISSUES

UNDERSTANDING
TRANSGENDER ISSUES

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  • Summary of a recommendation by COHERE Finland

  • The diagnosis and treatment of gender dypshoria

  • Generally Accepted Professional Medical Standards Determination on the Treatment of Gender Dysphoria

Other Resources

Lupron Victims Hub

The following *incomplete* list of lawsuits against Lupron's manufacturer entail its prescription to ``treat`` prostate cancer, endometriosis, fibroids, and infertility - and are listed in no particular order.

Ruling in THE TAVISTOCK AND PORTMAN NHS FOUNDATION TRUST case UK

This is a claim for judicial review of the practice of the defendant, the Tavistock and Portman NHS Foundation Trust, through its Gender Identity Development Service (GIDS) and the first and second Interveners (the Trusts) of prescribing puberty-suppressing drugs to persons under the age of 18 who experience gender dysphoria.

Research

The effect of GnRHa treatment on bone density in young adolescents with gender dysphoria

Background More young people with gender dysphoria (GD) are undergoing hormonal intervention starting with gonadotropin-releasing hormone analogue (GnRHa) treatment. The impact on bone density is not known, with guidelines mentioning that bone mineral density (BMD) should be monitored without suggesting when. This study aimed to examine a cohort of adolescents from a single centre to investigate whether there were any clinically significant changes in BMD and bone mineral apparent density (BMAD) whilst on GnRHa therapy.

Use of puberty blockers for gender dysphoria: a momentous step in the dark

We write with three areas of concern about the increasing use of puberty-blocking medication for gender dysphoria (GD) referred to in your recent leading article.

The Tavistock’s Experiment with Puberty Blockers

The Dutch protocol promised to create a more passable simulacrum of the opposite sex than could be achieved by physical intervention in adulthood. It was therefore embraced by trans-identified children and their parents, by older transgender activists, and by some clinicians specializing in gender dysphoria. The Gender Identity Development Service (GIDS), part of the Tavistock and Portman NHS Foundation Trust, treats children with gender dysphoria from England, Wales, and Northern Ireland. It launched an experimental study of “puberty blockers”—the more friendly term for GnRHa when administered to children with gender dysphoria—in 2011. The experiment gave triptorelin to 44 children, which in all or almost all cases led eventually to cross-sex hormones. This paper describes the origins and conduct of this study and scrutinizes the evidence on its outcomes. 

Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria

Turban et al. (2020) contributed nothing to our knowledge of the effects of suppressing puberty in adolescents.

Revisiting the effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria

Given that puberty suppression left up to a third of patients with abnormally low bone density, Joseph et al.’s recommendations are surprisingly complacent. One is to reduce DXA monitoring which ‘can have significant financial implications for healthcare providers’. Another is to change the computation of Z-scores; ‘reference ranges may need to be re-defined for this select patient cohort’. Rather than altering a measure that provides inconvenient findings, practitioners of puberty suppression must record fractures as adverse events.

Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria

According to Turban, King, Carswell, and Keuroghlian (2020), suicidal ideation is lower in transgender adults who as adolescents had been prescribed “puberty blockers”—gonadotropin-releasing hormone analogs (GnRHa). This finding was derived from a large nonrepresentative survey of transgender adults in the U.S., which included 89 respondents who reported taking puberty blockers. Turban et al. (2020) tested six measures of suicidality and three other measures of mental health and substance abuse. With multivariate analysis, only one of these nine measures yielded a statistically significant association: the respondents who reported taking puberty blockers were less likely to have thought about killing themselves than were the respondents who reported wanting blockers but not obtaining them. This finding was widely reported in the media; the lead author published a column on its implications for health policy in the New York Times (Turban, 2020).

Correction to Bränström and Pachankis

After the article “Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study” by Richard Bränström, Ph.D., and John E. Pachankis, Ph.D. (doi: 10.1176/appi.ajp.2019.19010080), was published online on October 4, 2019, some letters containing questions on the statistical methodology employed in the study led the Journal to seek statistical consultations. The results of these consultations were presented to the study authors, who concurred with many of the points raised. Upon request, the authors reanalyzed the data to compare outcomes between individuals diagnosed with gender incongruence who had received gender-affirming surgical treatments and those diagnosed with gender incongruence who had not. While this comparison was performed retrospectively and was not part of the original research question given that several other factors may differ between the groups, the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison.

The Right to Best Care for Children Does Not Include the Right to Medical Transition

Refuting that any child has the right to medically transition

Debate: Different strokes for different folks

A gender social transition in prepubertal children is a form of psychosocial treatment that aims to reduce gender dysphoria, but with the likely consequence of subsequent (lifelong) biomedical treatments as well (gender-affirming hormonal treatment and surgery).

Low Bone Mineral Density in Early Pubertal Transgender/Gender Diverse Youth: Findings From the Trans Youth Care Study

Transgender youth may initiate GnRH agonists (GnRHa) to suppress puberty, a critical period for bone-mass accrual. Low bone mineral density (BMD) has been reported in late-pubertal transgender girls before gender-affirming therapy, but little is known about BMD in early-pubertal transgender youth.

Puberty Blockers, Cross-Sex Hormones, and Youth Suicide

Lowering legal barriers to make it easier for minors to undergo cross-sex medical interventions without parental consent does not reduce suicide rates—in fact, it likely leads to higher rates of suicide among young people in states that adopt these changes. States should instead adopt parental bills of rights that affirm the fact that parents have primary responsibility for their children’s education and health, and that require school officials and health professionals to receive permission from parents before administering health services, including medication and “gender-affirming” counseling, to children under 18. States should also tighten the criteria for receiving cross-sex treatments, including raising the minimum eligibility age.

Articles

Podcasts

Powerpoints

Policy Briefs

Books

Videos

Organizations

Parent Support Organizations

Professional Organizations

Guides

  • Generally Accepted Professional Medical Standards Determination on the Treatment of Gender Dysphoria

Research

Transgender and Gender Diverse Children and Adolescents: Fact-Checking of AAP Policy

The American Academy of Pediatrics (AAP) recently published a policy statement: Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Although almost all clinics and professional associations in the world use what’s called the watchful waiting approach to helping gender diverse (GD) children, the AAP statement instead rejected that consensus, endorsing gender affirmation as the only acceptable approach. Remarkably, not only did the AAP statement fail to include any of the actual outcomes literature on such cases, but it also misrepresented the contents of its citations, which repeatedly said the very opposite of what AAP attributed to them.

Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy

In hypogonadal/postmenopausal individuals, hormone therapy has been associated with an increased risk for cardiovascular events (CVEs). A steeply growing population that often receives exogenous hormones is transgender individuals. Although transgender individuals hypothetically have an increased risk of CVEs, there is little known about the occurrence of CVEs in this population.

Pelvic pain and persistent menses in transgender men

Pelvic pain in transgender men can be a clinical challenge and has a broad differential diagnosis. Pelvic pain less than 6 months of duration is considered acute.

Use of puberty blockers for gender dysphoria: a momentous step in the dark

We write with three areas of concern about the increasing use of puberty-blocking medication for gender dysphoria (GD) referred to in your recent leading article.

Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study

Venous thromboembolism (VTE), ischemic stroke, and myocardial infarction in transgender persons may be related to hormone use.

Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria

Sociological and sociocultural explanations are offered to account for this recent inversion in the sex ratio of adolescents with gender dysphoria.

The Tavistock’s Experiment with Puberty Blockers

The Dutch protocol promised to create a more passable simulacrum of the opposite sex than could be achieved by physical intervention in adulthood. It was therefore embraced by trans-identified children and their parents, by older transgender activists, and by some clinicians specializing in gender dysphoria. The Gender Identity Development Service (GIDS), part of the Tavistock and Portman NHS Foundation Trust, treats children with gender dysphoria from England, Wales, and Northern Ireland. It launched an experimental study of “puberty blockers”—the more friendly term for GnRHa when administered to children with gender dysphoria—in 2011. The experiment gave triptorelin to 44 children, which in all or almost all cases led eventually to cross-sex hormones. This paper describes the origins and conduct of this study and scrutinizes the evidence on its outcomes. 

Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria

According to Turban, King, Carswell, and Keuroghlian (2020), suicidal ideation is lower in transgender adults who as adolescents had been prescribed “puberty blockers”—gonadotropin-releasing hormone analogs (GnRHa). This finding was derived from a large nonrepresentative survey of transgender adults in the U.S., which included 89 respondents who reported taking puberty blockers. Turban et al. (2020) tested six measures of suicidality and three other measures of mental health and substance abuse. With multivariate analysis, only one of these nine measures yielded a statistically significant association: the respondents who reported taking puberty blockers were less likely to have thought about killing themselves than were the respondents who reported wanting blockers but not obtaining them. This finding was widely reported in the media; the lead author published a column on its implications for health policy in the New York Times (Turban, 2020).

Revisiting the effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria

Given that puberty suppression left up to a third of patients with abnormally low bone density, Joseph et al.’s recommendations are surprisingly complacent. One is to reduce DXA monitoring which ‘can have significant financial implications for healthcare providers’. Another is to change the computation of Z-scores; ‘reference ranges may need to be re-defined for this select patient cohort’. Rather than altering a measure that provides inconvenient findings, practitioners of puberty suppression must record fractures as adverse events.

Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria

Turban et al. (2020) contributed nothing to our knowledge of the effects of suppressing puberty in adolescents.

Correction to Bränström and Pachankis

After the article “Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study” by Richard Bränström, Ph.D., and John E. Pachankis, Ph.D. (doi: 10.1176/appi.ajp.2019.19010080), was published online on October 4, 2019, some letters containing questions on the statistical methodology employed in the study led the Journal to seek statistical consultations. The results of these consultations were presented to the study authors, who concurred with many of the points raised. Upon request, the authors reanalyzed the data to compare outcomes between individuals diagnosed with gender incongruence who had received gender-affirming surgical treatments and those diagnosed with gender incongruence who had not. While this comparison was performed retrospectively and was not part of the original research question given that several other factors may differ between the groups, the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison.

The Right to Best Care for Children Does Not Include the Right to Medical Transition

Refuting that any child has the right to medically transition

Debate: Different strokes for different folks

A gender social transition in prepubertal children is a form of psychosocial treatment that aims to reduce gender dysphoria, but with the likely consequence of subsequent (lifelong) biomedical treatments as well (gender-affirming hormonal treatment and surgery).

Puberty Blockers, Cross-Sex Hormones, and Youth Suicide

Lowering legal barriers to make it easier for minors to undergo cross-sex medical interventions without parental consent does not reduce suicide rates—in fact, it likely leads to higher rates of suicide among young people in states that adopt these changes. States should instead adopt parental bills of rights that affirm the fact that parents have primary responsibility for their children’s education and health, and that require school officials and health professionals to receive permission from parents before administering health services, including medication and “gender-affirming” counseling, to children under 18. States should also tighten the criteria for receiving cross-sex treatments, including raising the minimum eligibility age.

Articles

Podcasts

Powerpoints

Policy Briefs

Videos

Organizations

Parent Support Organizations

Professional Organizations

Guides

  • Generally Accepted Professional Medical Standards Determination on the Treatment of Gender Dysphoria

Research

Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners

The study’s purpose was to describe a population of individuals who experienced gender dysphoria, chose to undergo medical and/or surgical transition and then detransitioned by discontinuing medications, having surgery to reverse the efects of transition, or both.

The Gender Affirmative Treatment Model for Youth with Gender Dysphoria: A Medical Advance or Dangerous Medicine?

What factors, aside from the lack of a rigorous evidence base, might contribute to dangerous medical practices? Can history inform us anything about what might lead physicians to over-enthusiastically and prematurely embrace risky and unproven treatments? History suggests there is most likely a complex interplay of multiple factors, and I discuss some of these in this section. In the subsequent section, I return to discuss the gender affirmative treatment approach for GD youth and highlight some themes that may suggest some parallels with this history.

Correction to Bränström and Pachankis

After the article “Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study” by Richard Bränström, Ph.D., and John E. Pachankis, Ph.D. (doi: 10.1176/appi.ajp.2019.19010080), was published online on October 4, 2019, some letters containing questions on the statistical methodology employed in the study led the Journal to seek statistical consultations. The results of these consultations were presented to the study authors, who concurred with many of the points raised. Upon request, the authors reanalyzed the data to compare outcomes between individuals diagnosed with gender incongruence who had received gender-affirming surgical treatments and those diagnosed with gender incongruence who had not. While this comparison was performed retrospectively and was not part of the original research question given that several other factors may differ between the groups, the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison.

Informed Consent for Transgendered Patients

This article reviews the history of informed consent, presents the conflicts of ethical principles, and presents three categories of risk that must be appreciated before informed consent is accomplished. The risks involve biological, social, and psychological consequences. Four specific risks exist in each category. The World Professional Association for Transgender Health’s Standards of Care recommend an informed consent process, which is at odds with its recommendation of providing hormones on demand.

The Right to Best Care for Children Does Not Include the Right to Medical Transition

Refuting that any child has the right to medically transition

Debate: Different strokes for different folks

A gender social transition in prepubertal children is a form of psychosocial treatment that aims to reduce gender dysphoria, but with the likely consequence of subsequent (lifelong) biomedical treatments as well (gender-affirming hormonal treatment and surgery).

Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden

The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person’s body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment.

Articles

Powerpoints

Policy Briefs

Video Library

The Transgender Agenda: Keep Out of Reach of Children

Browse more videos by topic.

Experts

Expert Interview: Dr. Patrick Lappert

Expert Interview: Dr. Michelle Cretella

Expert Interview: Dr. Quentin Van Meter

Victims

Transgender Victim: Erin’s Story

Transgender Victim: Billy’s Story

Transgender Victim: Sydney’s Story

Transgender Victim: Walt’s Story

Transgender Victim: Susan’s Story

Topics

Understanding Transgender Issues

Children. Can’t. Consent. Period.

Medical Experimentation on Children

Arresting Child Development: Puberty Blockers on Trial

Transgender Suicide: The Tragedy and the Truth

Transgender Surgery: “What Have I Done?”

Cross-Sex Hormones: The Horrors and the Harms

Trans-Identity Development: Potential Causes

The Transgender War on Parental Rights

The Transgender Agenda: Keep Out of Reach of Children

Advocacy Toolkit

Books

Organizations

Parent Support Organizations

Professional Organizations

Detransition Support

Guides

  • Navigating the Transgender Landscape School Resource Guide

  • Parent Resource Guide: Educating and Equipping Parents

  • Recommendations for Reporting on Suicide

  • The diagnosis and treatment of gender dypshoria

  • WoLF Media Style Guide

  • Summary of a recommendation by COHERE Finland

  • Healing Children with Gender Dysphoria

  • Back to School for Parents

  • Generally Accepted Professional Medical Standards Determination on the Treatment of Gender Dysphoria

Other Resources

TRA violent threats

Documentation of violent threats made by transgender rights activists.

Lupron Victims Hub

The following *incomplete* list of lawsuits against Lupron's manufacturer entail its prescription to ``treat`` prostate cancer, endometriosis, fibroids, and infertility - and are listed in no particular order.

Ruling in THE TAVISTOCK AND PORTMAN NHS FOUNDATION TRUST case UK

This is a claim for judicial review of the practice of the defendant, the Tavistock and Portman NHS Foundation Trust, through its Gender Identity Development Service (GIDS) and the first and second Interveners (the Trusts) of prescribing puberty-suppressing drugs to persons under the age of 18 who experience gender dysphoria.

DEFAMATION (LIBEL PER SE); AND 2. INJUNCTIVE RELIEF JURY TRIAL DEMANDED

Legal documents regarding false claims of conversion therapy.

American College of Pediatricians on Therapy Bans

Research

Do trans- kids stay trans- when they grow up?

In total, there have been three large scale follow-up studies and a handful of smaller ones. I have listed all of them below, together with their results. (In the table, “cis-” means non-transsexual.) Despite the differences in country, culture, decade, and follow-up length and method, all the studies have come to a remarkably similar conclusion: Only very few trans- kids still want to transition by the time they are adults. Instead, they generally turn out to be regular gay or lesbian folks. The exact number varies by study, but roughly 60–90% of trans- kids turn out no longer to be trans by adulthood.

Transgender and Gender Diverse Children and Adolescents: Fact-Checking of AAP Policy

The American Academy of Pediatrics (AAP) recently published a policy statement: Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Although almost all clinics and professional associations in the world use what’s called the watchful waiting approach to helping gender diverse (GD) children, the AAP statement instead rejected that consensus, endorsing gender affirmation as the only acceptable approach. Remarkably, not only did the AAP statement fail to include any of the actual outcomes literature on such cases, but it also misrepresented the contents of its citations, which repeatedly said the very opposite of what AAP attributed to them.

The effect of GnRHa treatment on bone density in young adolescents with gender dysphoria

Background More young people with gender dysphoria (GD) are undergoing hormonal intervention starting with gonadotropin-releasing hormone analogue (GnRHa) treatment. The impact on bone density is not known, with guidelines mentioning that bone mineral density (BMD) should be monitored without suggesting when. This study aimed to examine a cohort of adolescents from a single centre to investigate whether there were any clinically significant changes in BMD and bone mineral apparent density (BMAD) whilst on GnRHa therapy.

Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy

In hypogonadal/postmenopausal individuals, hormone therapy has been associated with an increased risk for cardiovascular events (CVEs). A steeply growing population that often receives exogenous hormones is transgender individuals. Although transgender individuals hypothetically have an increased risk of CVEs, there is little known about the occurrence of CVEs in this population.

Pelvic pain and persistent menses in transgender men

Pelvic pain in transgender men can be a clinical challenge and has a broad differential diagnosis. Pelvic pain less than 6 months of duration is considered acute.

Use of puberty blockers for gender dysphoria: a momentous step in the dark

We write with three areas of concern about the increasing use of puberty-blocking medication for gender dysphoria (GD) referred to in your recent leading article.

Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study

Venous thromboembolism (VTE), ischemic stroke, and myocardial infarction in transgender persons may be related to hormone use.

Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria

Sociological and sociocultural explanations are offered to account for this recent inversion in the sex ratio of adolescents with gender dysphoria.

Self-Harm and Suicidality in Children Referred for Gender Dysphoria

This study examined rates of self-harm and suicidality (ideation and behavior) in children referred clinically for gender dysphoria compared with their siblings, and referred and nonreferred children from the Child Behavior Checklist (CBCL) standardization sample.

Psychosocial and Psychological Vulnerability in Adolescents with Gender Dysphoria: A “Proof of Principle” Study

For adolescents with gender dysphoria, it has become common to be offered hormonal treatment to either delay or suppress pubertal development and/or to masculinize or feminize the body. At the same time, it has been our clinical impression that the psychological vulnerability of at least some of these youth has been overlooked.

Traits of autism spectrum disorder in school-aged children with gender dysphoria: A comparison to clinical controls.

Studies of children with gender dysphoria (GD) have reported an overrepresentation of autism spectrum disorder (ASD) or traits. One limitation of these studies has been the absence of a concurrent comparison group of children referred for other clinical problems. The present study addressed this gap by comparing 61 children referred for GD with 40 children referred for other clinical concerns (age range, 4–12 years).

Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria

In on-line forums, parents have reported that their children seemed to experience a sudden or rapid onset of gender dysphoria, appearing for the first time during puberty or even after its completion. Parents describe that the onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity.

Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners

The study’s purpose was to describe a population of individuals who experienced gender dysphoria, chose to undergo medical and/or surgical transition and then detransitioned by discontinuing medications, having surgery to reverse the efects of transition, or both.

The Gender Affirmative Treatment Model for Youth with Gender Dysphoria: A Medical Advance or Dangerous Medicine?

What factors, aside from the lack of a rigorous evidence base, might contribute to dangerous medical practices? Can history inform us anything about what might lead physicians to over-enthusiastically and prematurely embrace risky and unproven treatments? History suggests there is most likely a complex interplay of multiple factors, and I discuss some of these in this section. In the subsequent section, I return to discuss the gender affirmative treatment approach for GD youth and highlight some themes that may suggest some parallels with this history.

The Tavistock’s Experiment with Puberty Blockers

The Dutch protocol promised to create a more passable simulacrum of the opposite sex than could be achieved by physical intervention in adulthood. It was therefore embraced by trans-identified children and their parents, by older transgender activists, and by some clinicians specializing in gender dysphoria. The Gender Identity Development Service (GIDS), part of the Tavistock and Portman NHS Foundation Trust, treats children with gender dysphoria from England, Wales, and Northern Ireland. It launched an experimental study of “puberty blockers”—the more friendly term for GnRHa when administered to children with gender dysphoria—in 2011. The experiment gave triptorelin to 44 children, which in all or almost all cases led eventually to cross-sex hormones. This paper describes the origins and conduct of this study and scrutinizes the evidence on its outcomes. 

Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria

Turban et al. (2020) contributed nothing to our knowledge of the effects of suppressing puberty in adolescents.

Revisiting the effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria

Given that puberty suppression left up to a third of patients with abnormally low bone density, Joseph et al.’s recommendations are surprisingly complacent. One is to reduce DXA monitoring which ‘can have significant financial implications for healthcare providers’. Another is to change the computation of Z-scores; ‘reference ranges may need to be re-defined for this select patient cohort’. Rather than altering a measure that provides inconvenient findings, practitioners of puberty suppression must record fractures as adverse events.

Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria

According to Turban, King, Carswell, and Keuroghlian (2020), suicidal ideation is lower in transgender adults who as adolescents had been prescribed “puberty blockers”—gonadotropin-releasing hormone analogs (GnRHa). This finding was derived from a large nonrepresentative survey of transgender adults in the U.S., which included 89 respondents who reported taking puberty blockers. Turban et al. (2020) tested six measures of suicidality and three other measures of mental health and substance abuse. With multivariate analysis, only one of these nine measures yielded a statistically significant association: the respondents who reported taking puberty blockers were less likely to have thought about killing themselves than were the respondents who reported wanting blockers but not obtaining them. This finding was widely reported in the media; the lead author published a column on its implications for health policy in the New York Times (Turban, 2020).

Correction to Bränström and Pachankis

After the article “Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study” by Richard Bränström, Ph.D., and John E. Pachankis, Ph.D. (doi: 10.1176/appi.ajp.2019.19010080), was published online on October 4, 2019, some letters containing questions on the statistical methodology employed in the study led the Journal to seek statistical consultations. The results of these consultations were presented to the study authors, who concurred with many of the points raised. Upon request, the authors reanalyzed the data to compare outcomes between individuals diagnosed with gender incongruence who had received gender-affirming surgical treatments and those diagnosed with gender incongruence who had not. While this comparison was performed retrospectively and was not part of the original research question given that several other factors may differ between the groups, the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison.

Informed Consent for Transgendered Patients

This article reviews the history of informed consent, presents the conflicts of ethical principles, and presents three categories of risk that must be appreciated before informed consent is accomplished. The risks involve biological, social, and psychological consequences. Four specific risks exist in each category. The World Professional Association for Transgender Health’s Standards of Care recommend an informed consent process, which is at odds with its recommendation of providing hormones on demand.

Ethical Concerns About Emerging Treatment Paradigms for Gender Dysphoria

The increasing incidence of requests for medical services to support gender transition for children, adolescents, and adults has consequences for society, governmental institutions, schools, families, health-care professionals, and, of course, patients. The sociological momentum to recognize and accommodate to trans phenomena has posed ethical dilemmas for endocrinologists, mental health professionals, and sexual specialists as they experience within themselves the clash between respect for patient autonomy, beneficence, nonmaleficence, and informed consent. The larger ethical clashes are cultural and therefore political. There is a distinct difference between pronouncements that represent human rights ideals and the reality of clinical observations.

A Follow-Up Study of Boys With Gender Identity Disorder

This study reports follow-up data on the largest sample to date of boys clinic-referred for gender dysphoria (n = 139) with regard to gender identity and sexual orientation.

The Right to Best Care for Children Does Not Include the Right to Medical Transition

Refuting that any child has the right to medically transition

Do children with gender dysphoria have intense/obsessional interests?

This study examined whether children clinically referred for gender dysphoria (GD) show increased symptoms of autism spectrum disorder (ASD).

Epidemiology of gender dysphoria and transgender identity

This review provides an update on the epidemiology of gender dysphoria and transgender identity in children, adolescents and adults.

The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender non-conforming children” by Temple Newhook et al. (2018)

Temple Newhook et al. (2018) provide a critique of recent follow-up studies of children referred to specialized gender identity clinics, organized around rates of persistence and desistance. The critical gaze of Temple Newhook et al. examined three primary issues: (1) the terms persistence and desistance in their own right; (2) methodology of the follow-up studies and interpretation of the data; and (3) ethical matters. In this response, I interrogate the critique of Temple Newhook et al. (2018).

Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues

This article provides an overview of five contemporary clinical and research issues pertaining to adolescents with a diagnosis of gender dysphoria: (1) increased referrals to specialized gender identity clinics; (2) alteration in the sex ratio; (3) suicidality; (4) “rapid-onset gender dysphoria” (ROGD) as a new developmental pathway; (5) and best practice clinical care for adolescents who may have ROGD.

Debate: Different strokes for different folks

A gender social transition in prepubertal children is a form of psychosocial treatment that aims to reduce gender dysphoria, but with the likely consequence of subsequent (lifelong) biomedical treatments as well (gender-affirming hormonal treatment and surgery).

Gender Dysphoria in Adults

Prevalence studies conclude that fewer than 1 in 10,000 adult natal males and 1 in 30,000 adult natal females experience GD, but such estimates vary widely. GD in adults is associated with an elevated prevalence of comorbid psychopathology, especially mood disorders, anxiety disorders, and suicidality.

Intense/obsessional interests in children with gender dysphoria: A cross-validation study using the Teacher’s Report Form

Objective This study assessed whether children clinically referred for gender dysphoria (GD) show symptoms that overlap with Autism Spectrum Disorder (ASD). Circumscribed preoccupations/intense interests and repetitive behaviors were considered as overlapping symptoms expressed in both GD and ASD.

The DSM-5 and the Politics of Diagnosing Transpeople

In the DSM-5, there has been a change in the diagnosis for transpeople of all ages from Gender Identity Disorder (GID) to Gender Dysphoria (GD), in part to better indicate the distress that transpeople may experience when their gender identity feels incongruent.

Legal & Ethical Considerations For Informed Consent In Clinical Trials

The purpose of this article is to provide some thoughts as to the role each of us can play in clarifying some issues related to informed consent. These perspectives are based on my experiences as a registered nurse in a career that spanned more than three decades in private hospital settings, a private surgical association, and a university health system.

Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden

The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person’s body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment.

Detransition-Related Needs and Support: A Cross-Sectional Online Survey

The aim of this study is to analyze the specific needs of detransitioners from online detrans communities and discover to what extent they are being met.

Suicide Coverage in the Digital Press Media: Adherence to World Health Organization Guidelines and Effectiveness of Different Interventions Aimed at Media Professionals

This study evaluated the characteristics of suicide news articles in the digital press, their adherence to World Health Organization (WHO) recommendations, and the effectiveness of interventions.

Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population

Despite their growing number and increasing specific medical needs, there has been a lack of research on cardiovascular disease (CVD) and CVD risk factors in this population.

Psychiatry’s ethical involvement in gender-affirming care

To reflect on the role of psychiatry in authorising physical treatments for Gender Dysphoria and to examine the quality of evidence for gender-reassignment.

One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria

We agree with Turban et al.’s (2020) position that therapies using coercive tactics to force a change in gender identity have no place in health care. We do, however, take issue with their problematic analysis and their flawed conclusions, which they use to justify the misguided notion that anything other than “affirmative” psychotherapy for gender dysphoria (GD) is harmful and should be banned.

Peer Contagion in Child and Adolescent Social and Emotional Development

In this article, we examine the construct of peer contagion in childhood and adolescence and review studies of child and adolescent development that have identified peer contagion influences. Evidence suggests that children’s interactions with peers are tied to increases in aggression in early and middle childhood and amplification of problem behaviors such as drug use, delinquency, and violence in early to late adolescence.

A Typology of Gender Detransition and Its Implications for Healthcare Providers

Gender detransition is an emerging yet poorly understood phenomenon in our society. In the absence of research, clinicians and researchers have applied the concept of detransition differently, leading to inconsistencies in its use. The article suggests a typology of gender detransition based on the cessation or the continuation of a transgender identity to address this issue.

Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service

This prospective study examines the clinical characteristics of children (n = 79; 8.42–15.92 years old; 33 biological males and 46 biological females) presenting to a newly established, multidisciplinary Gender Service in New South Wales, Australia, and the challenges faced by the clinicians providing clinical services to these patients and their families.

Low Bone Mineral Density in Early Pubertal Transgender/Gender Diverse Youth: Findings From the Trans Youth Care Study

Transgender youth may initiate GnRH agonists (GnRHa) to suppress puberty, a critical period for bone-mass accrual. Low bone mineral density (BMD) has been reported in late-pubertal transgender girls before gender-affirming therapy, but little is known about BMD in early-pubertal transgender youth.

Outbreak: On Transgender Teens and Psychic Epidemics

Currently, we appear to be experiencing a significant psychic epidemic that is manifesting as children and young people coming to believe that they are the opposite sex, and in some cases taking drastic measures to change their bodies.

How common is intersex? a response to Anne Fausto-Sterling

If the term intersex is to retain any meaning, the term should be restricted to those conditions in which chromosomal sex is inconsistent with phenotypic sex, or in which the phenotype is not classifiable as either male or female. Applying this more precise definition, the true prevalence of intersex is seen to be about 0.018%, almost 100 times lower than Fausto-Sterling s estimate of 1.7%.

Puberty Blockers, Cross-Sex Hormones, and Youth Suicide

Lowering legal barriers to make it easier for minors to undergo cross-sex medical interventions without parental consent does not reduce suicide rates—in fact, it likely leads to higher rates of suicide among young people in states that adopt these changes. States should instead adopt parental bills of rights that affirm the fact that parents have primary responsibility for their children’s education and health, and that require school officials and health professionals to receive permission from parents before administering health services, including medication and “gender-affirming” counseling, to children under 18. States should also tighten the criteria for receiving cross-sex treatments, including raising the minimum eligibility age.

Absence of Behavioral Harm Following Non-efficacious Sexual Orientation Change Efforts: A Retrospective Study of United States Sexual Minority Adults, 2016–2018

This study attempts, for the first time, to isolate and examine the question of current psychosocial harm for former SOCE participants among sexual minorities in representative population data.

Mormon clients’ experiences of conversion therapy: the need for a new treatment approach

Perspectives were gathered of 50 Mormon individuals who had undergone counseling to change their sexual orientation. The data were analyzed using the constant comparative method and participant verification, thereby developing a grounded theory. A model emerged that depicted participants’ intrapersonal and interpersonal motivations for seeking conversion or “reparative” therapy, their perceived benefits and harms of such interventions, and the factors that facilitated self-acceptance and consolidation of a positive self-identity. Based on these descriptions, this study provides the foundation for a broader-based treatment approach (besides one focused solely on changing sexual orientation or adopting a lesbian, gay, or bisexual identity), which is designed to produce individualized congruent solutions for religiously conflicted, same-sex-attracted clients.

A longitudinal study of attempted religiously mediated sexual orientation change.

Evidence from the study suggested that change of homosexual orientation appears possible for some and that psychological distress did not increase on average as a result of the involvement in the change process. The authors explore methodological limitations circumscribing generalizability of the findings and alternative explanations of the findings, such as sexual identity change or adjustment.

Sexual Orientation Change Efforts (SOCE) *Reduce* Suicide: Correcting A False Research Narrative

Experiencing SOCE therapy does not encourage higher suicidality, as they claim; rather, experiencing higher suicidality appears to encourage recourse to SOCE, which in turn strongly reduces suicidality, particularly initial suicide attempts.

Polyamory, monoamory, and sexual fluidity: A longitudinal study of identity and sexual trajectories.

Prior research has documented shifts in sexual orientation identity, attractions, and partnering behavior over time and social context, commonly referred to as sexual fluidity (Diamond, 2008). Social contextual factors may include relationship status and type of relationship, and these may be particularly salient in polyamorous communities where multiple relationships and some degree of fluidity are common.

Sexual Orientation Change Efforts, Adverse Childhood Experiences, and Suicidality

Our interest is not to defend genuinely unethical practices but, rather, to promote scientific integrity in a domain of research that is subject to immense professional and political pressure to support specific legislative and policy aims.5 In our view, the Blosnich et al. study, as with most research in this literature, offers conclusions in support of expansive and imprecisely defined SOCE bans that run ahead of what methodological limitations allow.

Sexual Minorities who Reject an LGB Identity: Who Are They and Why Does It Matter?

Results suggested those who reject an LGB identity are more likely to be religiously active, full members of their church, and highly intrinsic and theologically conservative in their religious viewpoint. They further reported having slightly more lifetime heterosexual attractions, fantasies, and behaviors; greater internalized homonegativity; and being more interested in having children and a child-centered family life. They were also more likely to be single and celibate or in a heterosexual relationship. Contrary to expectations, these differences were not associated with health differences in depression, anxiety, and social flourishing.

The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender non-conforming children” by Temple Newhook et al. (2018)

The critical gaze of Temple Newhook et al. examined three primary issues: (1) the terms persistence and desistance in their own right; (2) methodology of the follow-up studies and interpretation of the data; and (3) ethical matters. In this response, I interrogate the critique of Temple Newhook et al. (2018).

Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development

Increasing numbers of adolescents present in adolescent gender identity services, desiring sex reassignment (SR). The aim of this study is to describe the adolescent applicants for legal and medical sex reassignment during the first two years of adolescent gender identity team in Finland, in terms of sociodemographic, psychiatric and gender identity related factors and adolescent development.

Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service

Our results suggest the need to bring into play a biopsychosocial, trauma-informed model of mental health care for children presenting with gender dysphoria. Ongoing therapeutic work needs to address unresolved trauma and loss, the maintenance of subjective well-being, and the development of the self.

Transgender medicalization and the attempt to evade psychological distress

The author argues that the quality of evidence supporting the biomedical approach is extremely poor. This puts young trans people at risk of receiving potentially damaging medical treatment they may later seek to reverse or come to regret, while their underlying psychological issues remain unaddressed.

Reflections on the Clinician’s Role with Individuals Who Self-identify as Transgender

Gender identity is only one aspect of an individual’s multifaceted identity. The contributions to the passionate positions in the trans culture debate are discussed along with the controversy over the official.

Impact of trauma on sexual functioning and sexual relationships

This paper considers the impact of traumatic experiences on sexual functioning and sexual relationships. There is a large literature on the way sexual trauma affects later sexual functioning and relationships. Non-sexual traumatic experiences also affect these domains.

Efficacy and risk of sexual orientation change efforts: a retrospective analysis of 125 exposed men

SOCE was perceived as an effective and safe therapeutic practice by this sample of participants. We close by offering a unifying understanding of discrepant findings within this literature and caution against broad generalizations of our results.

Effects of Therapy on Religious Men Who Have Unwanted Same-Sex Attraction

In our study, most of those who participated in group or professional help had heterosexual shifts in sexual attraction, sexual identity and behavior with large statistical effect sizes, similarly moderate-to-marked decreases in suicidality, depression, substance abuse, and increases in social functioning and self-esteem. Almost all harmful effects were none to slight.

Sexual Fluidity in Male and Females

These studies also provide evidence for gender differences in sexual fluidity, but the extent and cause of these gender differences remain unclear and are an important topic for future research.

Sexual Orientation Change Efforts, Professional Psychology, and the Law: A Brief History and Analysis of a Therapeutic Prohibition

In what follows, I will briefly describe the history of SB 1172 and analyze some of the likely factors that led to the pursuit of a statutory solution to a professional practice concern. I will also outline several recommendations for improving how controversial issues are addressed, not only by the profession of psychology, but also by politicians and judges. By examining these concerns through the lens of SB 1172, I hope to highlight the perils of resolving matters of professional practice through legislative action.

Homosexuality and Co-Morbidities: Research and Therapeutic Implications

People reporting SSA have a more widespread and intense psychopathological burden than probably any other group of comparable size in society, though college-age people may have more substance abuse problems. The reversed gender pattern of these conditions suggests some link with SSA itself. Surveys in recent literature suggest that perceived discrimination rather than objective discrimination is to blame for suicidality. Recent literature also finds that particular emotion/avoidant-based coping mechanisms used by people reporting SSA almost entirely account for the effects of this perceived discrimination.

Professional care for unwanted same-sex attraction: What does the research say?

In recent years, national and international medical and mental-health associations typically have emphasized the potential harmfulness of professional care for unwanted same-sex attraction (SSA or homosexuality) and behavior. State legislatures in the US and legislative bodies in other countries either have passed or are considering passing laws which would penalize professionals who provide professional care for unwanted SSA—to minors and/or adults—including the loss of the license to practice. This paper was written as a response to the present situation in the UK.

Happily Religious: The Surprising Sources of Happiness Among Lesbian, Gay, Bisexual, and Transgender Adults*

This article analyzes the impact of religion on reported levels of subjective well‐being (general happiness) among lesbian, gay, bisexual, and transgender (LGBT) adults. Although previous studies find religious affiliation to be a significant predictor of subjective well‐being among the general population in the United States, limited quantitative research investigates general happiness among sexual and gender minorities. This study augments the existing literature by using a national survey of LGBT adults conducted by the Pew Research Center in 2013. The results show that religious affiliation is a significant predictor of LGBT individuals’ happiness. LGBT individuals who identify as Catholic, agnostic or atheist, or with no particular religious affiliation report lower levels of happiness compared to mainline Protestants. Surprisingly, no significant differences are found between mainline Protestants (whose church doctrine often accepts same‐sex relations) and evangelical Protestants (whose church doctrine often condemns same‐sex relations). In addition, income is the only control variable that affects general happiness. Our analysis reveals interesting differences in the determinants of subjective well‐being between the LGBT and general population. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Sexual Orientation Trajectories Based on Sexual Attractions, Partners, and Identity: A Longitudinal Investigation From Adolescence Through Young Adulthood Using a U.S. Representative Sample

Some classes represent generally consistent indicators across dimensions over time, while other classes describe more emerging or discontinuous trajectories. Substantial changes were common not only from late adolescence to the early 20s but also from the early 20s to the late 20s, indicating that sexual orientation development continues throughout emerging adulthood.

Is Conservative Religiousness Inherently Associated with Poorer Health for Sexual Minorities?

Results of path analysis involving sexual minority participants (N = 1317) from diverse sociopolitical contexts revealed health outcomes to be associated with internalized homonegativity and the resolution of conflict between religious and sexual minority identities. Contrary to expectations, several markers of religiousness were not directly associated with either improved or worsened health outcomes for depression or anxiety. However, religious activity moderated the influence of internalized homonegativity (IH) on depression such that IH was less strongly related to depression among individuals who frequently attended religious services than among individuals who infrequently attended religious services. These findings have special salience for advancing a more accurate understanding of conservatively religious sexual minorities and directing culturally sensitive research, clinical services, and public policy.

Sex and gender are distinct variables critical to health: Comment on Hyde, Bigler, Joel, Tate, and van Anders (2019)

In this brief comment on Hyde, Bigler, Joel, Tate, and van Anders (2019), we maintain that sex and gender are distinct variables that impact human health in critical ways both individually and interactively.

Clinical approaches to conflicts between religious values and same-sex attractions: Contrasting gay-affirmative, sexual identity, and change-oriented models of therapy.

The literature germane to the care of clients presenting for psychotherapy with conflicts between their sexual orientation and religious values typically addresses the topic from within a particular therapeutic approach. This article addresses the issue from a broader perspective that takes into account 3 different paradigms: gay-affirmative therapy, sexual identity therapy, and change-oriented therapy. The authors describe the 3 approaches, compare and contrast them across several different key dimensions of theory and practice, and identify some strengths and potential limitations of each approach for assisting clients who are attempting to navigate the resolution of their conflict.

Same-Sex Marriage and the Boundaries of Diversity: Will Marriage and Family

I conclude with some recommendations through which the field of marriage and family therapy can reduce the potential for conflicts and thereby reassure these clinicians that they continue to be welcomed even if their vision of marriage differs from that which is formally endorsed by their professional associations.

Satisfaction and Health Within Four Sexual Identity Relationship Options

The SSR group had the least depression and anxiety and the most life satisfaction and physical health, followed by the MOR group, followed by the two single groups. Results from a stepwise regression predicting satisfaction from important aspects of life and relationships identified that meeting needs for connection, intimacy, and mutual understanding was the strongest predictor of satisfaction across all options. Other significant variables included participant-defined authentic sexual expression, resolving conflicts with religion, and reducing depression and anxiety. Results may inform SSA/LGB individuals who are questioning which option fits best for them and help guide therapists who work with these individuals.

The Pursuit of Change and Acceptance of Minority Sexual Orientation in Psychotherapy: Retrospective Perceptions of Helpfulness and Harmfulness

Traditional religious belief, identity, and activity were associated with rating some goals of SOCE as at least mildly helpful. Effect sizes were mostly moderate to large for these statistics. There was a heightened level of depression and anxiety among these sexual minorities overall, but past pursuit of change-oriented goals did not appear to be a major explanation for current levels of distress. We conclude by outlining some implications and cautions based on our findings for both proponents and opponents of change-oriented psychotherapy approaches.

Sexual Minorities who Reject an LGB Identity: Who Are They and Why Does It Matter?

Although many sexual minorities adopt a lesbian, gay, bisexual (LGB) identity, some persons who experience same-sex attractions reject an LGB identity in favor of other descriptions for their sexuality, such as “same-sex attracted” or “mostly heterosex- ual” (Lefevor et al., 2020). Because research typically focuses on LGB-identified individ- uals, very little is known about those who reject an LGB identity. In this study, we seek to identify characteristics of this group and how these characteristics may distinguish them from sexual minorities who are LGB-identified. We also examine to what extent these groups differ on several health measures and close with a discussion about why our findings matter for this literature.

Sexual Attraction Fluidity and Well-Being in Men: A Therapeutic Outcome Study

Recent legislative efforts initiated by politicians and activists have limited or threatened to limit the autonomy and self-determination of individuals desiring sexual attraction fluidity exploration in therapy (SAFE-T), claiming that SAFE-T is ineffective and harmful. The American Psychological Association has claimed that there is not enough rigorous research to draw conclusions about the efficacy or beneficence and nonmaleficence of SAFE-T. The present longitudinal study examined the sexual attraction fluidity (SAF) and wellbeing of psychotherapy clients while participating in SAFE-T. Participants were 75 adult male psychotherapy clients reporting both same-sex attraction experiences (SSAE) and the desire to participate in SAFE-T to achieve SAF. Well-being was measured with the OQ-45.2, SSAE, and opposite-sex attraction experiences (OSAE) with a Likert scale, and sexual attraction identity (SAI) with a Likert-type item. Results of t-tests of the means of baseline and final well-being measures revealed a clinically and statistically significant improvement in well-being. A linear mixed model was used to analyze the SSAE, OSAE, and SAI data obtained at baseline, 6 months, 12 months, 18 months, and 24 months, with results showing statistically significant fluidity of all three factors. SSAE decreased, OSAE increased, and SAI moved toward heterosexual identity.

Aricles

Podcasts

Letter Templates

Universal Opt-Out Letter

Letter to opt out of all CSE and SOGI.

Teacher Curriculum Request Letter

Letter to find out curriculum.

Sample School Board Letter

Letter to school board about promotion and affirmation of gender dysphoria.

Sample Letter to Superintendent

Letter to school superintendent regarding concerns about policies that promote affirmation of gender dysphoria.

Sample Letter to Teacher

Letter to school teacher regarding concerns about policies that promote affirmation of gender dysphoria.

UK Letters

Letter templates for those in the UK who are concerned about the gender ideology at their schools.

National Task Force for Therapy Equality

Letter to oppose therapy bans.

Letter from American College of Pediatricians

Letter to oppose therapy bans.

Template therapy ban letter to legislators

Letter to oppose therapy bans.

Serious Harmful Implications of Therapy Ban Bills

Letter to oppose therapy bans.

Powerpoints

Policy Briefs