Transgender youth fact check: Blaire White is wrong – Part 2: Outcomes

(Explaining why something is wrong can take a very long time! Please be sure to read Part 1 before continuing.)

So, someone by the name of Blaire White made a video about gender transition treatment for transgender children and adolescents. And I’m going to fact check it!

Examining the evidence on transition “regret”

“Which brings me to my next point, which is that there are health risks attached with going off of hormones once you’re already on them. Going on hormones is supposed to set you on a one-track trajectory, and you can’t really trust a child to make a decision now that they know they’re going to be happy with for the rest of their lives.”

Blaire White doesn’t explain what any of these supposed health risks are, so I can’t really address whatever they are. But a trans woman who doesn’t begin medically transitioning until adulthood will also be going off of hormones that she’s already on: she’ll take antiandrogens, and will go off the testosterone that her own body has been producing. Why is going off of those hormones an acceptable health risk, but going on HRT and then off of it an unacceptable risk? It’s almost as if Blaire White is asking, “What if they have to transition in adulthood, which is exactly what Blaire White wants?”

“For some reason, trans people don’t want to talk about the fact that there are a lot of people who decide to transition and then they go back because they realize it’s not the right decision for them. I’m not saying that’s the majority by any means, but at the same time, if there are adults who realize they were wrong, what makes you think a child will not grow up and realize they were wrong?”

Regret over transitioning is very uncommon, and several studies have found rates of regret of below 5%. That is what makes me think youth who transition will not grow up and realize they were wrong. One study of 767 trans people in Sweden over 50 years found that only 2.2% regretted transitioning (Dhejne, Öberg, Arver, & Landén, 2014). Other studies have found regret rates as high as 4% (Weyers et al., 2009) and as low as 0% (Johansson, Sundbom, Höjerback, & Bodlund, 2010). There is little indication that “a lot” of people who choose to transition will ultimately conclude that it was a mistake. Saying that this is “not … the majority” does not adequately express how rare this is. A better word would be “negligible”.

I have talked about this myth of widespread regret since last year – and more than that, I’ve investigated it. High-profile stories of regret are often nothing but the same handful of examples that have been circulated for the past 20 years. In many of these cases, the individuals only regretted transitioning due to the transphobic harassment and abuse they’d received from others. Many stated they did not actually regret transitioning, and some who had de-transitioned went on to transition once again. More trans people talking about this will mean more trans people talking about very high rates of satisfaction with transition, and very low rates of regret.

The role of expert medical diagnosis and ongoing counseling

“And I say this especially because we’re living in this world where transgender has become ‘cool’. In a lot of ways I think in this culture, transgenderism has become something that is less of a medical diagnosis and more of a fad. I mean it used to be something that you come to a revelation about through years of self-discovery and therapy, but now a lot of people seem to come to the revelation that they’re trans because they saw someone on YouTube and they think it looks cool, or they saw a Tumblr post about it.”

There’s no reason to be so dismissive of trans children’s genders or assume that they haven’t given a great deal of serious thought to their identities – professionals in the field clearly believe that these children are indeed serious about this. For trans youth, receiving puberty blockers requires a medical diagnosis. Transitioning in adolescence is also accompanied by years of ongoing counseling and therapy. They’re not being diagnosed by Dr. YouTube, they’re not getting medications from Nurse Tumblr, and they’re not being immediately administered treatment on the basis that it “looks cool”. They’re evaluated and treated by pediatric endocrinologists and therapists with extensive experience in these areas. If a child learns about the possibility of transition from the internet, they’re still subject to the same continual medical evaluations. So what exactly is there to disagree with here?

More than that, kids today do have more opportunities to learn about trans topics than ever before, whether from the internet or from other media. How is that bad? So many trans people had to grow up in decades past where there was little public understanding or awareness of even the basics of being trans. This wasn’t good for them – it meant prolonging a period of confusion for many unnecessary years or decades. Trans people would sometimes describe this in terms such as “I thought I was the only one in the world that was going through this” (Kuklin, 2014), or “Until I found out there were others, I knew I was alone” (Bolin, 1988). Is that supposed to be preferable to learning from information that’s available online? Why would anyone want a trans person to have to experience that?

The known benefits of transitioning in puberty

“It all seems to boil down to this argument that if you allow a child to transition when they’re 12, 13 years old, you know, delay puberty, that they ‘pass’ better later on in life. So what that means is that they physically resemble the sex that they want to be rather than the one that they were born as. But I’m sorry, that really just does not hold up with me. Your argument is still contingent upon the idea that this kid knows for a fact that they’re trans, and that what they’re experiencing, what they’re feeling, means in fact that they are transgender. There’s just way too much room for error, in my opinion, and I just can’t go with it.”

Transitioning during adolescence has benefits to health that go beyond the notion of “passing”. Early transition can reduce the need for later surgical interventions in adulthood, such as facial feminization, breast augmentation, chest reconstruction, tracheal shave, vocal surgery, and more. Minimizing the need for these major surgeries is directly beneficial to their health regardless of “passing”.

Followup studies on kids who transition early have also found that this improves their mental and emotional health and well-being. A study in 1997 of some of the earliest patients to transition in adolescence found that after transitioning, their levels of gender dysphoria dropped to within the range of their cis peers, and none of them said they regretted this (Cohen-Kettenis & van Goozen, 1997). Their psychological functioning following transition was similar to that of the overall population as well. Another study in 2014 replicated these results: trans people who had received puberty blockers experienced a reduction in dysphoria and an improvement in psychological functioning, and their overall well-being was comparable to that of cis people, with no reports of regret (De Vries et al., 2014).

Early transition is not only a matter of a child “knowing for a fact” that they are trans. Even if that child has a high degree of certainty about who they are, receiving this treatment is still contingent on a team of medical professionals also having a high degree of certainty about this. If there were as much susceptibility to error in diagnosis and treatment as Blaire White claims, we would expect to see substantial numbers of patients who regret transitioning early, with accompanying negative health outcomes. But this is not observed. We don’t have to address this at the level of clashing opinions when it’s already been addressed by consistent evidence.

Ability to grasp future consequences

“So, transitioning for me was the best decision I’ve ever made, hands down, and I would never go back. My life opened up in so many amazing ways both big and small, that I probably couldn’t even properly articulate here. My life really did improve exponentially, and it was hands down the best decision for me. It was a choice that came with many consequences and implications when it came to my health, my family, my social life, my money, so many different concepts that as an adolescent you really just don’t have a proper grasp on.”

Suppose a transgender girl is indeed unable to grasp the future consequences of delaying puberty and transitioning in later adolescence. How can we then presume that this girl has an adequate grasp of the consequences of going through a fully masculinizing puberty, and at a much younger age? Why would we assume she’s capable of understanding all of what’s entailed by choosing to wait until adulthood to transition and trying to treat whichever aspects of this masculinization are reversible?

A choice is still being made here, and real developmental consequences are still going to happen here. The difference is whether that choice incorporates the child’s own unique and considered insight into who they are and how they wish to live their lives, along with medical standards of care based on decades of studies and clinical experience. When you read the stories of trans people who transitioned early, like Nicole Maines, it’s clear that this isn’t just about whether the child was ready for puberty blockers. This was a child who wasn’t ready to be a boy, period. Withholding the option of early transition across the board means deliberately disregarding all of that relevant evidence when making a choice that will affect a child for the rest of their life. Kids deserve better than that.

What’s really “child abuse” here?

“Remember the days when we had that whole societal consensus that child abuse is wrong? Good times.”

One value that we can all agree on here is that we should responsibly pursue the best outcome for these children and avoid causing harm to them. In light of that, nothing about the process of early transition resembles child abuse. Given the available evidence, we can know that use of puberty blockers for properly diagnosed trans kids will generally improve their overall health, well-being, and ability to function in life. Deliberately withholding this medically indicated treatment means exposing them to a diminished quality of life and many other preventable risks to their health. This unwarranted and capricious choice of negative consequences for children falls much closer to the concept of child abuse. If you genuinely care for the people whose lives you’re talking about, you do your best to avoid hurting them. Facilitating transition in adolescence is the way to do that. ■

References

• Bolin, A. (1988). In search of Eve: Transsexual rites of passage. Westport, CT: Praeger.
• Cohen-Kettenis, P. T., & van Goozen, S. H. (1997). Sex reassignment of adolescent transsexuals: a follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 36(2), 263–271.
• De Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134(4), 696–704.
• Dhejne, C., Öberg, K., Arver, S., & Landén, M. (2014). An analysis of all applications for sex reassignment surgery in Sweden, 1960-2010: prevalence, incidence, and regrets. Archives of Sexual Behavior, 43(8), 1535–1545.
• Johansson, A., Sundbom, E., Höjerback, T., & Bodlund O. (2010). A five-year follow-up study of Swedish adults with gender identity disorder. Archives of Sexual Behavior, 39(6), 1429–1437.
• Kuklin, S. (2014). Beyond magenta: Transgender teens speak out. Somerville, MA: Candlewick Press.
• Weyers, S., Elaut, E., De Sutter, P., Gerris, J., T’Sjoen, G., Heylens, G., . . . Verstraelen, H. (2009). Long-term assessment of the physical, mental, and sexual health among transsexual women. Journal of Sexual Medicine, 6(3), 752–760.

Further reading

• “Supporting & Caring for Transgender Children” by the Human Rights Campaign, American Academy of Pediatrics, and American College of Osteopathic Pediatricians (2016).
• “Pediatricians should not be transgender children’s first bully” by the President of the American Academy of Pediatrics (2016).
• “Understanding Gender” by Gender Spectrum (2015).
• “Guiding Families of Transgender Children on a Path Toward Well-Being” in AAP Voices (2016).
• “Mental Health of Transgender Children Who Are Supported in Their Identities” in Pediatrics (2016).
• “Psychological and Medical Care of Gender Nonconforming Youth” in Pediatrics (2014).
• “Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth” in Journal of Adolescent Health (2016).
• “Care of a Transgender Adolescent” in American Family Physician (2015).
• “Suppression of Puberty in Transgender Children” in AMA Journal of Ethics (2010).
• “Gender reassignment and assisted reproduction” in Human Reproduction (2001).
• “Hate Group Masquerades as Pediatrics Organization to Attack Trans Kids” by the Human Rights Campaign (2016).

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