Yesterday on Tumblr, I posted a piece critical of PFLAG, the organization that used to advocate for lesbian, gay, and bisexual people and their parents. Like most formerly LGB groups, they have now been absorbed into the media and activist lobby for the transgender community.

One commenter took me to task, assuring me that there is plenty of support for lesbian and gay youth and their parents, and that it is fit and proper that those support organizations expand their mission to include trans and “genderqueer” advocacy.

But while support and visibility for “vanilla” lesbian youth and their parents has withered away, there is a large network of US organizations which have sprung up in support of (among other things) the medical transition of children and adolescents. In fact, there are so many of these pro-trans organizations that I could write a post a day on each one, and still not be finished in 2 months. And that’s without even touching the groups in other countries.

One such US organization is GenderSpectrum in the San Francisco Bay Area. I found no mention on their extensive website of the very real possibility that some of the kids who don’t fit gender stereotypes might actually turn out to be gay, lesbian, or bisexual (despite plenty of evidence that many LGB adults start out as gender nonconforming youth). No, in GenderSpectrum’s lingo, these kids are “gender expansive;” and paradoxically, but entirely consistent with the current Orwellian genderist reality we live in today, this means they need to eventually squeeze–not expand–their healthy bodies into breast binders and doctors’ examination rooms.

Here are some excerpts from the medical part of the GenderSpectrum website, wherein they counsel medical providers how to move their young “gender expansive” patients along the road to transition:

An important first step is the manner in which the provider creates space for the young person to talk about their gender. Sometimes a child’s gender-expansiveness will be obvious. Either the family has shared with you their observations/concerns about their child’s gender, or the child’s gender diversity is perceptible. In these situations, it is important to be affirming of the child’s presentation. For instance, if a child comes into the exam room in clothing stereotypically consistent with the “other” sex, show interest. Questions or comments such as “where do you get cool shoes like that?” “I love the color of that dress,” or “how do you keep your baseball hat’s bill so straight?” will demonstrate openness on your part that can help the patient relax and feel more secure.

Because what they wear is a key indicator of whether they will eventually need weekly testosterone injections and double mastectomies.

But it is also quite common to see no evidence of a young patient’s identification. Perhaps the child or teen lives in a context where it has been made clear that this topic is off-limits. They may feel great shame about their gender, or not even have the words to describe what they are feeling. Thus, the provider needs to open the door for this information to emerge. In taking the patient’s history, consider ways you might elicit information about a child’s emerging gender. Ask open-ended questions about the young person’s toys, activities, styles of dress, and friends. Specifically asking whether the child has questions about gender also establishes a setting where it is clear that gender diversity is ok.

Didn’t we already put this to rest in the 1970s and 1980s, during the Second Wave of feminism? Do we really need to be instructing medical practitioners that it’s ok for girls not to behave and dress like stereotypical-circa-1940 girly-girls? But of course, this isn’t really about accepting and supporting a “gender expansive” child. No, just supporting and encouraging a kid to dress and act the way they want to isn’t sufficient anymore:

In some cases, a pre-adolescent or teen patient (and perhaps their parents) may have a clear sense about the medical pathway they hope to travel. The well informed pre-adolescent sees a straight line from using pubertal suppressants to taking cross-sex hormones to undergoing gender affirmation surgery. The teen that has come to recognize their transgender identity recently is immediately ready for hormones. Further, they may have a strong notion about when this will all begin: NOW!

Ok, at least the author of this advice column gets it that pre-adolescents and teens have poor impulse control and the need for instant gratification. And we also see acknowledgment that some teens “recently recognize” they are trans (any mention of the trans trend on YouTube and Tumblr? Nah.)

But, careful, good doctor! You don’t want to dash the hopes of Jodi-call-me-Joe in her baseball cap and boy’s-definitely-not-pink Nikes:

However, for any number of reasons, your professional judgment might well be that it is not time to begin moving down this road. This reality, however medically sound, can be devastating for the child or teen that sees changing their body as the most important aspect of affirming their gender identity. For a young person experiencing significant body dysphoria, the impact is especially intense, and can have significant mental health repercussions. It may well be that the patient and caregivers came into the appointment assuming that the entire process will be a battle, and the fact that they are being told “not yet” may be perceived as affirmation that you will be a gatekeeper standing in their way.

“Gatekeeper” is now the pejorative term for a medical professional who doesn’t immediately agree that the “well informed pre-adolescent” (an oxymoron if there ever was one) knows exactly what they’re doing–including consigning themselves to lifelong infertility.

But have no fear, gatekeeper. GenderSpectrum will teach you how to gently tap the brake for an over-eager child, while assuring them that the gas pedal will be pushed to the floorboards in due time:

Consequently, it is important for the patient to get some sort of “yes” in the process. Maybe this is an explanation about the steps and processes for medical intervention, with a firm follow-up appointment to determine the patient’s readiness. Perhaps it is putting written materials in their hands, or discussing with them what being ready means and what they can look for in the meantime. You may wish to refer them to resources for how they can achieve the desired effects in more cosmetic ways until medical interventions are appropriate.

Because “getting to yes” and encouraging a kid to get on the road to lifelong cross-sex hormone treatment and plastic surgeries is the ultimate destination, sooner or later. Why help them feel comfortable in their own skin? That is so 1980.