Opinion

Want to know a child’s gender? Ask

Talk to any parent of a child with gender dysphoria, and the vast majority will say: “I don’t know what to make of it. My child just came to us that way.” Typically, many of these children will be consistent, persistent and insistent in their self-declarations that they are another gender than the sex assigned at birth.

These children have been increasingly coming to our attention. Unfortunately, there continues to be a substantial number of clinicians who believe it is important to dissuade these children from their declarations.

December marked an important milestone in the public discussion of the proper care of children who tell us early on they are not the gender we think they are. The Centre for Addiction and Mental Health in Toronto, one of the largest mental health research hospitals in Canada, shut down its Child Youth and Family Gender Identity Clinic after a months-long review. The therapy in question, which had generated a formal complaint from a coalition of mental health professionals and community activists, was applied to young children given a diagnosis of gender dysphoria. The goal of treatment was to facilitate a child accepting the gender that matched the sex assigned at birth. The intent was to ward off being transgender in adolescence, thereby avoiding the complex medical interventions and social stigma attached to being transgender. The underlying assumption: Gender identity is still malleable in a young child, not so later on; so let’s do what we can before it’s too late.

Celebrating nonconformity

A supporter of Dr. Kenneth Zucker, the researcher and director of the clinic, asserted in a Wall Street Journal opinion piece that “he had not been trying to dissuade anyone from being transgender. Instead his therapy facilitated exploration of gender identity.” But reports by Zucker describing his best practices reveal otherwise, advocating a form of treatment that includes switching children’s toys to those typical of their natal sex, fostering play and activities with same-sex playmates, requesting greater involvement from a like-sex parent in an effort to enforce a child’s acceptance of the gender matching the sex assigned at birth.

In our opinion, this qualifies as a form of social engineering.

The clinic also recommended treatment for the parents to address their contribution to the child’s gender dysphoria and individual psychotherapy for the child to help them understand the problems in their lives for which wanting to become the other gender was a solution, potentially disorienting and confusing for both parent and child in the absence of any such problems.

By present statutes in both Toronto and numerous U.S. states and municipalities, such practices attempting to change either a minor’s gender identity or gender expressions are banned. They are perceived as a form of “conversion” or “reparative” therapy and assessed as an unethical and potentially harmful practice among major health organizations and gender clinics internationally.

In contrast, new models that have gained acceptance are based on the premise that a child’s gender identity and expressions are always a combination of nature, nurture, culture and data continue to point to biological and/or genetic underpinnings to gender identity.

In these “gender-affirmative” models, gender nonconformity is seen as a form of diversity to be celebrated rather than a disorder to be treated.

Most of us who could see beyond what we were taught in school have found these gender-expansive children to be bright, creative and determined in their own paths. If they suffer from psychological problems, then these are usually caused by their being thwarted and stigmatized in their identity.

Acceptance and affirmation are rapidly replacing “reparative” treatment in gender clinics throughout the United States and Europe, as evidenced locally at UCSF Benioff Children’s Hospital San Francisco and Oakland gender clinics and the mental health wing of the Child and Adolescent Gender Center-Mind the Gap Mental Health Collaborative, a group of therapists which meets regularly to refine our understanding of these children who are expanding our initial binary thinking about gender.

Following children’s lead

Still, many have accused gender-affirmative practitioners of having a political agenda — of pushing a transgender identity on a child, and rubber-stamping whatever the child tells us about their gender. Let us dispel such myths and clarify what we professionals actually do: Listen carefully, follow the child’s development as it unfolds, help parents to accept rather than reject, learn to translate what the children are trying to tell us about their gender in words and action.

We do all of this to help bring that child’s gender into clear focus.

Studies have shown children pay the price of gender nonacceptance throughout the rest of their lives. And we now have strong data that show the “gender-affirmative” approach carefully followed leads to an improvement in the children’s mental health in adolescence and beyond.

By listening to the kids, we have learned well beyond anything we were taught about human diversity: Supporting children living the gender that feels most authentic to them, rather than the one others want them to be, fulfills the medical dictum to “do no harm” and enhances children’s well-being. And our greatest hope is that gender-affirmative programs will continue to spread around the country and beyond, fertilizing gender health wherever they go.

Dr. Herbert Schreier is a psychiatrist at the Department of Psychiatry at UCSF Benioff Children’s Hospital Oakland. Dr. Diane Ehrensaft is director of the mental health center at UCSF Benioff Children’s Hospital Child and Adolescent Gender Center. To comment, submit your letter to the editor at www.sfgate.com/submissions

Seeking support

Drs. Schreier and Ehrensaft have joined others in posting a petition online and are tweeting with #SupportTransKids. An excerpt follows:

“As a group of international care providers, academics and other professionals who work toward the health and well-being of gender diverse children and youth in a range of disciplines and fields (including psychiatry, psychology, pediatrics, social work, health studies, sociology, political science, nursing, law, education), we are writing to express support for the December 2015 decision to close the CAMH Child and Youth Gender Identity Clinic.

While some have worried that this closure means an end to support for families with gender diverse children, it is important to draw attention to the fact that there are other services ... that support these families through an affirmative approach that meets current best practices in the field. These affirmative services are drastically underfunded, and new commitments are required from all levels of government to ensure that families with gender diverse children are effectively supported.

... We also urge others to join us in calling for additional funding to develop more services to better support gender diverse children and their families through an affirming and trans-positive model of care, recognizing that gender diversity ‘is a matter of diversity, not pathology’.”

One child’s story

Charlie was a prodigious child, starting to read at age 2, said his mother, Anne. One night after a bath, he asked his mother in all earnestness when he could have his penis taken off as he was really a girl.

At age 3, he began asking to wear nail polish and girl’s clothing, a request his parents periodically granted, allowing Charlie’s hair to grow long as well. A psychologist who was testing Charlie for attention deficit disorder said not to worry about the gender issues, that it was a passing phase. It did not pass.

Charlie’s parents sought advice at Toronto’s Centre for Addiction and Mental Health, where they were enrolled in a two-day evaluation. They were told Charlie had, among many disorders, gender identity disorder. Charlie should spend more time with dad, the specialist recommended , even though both parents said dad was very involved and close to Charlie. And, he should stop playing with girls, spend more time with boys and play with boys’ toys. The psychologist they were referred to recommended the same. Rather than feeling helped, the parents felt demeaned and concluded they could not follow through with the recommended treatment. They feared it would hurt rather than help. Charlie is now in a fourth-grade class for gifted children, having transitioned as a girl when she entered school, and doing remarkably well .

— Herbert Scheirer