(Referral figures from Tavistock GIDS)

In the late Sixties, 90% of transsexual adults were male. Fifty years on and the latest published figures from the Tavistock clinic indicate that child referrals are almost 70% female.

In the year 2011/12 the overall referral rate of girls overtook boys for the first time. The latest referral figures saw the number of girls increase to more than double the number of boys and girls overtook boys in the under-12 age group for the first time (51.1%).

But it is in the 12 – 14 and 15 – 17.9 age groups that we see the biggest jump in referrals of girls: 74.4% and 71.4% respectively. Teenage referrals are over 70% girls. What we don’t know is the referral rate of girls over 17 years and 9 months who go straight to adult services but are still teenagers.

(Figures taken from FOI request)

Why is a condition historically associated with adult men manifesting primarily now in teenage girls? And what is the etiology which connects them?

The Blanchard typology of transsexualism in males presented two distinct etiologies: the homosexual male who is typically ‘feminine’ in childhood who ‘transitions’ early and ‘passes’ as a woman and the autogynephilic heterosexual male who is sexually aroused by the image of himself as female, who is typically ‘masculine’ and transitions later in life, often after a very ‘macho’ career. The term ‘autogynephilia’ was coined in 1989 by Ray Blanchard, but the idea of an erotic component to transsexualism has been around for over a century.

The fact that the majority of transsexual males are autogynephilic has been posited as a reason that transsexualism is far less common in women, as autogynephilia is unheard of in females. Although the ‘two type transsexual typography’ has been supported by research and accepted as credible by professionals and some autogynephilic transsexuals themselves, the idea has been eradicated from public discourse for political reasons.

Nevertheless, it is the only etiology we have and it is based on decades of clinical research and observation. What do we now have to replace it? Enter gender identity politics. Not an etiology but an ideology promoted by activist groups and campaigners, identity politics makes the claim that ‘gender identity’ is the true distinction between men and women. The political campaign for trans rights began by redefining the condition to make it more palatable to the public and, unlike ‘autogynephilia’ and ‘transsexualism,’ ‘gender identity’ and ‘transgender’ are sex-neutered terms which can therefore be applied to children.

There were no gender clinics for children in the UK in the Sixties; the first, the Tavistock, was established in London in 1989. Consistent with the adult male/female ratio, the service catered mainly to boys and referral numbers remained stable over the first two decades. Referrals began to rise more steeply from around the year 2009, the year that the Tavistock first received public funding. Since then referrals have increased by around 50% year on year until the year 2015/16 when numbers sky-rocketed.

Although actual numbers of boys and girls in the under-12 age group are not that different, in terms of the overall percentages of male referrals compared to female referrals since 2012, boys are proportionately more likely to be referred pre-puberty. According to Blanchard’s typology, these younger ‘feminine’ boys are likely to be ‘homosexual transsexuals’ in adulthood, or, far more commonly, simply gay men. According to the ‘gender identity’ model, they are ‘girls.’

The following graph makes clear that the pattern of referral for girls and boys is in direct inverse ratio based on the percentage for each age:

So what is the explanation for all these teenage girls who are suddenly inflating the referral figures?

The usual explanations for the overall rise in numbers (more visibility and acceptance of ‘trans’ people, more knowledge about services) do not suffice. They do not explain this huge discrepancy between boys and girls in the teenage years. Referring to this group as ‘young trans people’ just makes these girls invisible.

Only one part of Blanchard’s typology potentially fits: homosexual transsexualism. Lesbians with a history of childhood ‘cross gender’ play and interests could be said to have a similar profile to the young ‘feminine’ boys who grow up to be gay men or homosexual transsexuals. But how to explain the sudden recent increase in the number of lesbians who now see themselves not as lesbian but ‘trans guys’? Blanchard’s etiology has no answer to that. And what about the increasing number of teenage girls with ‘sudden onset’ gender dysphoria who were more typically ‘feminine’ in childhood and don’t fit any etiology?

In his talk at the Hot Topics in Child Health conference, Dr Thomas Steensma informed us that 10 – 13 years is the crucial period for gender identity development because of various social and developmental factors, including romantic and sexual attraction. If a girl who is being ‘affirmed’ as a boy feels same-sex attraction at this age she is likely to understand it as confirmation that she really is a boy. Added to the existing discrimination against lesbians is the fact that trans politics ensures that no-one will dare to suggest to her that this is what she is. There are no lesbian organisations going into schools to educate girls that ‘cross-gender’ preferences are more predictive of same-sex attraction in adulthood, not transsexualism. Some heterosexual girls, meanwhile, may try to hide their ‘cross-gender preferences’ (such as having an opinion or being good at Maths) in order to get a boyfriend, while others will find that denial of the self is too difficult. If it is in the early years that ‘cross-gender preferences’ are unacceptable in boys, for girls it is in the teenage years that non-conformity meets societal disapproval.

Another factor is the anticipation and experience of body changes. If puberty is ‘psychological torture’ for ‘trans kids’ as we were told at the GIRES presentation, that’s a description not unheard-of amongst women looking back at the time when their bodies first started betraying them to the world as female. ‘Gender dysphoria’ itself could be an apt description of what many girls go through during normal puberty and adolescence. Medicine is historically based on the male body and once again it seems that there is little attention paid to the female experience of puberty as distinct from the male.

What we do know is that teenagers are the group most likely to go forward to adult services and that there is a high incidence of significant associated difficulties in this group, such as self-harming behaviours, suicidal ideation, mental health issues and a link to autism spectrum disorders. We have written before about troubled teenage girls and the mental health problems which were unfortunately established long before girls started having ‘gender identity’ issues.

In the past, there have been some escape routes from the oppressive gender and sex-role stereotypes society applies to females. In the Sixties girls could embrace androgyny, in the Seventies Punk provided a way out. In the Eighties New Romantisism and gender-bending were the alternatives and in the Nineties into the Noughties Goths, Emos and Geeks were the tribes to join. But as popular culture, and in particular youth music culture, has become more hyper-sexualised for girls, escape routes have not only been closed down, but youth culture itself reinforces the sex-role stereotypes oppressive to teenage girls. Porn on smartphones passed around in school is now what they’re up against. Did cutting and self-harming evolve as a rejection aimed inwardly towards the self in place of the previous outward expressions of rebellion open to teenage girls?

Along comes a movement which deliberately confuses biological sex with the gender and sex-role stereotypes society attaches to each sex, and girls are misled into thinking that to reject the stereotypes means not only rejecting their actual sex but changing it to the opposite one. There has never been an escape route so complete, nor a tribe which welcomes you so enthusiastically, affirms both your specialness and your misunderstood victim status and promotes self-harming and drugs as the answer. The perfect cocktail for troubled adolescents, ‘trans’ is the latest teenage tribe to join for all kids who don’t fit in and it is obvious why it appeals to teenage girls more than boys. Everywhere a teenage girl looks today she is confronted by images of women groomed, waxed and toned to within an inch of their lives just to be ‘acceptable’ enough to appear on TV or in a magazine. Instagram celebrities set the bar even higher. You cannot be what you cannot see: gay men now have some cultural presence, but where are the butch ‘dyke’ lesbians? Where are the women who simply refuse to conform to these impossible ‘ideals’? Today the most visible young women throughout the media who dare to completely reject the performance of femininity, and are celebrated for it, are ‘trans guys.’

Teenage girls are also the largest users of social media and the only counterpoint to the selfie culture girls are caught up in today is the ‘trans’ culture promoted across the internet as progressive, daring and subversive. If you are seeking out an alternative culture, this is the only one you will find. If you look to gaming communities, manga enthusiast groups, feminist groups (the ‘liberal’ kind which is mostly what you will see) or LGBT societies you will find that all these groups are devoted disciples of gender ideology. The only alternative is radical feminism but radical feminists are ‘bigots,’ everyone knows that. The internet is packed with cool, edgy YouTube videos with hundreds of thousands of followers, all extolling the virtues of being ‘transgender,’ such as this one. Unless you want to be seen as a boring conventional girl, today you have to have a ‘gender identity’ which does not ‘match’ the sex you were ‘assigned at birth.’

Not only is this new regressive ideology promoted as the only ‘counter-culture,’ packaged and sold to young people as a ‘youth movement,’ the idea behind it (your identity is what makes you a boy or a girl, your biological sex is irrelevant) is actually supported as the new truth by the media and society. Unlike other self-harming practices of recent decades, this one is sanctioned and trans activists are given free rein to persuade kids that medical transition is the only answer to common teenage angst.

In place of an etiology we have a new political orthodoxy which bypasses the need to find any explanation for the surge in ‘trans’ teenage girls. The agonies of female adolescence, the effects of porn culture on girls, the social isolation of non-conforming and ASD girls, the adolescent need to find a tribe and to fit in, the social hostility towards lesbians, teenage vulnerability to indoctrination and social contagion: everything we know is irrelevant and no exploration is necessary. The new ‘gender identity’ model allows only one explanation: these teenage girls are really boys.

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