To the editor: Eric Vilain and J. Michael Bailey correctly warn about the limits of our knowledge about children who socially transition to another gender before puberty, but they wrongly conclude that we shouldn’t condemn conversion therapy for these children.

Older studies lumped together transgender-identified children with a larger group of children with gender nonconforming behavior but not necessarily cross-gender identity. We can’t conclude from these studies that transgender children could grow up to be well-adjusted as boys.

The strong cross-gender identity and patterns of thinking of some of these children are being studied by academics such as the University of Washington’s Kristina Olson as well as by a collaborative of pediatric experts at several university medical centers, so our knowledge base is bound to increase with time.

What do we know now? We have much knowledge of the harm of conversion therapy in children. The consensus of experts of the World Professional Assn. for Transgender Health (WPATH) is that conversion therapy for gender nonconforming children is harmful.


Therefore, WPATH’s most recent Standards of Care states, “Treatment aimed at trying to change a person’s gender identity and expression … is no longer considered ethical.”

Dan Karasic, MD, San Francisco

The writer, a clinical professor of psychiatry at UC San Francisco, is a WPATH board member.

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To the editor: If the authors have ever spent an hour with a young child sobbing in their office, and if they have ever witnessed the remarkable transformation from distress and anxiety to happiness and well-being when these children are listened to and allowed to transition to the gender they know themselves to be, they might think twice about putting the decision in the parents’ hands rather than in the child’s.

As for the research statistics about the number of children who by adolescence “desist” from their early diagnosis of gender dysphoria, I would ask the authors, “Don’t you know the difference between an apple and an orange?”

As reviewed by the team of researchers in 2013 who originally collected the data on desisters and persisters in the Netherlands, from early on the persisters are not the same group of children as the desisters and should never be lumped together. The apples, the persisters, are our youngest cohort of transgender folks, showing up early in childhood, saying “I am a girl” rather than “I wish I was a girl,” and being insistent, persistent and consistent in their declarations.

We can find them if we look for them, and the worst thing we could do for them is deny who they are and try to force them to be someone else.


Diane Ehrensaft, Oakland

The writer, a clinical psychologist, is director of mental health at the UC San Francisco Child and Adolescent Gender Center.

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