Parents are often stunned when a daughter confides that she is a male trapped in a female's body and has thought this way from early in her childhood.

This article focuses on adolescent females because they constituted the largest group of patients who underwent sexual reassignment surgery in a Boston study. Surgery was performed on 180 youths — 106 females and 74 males. The majority of the females were from divorced families and the median age when treatment was initiated was nine years of age.

At follow-up, these youth later had a two-fold to three-fold increased risk of psychiatric disorders, including depression, anxiety disorder, suicidal ideation and suicide attempt compared to a control group (1).

Initial parental response

Upon hearing figures like this parents are often terrified about their child’s future. Many become depressed, can’t sleep, lose weight and feel overwhelmed. At the same time powerful cultural pressures are at work to normalize transsexual attractions in youth in the media, schools, peer relationships and governments.

The search for reliable information can be challenging. Unfortunately, most paediatricians, doctors and mental health professionals have yielded to powerful transgender advocacy and propaganda within their professional organizations.

Additional stress can occur in the lives of parents when daughters announce at school that they are transgender and receive the support of uninformed teachers. (The American Federation of Teachers is actively advancing the transgender agenda for youth.)

This article offers parents an approach to understanding the psychological conflicts in these youth and in their parents and to suggest successful treatment that does not involve the use of puberty-blocking drugs, hormones or mutilating surgery.

Effective treatment approaches

The use of drugs in preparation for “transitioning” has been described as experimental without the provision of safeguards such as carefully controlled clinical trials and long-term follow-up studies. Such information is essential for helping parents and their children make the most appropriate decisions for the future health of their children based on science and not on feelings or confused thinking.

Dr Kenneth Zucker, a renowned Canadian psychologist who is the editor of Archives of Sexual Behavior, a leading journal for sexuality research, treated over 1,000 youth with gender dysphoria in his 30-year career. He and Dr Susan Bradley in Toronto have been recognized as leaders in the study of gender dysphoria in youth and are the authors of Gender Identity Disorder in Children.

He has written numerous papers on the origins and treatment of psychological conflicts in parents and in youth with gender dysphoria. He describes how his approach helped youth to accept and identify with their biological masculinity or femininity.

Because he and his colleagues found that gender dysphoria is usually rooted in profound and complex disturbances within the family, they would only recommend medical interventions if psychotherapy were not successful. An important BBC documentary presents his work and the current controversy surrounding approaches to youth with transsexual attractions. This documentary is highly recommended for parents and youth with gender dysphoria.

In 2015 Zucker was forced to resign from his practice and his Toronto clinic was closed. Over 500 health professionals from around the world signed a petition protesting this politically correct action against a highly respected child psychologist and scholar.

Conflicts in parents

Zucker and Bradley have identified a number of conflicts in the families of children with GID. It appears that the mother’s psychological conflicts correlated quite strongly with their children’s behavior problems. The rate of the mother's psychiatric illnesses was high by any standard and included depression and bipolar disorder.

Parents often had difficulty resolving the conflicts they experienced in their own marital relations and failed to support each other. The fathers were often easily threatened and felt inadequate themselves, making it very difficult for them to connect with children. Many fathers also demonstrated depression and substance abuse disorder.

Zucker and colleagues observed that psychological conflicts among the parents of children with gender dysphoria deserve careful study (2). They also found that the youth had high rates of general behaviour problems and poor peer relations (3).

These observations are not derived from controlled studies. As such, there is no comparison to the prevalence of such conflicts among control groups. Thus the specificity of these conflicts (or their prevalence in children with gender dysphoria) is not clear. There is no conclusive evidence of the role of such conflicts in the development of gender dysphoria, or whether treatment leads to improvement. However, the comments of Zucker and Bradley do seem relevant to understanding the development of gender dysphoria.

Additional conflicts that we have seen while engaging in family therapy include the following ideas.

Conflicts with fathers include:

An excessive fear of the father's anger or his controlling behaviour, leading to a fear of being hurt as a female, coupled with a belief that being a male would help her feel safer in relationships;

Severe mistrust of the father because of his mistrust of female love arising from traumatic experiences with his mother; insensitive and angry treatment of the mother; harming the family by abandonment; or his emotional, personality, or behavioural conflicts

The father's failure to attach to attach securely to his daughter and to affirm her feminine goodness, beauty and gifts

Anger at the father together with pleasure in upsetting and punishing him by rejecting her own femininity

The failure to communicate that fulfilment and happiness can be found in embracing the goodness of femininity and in being a psychologically healthy female

A daughter’s unconscious belief that she wil gain acceptance and love from a rejecting, cold, unloving father by being a male rather than a female

The failure to critique and protect a daughter from gender theory errors

I recall one family session with a young woman who was taking testosterone and was planning on sexual reassignment surgery. The father told her that his excessive anger throughout her childhood had made her fearful of trusting males. He suggested that deep down she thought that she would be safer if she had a masculine appearance and identity. His daughter reflected on this and said, “You could be right.”

Conflicts with their mothers include:

A controlling, emotionally distant, angry, selfish, depressed, or critical mother who has failed to bond with her daughter

Failure to affirm the daughter's goodness and special gifts because of the mother's deep insecurities and unhappiness

The rejection of the mother as a role model

Pleasure in venting anger at the mother by rejecting femininity

Failure to support and encourage same sex friendships and play in childhood

Failure to criticize excessive identification with and modelling after the opposite sex

Failure to communicate that fulfilment and happiness can be found in being a psychologically healthy female

Failure to protect her daughter from gender theory errors.

Conflicts with peers and siblings include:

The absence of close female friendships together with a sense of not fitting into the female world; a subsequent belief that one would be less lonely and happier as a male

A need for attention and acceptance which could come from a transgender identity;

A poor body image or a sense of failure as a female and a belief that one would be more attractive if she were male

In strong, young females, a love for male strength and preferential treatment for males, together with the desire to become what she loves;

In very athletic and strong young females, an intense bonding and identification with young males through athletic activities

Pressure from a significant other in a homosexual relationship or peers to cross-dress, take hormones, and move toward sex reassignment surgery

An identification with peers who identify as transgendered

Pleasure in rejecting and expressing anger at the values and moral code of her parents

An acceptance of gender theory’s notion that her sex is not a gift but a constraint that must be overcome;

A delusional belief that she can create herself as she wants

The exposure of youth to gender theory in college can result in their embrace of post-modern philosophies, focused on freedom as an end in and of itself. Such ideas come from various sources, including the writings of Friedrich Nietzsche and Jean-Paul Sartre. If freedom (some would call it license) is the greatest good in the world, then why should anyone be constrained by biology?

Rapid-onset gender dsyphoria

Some children experience a rapid onset of gender dysphoria which during or after puberty. In our clinical experience, these daughters previously identified with their femininity, enjoyed playing with dolls and had secure attachment relationships with each parent. However, the history revealed that these females often did not have a best female friend or a close group of female friends.

In a 2017 study of 164 adolescents with rapid-onset gender dysphoria, 93% were females with average age of 15 when they announced that they were transgender. Contrary to earlier research findings, parent-child relationships were worse in 75.7% of the families two years after the announcement. Where popularity status was known, 64.2% of adolescents had an increase in popularity within the friend group after announcing that they were transgender. In these youth 37.3% received online advice that parents who didn't agree with their taking hormones were abusive and transphobic and 46.5% of youth withdrew from their families.

Also, in this study, 53.1% of youth only trusted information about gender dysphoria from transgender sources. Parents reported a worsening in the mental health in 51.2% of their children and an improvement in 13.6% two years after announcement.

The author recommended more research to understand this phenomenon and the worsening mental well-being and parent-child relationship. (5)

Other treatment approaches

Given the identified conflicts in the families of youth with gender dysphoria, family therapy should be an essential aspect of the treatment plan for these youth. The major goal of treatment is to help the girl/teenager to appreciate her goodness, gifts and beauty as a female. An essential aspect of healthy psychological development in early childhood is the establishment of same peer friendships.

In one of our cases, a 12-year-old female expressed a desire to be male. She cut her hair very short and wore boys’ clothing. We worked to uncover difficulties she had in establishing friendships with other girls. The basic conflicts were twofold – she was so involved in a demanding competitive sport that she had no time after school for friendships and she had lost confidence in female friendships because other girls were so competitive and jealous.

When she decided to let go of this sport, she began to work on female friendships with her mother's encouragement. This led to greater identification with new female friends and to a resolution of the desire to be male.

Each parent should regularly compliment their daughter and affirm her goodness as a female that enriches their lives. Those with Faith can also express the belief that God has a special plan for her as a female.

Parents can be particularly helpful in encouraging the pursuit of a best friend with those of same sex and, if necessary, discouraging the pursuit of a best friend with those of the opposite sex.

Significant anger is often uncovered in these youth toward a parent, sibling or peer. The process of forgiveness is recommended which has been demonstrated empirically to decrease sadness, excessive anger and anxiety, as well as increase confidence. The forgiveness process is particularly challenging when the girl has intense anger at an insensitive parent or at rejecting, angry peers or siblings.

Children who seek sexual reassignment surgery should be evaluated for psychological conflicts, but often are not. A Dutch researcher and clinician who specializes in treating such youth, Dr Peggy T. Cohen-Kettenis, has written in this regard:

The percentage of children coming into our clinic with GID as adolescents wanting sex-reassignment is much higher than the reported percentages in the literature. We believe (psychological) treatment should be available for all children with GID, regardless of their eventual sexual orientation (5).

Reasons for hope

A 2017 study led by Dr Paul Hruz, a pediatric endocrinologist and an associate professor of cell biology and physiology at Washington University School of Medicine, in St Louis, reviewed 50 articles on transsexual conflict in youth. “ Growing Pains: Problems With Puberty Suppression in Treating Gender Dysphoria ,” stated,

“Young people with gender dysphoria constitute a singularly vulnerable group and experience high rates of depression, self-harm and even suicide. Moreover, children are not fully capable of understanding what it means to be a man or a woman. Most children with gender identity problems go on to accept the gender associated with their sex and stop identifying as the opposite sex.”

Dr Zucker and Bradley wrote of their work:

The fantasy solution provides relief but at a cost. They are unhappy children who are using their cross-gender behaviours to deal with their distress. The treatment goal is to develop same-sex skills and friendships. In general, we concur with those who believe that the earlier treatment begins, the better. It has been our experience that a sizable number of children and their families can achieve a great deal of change. In these cases, the gender identity disorder resolves fully and nothing in the children’s behaviour or fantasy suggest that gender identity remain problematic. All things considered, however, we take the position that in such cases, clinicians should be optimistic, not pessimistic, about the possibility of helping children become secure in their gender identity (6).

The pressure on youths to normalize transsexual attraction, experimental hormonal use and sexual reassignment surgery is severe and unrelenting. I strongly believe that we need a presidential commission to evaluate the science and risks involved for youth with transsexual feelings and thinking. Experts such as Drs Hruz, McHugh, Mayer and Zucker should be involved. At the moment we are creating a whole generation of abused children. This is a ticking time-bomb which will explode disastrously in years to come.

Rick Fitzgibbons MD is a psychiatrist in Conshohocken PA who has treated youth and adults with gender dysphoria. He is the co-author of Forgiveness Therapy: An Empirical Guide for Resolving Anger and Restoring Hope.

Helpful resources for parents:

Transgender Kids: Who Knows Best? by BBC

American College of Pediatricians. “Gender Ideology Harms Children”. May 2017.

Rick Fitzgibbons. “Transsexual attractions and sexual reassignment surgery”. Homilectic and Pastoral Review. August 29, 2016.

Mayer, L., S. & McHugh, P.R. (2016). “Sexuality and Gender: Findings from the Biological, Psychological and Social Sciences”.

O’Leary, Dale, and Peter Sprigg. 2015. “Understanding and responding to the transgender movement”. Family Research Council

Article references

1. Reisner, S. et al. (2015). Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study. Journal of Adolescent Health 56: 274¡V79.

2. Zucker, K., Bradley, S., et al. (2003) Psychopathology in the parents of boys with gender identity disorder. Journal of the American Academy of Child and Adolescent Psychiatry 42: 2¡V4.

3. Zucker, K. & Bradley, A., et al. (2012). Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism. Journal of Sex & Marital Therapy 38: 151¡V 89.

4. Littman, L. (2017). Rapid Onset of Gender Dysphoria in Adolescents and Young Adults: A Descriptive Study. Poster Abstracts/ 60 (2017) S95-6.

5. Cohen-Kettenis, P (2001). Gender identity disorder in the DSM? Journal of the American Academy of Child and Adolescent Psychiatry 40: 391.

6. Zucker, K. & Bradley, S.A. (1995) Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Publications. 281-2.