by Brie J

On February 20, The Advocate, one of the leading LGBT publications in the US, ran an article which attempted to invalidate data collected by physician and researcher Lisa Littman from parents whose children experienced Rapid Onset Gender Dysphoria (ROGD). The author, Brynn Tannehill, immediately posted the article to the WPATH Facebook page.

In the thread, Tannehill (along with Jo Hirst, author of the Gender Fairy), suggested The Journal of Adolescent Health should be asked to retract and/or apologize for publication of Littman’s preliminary findings. UCSF’s Dan Karasic, MD (moderator of the Facebook page and WPATH official) agreed.

Littman’s abstract had been accepted for poster presentation and the poster was presented at the March 2017 Annual Meeting. (The full paper has not been published yet, and we look forward to its availability).

Note: Interestingly, as of this writing, four days after they were written, the last three comments have been deleted from the original thread.

The dismissal of Littman’s work, and the move to suppress it, is unconscionable. For one thing, some young people (like my daughter) who experienced ROGD have already desisted. Others, who were supported in procuring medical intervention, have already experienced regret. Many more desisters and detransitioners are sure to follow.

This trend has not gone unnoticed by at least some in WPATH. For example, veteran WPATH clinician Rachael St. Claire, in a Facebook post on January 5 of this year, made this comment (notice that commenting was turned off immediately after St.Claire posted):

This concern is echoed by UCSF clinical psychologist Erica Anderson, herself a transgender woman, in a recent Washington Post article:

“I think a fair number of kids are getting into it because it’s trendy,” said Anderson, who was married for 30 years and fathered two children before transitioning seven years ago. I’m often the naysayer at our meetings. I’m not sure it’s always really trans. I think in our haste to be supportive, we’re missing that element. Kids are all about being accepted by their peers. It’s trendy for professionals, too.”

In addition, clinics around the world have noted a sharp increase in the number of girls presenting for treatment in the last few years.

A once-rare condition is now increasingly common. It is surely in the interest of all people who care about gender dysphoric youth to investigate the reasons for the increase, and Littman’s work is an early contribution to this effort.

The ostensible reason given for Karasic et al’s desire to have Littman’s abstract retracted is that the data comes from a self-selected group of parents, culled from websites where such parents gather, in an anonymous survey format, and is thus deemed to be worthless. Yet advocates for pediatric transition constantly promote other survey studies, also culled from “self selected” groups (such as the Williams Institute suicidality survey), as well as research conducted by investigators who only recruit subjects from pro-early transition organizations (such as Kristina Olson’s two studies), with no attempt to broaden their samples to children who are not socially or medically transitioned.

In fact, Littman’s work is the first to study this new presentation of gender dysphoria, and she collected information from the people who know these children and teens better than any transgender advocate, endocrinologist, psychologist, or therapist ever could — their parents.

But you’re not listening to us.

Littman’s study, according to its critics, is contentious for a few reasons, but most notably for using the term “Rapid Onset Gender Dysphoria” as a descriptor for a new kind of trans-identifying youth, primarily natal females, who during or after puberty, begin to feel intense unhappiness about their sexed bodies and what it means to feel/be/present as a woman.

Let me emphasize: What is “rapid onset” in this population is the dysphoria, not the gender atypicality. What distinguishes these young people from the early-onset populations studied previously is that they may have been happily gender nonconforming throughout childhood (though some were more gender typical), but they were not unhappy (which is all “dysphoric” really means), nor did they claim or wish to be the opposite sex. The unhappiness set in suddenly, in nearly every case only after heavy peer influence, either on- or offline.

This phenomenon has only recently been noted by clinicians directly involved in treating gender dysphoric youth, as well as other mental health professionals. While there is no lack of evidence for adolescent emotional and behavioral social “contagions,” Littman’s research is the first to collect data on this phenomenon as it relates to identifying as transgender.

Even though rapid onset gender dysphoria has been noted by other researchers and clinicians who work with these populations, The Advocate and WPATH’s Dan Karasic consider the descriptor “junk science.” In a swift attempt at censorship, Karasic deleted all but one of my comments on the public WPATH Facebook page and then banned me from the group when I asked him to please consider the experiences of young people, like my daughter, for whom gender dysphoria set in hard and fast after being exposed to the idea that her gender nonconformity was in fact a sign of being transgender.

Interestingly, after I was purged, Karasic posted links to both my and my daughter’s stories on 4thWaveNow, and unfounded accusations were leveled against me and 4thWaveNow; since I was banned, I was not able to respond to them.

Interested readers may refer to these Twitter threads should you want more blow-by-blow details:

The subject of the linked article twice, in a public forum, accused 4thWaveNow of "attacking my children" in the writeup. Is there any basis for this claim? https://t.co/qwSqvaFGPX — 4thWaveNow (@4th_WaveNow) February 22, 2018

1. @wpath Dan Karasic interesting you linked to my daughter's interview by @4th_WaveNow *after* banning me from your group for asking that you consider the existence of #ROGD. Are you suggesting that teens aren't able to speak authentically about why they rejected trans ideology? pic.twitter.com/pattENg86x — Brie Jontry (@briejnm) February 22, 2018

1. This is what happens when parents try to engage in meaningful dialogue about the welfare of their gender nonconforming children with Dan Karasic and @wpath. I was blocked as soon as I asked why he won't listen to parents who've seen #ROGD in their families pic.twitter.com/a12TnTAf3i — Brie Jontry (@briejnm) February 22, 2018

It is concerning, given Karasic’s reaction to Littman’s research, that he and others evidently leave no room for a teenager to be incorrect about how they are interpreting their feelings, no room for a clinician to be incorrect when recommending transition, and no room for a parent to understand what is going on with their own child. It is narrow minded and short-sighted, especially considering there is no long-term data supporting the benefits of early medical transition for gender dysphoria or consensus from the medical community about best treatment methods.

This lack of consensus, while well known and acknowledged by the international medical community, has been ignored by many transgender advocates, along with the “gender affirmative” recipients of a $5.7 million NIH grant, who, with the help of the mainstream media, have manipulated the public into believing early social transition, pubertal blockade, and early cross-hormone treatment constitute settled science.

To be clear, in “Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study,” a 17-clinic international study published in The Journal of Adolescent Health, the authors explain that:

As still little is known about the etiology of GD and long-term treatment consequences in children and adolescents, there is great need for more systematic interdisciplinary and (world- wide) multicenter research and debate. As long as there are only limited long-term data in support of the guidelines, there will be no true consensus on treatment. To advance the ethical debate, we need to continue to discuss the diverse themes based on research data as an addition to merely opinions. Otherwise ideas, assumptions, and theories on GD treatment will diverge even more, which will lead to (even more) inconsistencies between the approaches recommended by health care professionals across different countries. (372)

I am sure some WPATH members, like the treatment teams in Lieke et al., “feel pressure from parents and adolescents to start with treatment at earlier ages.” I know there are others, besides those reported in Lieke et al. who:

[…] wondered in what way the increasing media attention affects the way gender-variant behavior is perceived by the child or adolescent with GD and by the society he or she lives in. They speculated that television shows and information on the Internet may have a negative effect and, for example, lead to medicalization of gender-variant behavior. “They [adolescents] are living in their rooms, on the Internet during night-time, and thinking about this [gender dysphoria]. Then they come to the clinic and they are convinced that this [gender dysphoria] explains all their problems and now they have to be made a boy. I think these kinds of adolescents also take the idea from the media. But of course you cannot prevent this in the current area of free information spreading.” –Psychiatrist

It is unconscionable that transgender advocates, and the leading international body concerned with transgender medicine, would seek to quash data that address unsettled and mostly unexplored areas of concern. It is incredibly important that ROGD be included as a research point because the main studies used to justify the use of puberty blockers, cross-sex hormones and surgery in adolescents required “persistent gender dysphoria since childhood” and “no serious comorbid psychiatric disorders that may interfere with the diagnostic assessment” before the patients were eligible for medical intervention. In other words, none of the participants in these treatment studies had adolescent-onset of their gender dysphoria and none of the participants had serious psychiatric issues.

It is a huge leap to assume that an entirely different population of adolescents with a different presentation of symptoms will have the same results as the adolescents in the Amsterdam cohort. An additional gap in the research is that because all the desistence and persistence studies are about adolescents who had childhood onset of gender dysphoria, the persistence and desistence rates for adolescent-onset gender dysphoria are unknown.

In all areas of medicine, best practices come from intense discussion and research into indications and contraindications, and into risks, benefits, and alternatives. Yet, WPATH’s Karasic, along with the trans advocates who have prominent roles in the organization, appear to believe it is in their community’s best interest to shut down all discussion about contraindications, risks and alternatives. This is inappropriate and undermines the very concept of informed consent.

Furthermore, The Advocate article suggests that Littman’s sample is biased because it gathered data from “unsupportive” parents. This framing is both fallacious and dangerous to gender nonconforming and dysphoric youth. It suggests that the only path for gender dysphoric youth, even those with a rapid onset, is full affirmation including fulfillment of requested medical interventions. It also implies that parents aren’t able to be both supportive and cautious.

I have spoken to some of the parents who participated in the study. Few could be described as “unsupportive.” In fact, almost overwhelmingly, these parents supported their children in thinking about their gender identity and helped facilitate their preferences for atypical gender presentation and interests (taking them for haircuts, new clothing, and so forth). Many sought professional mental health consultations and treatment for their children. But what many of these parents did not support for their underage teenagers were hormonal and surgical interventions. This is an important distinction: Littman’s sample were supportive parents who were unsupportive of a particular medical treatment option.

It is entirely possible to be supportive parents invested in our child’s well-being and not agree to unproven medical procedures for which there is no consensus from the medical community of long-term safety or benefit to the majority of dysphoric youth. However, the loudest voices in pediatric transgender medicine often cite Kristina Olson’s descriptive research about early social transition for children which relies on the methods that they decry as “junk” when used in Littman’s research (targeted recruitment and the collection of data from parents). Kristina Olson recruited her sample from support groups and conferences to find parents who have socially transitioned their children, which might consist only of parents who are supportive of early social and medical transition. So is it an acceptable method for both studies, junk for both studies, or are the WPATH activists simply going by whether they like or dislike the findings?

As all parents know, we can tell when our children are suffering. To remain credible, advocates for gender dysphoric youth and the international organization which claims to be concerned with generating best practices in the field of transgender medicine must acknowledge that ROGD exists and there are some trans-identifying youth who arrive at their identity from external social pressures, and at times, internalized homophobia.

Related to this last point, the WPATH Facebook page wasn’t the only place my respectful questions were deleted. In a comment on The Advocate article itself, I asked Tannehill and Advocate readers to consider the recent research into how homophobic name-calling influences (hint: greatly) children’s perceptions of their gender identity.

My comment was swiftly scrubbed from existence. For those interested in reading “The Influence of Peers During Adolescence: Does Homophobic Name Calling by Peers Change Gender Identity?” the full text is here.

Finally, the fact that ROGD is being discussed by the conservative media is not, no matter how many “incriminating” links Tannehill dropped in the Advocate piece, a legitimate reason to discredit the data. The irony is not lost on many 4thWaveNow parents that our stories are covered by media outlets we typically avoid. In this politically charged climate, it is important for researchers, clinicians, and parents to work together to “first do no harm” even when those we otherwise disagree with call for the same cautions.

Clearly, Brynn Tannehill and Dan Karasic do not speak for all members of WPATH. I know for certain that they do not speak for many professionals currently working with gender dysphoric youth who see in their own practices what can only be described as “rapid onset gender dysphoria” in an increasing number of adolescents, particularly girls. Clinicians are aware of the rapidly growing numbers of young people requesting services and the possibility of social contagion; there are those among you who are concerned by the potential for misdiagnosis and the subsequent harm that will come to some of your patients as a result.

It is time for those with concerns to speak out. Please do not allow your ethical and professional concerns to be held hostage by ideology.

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