Pressure to conform

On an online forum for parents concerned about their teenagers’ sudden change in sexuality, one mother confesses: “I am desperate. My 14-year-old daughter just told me that she is trans. These past weeks have felt like a hundred years.”

Another grieving parent says that nothing in her 14-year-old daughter’s demeanor or history explains her sudden declaration of transgenderism. “She has exchanged her pointe shoes for a chest binder, her ballerina bun for a buzz cut,” the mother wrote. “All because some stranger on the internet told her that being uncomfortable in her developing body meant she must be a boy.”

Unlike the growing trend of children expressing gender confusion at a younger age, the teens these parents describe are part of a different phenomenon some therapists and researchers are calling rapid-onset gender dysphoria.

As the name suggests, the affected teenagers—usually girls—go from a seemingly normal gender expression to a sudden declaration that they are in the wrong body. It usually happens at puberty or shortly after. Many of the teens request cross-sex hormones.

Some ask for mastectomies.

Many clinicians and therapists oblige—at least with hormones—and they persuade parents to go along by using frightening leverage: They warn the alternative could be suicide. Terrified parents often give in.

But some researchers and physicians warn against the rush, and they point to another common thread among the teens: Sometimes their transgender declarations happen in clusters.

These researchers think the trend shares similarities with at least one other phenomenon therapists have observed for years: teenage girls in groups of friends who develop eating disorders suddenly and at the same time.

In a similar way, these experts say the influence of peers and social media can lead some girls to search for meaning in a transgender identity or to grasp for answers to other forms of distress by assuming their angst is rooted in dysphoria with their sex.

This isn’t a popular theory, and those who speak out about it—or even study it—often pay a price. But the price for staying quiet is far greater, as teenagers plunge into radical medical interventions often with irreversible effects.

Meanwhile, many parents—often from non-conservative backgrounds—express despair at what they see as a fad. “We are a progressive family caught in the teenage transgender wave,” wrote one commenter on the parental blog 4th Wave Now.

“What we are seeing are pockets of teens … who are declaring themselves either non-binary [neither male nor female] or transgender. … Peer influence is just so huge on these kids … Very, very scary.”

LISA LITTMAN found out the price of raising questions firsthand. When the Brown University researcher published the first academic study exploring rapid-onset gender dysphoria (ROGD) last fall, the blowback was swift.

Some critics questioned Littman’s methods. Others said ROGD wasn’t a legitimate theory. Transgender activist Julia Serano called ROGD “scientifically specious” and an excuse for parents to “disbelieve and disaffirm their child’s gender identity.”

Eleven days after the academic journal PLOS One published Littman’s peer-reviewed study, the editors said they were looking into concerns about her methodology. The same day, Brown University removed a news release about the study from its website.

Critics of Littman’s methods noted she studied ROGD by surveying parents concerned about the phenomenon in their children. (Critics thought she should survey a wider sample.) But the purpose of Littman’s research was to survey parents concerned about ROGD in their teens, not to study all parents of transgender children. And Littman acknowledged the study was a starting place in a field with no other formal research available.

Though editors at PLOS One mentioned Littman’s methods, they also responded to complaints from transgender activists. One person described as a transsexual dominatrix complained on Twitter: “The linked article was written using transphobic dogwhistles (sex observed at birth, for example), so it’s most likely they have a transphobic contributor who knows exactly what they’re doing.”

PLOS One replied and assured the activist the journal was looking into it.

Jeffrey Flier, a former dean of Harvard Medical School, openly questioned the move to sideline the study immediately: “In all my years in academia, I have never once seen a comparable reaction from a journal within days of publishing a paper that the journal already had subjected to peer review, accepted and published.”

Brown University officials said they weren’t squelching academic inquiry on a controversial topic by pulling the school’s news release about the study. But their statement also underscored “Brown is proud to be among the first universities to include medical care for gender reassignment in its student health plan.”

Meanwhile, beyond the publishing controversy, Littman’s findings were disturbing. She received 256 responses from a slew of parents concerned about their teenage children declaring transgenderism with no previous signs of gender dysphoria. More than 85 percent of the survey respondents said they support gay marriage—establishing that the parents likely weren’t concerned about transgenderism for religious or ideological reasons.

Instead, they worried about its onset in their children—mostly girls with an average age of 16 years old. Nearly 70 percent of the parents suspected their child used language they found online to explain their transgenderism, and many said their teens had spent an excessive amount of time on the internet before declaring they were transgender.

Indeed, thousands of videos and forums on popular networking sites feature teens documenting their attempted transition and sometimes offering guides for how to convince parents or physicians to prescribe hormones. One parent in the study said she overheard her teenager boasting about convincing a doctor to prescribe cross-sex hormones and proclaiming, “Easiest thing I ever did.”

When it comes to the theory of clusters, nearly 70 percent of the parents said their teen had been part of a friend group where one or more friends came out as transgender during a similar timeframe. That’s consistent with other comments from parents on 4th Wave Now—a site for parents skeptical of ROGD. (Some participants in Littman’s study learned about the survey from the 4th Wave site.)

In the comments section of the blog, one parent said her daughter was friends with some of the girls in her high school’s color guard team: “Last year my daughter told me that almost all of them felt they were lesbian. This year, most of them feel they are transgender, agender, or, at the very least, are questioning their gender identities.”

In Littman’s survey, 60 percent of the parents said they thought their teens’ declaration of transgenderism increased their child’s popularity at school. One parent wrote, “Being trans is a gold star in the eyes of other teens.”

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In Littman’s survey, 60 percent of the parents said they thought their teens’ declaration of trans-genderism increased their child’s popularity at school.

If being trans is a gold star, being straight is unacceptable to some teenagers. “To be heterosexual, comfortable with the gender you were assigned at birth, and non-minority places you in the ‘most evil’ of categories with this group of friends,” one parent wrote.

Another common characteristic: More than 60 percent of the parents said their child had been diagnosed with a mental health disorder before claiming gender dysphoria, suggesting the teens do need help, but perhaps for other underlying problems.

Other parents said they thought their teens were using an extraordinary method to cope with a common experience: “I believe my child experiences what many kids experience on the cusp of puberty—uncomfortableness!—but there was an online world at the ready to tell her that those very normal feelings meant she’s in the wrong body.”

The pressure on parents to allow their children to take cross-sex hormones, or even undergo mastectomies, is often intense. The claim their child might commit suicide looms large, though some studies show the rate of suicide attempts among transgender people remains high, even after they attempt transition to the opposite sex. Still, Diane Ehrensaft, a psychologist who advocates letting small children dictate their gender, has called transgender interventions for children and teens “suicide prevention.”

That’s enough to leave some parents reeling.

THOUGH SOME CRITICS lambasted the study, Littman isn’t alone in her findings.

Lisa Marchiano, a secular therapist in Pennsylvania, wrote a blog post in 2016 cautioning parents about plunging into medical interventions with children and teens claiming to be transgender. Afterward, she began taking phone consultations with parents of teens experiencing ROGD. A year later, she wrote, “I am overwhelmed by the sheer volume of parents who call me.”

Some parents plead with Marchiano to allow them to fly their children into town for therapy or to help them find a therapist who won’t push their teens to transition with cross-sex hormones.

“At times I am able to offer advice that helps a family steer clear of drastic medical intervention of dubious benefits or necessity,” she wrote. “But sometimes all I can do is stand helpless and watch the wreckage.”

Marchiano described working with a family whose daughter declared transgenderism at age 18. The young woman had experienced other mental health problems but hadn’t expressed a conflict with her sex until high school. The parents had taken her to a clinician, and after a 30-minute consult, a physician’s assistant made an appointment for the teen to begin testosterone injections the following week.

Her parents convinced her to wait, but by the end of her freshman year of college the teenager had begun taking cross-sex hormones and had undergone a mastectomy—paid for by student health insurance. (Eighty-six colleges nationwide have student health plans that include cross-sex hormones and cross-sex surgery.)

Marchiano says the parents reported the radical physical steps didn’t decrease their daughter’s mental anxiety. She had dropped out of college and remained mostly isolated in her home.

Some teenagers report feeling relief after taking hormones or pursuing surgery, and some transgender activists claim social acceptance is a key to transgender adolescents becoming happy. But given that many parents who worry about their teenagers’ decline after experiencing ROGD also expressed left-leaning views of sexuality, social conditions alone don’t account for the distress some adolescents and young adults still feel.

And short-term relief doesn’t negate the long-term consequences of a person rejecting his or her sex and beginning lifelong medical interventions. For example, cross-sex hormones can cause sterility, leaving teenagers to decide whether to forgo having biological children later in life.

Other experts say cross-sex hormones increase risk of stroke and that puberty blockers could decrease bone density in adolescents. And since the practice of giving cross-sex hormones to children is only about a decade old, even pro-transgender physicians admit they don’t know the long-term outcomes.

More studies make sense, including research into the dangers of pursuing such paths. But while studies like Littman’s are under fire, the federally funded National Institutes of Health has given more than $5 million in grants to a group of doctors and psychologists tasked in part with studying transgender children over a period of decades.

The views of at least some of the researchers seem clear from the outset: Norman Spack is a Boston physician who opened the nation’s first gender clinic for children. Johanna Olson-Kennedy is a pro-transgender pediatrician who sees hundreds of children at the Center for Transyouth Health and Development at Children’s Hospital Los Angeles.

Late last year, the American Academy of Pediatrics (AAP) for the first time officially recommended that parents accept and encourage the preferred gender expression of their children.

That cuts across decades of therapists who argued parents should encourage their children to embrace their birth sex, knowing that some studies show as many as 80 percent of children who express gender dysphoria will outgrow those feelings by adulthood.

But in 2016, Cora Breuner, a pediatrician and head of the AAP’s committee on adolescence, told PBS she wanted to see gender clinics available to children all over the United States: “My goal is to make this absolutely mainstream.”

Research into alternate ideas doesn’t promise to become mainstream again any time soon.

Michael Bailey is a psychologist at Northwestern University who faced intense criticism a decade ago for challenging the prevailing ideas about male transgenderism. He still raises questions: “Right now there’s this bias for the narrative that all gender dysphoria is real and that it’s great to transition—and against people who are concerned about this.”

He doubts he’d be able to get a government grant to study the issue. Instead, Bailey’s working on a study similar to the one Littman released last year. He’s conducting a survey in conjunction with the website Parents of Rapid-Onset Gender Dysphoria Kids. (He notes it’s possible some of the same parents may respond to his survey as responded to Littman’s study.)

He says the study will likely be published later this year, but so far, he says the results are very similar to what Littman found. He thinks the reaction against her study was “clearly ideologically motivated” and that it communicated, “This is not valid … and let’s punish anyone who tries to study this.”

Bailey says he knows other psychologists who are worried about the push to encourage children to pursue medical interventions, but who don’t want to speak out for fear of retribution.

‘Right now there’s this bias for the narrative that all gender dysphoria is real and that it’s great to transition—and against people who are concerned about this.’—Michael Bailey

Paul Hruz, an endocrinologist at Washington University in St. Louis, says a substantial number of his colleagues feel the same way, but won’t speak up either: “It’s one of the ways we’re failing our patients.”

Hruz notes that when children or teens come seeking cross-sex hormones, they are usually physically healthy, but entering into lifelong dependency on hormones. And he emphasizes the biologically obvious: No one can change his or her sex.

“Sex is biologically determined from at the moment of conception” says Hruz. “It’s recognized at the time of birth, it’s not assigned at the time of birth. And even if you modify the appearance of the body, you don’t do anything to change the sex.”

Despite that biological reality and the many unknowns about the long-term consequences of cross-sex hormones (as well as the already-known side effects), he’s dismayed to see physicians and psychologists pushing such medical procedures on children:

“I’ve not in my career encountered another condition where we’ve moved ahead so rapidly and so vigorously to affirm one particular intervention with this level of evidence.” He hopes the medical community will wake up to the dangers: “But I don’t know how many children will have been harmed by then.”

ANDREW WALKER, author of God and the Transgender Debate and a fellow at the Ethics and Religious Liberty Commission, thinks in a hundred years people will look back on this era of medicine the way we now look back on the eugenicist movements of the early 20th century.

While many obvious biological reasons exist for opposing the embrace of transgenderism, Walker says Christians also should be well-versed in the Biblical teaching about God creating people male and female in His image.

He says that’s particularly important for parents talking with children about these issues: “And I err on the side of having the conversation sooner than later because if you don’t have the conversation with your children, the culture will.”

(Walker says a parent can teach even a young child that some people are confused about the way God made them, and that we should have compassion on those who are suffering in this way and help when possible.)

The suffering is intense for many.

Hacsi Horvath, a lecturer in epidemiology and biostatistics at the University of California, San Francisco, has written about his own experience of trying to live as a woman for 13 years. He says he stopped taking estrogen in 2013 and “very rapidly came back to my senses.”

Today, he says he grapples with anger but writes about his experience because “I am far angrier that thousands of young people are being irreversibly altered and sterilized as they are inducted into a drug-dependent and medically maimed lifestyle.”

He hopes to spare others what he’s suffered: “an inward bruise … I have been badly harmed.”