The Human Right to Desistance: A Response to Kristina Olson's Pro Underage Trans Medicalization Scientific American Article

Opinion

There is an expanding community of lesbian, gay, and bisexual adults troubled about the growing numbers of physically and psychologically damaged young people who have undergone medical transition for gender dysphoria (GD), and the potential for their numbers to increase with hundreds of gender clinics opening in the United States. The association with childhood dysphoria and adult LGB identity is well-established, and it is no surprise high numbers of GD desisters and detransitioners are LGB. The stridency and passion of our concern is inversely proportional to the glaring lack of it expressed by psychologist Kristina Olson when she writes pro-pediatric transition articles for public consumption (here, here). In this way, Olson, a researcher for the TransYouth Project, is like all of the prominent pro-pediatric transition advocates in the health professions, academia, “LGBT” organizations, and Elizabeth Warren, who circulated her recent article on Twitter.

This most recent lack of expressed concern for the risks of pediatric transition is titled “Gender-Affirming Health Care Should Be a Right, Not a Crime” and appears in Scientific American as a response to legislative attempts to illegalize hormone blockers, cross-sex hormones, and surgery for minors. Minors are undergoing all of this, including double mastectomies and genital surgeries under the age of 18. Hormone blockers may start as young as 9 years old in the United States and elsewhere. The reason for this lack of expressed concern for existent dangers in transitioning huge increases of children and teens is simple in my assessment after listening to Olson and others like her for six years now. Supporters of socially and medically transitioning minors, called “affirmative model advocates,” have decided the benefits of this new and not well-studied protocol outweigh the negatives. Why talk about negatives that will only create roadblocks to doing the great work of giving dysphoric youth precisely what they want, as early as possible, to improve their mental health. The “roadblocks” here are human beings, young people whose health and maturation process have been severely damaged by mental health and medical professionals involved in transitioning young people. It’s relevant to note full executive function isn’t mature in the human brain until the mid-twenties.

I do not want to discuss legal issues regarding the government inserting itself between professional/client relationships. I want to discuss Kristina Olson’s article to highlight how affirmative advocates obscure dangers of pediatric transition to make it seem safer, healthier, and more moral than it is, to ensure the public goes along with this desired agenda, rather than inform them of all the facts. This is a dereliction of duty by a publication that calls itself “Scientific” American, and yet just one of many examples of how safeguarding of mostly LGB and autism spectrum minors is considered so irrelevant, it’s not even worth acknowledging risks to them exist.

Others have already pointed out the issues with her articles and research, and myself personally and through contacts to the TransYouth Project from board members of Gender Health Query, a medical watchdog organization. There is no space here to “steel-man” her pro-pediatric transition stance, which I always prefer to do for honest debate. If one wishes to view its justifications, refer to Kristina Olson’s research and the Cornell review indicating low regret rates and reports of significantly reduced dysphoria. These are flawed studies but important information to consider.

Let’s address the half-truths, intentional omissions, fallacies, and manipulations in her recent article. No one should politicize these young people but this is a textbook example of why it has become necessary to form groups like LGBAlliance, LGBFightback, and Lesbian and Gay News to have discussions about significant issues like the human right of same-sex attracted people to grow up without medical defacement that rarely, if ever, is acknowledged by most affirmative advocates in any public way. 

Half-Truths 

The below quotes refer to the use of hormone blockers that enable medical manipulation of normal puberty to help the youth appear as the opposite sex:

“though that effect was entirely reversible”

And:

“the impact of blockers is reversible.”

Doctors have used hormone blockers for children undergoing puberty at unhealthily early ages, where the pubertal process resumes when the blockers are stopped. They are also used to help control endometriosis and cancers and to chemically castrate sex offenders. They have not been well-studied for the purpose of halting normal puberty in physically healthy young people.

Even for prior uses, there are large numbers of negative side effect reports for the hormone blocker Lupron to the FDA. Below are some of the complaints, and they are serious:

“As with many drugs, side effects have long been a problem. More than 20,000 adverse-event reports have been filed with the FDA in the last decade. Women have reported to the FDA hundreds of cases of insomnia, depression, joint pain and more than 100 cases of blurred vision. About 900 reports cite side effects that children below age 13 have suffered, mostly within months of taking Lupron. Those reports frequently note injection-site pain but also include dozens of cases of bone problems, such as pain or disorders, and the inability to walk.”

While puberty may resume when blockers are stopped, what she fails to mention, but is certainly aware of, is the genital stunting (micropenis) caused by the blockers that solidifies when they start estrogen. Because of this, some of these youths will have gone through life never having had an orgasm but once. If they don’t want to spend life with a child’s penis, they must undergo a more complicated and riskier vaginoplasty surgery than they would have as an adult. This uses the peritoneal lining or colon and skin flaps from the thighs. It causes significant scarring and risks serious complications, needs for corrective surgeries, and odor problems. For example, Jazz Jennings had to undergo three additional painful corrective surgeries after the initial one “popped” and turned blue (cyanosis due to lack of blood flow that can result in necrosis). These side effects negate the pro-pediatric transition argument these youths will need fewer surgeries if they medically transition at very young ages. There are other accounts of youth distressed by unwanted effects of blockers. This path is decided by 11-year-old children, who will never experience a normal process of identity formation, romantic/sexual exploration, or natural puberty. 

Affirmative model advocates are doing no less than imploring modern civilization to normalize severe genital disfigurement for minors as “affirming healthcare.” This is considered ethical in affirmative circles despite the fact many adult MtFs do not have severe genital dysphoria, may want to use their genitals, and do not want bottom surgery. And some men are willing to be “out of the closet” having long-term relationships with feminine males, who may not pass perfectly, and have not had bottom surgery. None of these complexities have been addressed by Kristina Olson, despite them being concerns expressed among trans people, some of who adamantly oppose pediatric transition.

When a child is given blockers at the start of puberty and proceeds to cross-sex hormones, they will be irreversibly sterilized.

Olson provides this quote about the very first use of blockers in a GD patient that would:

“give him time to ‘explore gender issues for an extended period, without being pressured by any physical developments’ as the study put it.”

Yes, the study puts it that way. It’s a favorite talking point around blockers. She won’t point out in this article the truth; there is no proof blockers aid in the healthiest possible “exploration” of gender for every young person or that their psychological effects are reversible. Other dysphoria experts have commented the pubertal process and experiencing romantic exploration helps youth adjust to their bodies. Researchers, some with years more experience with GD than Olson, believe that there should be worry blockers will affect identity development by significantly interfering with the hormones necessary for self-discovery, especially when youths are given blockers barely into puberty before experiencing the butterflies of crushes and feelings of desire.

If you wait until puberty has got a little way along, a fair proportion of the children change the clinical presentation and feel more like a straightforward lesbian and gay kid. They don’t seek social role change anymore and will end up with no need for lifelong medical intervention, surgery and no loss of fertility should they want children. -Dr. James Barrett,

The younger ones can really, really want to be girls or boys, and then they can give that up and their relationship to their bodies can settle down quite comfortably. If we can help some of those young people through adolescence, they might make a different choice later. -Dr. Bernadette Wren

Anyone well-informed about pediatric transition knows that there is evidence hormone blockers may weaken bones and IQ scores and this may not be reversible. Lowering IQ by as much as 10 points would be enough to affect a person’s career choice or whether their art is good enough to be shown in a quality gallery. These aren’t trivial matters for a young person’s future, and a 10-year-old cannot give consent if these sacrifices are worth a passing, feminized or masculinized face:

Schneider et al.(2017): Brain Maturation, Cognition and Voice Pattern in a Gender Dysphoria Case under Pubertal Suppression

More on medical side-effects, including future circulatory health risks and menopausal symptoms, can be found here.

Another half-truth regarding her mention of the anecdote of the first person to be put under this protocol:

“B was happy with his life.”

She doesn’t include quotes about the fact that “B” had psychological issues about not being in a relationship and feelings of “shame” and sexual “inadequacy,” understanding the fully heterosexual women needed to validate B’s identity, want heterosexual intercourse. A 10-year-old female child going on blockers does not fully comprehend these matters. I have not seen gender clinicians be honest about these facts in my extensive research, as this Pollyanna article demonstrates. Young people are entering dating scenes entitled and extremely angry at others for not emotionally and sexually validating their gender identities.

Omissions

In this article and others, she doesn’t mention that young people with significant GD may desist and are likely to be gay or lesbian adults. There is a strong motivation in these circles to downplay the connection with childhood gender dysphoria (and in some cases rapid-onset gender dysphoria) and a resolved adult gay or lesbian identity. This is despite observations by other clinicians, the fact many on the r/detrans subreddit are lesbian or bisexual women, and what anyone who has been in LGBT circles knows themselves, the line between gender-nonconforming gay and lesbian and trans is blurry: 

“This is a form of conversion therapy among people that are gay or lesbian.” -Dr. David Bell

What you're saying is that this approach essentially tracks them into a transgender identity?

That would be my prediction, yes. -Dr. Ken Zucker

She doesn’t discuss the high rate of desistance in the Dutch clinic study used to justify pediatric transition. Based on her other comments, she leans towards the idea that if a minor says they are trans, they likely are, and that many children previously diagnosed with GD were just gender nonconforming children. While over diagnosis in past studies is an issue, there are many reasons not to have faith in the ability of gender clinicians to diagnose and medicalize only the “true trans” kids. These criteria don’t matter anyway. They are transitioning “nonbinary” minors who can choose from an array of hormone and surgery mix and match options to be their “true selves.” This is only positive for people who like the idea of performing breast amputations for unstudied “non-binary” identities on cognitively immature teenagers.

“Even among children who manifest a major degree of discomfort with their own sex, including an aversion to their own genitalia (GID in the strict sense), only a minority go on to an irreversible development of transsexualism (6). Irreversibility of the manifestations, however, is considered to be an indispensable requirement before the diagnosis of transsexualism can be made, or any body-altering treatments initiated.” -"Gender Identity Disorders in Childhood and Adolescence:"

“During puberty and adolescent development there may be some overlap between normative testing of sexuality and gender roles in the one end, and gender dysphoria as a disorder in the other end of the spectrum. This would implicate that GD in adults and in adolescence may not be the same issue in general. For these reasons it is more challenging to assess whether the gender identity of an adolescent is so firmly established that physical intervention is indicated than it is to assess this among adults.”  - “Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development”

She doesn’t mention that the pediatric transition protocol will leave many of them sterilized. At the same time, many articles highlight trans people with kids. Studies exist showing many trans people want biological children. She doesn’t mention trans people who see their sterilization as damage, so much so, they have sued the Swedish government. This isn’t only analogous to eugenics for LGB people but also now sterilized trans-identified people.

She doesn’t mention the demographics have changed drastically recently and are unstudied, with many more females, bisexuals and heterosexuals, and youth wanting medicalization for “non-binary” identities. 

She doesn’t mention that gatekeeping is often non-existent in the United States, with children and teens being put on blockers or cross-sex hormones, often with severe comorbid conditions, immediately, whereas early studies screened for stable patients for transition. 

She doesn’t mention that one of the young people from the Dutch study used to justify this protocol died from vaginoplasty surgery.

She doesn’t mention in Carmichael (2021) they could not replicate the success of the pioneering Dutch study. 

She doesn’t mention the NICE (2021) review claimed evidence for blocker efficacy was “very low certainty.”

She doesn’t mention Thailand had a problem with too many gay youths with transition regret and that gay rights activists there successfully raised the age of consent to eighteen with parental consent and twenty-one without it. It may give people pause to care about gay youth who need some time to mature, not be lied to you can change your sex, encouraged to see their bodies as the enemy, and medicalized before their brains are finished developing. That may stop easy and rapid access to social affirmation and extreme medical treatments underage, which she doesn’t want. Thailand’s transition protocol was arguably less aggressive than the one in the United States, given our use of hormone blockers at very early ages. We will see how many more stories will be added to the mounting ones we currently have with thousands on this detransition subreddit, of which she is certainly aware.

She doesn’t mention unsettling accounts in “trans kid” social media groups of parents who seem disturbingly enthusiastic about transitioning their kids, sound disappointed when they desist, and multiple families who have statistically bizarre, multiple trans-identified children.  (see here and here).

She doesn’t mention a Christian mother who used to slap her now media celebrity “trans child” because she worried he would be gay, or accounts from UK clinicians that parental homophobia is fueling transition in children, or that homophobia increases the likelihood of trans-identification.

She doesn’t mention the reverse situation of the government prevention she opposes because it will upset a lot of people. What is coming is normalized state-enforced chemical castration and medical alterations of minors with hormones and surgeries underage, against the parents’ will, on any minor who wants transition, regardless of comorbidities or complicated reasons why they may be adopting a trans-identification. Don’t go along with it and your child will be taken away.

She doesn’t mention that while there are minors who are consistent in their desire to transition, there is also much evidence that social factors like psychogenic contagions, homophobia, and unstable homes influence dysphoria, challenging their bio essentialist views of gender. Why would she bother when a 9-fold increase in trans-identification in the young versus older people, who are emotionally regulating through hormones, surgeries, and pronoun obsessions, isn’t a “problem?” Does Olson believe the non-medicalized Gen Xers aren’t reaching their full potential by not seeking cross-sex hormones, plastic surgery, or validation for their they/them pronouns?

Gallup

I’m part of a community of LGB people, many of us having had dysphoric experiences ourselves, who aren’t afraid to make value judgments. An integrated self without desperate dependency on hormones, surgeries, and outside validation is a better outcome. And a process of struggling to come to this place is a worthwhile journey, even if it means a difficult childhood or puberty.

She doesn’t consider increased trans-identification and nonbinary identities may be related to autism spectrum issues or serious mental health problems like personality disorders or body dysmorphic disorder. You can see a reference to some studies showing nonbinary identities have worse mental health than binary trans on the APA’s own “fact” sheet.

She doesn’t consider youth with better mental health (such as the likely privileged ones in her cohort or the pre-screened youth in the Dutch study) may be served by waiting, receiving solid emotional support, for the sake of bone, brain, and sexual health reasons. This position is held by some vocal trans adults.

She doesn’t acknowledge even the most optimistic “false positive” rates represent thousands of pointlessly medically altered young people in the coming years as medicalizing gender-stereotype nonconforming minors becomes the norm.

Regarding this quote:

“These laws are out of sync with the recommendations of the American Medical Association, the Endocrine Society, the Pediatric Endocrine Society, the American Academy of Pediatrics, the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry, who all agree that gender-affirmative treatments are an important option for transgender youth.”

What Kristina Olson fails to mention is that the guidelines for all these organizations are being written by people like her, who omit or de-emphasis very relevant information like desistance statistics or severe medical side effects, who then get to point back to these medical bodies’ statements and say “see, I’m right, all the important people agree with me.” See how this works? For just one example, we (LGB members of Gender Health Query) had to send a letter due to omissions and outright factual errors to the Endocrine Society and Pediatric Endocrine Society that appear in some recent public statements. Problems with activist-driven academia and “science” will be familiar to many.

It’s not that there are not experts on gender dysphoria and child psychology who are very concerned about what is going on with significant increases in youth undergoing medical transition. There are many, and they are afraid for their jobs in a McCarthyistic environment around this subject. Olson doesn’t mention several clinicians quitting working in gender clinics in the UK, a country with a recent successful lawsuit against the use of blockers in minors. The protocol there is arguably better than what is going on in the US with privatized care. None of this is consensus this is safe and that the risks outweigh the benefits. 

Another quote that doesn’t tell the whole story (emphasis mine):

Importantly, as Jules Gill-Peterson of the University of Pittsburgh points out in her book Histories of the Transgender Child, ‘the vast majority of [trans youth] lack access to competent, responsible, and affordable care in whatever form they might ideally ask for it.’ These young trans people, including many individuals from lower-income backgrounds, people of color and homeless youth, lack the financial means, insurance or support of the adults around them—including medical staff—to receive the care they seek.

The American public should know the extremity of what is going on in transgender “healthcare.” Aside from double mastectomies on 13-year-olds and vaginoplasty surgeries on 16-year-olds, there are now surgeries for unstudied non-binary identities, surgeries where the doctors remove the nipples or whole penis and testicles for “nullo” identities, and bigender surgeries where the penis is retained but a neovagina cavity is created. The public should know that doctors are doing surgeries on people with schizophrenia and who claim they have multiple personalities with varying genders. Even phalloplasty, an FtM surgery, has such high complication rates one may ask why they are legal. Some complications are so severe they have almost killed people and have put some in ileostomy bags. These realities don’t have the nice ring of “gender-affirming healthcare” 

You won’t find her discussing how normalized medical distorting of thousands of male minors a year, through blockers and cross-sex hormones, will affect sex-segregated opportunities for girls, like sports. Females will now be competing against a newer and better girl; a “fiercer and braver” girl; a stronger and faster girl, with bigger hearts and lungs, no matter how many hormone blockers they are given at the earliest possible age. These similar, often ignored points are made by Stephania Ari in this video. The burden falls on girls to validate these individuals, not on males to be kind and accepting of gender-nonconforming males, who we all agree deserve support and a safe place in society. 

Fallacies

Inductive Hyperbole- “The argument draws a conclusion that is stated more strongly than the actual observations would support.”

Sure, we all do this for effect, but this is Scientific American, I repeat “Scientific.” Why is this piece subtitled “Some states are going to war against young transgender people,” when agree or not with governmental interference, there are serious risks to pediatric transition people who very much care about these kids and teenagers have, including trans-identified adults? I will tell you why. Using words like “war” serves to demonize people and whip up the liberal base around ideological tribes, which is especially successful when you fail to mention any of the above risks and negative side effects or that minors adjust to their natal sex if allowed to go through normal puberty.

She also over reports the benefits of hormone blockers from this study. The benefits may have resulted from counseling—these details matter.

Manipulations

The quote Olson uses about patient “B” includes a comment B felt suicidal. Olson mentions suicide in this LA Times piece and in this Slate piece referencing Dr. Debra Soh, written to assuage justified worries about transitioning would-be desisters. Suicide is an extremely serious matter. GHQ has a thorough review of most of the relevant studies. It took months to complete it. On the question of whether transition reduces suicide, the truth is the data is mixed (see Bauer (2015) for the strongest case, and Adams (2017) and Branstrom (2020) for the weakest). In summary, I would state the chances of a dysphoric youth committing suicide precisely due to not receiving immediate, extreme medical protocols is greatly exaggerated, and the benefits of medical transition on the reduction of suicide may be exaggerated or it may not be effective at all. Here are many examples showing how affirmative model advocates use suicide to shut down debate about the safety of this protocol. They do it so much so, they violate all guidelines put out by suicide prevention organizations, as suicide is known to be socially contagious.

Want to increase suicide ideation in dysphoric youth? Keep putting the message out there, as often and loudly as possible, they will kill themselves if people have concerns about their physical health, under an unstudied protocol with significant side-effects, that there is a “war or on them,” and that people hate them because they believe feminine males should not be on girls’ sports teams. It’s odd this has to be stated to mental health professionals when there is such extensive research on how this increases negative rumination and is anti-resilience.

Conclusion

There is nothing inherently unethical about being an activist for a cause. I am an activist around the fact I view medically defacing minors for transient dysphoria or sterilizing them, destroying their sexuality, and interfering with their brain development, regardless of outcome, to be a profound human rights violation. This view is shared by many other LGB people, including ones who feel puberty blockers would have been a danger to them personally, like conservative journalist Chad Felix and academic/author, Camille Paglia. Kristina Olson, a Princeton professor, and head of one of the most high-profile studies on dysphoric youth, behaves like an activist, not an objective source in relaying all the important facts to the public. Scientific American behaves like an activist around this and other gender-ideologue articles. They need to be up front this is what they are because it is entirely possible to write more balanced articles such as “Is the Tide Starting to Turn?” These individuals and entities have taken it upon themselves to downplay or ignore very relevant information in their messaging and have had undue sway over all of the significant medical bodies and mental health organizations, media, and now Elizabeth Warren. 

For these reasons, LGB people concerned about the increasing numbers of damaged young people we see in our populations, and the future damage to come, we will have to be invested in their care after they are sterilized, castrated, scarred, and otherwise psychologically and medically injured. The obvious risks to them and the profound harm that we see resulting, aren’t even worth a passing mention to increasing numbers of people in media, academia, and the health professions.  




Edit 06/11/21: Added something K. Olson didn’t mention about gay youth transition regret in Thailand and that state enforced medicalization of minors against the parents’ will is becoming the new norm.