Gender dysphoria and its “treatment”

Imagine a small child, perhaps as young as ten years old. Imagine a little boy or a little girl, or a young teen—your child—distressed and “unable to function emotionally for at least six months” for some or all of the following reasons:

A strong desire to be of the other gender or an insistence that one is the other gender; a strong preference for wearing clothes typical of the other gender; a strong preference for cross-gender roles in make-believe play or fantasy play; a strong preference for toys, games or activities stereotypically used or engaged in by the other gender; a strong preference for playmates of the other gender; a strong rejection of toys, games and activities typical of one’s assigned gender; and a strong dislike of one’s [anatomy] (12).1

If you brought your child to the Tavistock and Portman NHS Foundation Trust in London, England (or to an equivalent clinic in your country), he/she might well be diagnosed with “gender dysphoria” and be referred to its Gender Identity Developed Service (GIDS). Dysphoria (from dus—difficult; and pherein—to bear, which is the opposite of euphoria from eu—well) is a profound state of unease or dissatisfaction. Gender dysphoria is a profound state of unease or dissatisfaction about one’s gender. One does not merely dislike one’s gender, but one has a strong, perhaps overwhelming and crippling, desire to be the other gender. A boy wants to be a girl, or a girl wants to be a boy. More than that, a boy insists that he is a girl, and must be called such and become such; or a girl insists that she is a boy, and must be called such and become such. “Gender dysphoria [is] a condition where persons experience distress because of a mismatch between their perceived identity and their natal sex, that is, their sex at birth. Such persons have a strong desire to live according to their perceived identity rather than their natal sex” (3).

Modern medicine claims the ability to change boys into girls and vice versa. The first step is to delay puberty, which is to block the hormones that in the teenage years cause boys and girls to mature into young men and women. These puberty blockers can be prescribed to boys and girls as young as ten, so that they do not become men and women until they have decided what gender they want to be. The director of GIDS testifies, “The primary purpose of puberty blockers is to give the young person time to think about their gender identity” (52). The literature published by GIDS states: “[Puberty blockers] may improve the way you feel about yourself.” “[They] will make you feel less worried about growing up in the wrong body” (63).

The second step, if the patient still experiences gender dysphoria, is to prescribe cross-sex hormones from the age of sixteen. These drugs stimulate the body to develop some of the physical characteristics associated with the desired gender. For example, a pubescent girl will grow facial hair and her voice will deepen; and a pubescent boy will not develop the normal muscle mass and may even develop breasts. However, cross-sex hormones do not give teenagers the private parts of their preferred gender.

The third step is gender-reassignment surgery, which attempts to give a person a body closest to their preferred gender, which, of course, can never achieve a true metamorphosis. This option is only available in the UK to people over the age of eighteen years.

I repeat, this is happening to children as young as ten. They are being placed on a pathway, beginning with puberty blockers, which, they are promised, will enable them one day to become the man/woman that they want to be. Once transition is complete—or even before that point—society demands and the law will enforce that demand, that Sheila be called Simon and Stanley be called Sue, that Simon (really Sheila) be allowed to use the men’s bathroom, be called “he/him” and even “they/them;” and that Sue (really Stanley) be allowed to use the women’s bathroom.

Bell vs. Tavistock Clinic

In 2020 the (UK) High Court of Justice ruled in favor of an individual called Bell, who had transitioned from female to male, but then desired to “detransition” to her birth gender. (By the way, there are increasing numbers of gender dysphoria patients who regret their “transition”—such confused individuals must live with the consequences of decisions made in childhood/ adolescence for the rest of their lives.) Bell is one with “buyer’s remorse.” Her lawsuit alleges two things: first, “that children and young persons under eighteen years of age are not competent to give consent to the administration of puberty blocking drugs” and second, “that the information given to those under eighteen years of age by the [Tavistock clinic] is misleading and insufficient to ensure such children or young persons are able to give informed consent” (7).

Of course, a secular court does not address the issue of morality: is it lawful in the sight of God to do this to people, and especially to young and vulnerable children/ teenagers? Obviously not! God made them male and female (Matt. 19:4). The court is concerned only with the question of “informed consent.” Can a child/ teenager comprehend the enormous, life-changing implications of such a decision at such a young age? And, if not, what protections should there be in place; and what is/should be the role of parents and the courts in such decisions?

Bell herself testifies that she was not ready. “From the age of four or five she displayed gender non-conformity,” and after researching her problems online, she writes, “I thought I had finally found the answer as to why I felt so masculine, uncomfortable with my female body and why I was so much more similar to a stereotypical boy than to a stereotypical girl in physical expression and interests” (78). At the age of fifteen Bell was referred to GIDS and began taking puberty blockers. She then began to discuss surgery, “visualizing [herself] becoming a tall, physically strong young man where there was virtually no difference between [her] and a biological boy” (80). After three years of testosterone treatment she began to have doubts, but these were allayed through participating in online forums with other trans people: “The consensus was that most transsexual people have doubts and that it is a normal part of transitioning, so the doubts should be ignored.” Bell had a double mastectomy at the age of twenty. Bell concludes:

I started to realize that the vision I had as a teenager of becoming male was strictly a fantasy and that it was not possible. My biological make-up was still female and it showed, no matter how much testosterone was in my system or how much I would go to the gym. I was being perceived as a man by society, but it was not enough. I started to just see a woman with a beard, which is what I was. I felt like a fraud and I began to feel more lost, isolated and confused than I did when I was pre-transition (81).

From January 2019 Bell stopped taking testosterone. “She now wishes to identify as a woman and is changing her legal sex back to that on her original birth certificate” (83). Bell now wants to prevent others making the same catastrophic mistake. She writes:

I made a brash decision as a teenager, (as a lot of teenagers do) trying to find confidence and happiness, except now the rest of my life will be negatively affected. I cannot reverse any of the physical, mental or legal changes that I went through. Transition was a very temporary, superficial fix for a very complex identity issue (83).

The Tavistock clinic defended its practices, insisted that children and teenagers are competent to make such decisions concerning their gender identity, and maintained that the information provided is age-appropriate, clear, and not misleading. The judges of the High Court expressed serious concerns, concluding:

There will be enormous difficulties in a child under sixteen years of age understanding and weighing up this information and deciding whether to consent to the use of puberty blocking medication. It is highly unlikely that a child aged thirteen years or under would be competent to give consent to the administration of puberty blockers. It is doubtful that a child aged fourteen or fifteen years could understand and weigh the long-term risks and consequences of the administration of puberty blockers (151).

The court identified the following concerns.

First, the data provided by the Tavistock Clinic lacked detail on patients’ age distribution, reasons for gender split, and reasons for increased referrals to GIDS (29-32). For example, in 2009 ninety-seven children were referred and in 2018 that number rose to 2,519! The Clinic offered no explanation. In 2011 the gender split was 50/50 between boys and girls, while in 2019 the split was 76/24—why are girls suddenly affected in much larger numbers than boys? Again, the Clinic could not provide the data. The Clinic also had no data on the “proportion of young people referred by GIDs for puberty blockers who had a diagnosis of Autistic Spectrum Disorder,” an added complication in the case of a gender-confused child. The court found this “lack of data analysis—and apparent lack of investigation on this issue—surprising” (34).

Second, the court found the process for taking consent inadequate:

The court gained the strong impression from the evidence and from those submissions that it was extremely unusual for either GIDS or the Trusts to refuse to give puberty blockers on the ground that the young person was not competent to give consent (44).

The court goes on: “The evidence…clearly shows that practically all children/young people who start puberty blockers progress on to cross sex hormones” (56); in fact, the path from one drug to the next is “virtually inexorable” (68). The court added, “The treatment may be supporting the persistence of gender dysphoria in circumstances in which it is at least possible that without the treatment the gender dysphoria would resolve itself” (77). “There is strong evidence that once a child commences on puberty blockers they will progress to cross sex hormones, which will cause irreversible changes to the child’s body with lifelong medical, psychological and emotional implications for the child” (93). The court judged that puberty blockers do not give young people “time to think” (as the Clinic argued), but are really stepping stones to cross sex hormones, noting that in the Netherlands only 1.9% “stopped the [puberty blockers] treatment and did not proceed to cross sex hormones” (57). The court was “surprised” that GIDS did not provide equivalent data for the UK (59).

Third, the court heard evidence that young children and adolescents with underdeveloped brains make “different, more risky decisions than adults.” One expert witness testified:

It is very possible for an adolescent to be unable to fully grasp the implications of puberty-blocking treatment. All the evidence we have suggests that the complex, emotionally charged decisions required to engage with this treatment are not yet acquired as a skill at this age, both in terms of brain maturation and in terms of behavior (46).

Of course, any parent of a teenager knows that!

At the “mercy” of the courts and prey to social pressure

That leaves the fate of British children under sixteen with gender dysphoria at the dubious mercy of the courts. Since such young people cannot judge their readiness for such treatment, a court would adjudicate with or without parental consent. Transgender groups reacted angrily to the judgment and the Clinic plans to appeal. Transgender activists need not worry, however, and I take cold comfort from this judgment. Courts have been slow to protect children and young people from the menace of transgenderism, often overriding parents’ concerns, even punishing recalcitrant parents who refuse to recognize their child’s gender preferences. I mention only the case of Robert Hoogland, who in April 2021 was sentenced to six months in prison in British Columbia, Canada, and fined $30,000, on the charge of “family violence.” In February 2019 the Supreme Court of British Columbia had ordered that Hoogland’s daughter, then fourteen years old, should receive testosterone treatments in order to allow her to transition to her preferred male gender. The court had also ruled that the child’s parents would be guilty of “family violence” if either of them referred to their daughter as a “girl” or with female pronouns. Hoogland violated that order, by, among other things, refusing to recognize his child’s preferred gender and by naming and shaming the health professionals involved. The court took a dim view and Hoogland was punished.

There is also evidence that, especially among girls, gender dysphoria diagnoses are exploding because of peer pressure. The blog Science Based Medicine featured two articles on that subject by Harriet Hall.2 In the first post, Hall analyzes the work of Lisa Littman, (former) assistant professor of Brown University in Providence, Rhode Island (I say “former” because her research was pulled from the university website and she was fired due to pressure from “trans activists”). Littman coined a term, “Rapid-Onset Gender Dysphoria,” which, she suggests, is due to “social contagion and online influences, rather than to an innate, immutable sense of incongruence between anatomical sex and personal sense of gender.” Girls, much more than boys, feel social pressure in their teenaged years to become “trans.”

In the second post, Hall reviews a book, Irreversible Damage: The Transgender Craze Seducing Our Daughters, by Abigail Shrier, which builds upon Littman. “There are many social media sites and online forums that facilitate the discovery of a trans identity,” writes Hall. Notice the word “facilitate.” Such websites advise confused girls: “If you think you might be trans, you are.” They also encourage girls to “deceive parents and doctors” so that they obtain the treatment that they want, and deceptively paint a rosy future for those who transition. Schools and therapists either cannot or will not help: laws against so-called “conversion therapy” make it very difficult for anyone to “question a patient’s self-diagnosis of gender dysphoria.” Hall makes mention of “a highly respected expert on gender dysphoria [who] refused to reduce the source of distress to one problem”:

He insisted on looking at the whole kid. In a series of 100 boys he treated who had not been socially transitioned by parents, a whopping 88% outgrew their dysphoria. He was accused of practicing conversion therapy, was fired, and his reputation was ruined.

Schools routinely teach “gender and sexual identification instruction,” beginning in Kindergarten. In many states, it is not possible to opt out of such instruction in the public schools. That is horrifying and another reason to cherish and support Christian education.

Parents, be very careful about the access your children, especially teenaged girls, have to social media and the Internet. Be cautious about your children’s friends and peers. The planting of a seed into an impressionable child’s mind can have devastating, lifelong consequences. “Keep thy heart [and the hearts of thy children] with all diligence; for out of it are the issues of life” (Prov. 4:23).

1 In this article I refer to the judgment of the (UK) High Court of Justice in “Quincy Bell and Mrs A vs. The Tavistock and Portman NHS Foundation Trust (Defendant).” Paragraph (not page) numbers are from that document issued on December 1, 2020, and italics are mine: https://www.judiciary.uk/wp-content/uploads/ 2020/12/Bell-v-Tavistock-Judgment.pdf

2 Harriet Hall, “Rapid-onset Gender Dysphoria and Squelching Controversial Evidence” and “Book Review: Irreversible Damage: The Transgender Craze Seducing Our Daughters” on www. sciencebasedmedicine.org.