Proposed changes to the BDMRR Bill (“self-ID”): effects on children/young persons under 18

Speak Up For Women has concerns about the impact of the proposed changes to the Births, Deaths Marriages and Relationships Registration (“BDMRR”) Bill in relation to children and young persons.

The proposals remove the existing Family Court “gatekeeping” function, and the need for medical treatment, in relation to children under 18 who wish to change their legal sex1. These protections will be replaced by the need for a “recommendation” from a “health professional.” The latter is defined extremely widely to include counsellors and social workers.

There is growing concern among clinicians and parents about the startling increase in children and adolescents presenting for “gender identity” treatment in recent years2.

Referrals to London’s Tavistock clinic rose from 97 in 2009 to 2519 in 20173. Girls made up 41% of referrals in 2009, but 70% of referrals in 2017.

In New Zealand, a recent (2018) study into referrals to Wellington’s Endocrine Services between 1990 and 2016, confirms this trend4. The sample sizes for each year are small, but a discernible pattern emerges: there is an increasing rate of presentation at younger ages, as well as an increasing proportion of “female to male” persons. The following table illustrates:

Similar trends are being observed in Australia5.

The transgender activists’ position is that these figures simply reflect growing awareness, and people discovering their “authentic selves,” or innate “gender identities.” It is argued that parents, teachers, etc. need to be “vigilant” to observe signs of transgender identity in children (even babies, according to some6) and that they must “affirm” these identities. LGBT youth advocacy group InsideOUT has published guidance for NZ schools7, which stresses the importance of “affirming” a young person’s chosen identity, and keeping that identity confidential from parents in the absence of the child’s consent8.

Of course parents and schools should encourage children to be themselves. As a group, we condemn gender stereotypes as harmful and restrictive for children of both sexes. Gender non-conforming behaviour should be supported. It is normal and healthy: all of us are “non-binary” in this sense.

What we take issue with is the assumption that such behaviour is a sign that the child is transgender, or “in the wrong body.” As the author of a recent article in the British Medical Journal observes, media narratives around transgender children will typically focus on behaviour that does not conform to stereotypes, yet: “playing with dolls and liking dresses doesn’t make children female, just as playing with trucks and liking mud doesn’t make them male.”9

The trans rights advocates’ insistence on blurring the distinction between sex (biological) and gender (cultural) is, in our view, causing widespread confusion10. We recognise, of course, that gender dysphoria is a real condition that causes real distress to sufferers. In rare cases, particularly with children who have an early-onset of gender dysphoria, medical transition may be the path they ultimately choose. Statistically however, most of these children will grow up to be lesbian or gay adults (see the discussion of “desistance” below). We are concerned that the rush to “affirm” these children as transgender, thereby placing them on a path to medical transition, may be doing more harm than good.

It is important that trans-identifying young people are supported and not stigmatised. But it is also important that mind/body disconnect, and the serious medical interventions that may ensue, are not normalised or, worse, presented as desirable.

We believe there is strong reason to sound a note of caution about what is taking place in our communities, particularly in relation to our girls.

A recent mainstream Cosmopolitan article featured a “beginner’s guide to breast binding” for teenagers. In the breezy style of that magazine (byword: “Fun, Fearless, Female”), the author writes11:

“Chest binding basically just means flattening your breasts using a binder, which is like a super-tight sports-bra. Many transgender men bind because they can’t afford top surgery12 or decided not to get it.

When you do a Google search for chest-binding, you get a slew of information which mostly links to binders that may or may not be too small or too painful or poorly made or super expensive or won’t work if you’re over a B cup. And then you get a bunch of additional information about how if you bind the wrong way, you can seriously hurt yourself, so you end up thinking “OK then so WTF am I supposed to do with these boobs I am not thrilled at having?” To spare you the same confusion, I spoke with a bunch of queer women and transgender men who know how to bind responsibly…

[I]f you can’t breathe in your binder you need to go up a size because, duh, you need to breathe.”

Needless to say the article contains no mention of gender dysphoria as a mental health condition; the serious consequences of medical transition (or indeed breast binding); or any hint of analysis of the cultural forces that may influence young women to despise their bodies. Breast-binding is presented as a “feminist” choice, for those who believe, in the author’s words, that “gender is BS and I am a rainbow of possibilities.”

Double mastectomies are now performed on teenaged girls as young as 13 in the US13. The Royal Children’s Hospital in Victoria, Australia is considering following suit14.

UK Government calls for an enquiry

On 27 August 2018, the UK Women’s Minister, Victoria Atkins, expressed concern about the rising number of teenagers seeking “life changing” medical interventions, and said it was important to explore the reasons why this was happening15.

On 15 September 2018 the UK Government announced an inquiry into the reasons for the massive increase in girls being referred for gender identity treatment16.  The Equalities Office said the number of referrals for girls had risen by more than 4000% in less than a decade, and that “little is known of the reasons, or of the long-term impacts.”

This move follows a senior NHS gender clinician17, Bernadette Wren, taking the unusual step of making a public statement warning that children as young as 11 were being offered medical treatments that could leave them infertile, and that schools were moving too fast in allowing pupils to be treated as members of the opposite sex (i.e. changing names, pronouns, uniforms) when this was not in every child’s best interests.18 Ms Wren said future generations may condemn the way such children are being handled, and that the risks of regret (especially in relation to the loss of fertility, and sexual function) were real19. She also confirmed transgender advocacy groups were pushing for faster recognition of children’s “gender identity” and were critical of the NHS for being “too cautious”.20 Ms Wren said:

“If a school just gets a whisper of a child who may be querying their gender and within minutes they are doing everything to make sure that child is regarded as a member of the opposite sex from the word go – that may not be the best for that child.21

“While nearly half of older children referred to the clinic opt for possible medical treatment to delay their puberty, only about a quarter of children referred as 5 to 12 year olds made the same choice when and if offered after the onset of puberty.”

We note that a practice of immediately affirming a child’s declared “identity” (and keeping that information secret from “unsupportive” parents) is precisely what the InsideOUT guidance for NZ schools recommends.

More recently, the Tavistock clinic released a statement critical of a recent TV series’ portrayal of the story of a “trans kid” (“Butterfly”). It said the programme found it difficult to capture the “complexity” of gender identity treatment, and was “not helpful” in its depiction of a suicide attempt by the 11 year old boy22. While trans lobby groups frequently cite the high risk of suicide as justification for an affirmative approach23, the clinic noted that suicidality among young people seeking its services is “very unusual” and similar to that of young people referred to mental health services.

A head teacher at a UK secondary school is quoted in the Guardian as saying her school has seen 12 children, all girls, come out as transgender in the past 18 months. The majority have autism and some have experienced sexual abuse. When they ‘come out’ they produce information sourced from Tumblr blogs and YouTube videos. Staff are too frightened to challenge what are seen as harmful practices:24

“we have chest binders worn in school, which is horrible, If a child was cutting they would be straight in with a counsellor. Yet damaging developing breast tissue goes unquestioned. It’s a gross failure in terms of child protection.”

Some reasons for caution

The “born in the wrong body” trope does not reflect science, let alone scientific consensus. The aetiology of gender dysphoria is not fully understood but is generally considered to be multi-factorial25.

There is evidence that children and adolescents with autism spectrum disorder (ASD) are significantly overrepresented in those presenting for gender identity treatment.26 This poses considerable diagnostic difficulties (compounded by under-diagnosis of ASD, particularly in girls). There is no real data on optimal treatment for patients with co-occurring ASD and gender dysphoria, and concern that the frequent obsessions and rigid thinking that characterise many of those with ASD may be playing a part28 (most commonly anxiety and depression)29.

Other studies have suggested a correlation with eating disorders, and with schizophrenia30.

A growing body of evidence highlights a link between child abuse (including sexual abuse) and the development of gender dysphoria 31.

There is also evidence that parental/peer/societal attitudes that are negative towards homosexuality may play a part in some cases32. (Iran has the highest rate of sexual reassignment surgery in the world. Homosexuality is also a capital offence33.)

Data are beginning to emerge about a phenomenon, described as Rapid Onset Gender Dysphoria, wherein teenagers with no previous sign of unhappiness with their bodies, suddenly announce they are transgender.  This typically occurs in the context of a peer group where one or more friends have become trans-identified, and it often follows a period of increased social media/internet use34.  In other words, there is emerging (albeit incomplete) evidence that social contagion plays a part in the development of trans-identity and dysphoria in some cases.  A recent article in Adolescent Health, Medicine and Therapeutics observes:37.  While the percentages vary depending on the study, it appears to be generally recognised that a majority (between 60-90%) of dysphoric children will eventually desist, with most growing up to be gay or lesbian38. Despite the overwhelming evidence39 of desistance, many trans rights advocates continue to insist that it is a transphobic “myth.”40 (A recent effort to research the related phenomenon of “detransition” was stymied by concerns about online backlash from trans activists.41) .

A complicating factor, however, is that interventions (e.g. social and medical ‘affirmation’ of the new identity – which, in crude terms, is the dominant treatment paradigm, especially in the US) are a self-fulfilling prophecy. If children are ‘affirmed’ in their new identity they are more likely to ‘persist’ with it.42 Ultimately the potential consequences are very serious and life-changing: puberty blockers, a lifetime of hormone therapy, sterility, impaired sexual functioning, and invasive surgery.

Into the mix here must be added current understanding about the immaturity and ongoing rapid development of teenaged brains43.

All of this is taking place in an incredibly fraught ideological minefield, whereby clinical practice and study are highly vulnerable to activism, targeted harassment and no-platforming by trans rights groups.44 The significance of this is difficult to overstate. The lead author of the American Academy of Paediatrics’ (AAP’s) 2016 guidelines on transgender youth is not a paediatrician or even a psychologist but a female-to-male transactivist and “gender studies” graduate45.

The lead author of the AAP’s more recent (2018) policy statement, Dr Jason Rafferty, has published no papers on gender treatment.46 The policy statement, which endorses an “affirmative” treatment model and has the backing of activists,47 has been excoriated by expert clinicians and described as “shockingly bad scholarship.”48

Conclusion

In this complex and highly charged context it is very troubling that the Government is proposing a removal of existing safeguards in relation to children wishing to change their legally-recognised sex, without consultation or policy analysis.49 We believe the UK Government’s recently announced inquiry must serve as a red flag to our Members of Parliament.

  1. The proposals also remove the existing provision that the Court must be satisfied, on the basis of medical advice, that the child’s gonadal or genital development is such that it is more likely (after medical treatment) that the child will be able to “assume the gender identity” of the nominated sex than it is that the child will be able to assume the gender identity of their current sex. The requirement that the Court needs to be satisfied that it is in the child’s best interests to be brought up as a person of the nominated sex, has also disappeared.
  2. For further information from parent-led groups questioning these issues see https://www.transgendertrend.com/ or https://4thwavenow.com/ A website for professionals questioning these trends is https://youthtranscriticalprofessionals.org/
  3. Gender Identity Development Statistics (GIDS) https://www.theguardian.com/world/2018/may/10/the-gender-recognition-act-is-controversial-can-a-path-to-common-ground-be-found
  4. Delahunt et al “Increasing rates of people identifying as transgender presenting to Endocrine Services in Wellington” NZMJ 19 January 2018 https://www.nzma.org.nz/__data/assets/pdf_file/0005/79223/Delahunt-FINAL.pdf
  5. http://www.abc.net.au/news/2018-09-20/childhood-demand-for-biological-sex-change-surges-to-record/10240480
  6. See Dr Diana Ehrensaft (San Francisco Gender Spectrum Clinic) https://vimeo.com/185149379
  7. Making Schools Safer For Trans and Gender Diverse Youth
  8. P19
  9. https://www.bmj.com/content/360/bmj.k1312
  10. For example, the InsideOUT guidance for NZ schools referred to above states that sex is not a binary concept, and that it is wrong to refer to body parts (e.g. vulva, penis) as either male or female (p20). It also refers (p25) to “sex assigned at birth.” (With the exception of a very small number of babies born with intersex conditions, sex is observed at birth, not “assigned”). Conflation of intersex conditions with transgender identity is another source of confusion for many people.
  11. https://www.cosmopolitan.com/sex-love/news/a55546/how-to-bind-your-chest/
  12. A euphemism for double mastectomy, now regularly performed on trans identifying girls as young as 13 in the US (https://thefederalist.com/2018/09/12/u-s-doctors-performing-double-mastectomies-healthy-13-year-old-girls/ )
  13. https://thefederalist.com/2018/09/12/u-s-doctors-performing-double-mastectomies-healthy-13-year-old-girls/
  14. http://www.abc.net.au/news/2018-09-20/childhood-demand-for-biological-sex-change-surges-to-record/10240480
  15. https://www.telegraph.co.uk/news/2018/08/27/transgender-activists-accused-attempting-shut-downdebate/ . Trans activists characterised the Minister’s comments as “scaremongering” in circumstances where the “lives” of trans people were at stake (https://www.theguardian.com/society/2018/aug/27/lgbt-activists-victoria-atkins-minister-women-trans-comments). A follow-up article in the Telegraph quotes politicians, a gender clinician and an academic as criticising the trans lobby for attempting to shut down debate with aggressive tactics (https://www.telegraph.co.uk/news/2018/08/27/transgender-activists-accused-attempting-shut-downdebate/ )
  16. https://www.thetimes.co.uk/article/inquiry-into-surge-in-gender-treatment-ordered-by-penny-mordaunt-b2ftz9hfn
  17. Ms Wren is a consultant psychologist with the NHS Gender Identity Development Service (GIDS) and Head of Psychology at GIDS.
  18. https://www.thetimes.co.uk/article/schools-rushing-on-whisper-to-label-pupils-as-transgender-0d8zm53qs (The Times 21 January 2018)
  19. Idem
  20. Idem
  21. A subsequent clarification of Ms Wren’s comments to the Times made it clear Ms Wren did not intend to suggest that schools were in fact acting on a “whisper” of transgender identity, however it was noted that schools inevitably have to have protocols which may not be entirely appropriate for everyone: https://tavistockandportman.nhs.uk/about-us/news/stories/our-response-sunday-times-article-gender-diverse-young-people-and-schools-published-sunday-21-january-2018/
  22. https://www.thetimes.co.uk/article/b0beaec2-cf38-11e8-b379-c268e57d77d4
  23. https://www.thetimes.co.uk/article/b0beaec2-cf38-11e8-b379-c268e57d77d4 ; https://www.transgendertrend.com/butterfly-a-mermaids-tale/ For a statistician’s critique of the much-cited “Trans Mental Health Study” (2012) study see Paul Hewson https://medium.com/@paulhewson_11172/responses-stating-they-had-experienced-childhood-abuse-49-541e2f50cd5a
  24. https://www.theguardian.com/education/2018/may/15/transgender-row-teachers-afraid-challenge-breast-binding
  25. Saleem “Transgender Associations and Possible Etiology: A Literature Review” (2017) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825045/
  26. https://www.jaacap.org/article/S0890-8567(17)31682-9/fulltext ; https://www.ncbi.nlm.nih.gov/pubmed/26753812; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345542/ Data from UK’s Gender Identity Development Service (GIDS) between 2011-2017 reveal that approximately half of children and adolescents referred to GIDS present with features of
  27. https://www.ncbi.nlm.nih.gov/pubmed/26753812[/note].

    Gender dysphoric children and adolescents are also likely to have other psychiatric disorders27https://www.ncbi.nlm.nih.gov/pubmed/26753812

  28. https://digest.bps.org.uk/2018/01/17/most-children-and-teens-with-gender-dysphoria-also-have-multiple-other-psychological-issues/
  29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825045/
  30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825045/
  31. https://link.springer.com/article/10.1007%2Fs10964-017-0749-6
  32. https://www.huffingtonpost.com/2012/06/04/iran-sex-change-operation_n_1568604.html
  33. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330 (Lisa Littman, Rapid Onset Gender Dysphoria in adolescents and young adults: a study of parental reports (16 August 2016). See also https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841333/ (“Emerging discussions raise concern for post-pubertally abruptly emerging cross-gender identification (“rapid onset”) particularly among biological girls, suggesting a role for intensive media influences and generous group validation as shaping the understanding of, and giving new meanings to, the body discomfort common among female adolescents at large. The persistence of increasing adolescent onset transgender identification is not known.”). See also discussion of Dr Littman’s study in the Economist: https://www.economist.com/united-states/2018/09/01/why-are-so-many-teenage-girls-appearing-in-gender-clinics
  34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841333/35

    “More empirical research is needed regarding virtually all aspects of [gender dysphoria] in adolescents to create treatment approaches that optimise these young people’s future psychosocial health and well-being. It seems unlikely that all the psychopathology observed in the referred samples is secondary to gender identity issues and would resolve with hormonal and later surgical treatments. There is still no clear consensus regarding hormonal treatment for adolescents because long-term data are unavailable.”

    As a related point, there is evidence about high rates of “desistance” among transgender children/young people (i.e. the children cease to be dysphoric over time)36Zucker The myth of persistence: response to ‘A Critical Commentary on Follow Up Studies and ‘Desistance’ Theories about Transgender and Gender Non-Conforming Children’ by Temple Newhook et al (2018) International Journal of Transgenderism

  35. https://en.wikipedia.org/wiki/Gender_dysphoria_in_children ; https://www.docdroid.net/hY664Sc/steensma2013.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841333/ (“Evidence from the 10 available prospective studies from childhood to adolescence…indicates that for ¬80% of children who meet the criteria for GDC[gender dysphoria in childhood], the GD recedes with puberty”) ; For a mainstream media discussion of these issues see https://www.theatlantic.com/magazine/archive/2018/07/when-a-child-says-shes-trans/561749/ . Critics point out that the higher percentages in some of the older studies are likely inflated by over-inclusive definitions of dysphoria.
  36. https://www.theatlantic.com/magazine/archive/2018/07/when-a-child-says-shes-trans/561749/ citing (inter alia) the American Psychological Association, WPATH and the Endocrine Society (US).
  37. https://thinkprogress.org/transgender-children-desistance-a5caf61fc5c6/
  38. https://www.bbc.com/news/uk-41384473
  39. See Zucker https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1468293
  40. http://www.npr.org/templates/story/story.php?storyId=141164708
  41. See https://www.thecut.com/2016/02/fight-over-trans-kids-got-a-researcher-fired.html (in relation to the closing of Dr Ken Zucker’s gender clinic) See also: Alice Dreger, Galileo’s Middle Finger (2015) Penguin Press (addressing the trans activists’ targeting of Dr Michael Bailey following the publication in 2003 of his book “The Man Who Would Be Queen”) . As a very recent example, Lisa Littman’s peer-reviewed study into the ROGD phenomenon published on 16 August 2018 (above fn 9) has been met with an extraordinarily vitriolic campaign on social media by trans activists, resulting in her University deleting an article linking to her research. The University’s actions have been strongly criticised by a former dean of Harvard Medical School (see https://quillette.com/2018/08/31/as-a-former-dean-of-harvard-medical-school-i-question-browns-failure-to-defend-lisa-littman/ ). A further recent example is gender clinician James Caspian being turned down for research into the “detransition” phenomenon on the basis that it might provoke an online backlash from trans activists: https://www.telegraph.co.uk/news/2017/12/23/academics-say-research-hindered-universities-fear-online-backlash/
  42. https://www.nationalreview.com/2018/09/pediatrician-groups-transgender-orthodoxy/ . One of the other contributors to the 2016 AAP guidelines is Diane Ehrensaft, a San Francisco “gender therapist” (and developmental psychologist) best known for her views that pre-verbal children are capable of communicating that they are transgender (she cites as examples: a baby girl pulling hair clips out of her hair, a baby boy ripping the domes of his onesie, or a male toddler wrapping blankets around his head to create “long, flowing hair” (https://theconversation.com/we-trust-children-to-know-what-gender-they-are-until-they-go-against-the-norm-42093 ). Ehrensaft boasts about the “astronomical” increase in referrals to her clinic, and is upbeat about the large numbers of children on the autistic spectrum presenting for gender treatment, describing them as her “double helix rainbow children” (https://gendertrender.wordpress.com/2018/08/31/double-helix-rainbow-kids-by-diane-ehrensaft/).
  43. Madeleine Kearns “Dr Zucker defied trans orthodoxy. Now he’s vindicated” 25 October 2018 https://www.nationalreview.com/2018/10/transgender-orthodoxy-kenneth-zucker-vindicated/
  44. Idem
  45. Idem. Also http://www.sexologytoday.org/2018/10/american-academy-of-pediatrics-policy.html . (and see journalist Jesse Singal’s analysis https://threadreaderapp.com/thread/1052939041069588480.html )
  46. Indeed legal recognition could be construed as a form of ‘intervention’ or psychosocial treatment that increases the odds of long-term persistence. See Zucker, above at fn9 (discussing social transition of children as a psychosocial treatment increasing the odds of long term persistence)
  1. Excellent article!! The ‘gender affirming’ medical and surgical treatment of young children is perhaps the most disturbing side effect of the trans activist campaign. There will be significant medical and legal consequences, and we won’t have to wait too long to see them, but in the meantime, young lives and healthy bodies will be irreparably damaged.

    Reply

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