I mentioned this article this morning, but wanted to give a bit more detail because it’s important in two ways. First, it’s a good and objective assessment of gender transitioning in America, giving both the upsides and downsides. Second, it’s in the New York Times, which has, until recently, taken the “affirmative treatment” side of gender transitioning, staying away from the topics of harmful puberty blockers and those who reverse transitioning (“detransitioners”) or those who avoid medical transitioning after thinking about it (“desisters”). Recently, however, the paper has become more objective on transitioning (this started with Emily Bazelon’s 2022 article “The Battle Over Gender Therapy“, for which Bazelon got a lot of pushback from her colleagues). Pamela Paul’s article takes that even farther. It’s well worth reading. For more plaudits, read Eliza Mondegreen’s short UnHerd piece about Paul’s article, “The New York Times Gets Braver With Gender Coverage“. An except from Mondegreen:

This is a deeply moving piece that goes much further in its implications than anything the New York Times has run before. There are, however, also curiosities surrounding Pamela Paul’s piece, like the editorial decision to relegate her reporting to the opinion pages, and to run an apologia of sorts by Times opinion editor Kathleen Kingsbury, in which she suggests, in the mildest possible terms, that more conversation is a good thing for “humanity, nuance and empathy,” and that gender medicine is full of “complexities.”

If you read that apologia, by the editorial page editor, it’s pretty worthless, trying not to denigrate what Paul said but simply urging “more discussion.” Yes, of course, but all of us have said that all along. But more important, we need more research!

To read Paul’s piece, you can click below, or find it archived for free here if you’re not a subscriber.  This is definitely not an op-ed, however it’s labeled. At nearly 5,000 words, it qualifies at least as “news analysis”.

In short, Paul’s thesis is that America is dealing poorly with adolescents who wish to transition (nobody seems to have any issue with those over 25 who want to change gender), forcing them into an “affirmative treatment” program that affirms their “wrong body” feelings without question, gives them hormones to halt puberty, and then goes on to prescribe hormones that change your secondary sex characteristics, as well as surgery. Rarely do children with gender dysphoria get longer-term, objective care that explores their feelings rather than hustling them on to adopt another gender presentation.  Further, Paul makes three claims—all supported by evidence—that gender activists hate (this is my summary):

1. There is indeed evidence for a form of “rapid onset gender dysphoria” (ROGD), in which children, without prior indication, suddenly claim they’re in the wrong body and want to change gender.  Gender activists have long claimed that ROGD is a fictional syndrome, one wrongly supported by Abigail Shrier in her readable but much-criticized (by gender activists) book Irreversible Damage: The Transgender Craze Seducing Our Daughters. This book is still causing controversy, but it seems that, in the main, Shrier’s claims were correct. ROGD does seem to be a real syndrome.
2. It appears that ROGD may be promoted by social media and the urging of peers, who, perhaps having transitioned themselves, urge others to do so. Gender activists have long denied that social pressure plays a significant role in the transitioning of children and adolescents. Given social media and what I’ve read from those who have transitioned, I think social pressure is important.
3. The majority (80%) of gender dysphoric children, if they don’t transition, resolve their identities by the time they reach puberty, often coming out as gay—a much less intrusive result. Further, about a third of people who take hormone therapy stop the procedure within four years, though by then permanent physiological damage, including infertility, might have been done.

Paul will undoubtedly be demonized for this, but I give her many encomiums. She’s a brave woman, who, like John McWhorter, isn’t afraid to tackle “antiwoke” topics in the NYT op-ed section. (Paul used to be the Sunday book-review editor.) She is a woman who is doing good, and I sugggest subscribi9ng to her columns if you take the NYT.

I’ll give a few quotes from Paul (indented) under each topic.

Improper treatment of gender dysphoria:

At 17, desperate to begin hormone therapy, Powell broke the news to her parents. They sent her to a gender specialist to make sure she was serious. In the fall of her senior year of high school, she started cross-sex hormones. She had a double mastectomy the summer before college, then went off as a transgender man named Grayson to Sarah Lawrence College, where she was paired with a male roommate on a men’s floor. At 5-foot-3, she felt she came across as a very effeminate gay man.

At no point during her medical or surgical transition, Powell says, did anyone ask her about the reasons behind her gender dysphoria or her depression. At no point was she asked about her sexual orientation. And at no point was she asked about any previous trauma, and so neither the therapists nor the doctors ever learned that she’d been sexually abused as a child.

“I wish there had been more open conversations,” Powell, now 23 and detransitioned, told me. “But I was told there is one cure and one thing to do if this is your problem, and this will help you.”

. . .In May 2017, Emerick began searching “gender” online and encountered trans advocacy websites. After realizing she could “pick the other side,” she told her mother, “I’m sick of being called a dyke and not a real girl.” If she were a man, she’d be free to pursue relationships with women.

That September, she and her mother met with a licensed professional counselor for the first of two 90-minute consultations. She told the counselor that she had wished to be a Boy Scout rather than a Girl Scout. She said she didn’t like being gay or a butch lesbian. She also told the counselor that she had suffered from anxiety, depression and suicidal ideation. The clinic recommended testosterone, which was prescribed by a nearby L.G.B.T.Q. health clinic. Shortly thereafter, she was also diagnosed with A.D.H.D. She developed panic attacks. At age 17, she was cleared for a double mastectomy.

“I’m thinking, ‘Oh my God, I’m having my breasts removed. I’m 17. I’m too young for this,’” she recalled. But she went ahead with the operation.

Gender activists and their drive for “affirmative care”:

Activists’ resistance to objective care:

Laura Edwards-Leeper, the founding psychologist of the first pediatric gender clinic in the United States, said that when she started her practice in 2007, most of her patients had longstanding and deep-seated gender dysphoria. Transitioning clearly made sense for almost all of them, and any mental health issues they had were generally resolved through gender transition.

“But that is just not the case anymore,” she told me recently. While she doesn’t regret transitioning the earlier cohort of patients and opposes government bans on transgender medical care, she said, “As far as I can tell, there are no professional organizations who are stepping in to regulate what’s going on.”

Rapid onset gender dysphoria:

Most of her patients now, she said, have no history of childhood gender dysphoria. Others refer to this phenomenon, with some controversy, as rapid onset gender dysphoria, in which adolescents, particularly tween and teenage girls, express gender dysphoria despite never having done so when they were younger. Frequently, they have mental health issues unrelated to gender. While professional associations say there is a lack of quality research on rapid onset gender dysphoria, several researchers have documented the phenomenon, and many health care providers have seen evidence of it in their practices.

“The population has changed drastically,” said Edwards-Leeper, a former head of the Child and Adolescent Committee for the World Professional Association for Transgender Health, the organization responsible for setting gender transition guidelines for medical professionals.

For these young people, she told me, “you have to take time to really assess what’s going on and hear the timeline and get the parents’ perspective in order to create an individualized treatment plan. Many providers are completely missing that step.”

. . . . In a recent study in The Archives of Sexual Behavior, about 40 young detransitioners out of 78 surveyed said they had suffered from rapid onset gender dysphoria. Trans activists have fought hard to suppress any discussion of rapid onset gender dysphoria, despite evidence that the condition is real. In its guide for journalists, the activist organization GLAAD warns the media against using the term, as it is not “a formal condition or diagnosis.” Human Rights Campaign, another activist group, calls it “a right-wing theory.” A group of professional organizations put out a statement urging clinicians to eliminate the term from use.

Social pressure:

Many parents of kids who consider themselves trans say their children were introduced to transgender influencers on YouTube or TikTok, a phenomenon intensified for some by the isolation and online cocoon of Covid. Others say their kids learned these ideas in the classroom, as early as elementary school, often in child-friendly ways through curriculums supplied by trans rights organizations, with concepts like the gender unicorn or the Genderbread person.

The suicide trope (the tactic of warning parents that their kids will commit suicide if not allowed to transition, often expressed as “do you want a dead daughter or a live son?”, or vice versa):

After Kathleen’s 15-year-old son, whom she described as an obsessive child, abruptly told his parents he was trans, the doctor who was going to assess whether he had A.D.H.D. referred him instead to someone who specialized in both A.D.H.D. and gender. Kathleen, who asked to be identified only by her first name to protect her son’s privacy, assumed that the specialist would do some kind of evaluation or assessment. That was not the case.

The meeting was brief and began on a shocking note. “In front of my son, the therapist said, ‘Do you want a dead son or a live daughter?’” Kathleen recounted.

Parents are routinely warned that to pursue any path outside of agreeing with a child’s self-declared gender identity is to put a gender dysphoric youth at risk for suicide, which feels to many people like emotional blackmail. Proponents of the gender-affirming model have cited studies showing an association between that standard of care and a lower risk of suicide. But those studies were found to have methodological flaws or have been deemed not entirely conclusive. A survey of studies on the psychological effects of cross-sex hormones, published three years ago in The Journal of the Endocrine Society, the professional organization for hormone specialists, found it “could not draw any conclusions about death by suicide.” In a letter to The Wall Street Journal last year, 21 experts from nine countries said that survey was one reason they believed there was “no reliable evidence to suggest that hormonal transition is an effective suicide prevention measure.”

Leave our kids alone: All kids who have serious problems about their sexuality or gender deserve therapy. But they should get good, objective therapy, not “affirmative therapy”.

To the trans activist dictum that children know their gender best, it is important to add something all parents know from experience: Children change their minds all the time. One mother told me that after her teenage son desisted — pulled back from a trans identity before any irreversible medical procedures — he explained, “I was just rebelling. I look at it like a subculture, like being goth.”

“The job of children and adolescents is to experiment and explore where they fit into the world, and a big part of that exploration, especially during adolescence, is around their sense of identity,” Sasha Ayad, a licensed professional counselor based in Phoenix, told me. “Children at that age often present with a great deal of certainty and urgency about who they believe they are at the time and things they would like to do in order to enact that sense of identity.”

Ayad, a co-author of “When Kids Say They’re Trans: A Guide for Thoughtful Parents,” advises parents to be wary of the gender affirmation model. “We’ve always known that adolescents are particularly malleable in relationship to their peers and their social context and that exploration is often an attempt to navigate difficulties of that stage, such as puberty, coming to terms with the responsibilities and complications of young adulthood, romance and solidifying their sexual orientation,” she told me. For providing this kind of exploratory approach in her own practice with gender dysphoric youth, Ayad has had her license challenged twice, both times by adults who were not her patients. Both times, the charges were dismissed

And I find this statistic, which is stable, to be pretty telling:

. . . Studies show that around eight in 10 cases of childhood gender dysphoria resolve themselves by puberty and 30 percent of people on hormone therapy discontinue its use within four years, though the effects, including infertility, are often irreversible.

I could go on with Paul’s stories of “detransitioners” and “desisters,” but you can read the article yourself, especially since it’s archived. But for writing this story, and especially for calling attention to the problems of “affirmative therapy” and for telling stories of those who de-transition, Paul will be called a “transphobe”. She is not, nor are any of us who simply want gender-dysphoric kids to be treated properly.

And good for the NYT  for publishing this. Now we’ll know they’re really serious when they start questioning whether trans women should be competing against natal women in sports, or put in women’s prisons.