Transgender May Be Forever

 Many anti-transgender people claim that being transgender just goes away in late teenage years, so there is no need for affirmative treatment. They base this claim on clinical findings from psychiatric gender clinics. Should transgender children receive treatment that affirms their congruent gender if they are likely to stop being transgender? We all would like to know our future as transgender people. Does being transgender fade in time only to reappear later in life? Is being transgender forever?

I am getting ready to talk at Dragon Con in Atlanta and the resuscitated Southern Comfort Conference in Fort Lauderdale next month which forced me to review this issue. There is new evidence that comes from a review of the records of the disbanded gender center at the Canadian Center for Mental Health (CAMH). This was a gender center that practiced reparative “therapy.” The new finding is that, after case review, most of the children in the CAMH gender center studies could not really be diagnosed as being transgender. This means that the data from a large relevant clinical sample of children is unreliable regarding the adult outcomes of transgender children. So, on what basis were these children at CAMH and elsewhere being treated? Some in Canada are still wondering whether there had been some intentional mis-diagnoses.

I love scientific detective stories. So, I went back and re-reviewed the relevant research papers to look for clues and did some analysis to summarize the outcome results. What I found was that the children in 5 of the 6 relevant studies were not transgender at all. Careful reading of many of the older papers indicating that they were not using transgender criteria to diagnose their patients. They kept referring to exaggerated cross sex-type behavior as the symptoms used to assign the children to treatment in psychiatric gender clinics. To be sure, the children in these studies would engage in cross dressing but their behavior was flamboyant, exaggerated and they wanted sex with same-sex children. This is not how most transgender children or adults usually present to mental health professionals. Transgender people generally present as withdrawn and concerned with their gender and societal rejection, not with aggressively showing off and pursuing homosexual sex. The psychiatrists obviously knew the difference because the children were not originally diagnosed as cases of Gender Identity Disorder (GID).

The exaggerated cross sex-typed behavior of these children was undoubtedly extremely scary for their parents, so the parents sought help through psychiatric clinics. You should bear in mind that 40% of the patients in such psychiatric clinics have more than one thing going on. They frequently have co-occurrence of such things as schizophrenia, enuresis, inguinal hernia, undescended testicles, ADHD, depression, and speech impediments. We do not know what those children and parents in the studies had to deal with besides these exaggerated cross sex-type behaviors because none were reported in the research papers. But such psychiatric clinics typically get the most difficult, complex cases.

It was obvious from the research papers that the psychiatrists were not at all surprised by the way these children behaved. Clinicians had seen this behavior before. It indicated that these children would likely be homosexual in adult life. The psychiatrists diagnosed these kids as pre-homosexual children based on exaggerated cross sex-typed behavior. The clinicians would not have wanted to turn their desperate parents away and they probably also wanted to study these kids.

The psychiatrists were in a bind. Most of these studies and treatments occurred were conducted after homosexuality had been deleted from the list (DSM) of mental disorders in 1972. So, they could not use the deleted homosexual diagnosis and treatment criteria. Their solution was to just consider these children as gender non-conforming (GNC). They were not using GNC in the same way we today use gender non-conforming or gender queer/fluid, as people who find that their biological gender predisposition is not congruent with either Western gender category. They were using it as a pathological, deviant mental illness.

The psychiatrists also influenced the inclusion of the Gender Identity Disorder in Children (GIDC) diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM) so that GIDC would fit the pre-homosexual kids. Later review articles also dutifully identified these cross sex-type children as children with GIDC. This approach was expedient and may have been for an altruistic purpose, but it was certainly unethical from a scientific point-of-view. If they wanted to diagnose these children as pre-homosexual, they should have petitioned the DSM process to re-instate homosexuality or make some exception for these children. But that would have been too controversial, so they took the easier path. Unfortunately, it now hurts transgender people and creates current public doubt about appropriate mental health treatment for transgender kids.

Some psychiatrists told parents that their children with cross sex-typed behavior would become homosexual or even worse, transsexual, if they did not receive treatment. I need to make the point here that that IMHO there is nothing wrong with being homosexual or transsexual, gender queer or heterosexual for that matter. But some parents could easily have been scared into some forms of treatment including reparative therapy treatment by a predicted homosexual or transsexual outcome from psychiatrists.

So here are the summary numbers from the early relevant 5 cross sex-type behavior studies. The studies involved diagnoses at ages 8-12 with outcome follow-up in late teens and early adulthood. All of the children were diagnosed as pre-homosexual but were counted as GIDC in later summaries. Of the 177 children that started the 5 studies, 102 were diagnosed as homosexual as adults, 6 as still cross sex-typed, 7 as heterosexual and 62 had uncertain outcomes. Those with uncertain outcome included drop outs and probably some who did not want to reveal their status. So, the expectation of clinical researchers was confirmed, 62% of the children with cross sex-type behavior became homosexual adults. But these children were not transgender.

There is one study (Wallien, 2008) that appeared to actually involve transgender kids as transgender and not cross sex-typed pre-homosexuals. Out of 77 who started the study, 0 became homosexual adults, 21 applied for transsexual transition as young adults after affirmative treatment, and 56 were drop outs or had uncertain outcomes. Quite a difference in outcome from the earlier studies.

But what of all the children who dropped out or whose outcomes were uncertain? As I have indicated in previous posts, transgender behavior starts to emerge at ages 4-6 although emergence does not always occur until adulthood. Only 31% of transgender children tell their parents. Rejection for being transgender increases in childhood and becomes most intense during years 11-13. Increasingly children are coming out as transgender in early childhood, while others come out in their 40s and some like Caitlyn Jenner come out in their 60s. Most engage in transgender behavior in secret for many years. It is likely that many of the dropouts or uncertain outcomes were young adults who went into secrecy when they realized the rejection they were facing or just or preferred not to accept the stigma of being labeled as mentally ill as children. Maybe some of them actually stopped transgender behavior but we will never know.

There is no known cure for being transgender — not that we would want one. Basically, there is no reliable evidence from the scientific studies that being transgender ends during one’s lifetime. Future research may change this conclusion but the evidence as it now stands seems to indicate that being transgender is forever (apologies to De Beers and Ian Fleming). It is still there no matter what we do and can come out at any time.

P.S. I was curious, so I tried to find out what is the currently published treatment for “pre-homosexual” children. However, reports about these children seemed to have disappeared from the scientific literature as of 2011. This may be due to the change in public policies and passage of laws at the country and state level that ban reparative “therapy” and/or the trend towards affirmative therapy.

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Tags: featured, Identity, trans kids, Transgender

Category: Transgender Body & Soul