Since gender reassignment has become a hot topic in the past few years, we are seeing higher numbers of younger-aged children in our clinic who are questioning their birth gender. Gender dysphoria (the strong feeling that a person doesn’t identify with the biological gender they were born with, when it causes them distress, and when they have felt this way for at least six months) can happen as early as age 4, although most transgender people don’t begin to feel a disconnect with their gender until puberty begins and their body starts changing.

Now, however, a greater number of children are coming in and saying they’re transgender at around age 7 or 8. In fact, I would say intakes at our clinic are two to three times what they were just five years ago.

While there is no doubt that some transgender children have an early awareness of their incorrect natal gender, at this young age many children are really still exploring what it means to be “me.” Societal and peer pressures can further influence a child’s dysphoria during this time, especially if they think they must act or “feel” a certain way in order to be accepted by peers.

So the question becomes, are these truly trans children or are they simply kids who are trying on different facets of identity to see what fits? Are we pushing children into becoming what they’re really not? I fear we are doing just that.

In an article about a study done on people who were detransitioning, the Society For Evidence Based Gender Medicine (SEGM) stated, “Nearly a third (30%) endorsed the response “someone else told me that the feelings I was having meant that I was transgender and I believed them” to describe how they felt about identifying as transgender in the past. Many participants selected social media, online communities, and in-person friend groups as sources that encouraged them to believe that transitioning would help them.”

Adding to the problem is the fact that often parents are trying to be supportive, so they allow the child to go to a doctor and begin taking hormones at an early age (even before puberty). This is partly because today’s culture has reinforced this approach and partly because people haven’t questioned enough about the potential outcomes of treatment.

In some states, parental approval isn’t even required to begin the transition process. After a brief consultation with a doctor or, in some cases, just an online visit, a child can initiate treatment on their own. In fact, Planned Parenthood will provide these hormones after a first appointment and without requiring a letter from a licensed mental healthcare provider.

It is simply too easy to get these prescriptions!

What’s The Hurry?

What are the long term goals of starting such early hormone blockers for transgender youth? Why not wait until 18 to begin to transition? Experts say it’s to help the child avoid the discomfort that can come with a puberty that doesn’t fit their gender image (ie: voice changes, growing an Adam’s apple, menstruation, and so on).

Except we don’t know that gender dysphoria is a permanent condition – yet we are blocking hormones and using surgical intervention on these kids. We are subjecting people to potential future health concerns and complications, as well as the possible inability to have children, and more.

The New York Times recently said, “…there is emerging evidence of potential harm from using blockers, according to reviews of scientific papers and interviews with more than 50 doctors and academic experts around the world. The drugs suppress estrogen and testosterone, hormones that help develop the reproductive system but also affect the bones, the brain and other parts of the body. During puberty, bone mass typically surges, determining a lifetime of bone health. When adolescents are using blockers, bone density growth flatlines, on average, according to an analysis commissioned by The Times of observational studies examining the effects.”

Because so little is known about prospective outcomes, the National Health Service in the U.K. has taken steps to block this treatment for transgender youth in their country. I believe the United States should do the same.

There is also the prospect that gender reassignment might not make the person feel any better about themselves. Think back to when you were a child or teen. You thought your opinions and beliefs were set in stone – never to be changed – but I’d be willing to bet you have some very different ideas about some things now that you have matured.

We really don’t understand about our personal thoughts, opinions, and beliefs until we get closer to age 30, so to allow hormone blocking in kids who are 7, 8, 9, and 10 years old is plain wrong. How can a child make such a life-altering decision with so little life experience to help guide them? 

Watchful Waiting

Using hormones in the childhood and teen years doesn’t allow the body to complete maturation, so a young person undergoing this therapy really doesn’t know if they will be okay with their gender once maturation has ended. In fact, the SEGM article I cited earlier stated that 65 percent of females and 48 percent of males who detransitioned said they did so because they ultimately felt “more comfortable with identifying with their natal sex due to a change in personal definition of female and male.”

There’s that life experience I mentioned.

This is in sharp contrast to a statement issued by the American Academy of Pediatrics (AAP), though. They call watchful waiting an “outdated approach [that] does not serve the child because critical support is withheld. Watchful waiting is based on binary notions of gender in which gender diversity and fluidity is pathologized; in watchful waiting, it is also assumed that notions of gender identity become fixed at a certain age.”

Nevertheless, it is a fact that many people who have detransitioned wouldn’t have had to go through the trauma of surgery and hormone therapy (not to mention the hormones and surgery involved in detransitioning) if they had waited to make a decision about it once they had matured.

The AAP also refutes that a person could have any underlying mental health concern that might be being masked by transgender identity. They say in their statement,” if a mental health issue exists, it most often stems from stigma and negative experiences rather than being intrinsic to the child.”

Yet I know from four decades of experience in treating children and adults that there are plenty of mental health conditions that might be at play and transitioning won’t solve them – it will only leave the person in the same condition, but with a different outer appearance.

It’s interesting to note that the AAP’s view on tattoos – an obviously much less invasive body modification – states, “As with any adolescent or young adult, for those with piercings and tattoos, it is advised that the pediatrician conduct a careful adolescent psychosocial history with targeted behavioral interventions to assist in decreasing risk behaviors.”

Think about that for a minute.

According to the AAP, hormone blockers and transgender surgery are perfectly fine and do not need to be addressed with a proper and thorough mental health intervention…but a child who wants a piercing or a tattoo should undergo “careful adolescent psychosocial history with targeted behavioral interventions” before going forward with their plans.

The hypocrisy is mind-boggling.

What If It Doesn’t Help?

It often isn’t so simple that it’s just the person’s gender making them unhappy or feeling incomplete. As I said, it could be that something else is underlying. Once you start transitioning, you assume you’ll be happy when you’re finished. But if you go through surgery and don’t get the desired outcome, then what? Some people will still be depressed or anxious no matter their gender.

Indeed, in a recent study of detransitioned people, the most frequent reason for doing so was that the person’s personal definition of male and female had changed. That said, “Other commonly endorsed reasons were concerns about potential medical complications (49.0%); transition did not improve their mental health (42.0%); dissatisfaction with the physical results of transition (40.0%); and discovering that something specific like trauma or a mental health condition caused their gender dysphoria (38.0%).

Final Thoughts

There is a difference between tolerance and the idea that you’re behind the times if you aren’t on board with early transitioning. Most of the encouragement for hormones and surgical reassignment comes from the woke community, which negatively labels anyone who disagrees with the narrative, and is less likely to want a dialogue. We need to realize, however, that not everyone who disagrees with young transgender intervention is homophobic or misogynistic – it just means they are advocating caution and saying, “don’t make these changes so quick and easy”.

I believe that we should support the transgender person, but we should also have statistics on the outcomes of treatments for gender reassignment before completely jumping into hormones and surgery. What’s wrong with taking a slow and cautious approach? This is not a just psychological idea anymore. There is no more experimenting: we have the science to do this.

So, where does this leave us? Hopefully, with the fairmindedness and ability to allow discussion and restraint about something we know very little about. To immediately label cautionary dissenters as transphobic and to not allow a conversation on such a life changing procedure is the worst form of prejudice and narrowmindedness.

We Can Help

If you or a loved one have questions about whether gender reassignment is right for your situation, we can help to identify and address these concerns in a supportive environment.

For more information, please contact The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida at 561-496-1094 today.  

Dr. Andrew Rosen PHD, ABPP, FAACP is a Board-Certified Psychologist and the Founder and Director of The Center for Treatment of Anxiety and Mood Disorders, as well as, the Founder of The Children’s Center for Psychiatry Psychology and Related Services.