Gender ideology is a belief system that holds that sex is a social construct. Gender ideology teaches that every person has something called a “gender identity” in the brain that may or may not be the same as that person’s biological sex. It’s central tenet is that this “gender identity” is more real than the material biological reality of a person’s sex. In philosophical terms, it meets the definition of gnostic dualism. In the last 5 years, gender ideology has overtaken every major public institution in our society from mass and social media, to public and private education from pre-school forward, to professional medicine and psychiatry, and increasingly, law. It has essentially become America’s government sponsored religion.
Why should every thinking American be alarmed by this? Three year olds are being taught that they may be “trapped in the wrong body” by pre-school teachers and by drag queens in public libraries; kindergarteners are having “coming out trans” celebrations in the classroom; teens are falling prey to social contagion and coming out trans in peer groups, boys are allowed into girls bathrooms, locker rooms and even onto girls’ sports teams. The top two sprinters in Connecticut’s high school state competition for girls in 2018 were boys; boys who had competed on the boys track team earlier in their high school careers, but who were allowed to run on the girls’ team this year because they “identify as” girls. In ten states, Washington, D.C., and several individual counties, it is illegal for minors to receive therapy for gender confusion (or gender dysphoria) that will bring their thinking in line with their sex. Instead, across the country, physicians and therapists are taught to rapidly affirm this confusion as proof that the child was born in the wrong body and encourage them to impersonate the opposite sex, even to the point of prescribing puberty blockers, cross-sex hormones and sex change surgeries prior to age 18.
How can parents and all professionals of good will protect our children? We must first educate ourselves with the facts so that we can immunize our children against the lies before they are propagandized. That is the purpose of this article.
Sex is a binary biological characteristic of the human person that is established by our DNA at conception. One is conceived either male or female. Gender, in contrast, is a term that refers to the psychological and cultural characteristics associated with biological sex. Gender is a social construct linked to sex stereotypes. For example, in Spanish, the word “amigo” has been assigned a male gender; “amiga” is the feminine form of the same word. As another example, when we assign a hurricane the name “Gloria” we have assigned it a feminine gender. Gender is not a biological term, it is not found within the person’s being, though gender ideologues maintain otherwise, there is no rigorous scientific evidence for this.
Gender identity refers to an individual’s awareness of being male or female and is sometimes referred to as an individual’s “experienced gender.” Gender identity has to do with thoughts and feelings. Thoughts and feelings people develop over time. Normal thoughts align with physical reality. Therefore, a person’s gender identity should match the person’s biological sex.
Dysphoria is defined as a state of dissatisfaction or unease about a given situation. Gender dysphoria (GD) is a psychological condition in which the individual feels a marked incompatibility between his/her experienced gender and biological sex. This condition is associated with varying levels of anxiety and unhappiness. These individuals often express the belief that they are the opposite sex or trapped in the wrong body, or that they are neither sex. Gender dysphoria in children is diagnosed in the pre-pubertal child.
Human sexuality is an objective biological binary trait: “XX” and “XY” are genetic markers of sex, female and male. The norm for human design is to be conceived either male or female with the obvious purpose the reproduction and flourishing of our species. This principle is self-evident. People who identify as “feeling like the opposite sex” or “somewhere in between” do not comprise a third sex. They remain biological men or biological women. An infant is not “assigned” a sex or a gender at birth. The sex of the newborn was established at conception, is declared anatomically in utero and simply acknowledged at birth.
No one is born with an awareness of being male or female; this awareness develops over time. As the awareness develops during the early years of the child’s life, there may be a time when the child may have feelings of uncertainty and even confusion about his or her gender identity. A small number of these children will show the additional symptoms of dissatisfaction and unhappiness with their biological sex. Some children insist they are the opposite sex and start a behavior pattern that imitates the opposite sex. These children will be diagnosed with gender dysphoria.
When GD occurs in the pre-pubertal child, it resolves in 80-95 percent of patients by late adolescence after they naturally pass through puberty. Prevalence rates of GD among children have been estimated to be a fraction of 1%. In pre-pubertal children, the ratio of boys to girls ranges from 2.1 to 4:1.
These are the facts. What is the science?
Behavior genetics posits that while genes and hormones influence behavior, they do not hard-wire a person to think, feel, or behave in a particular way. The science of epigenetics has established that genes are not analogous to rigid “blueprints” for behavior. Rather, humans develop traits through the dynamic process of gene-environment interaction.
Claims have been made, derived from brain imaging studies, that the transgender brain microstructure is different from the non-transgender brain. These studies are of questionable clinical significance due to the small number of subjects and the existence of neuroplasticity. Neuroplasticity is a well-established phenomenon by which long-term behavior alters brain microstructure. There is evidence that experience changes brain microstructure. Therefore, if and when valid transgender brain differences were identified, these will likely be the result of transgender behavior rather than its cause.
Studies of identical twins prove that GD is predominately influenced by post-natal events. The largest study, which includes 74 pairs of identical twin transsexual adults, found that 28 percent were both trans-identified. Identical twins’ DNA is identical from conception and develop in exactly the same prenatal environment where they are exposed to the same prenatal hormones. If genes and/or prenatal hormones contributed significantly to transgenderism, the concordance rate should be close to 100 percent. Instead, 72 percent of identical twin pairs were discordant for transgenderism. This means that at least 72 percent of what contributes to transgenderism in one adult co-twin consists of one or more non-shared experiences after birth.
Clinical case studies suggest that social reinforcement, parental psychopathology, family dynamics, and social contagion facilitated by mainstream and social media, all contribute to the development and/or persistence of GD in some vulnerable children. There may be a causal association between adverse childhood events, including sexual abuse.
Is GD a mental disorder?
Until recently, the prevailing worldview with respect to childhood GD was that it reflected abnormal thinking or confusion on the part of the child that may or may not be transient. The standard approach was either watchful waiting or family and individual psychotherapy. The goals of therapy were to address family pathology, treat any psychosocial morbidities in the child, and aid the child in aligning gender identity with biological sex.
This approach has now shifted. The suffering of transgender adults was invoked to argue for the urgent rescue of children from the same fate by early identification, affirmation, and pubertal suppression. It is now alleged that psychopathology and suicide are the direct and inevitable consequences of withholding social affirmation and puberty blockers from a gender dysphoric child. The claim is made that GD children will suffer and commit suicide. Therefore, sex reassignment should start in the pre-pubertal child.
Over 90 percent of people who die of suicide have a diagnosed mental disorder. There is no evidence that gender dysphoric youth who commit suicide are any different. Therefore, the cornerstone for suicide prevention should be the same for them as for all children: early identification and treatment of psychological co-morbidities.
The American Psychiatric Association explains in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that GD is listed therein not due to the discrepancy between the individual’s thoughts and physical reality, but due to the presence of emotional distress that hampers social functioning. Once the distress is relieved, GD is no longer considered a disorder.
One of the chief functions of the brain is to perceive physical reality. Perception in accordance with physical reality is normal. Perception that deviates from physical reality would be considered abnormal. This is true whether or not the individual who experiences the abnormal thoughts feels distress. A person’s belief that he is something or someone he is not is, at best, a sign of confused thinking; at worst, it is a delusion.
What is the recommended treatment?
Since gender dysphoria is a psychological diagnosis one would think the treatment for this anxiety provoking disorder would be in the hands of a mental health specialist whose job would be to discover and treat the source of the gender dysphoria. This is not the case. Instead, treatment recommended for gender dysphoria in children includes affirming the child’s gender confusion, social impersonation of the opposite sex, chemically blocking puberty, beginning lifelong cross-sex hormones, and mutilating surgeries prior to age 18.
Social transition consists of first affirming the child’s false self-concept by instituting name and pronoun changes and facilitating the impersonation of the opposite sex within and outside of the home. Next, puberty is suppressed via puberty blocking drugs as early as age 10 years.
Puberty blocking hormones arrest bone growth, decrease bone density, prevent the sex-steroid dependent organization and maturation of the adolescent brain, and inhibit fertility by preventing the development of gonadal tissue and mature gametes for the duration of treatment.
If the child discontinues the puberty blocker, puberty will ensue. Consequently, the Endocrine Society maintains that suppression of puberty, and living socially as the opposite sex, are fully reversible interventions that carry no risk of permanent harm to children. However, social learning theory, neuroscience, and long-term follow-up study of adolescents who have received pubertal suppression challenge this claim.
At least one prospective study demonstrates that nearly all pre-pubertal children placed on puberty blocking drugs eventually choose to begin sex reassignment with cross-sex hormones. This suggests that impersonation of the opposite sex and pubertal suppression, far from being fully reversible and harmless sets into motion a single inevitable outcome that requires lifelong use of toxic cross-sex hormones, resulting in infertility and other serious health risks.
Children will graduate to cross-sex hormones at age 16 or younger in preparation for sex-reassignment surgery as an older adolescent or young adult. This stage of the sex reassignment protocol will feminize the boys and masculinize the girls. Cross-sex hormones (estrogen for boys and testosterone for girls) are associated with dangerous health risks.
Estrogen administration to boys may place them at risk for cardiovascular disease, and breast cancer. Girls who receive testosterone may experience an elevated risk for cardiovascular disease, diabetes, and unknown effects on breast, uterine and ovarian tissues.
Pre-pubertal children who receive puberty-blocking hormones followed by cross-sex hormones are permanently sterilized. Adolescent girls with GD who have taken testosterone daily for one year may obtain a double mastectomy as young as age 16. To the detriment of the suffering child, the mental health aspect of this condition is ignored because the condition is not considered a disorder as long as the child reports relief of anxiety from the impersonation process.
The first gender clinic in the US was established in 2007. In 2014 there were 24 gender clinics clustered chiefly along the East Coast and in California; one year later there were 40 across the nation. Today, virtually all of the 215 pediatric training hospitals offer this transition affirming protocol in spite of the absence of long term evidence of safety.
Sex reassignment in adults: Consequences.
Surveys suggest that transgender adults express an initial sense of “relief” and “satisfaction” following the use of cross-sex hormones and sex reassignment surgery.
A 2001 study of 392 male-to-female and 123 female-to-male transgender persons found that 62 percent of the male-to-female and 55 percent of the female-to-male transgender persons were clinically depressed. Nearly one third of each population had attempted suicide.
In Sweden, a thirty year follow up study found rates of suicide nearly twenty times greater among adults who undergo sex reassignment. This demonstrates that while sex-reassignment eases some of the gender dysphoria, it does not result in levels of physical and mental health on par with that of the general population. Sweden is among the most LGBT affirming countries; suggests that the mental health disparities are primarily due to the pathology that precipitated the transgender feelings in the first place and/or the transgender lifestyle itself and not due to social prejudice. The psychological disorder that started in childhood is still present in the adult. Sadly, psychological therapy had been ignored.
Gender dysphoria (GD) in children is a term used to describe a psychological condition in which a child experiences marked incongruence between his or her experienced gender and the child’s biological sex. Without pre-pubertal affirmation and hormone intervention 80 to 95 percent of children with GD will accept the reality of their biological sex by late adolescence.
Affirming gender dysphoria via public education and legal policies will confuse children and parents, leading more children to present to “gender clinics” where they will be given puberty-blocking drugs. This, in turn, virtually ensures that they will choose a lifetime of sterility, toxic cross-sex hormones, and unnecessary surgical mutilation of their healthy body parts.
There is a serious ethical problem with allowing irreversible, life-changing procedures to be performed on minors who are too young to give valid consent themselves. Conditioning children to believe the absurdity that they could be “born into the wrong body,” and that a lifetime of chemical and surgical impersonation of the opposite sex is normal and healthful is child abuse.
Michelle Cretella, MD, is president of the American College of Pediatricians.
Felipe E. Vizcarrondo, MD, MA, is a member of the American College of Pediatricians.