Transgender issues in children and adolescents

Christl Ruth Vonholdt in an interview with journalist Michal Cop, Bratislava

July 1, 2022

  1. At what age are the first cases of transgenderism being diagnosed?

Transgenderism is a multi-faceted phenomenon, not homogenous at all and not an official diagnosis. It is neither inborn nor biologically fixed. It can start early in childhood, at the beginning of puberty, during puberty or at any time later. Transgender feelings can change throughout one’s lifespan.

Even when it starts early in life, that does not mean that it is inborn. There are many reasons why a small child might exhibit transgender behaviors. For example, a small boy may feel that he would be more loved and more valued by his family if he were a girl.

There is no laboratory test, no gene test, no hormone test and no brain test that could reliably identify a “transgender child”. In other words: There is no objective medical diagnosis. The official diagnosis “gender dysphoria” or “gender incongruence” relies heavily on a child’s “strong preference for the toys, games or activities stereotypically used” by the other sex. This is problematic. A boy does not become a girl because he prefers activities typically associated with girls or prefers to wear girls’ clothes. He remains a boy. The same with a girl: She does not become a boy because she prefers activities stereotypically associated with boys.

Robert Kosky (1987) reports about children whose transgender behaviors and cross-dressing started, when they were 2 years old. He successfully treated them with psychotherapy. The treatment, he writes, brought an immediate improvement in the children’s self-esteem, most of the children lost their transgender behaviors, overcame their unhappiness, and became at ease with themselves and their sex.

  1. What is the standard medical procedure in western countries for children?

Transgenderism is a psychological condition. In the past, therefore, common treatment was either “watchful waiting” or psychological counselling, including family counselling, exploring for possible underlying mental health issues or unresolved trauma, and supporting a child as much as possible to find peace in its body.

While some of this is still being done today, a new medical treatment has become increasingly dominant. It is called “gender affirming treatment” – a very confusing term. Instead of helping a child to align its thoughts with the objective reality of its body, the new treatment affirms a child’s misguided belief that “inside” it is of the opposite sex. This belief has no basis in objective science.

The new treatment affirms rather than heals the split between mind and body. In an immature child it cements a child’s phantasy that it can change its sex. “Gender affirming treatment” is the process of social and medical transition in order to live, to some extent, in the role of the other sex and to change one’s outer appearance.

Medical transition in children and adolescents means puberty blockers, cross-sex hormones, and later often surgeries. Puberty blockers are given when the first signs of puberty appear, often when the child is 11 years old. Cross-sex hormones are administered when the child is 16 years old, sometimes already when the child is only 13-14 years old. “Sex reassignment surgeries” are often done when the adolescent is 18 years old. Sex reassignment surgery is surgical removal of healthy body organs: breasts, ovaries, uterus, male genitals. In some cases, girls as young as 13 or 14 years old have had their healthy breasts removed.

Before medical transition comes mandatory social transition. Social transition is an active psychological intervention. A girl for example has to be constantly addressed by a boy’s name, using male pronouns only, referring to her as “he” and “his”. Social transition in the girl includes rigid use of stereotypical male clothing and male hairstyle. It reinforces – on a daily basis – the child’s delusionary belief that it is, on the “inside”, of the opposite sex and only “trapped in the wrong body”. In an immature child social transition is a form of mind manipulation. It also reinforces sex stereotypes. 

  1. What do puberty blockers cause in a young person’s body?

The health consequences of puberty blockers are detrimental. Puberty blockers are hormone-like substances. They stop puberty, stunt growth, and block the production of estrogen in the girl and testosterone in the boy. What normally happens in puberty is being blocked: Sperm cells and egg cells do not mature and the child remains infertile. When the child later takes cross-sex hormones the infertility may become permanent and irreversible.

Puberty is also a critical time of bone density development. Puberty blockers lead to a reduced bone mineral density with a risk for osteoporosis and bone fractures. In girls, during normal puberty, the female pelvis considerably changes its shape in order to function as a birth canal. Under puberty blockers, the female pelvis remains in a childlike configuration. Should a girl later decide to live in her natural sex again and she then becomes pregnant, her pelvis may not be suitable as a birth canal. Pregnancy may end in obstructed labor – a possible grave danger for mother and child. The American endocrinologist Michael Laidlaw comments that it is completely unknown if – after stopping puberty blockers – there is still a developmental window for the pelvis to reach its optimal female shape.

Another area in which puberty blockers may have devastating effects is brain maturation. During normal puberty, the adolescent brain undergoes major changes. Puberty blockers may impair brain maturation and cognitive skill development. Puberty blockers may lead to a potential drop in IQ and to depressive symptoms.

Oxford University Professor Michael Biggs examined unpublished data from the Tavistock Gender Identity Clinic in London and found: After a year on puberty blockers, children reported greater self-harm and greater suicidality! Girls reported more emotional problems and developed an even greater dissatisfaction with their bodies. These are devastating results, also because medical transition is sometimes promoted with the argument that it may reduce symptoms of depression in a child. Depression and emotional lability are also known side effects of “Lupron”, the most commonly used puberty blocker. Puberty is not a disease and the use of puberty blockers has severe negative effects on body and psyche.

  1. Why is puberty important?

Adolescence and puberty are critical stages for developing from a child into an adult. It is a special time for physical, psychological, social and also spiritual development. The child’s body matures and becomes capable of sexual reproduction. This is much more than just a physical process. The brain – including its prefrontal cortex – undergoes major changes. The prefrontal cortex is critical for decision making, reasoning, judging, planning, impulse control, for understanding long-term consequences of decisions, for thinking first, and only then acting. All this needs to be learned during puberty. The prefrontal cortex does not become fully mature until a person is about 25 years old.

  1. What are the arguments of those who recommend puberty blockers to children?

Proponents of puberty blockers say they are like a “pause button” that gives a child time to consider if he or she wants to continue with cross-sex hormones. Proponents say that puberty blockers save the child from having to experience unwanted physical changes that come with normal puberty. If a child then decides to reverse course and stop puberty blockers, they argue, all adverse effects of puberty blockers will be reversible. But this claim is highly questionable.

Children who struggle with navigating their way through the difficult challenges of puberty need adults who lovingly and caringly are there for them, but who also tell them the truth that transition will not help.    

  1. Can the effects of puberty blockers be reversed?

This is very unlikely. It may take a full year after stopping puberty blockers before normal oestrogen in the girl and testosterone in the boy are being produced by their bodies. In some adolescents, remarks Michael Laidlaw, normal production of these hormones may never fully start. We do not know how long the developmental window of puberty remains open. Can a body do at age 17 what it was supposed to do at age 11? Additionally, a groundbreaking study from Amsterdam shows: None of the children decided to reverse course and live in their natural sex again. All children on puberty blockers decided to continue with cross-sex hormones and the vast majority then also with surgeries. Not a single adolescent opted for the possibility to align its thoughts with its body. This is in stark contrast to what happens when a child is allowed to go through normal puberty: The majority of them outgrows their transgender condition. Puberty blockers cement, rather than heal, the rift between mind and body. They make a condition permanent that otherwise, in most cases, would be temporary.

  1. Are there countries that have set more strict limitations on the administration of puberty blockers, based on their experience?

Yes. In February 2022 Sweden reversed its national health policy. It now prohibits puberty blockers and cross-sex-hormones in children under the age of 18 – the only exception are strictly monitored clinical trials. The Secretary of State for Health in the United Kingdom, Javid, recently said that the current use of puberty blockers and cross-sex hormones in his country is “failing children”.

  1. What types of transitions do we know?

Social transition and medical transition, both are closely intertwined. Social transition is mandatory before medical transition. Social transition is not neutral. It is an active psychosocial intervention. It involves parents, teachers, counsellors, and others in positions of authority. It prepares a child for harmful medical transition. We, as adults, are responsible, but the child has to pay the price: medications and surgeries that seriously harm their bodies and cause infertility. Psychotherapist Kenneth Zucker predicted that social transition would dramatically increase the rate of persistence in gender dysphoria. We are seeing this today.

  1. Has transition been proven to help?

No, it has been proven NOT to help. Regarding health consequences: Medical transition is detrimental and social transition prepares for this. Medical transition includes potential harm to bone health, cardiovascular health, brain development, sexual function, and leads to possible irreversible infertility. The hope of some people that medical transition would reduce the higher risk of depression and suicide attempts in individuals with transgender conditions has been proven to be an illusion.

A new representative study from the world’s largest dataset, from Sweden (2020), shows that neither cross-sex hormones nor surgeries reduce the high rates of depression, anxiety disorders and suicide attempts in individuals with transgender conditions. Another Swedish study (2011) shows: The rate of completed suicides rose rapidly about 10 years after the sex-reassignment surgeries and was then 19 times higher than in the general population. Neither cross-sex hormones nor surgeries bring the desired happiness and peace. What they bring is life-long dependency on medications with potentially serious side-effects, destruction of healthy body organs and infertility. The results of these studies should wake us up and cause us to think anew.

  1. Why do some people experience transsexual feelings?

This is difficult to say. Many factors, known and unknown, play a role. Twin studies show that psychological and social factors are more important than potential genetic factors. Psychological factors include a child’s bio-psychological personality traits. A highly sensitive child for example with an interference-prone temperament is probably more at risk. Social factors are always individually experienced and therefore too, are influenced by a child’s personality.

Many children with transgender conditions suffer from mental health problems, including anxiety, depression, suicidality, and self-harming behaviours. Most studies do not tell us what came first: mental health disorders or gender dysphoria. Some recent studies found that mental health problems, including depression and suicidality, came first and gender dysphoria came later.

Some children with transgender conditions have neuro-developmental disorders like autism or learning difficulties.

Many suffer from unresolved childhood trauma including early attachment trauma. Early attachment trauma can be very hidden and may express itself in severe forms of inner loneliness.

All these children may grab onto a transgender identity in the hope that when living in a completely new identity they can leave all their emotional pain and problems behind. Adopting a transgender identity may be for them a defense mechanism against deep emotional pain. 

  1. Why has transsexuality seen a rapid increase in recent years?

The British homosexual journalist Matthew Parris wrote that we will see more transgender conditions because the psyche of vulnerable children is like “soft clay”. “By social pressure, classroom pressure, media pressure and, yes, through mere fashion, we are moulding soft clay”, he comments on the current trend. Glamourizing pictures of transgender lives on the internet contribute to this.

  1. Can we tell why it affects more girls than boys?

This is difficult to say. The role of peer clusters and peer contagion in adopting a transgender identity most likely plays a greater role in girls than in boys. More girls also seem to develop transgender desires only at the beginning of puberty or in puberty. But why do so many girls feel uncomfortable in their bodies and want to become men? Is it more difficult for girls to find their feminine identity? Is there an underlying misogyny in our culture which affects both, men and women?

In puberty, the girl realizes that with her body’s four-week cycle of ovulation and the regular rhythm of fertile times and barren times, she is more deeply tied to her body – more “dependent” on her body than the boy. Our culture highly values independence, effectiveness and speed. Any thought the girl may have about a possible later pregnancy reminds her too, that pregnancy is 9 months and cannot be sped-up. To make things even more complicated for her: The female organ, the vagina, symbolizes receptiveness. Our culture dreads receptiveness. It is an important sign of freedom that our culture gives girls the opportunity to choose the professional career that suits them, be it as civil engineer, car mechanic, teacher, nurse or whatever. But the fact that the female body is deeply tied to the rhythm and life of nature, to the “pulse beat of the Cosmos” (Karl Stern), is something we need to discover anew if we want to help young girls to be reconciled with their body.

  1. What is the role of parents or family in all this? Could the parents be to blame that children feel transsexual?

Nobody is to blame. In almost all cases parents love their children. It does happen that a parent, more often the mother, heavily invests in the idea that her child is transgender. But possible reasons for this need to be evaluated individually.

More often today we see that parents who do not agree with the destructive path of transition face legal action against them and are being threatened to have their child removed from home.

In general: If mental health issues are present in the family, if a mother is depressed, if there are family factors contributing to a child’s experiences of trauma, parents should be encouraged to seek professional help. A vulnerable child, whatever its psychological condition, benefits greatly from a secure attachment to both parents and from parents who live in a peaceful relationship with each other.  

  1. How should we approach people who suffer from transsexuality?

 Adults have the liberty to choose a path of transition. They, like all suffering people, deserve our compassion and our respect. This does not mean however, that we should be silenced and not talk anymore about the dangers of transition.

  1. Should we simply be tolerant if someone wants to be called by another name?

Let me concentrate on children and adolescents under the age of 18 and on situations where adults have a direct duty of care. This is the case in schools. Addressing a girl by a boy’s name and always using male pronouns for her (and vice versa) is part of social transition. Social transition dramatically increases the rate of persistence in gender dysphoria! It makes permanent what otherwise in most cases would be temporary. It prepares for medical transition with all its devastating health consequences. I don’t see how this would do any good to any child.

It might be wise for a school to develop guidelines that state – and also explain why – all children, without exception, should be addressed by their sex-appropriate birth name and that only sex-appropriate pronouns are to be used. The guideline should include that all children should be protected from bullying – whatever the reason for bullying might be. 

Refusing to agree to social and medical transition is sometimes portrayed as rejection of a child. But the contrary is true: Knowing the medical and psychological facts help us to more truly and more compassionately care for vulnerable and hurting children.

All children deserve our compassion, our respect. But they also deserve to know the truth. A lifelong war against one’s own body cannot reflect the truest identity of these children. We need to think anew and find better and more humane ways to help them.