In the first installment of our critical review of the National Geographic Gender Issue, we considered the statement on page 14 (“Helping Families Talk About Gender”) that it is likely that there are both biological and social factors for the onset of gender nonconformity in children, or for it continuing into adolescence. I argued that considering their otherwise strict adherence to the mass-media trans-narrative, this was a most fascinating admission. It is one with which I agree, and especially in light of very recent trends in children seeking help for gender dysphoria. The exponential rise in children referred to gender clinics and the skewing of the male to female ratio significantly towards girls virtually demands social factors be present.
At the end of the day, I concluded that its hard to know what Nat Geo intends with the “social” claim; perhaps it is a slight nod to the Dutch Approach while simultaneously denying its validity (“there is no evidence of a link to parenting or experiencing childhood trauma”). In any event, they contradict themselves within the space of a few sentences. In the paragraph immediately following they say, “Research suggests that gender is something we are born with; it can’t be changed by any interventions.” Two other similar statements occur in the piece; “Research suggests that like gender identity, sexual orientation cannot be changed”, and “Understand that gender identity and sexual orientation cannot be changed, but the way people identify their gender identity or sexual orientation may change over time as they discover more about themselves.”
So “gender is something we are born with” and “gender identity… cannot be changed”. And yet change occurs; “gender identity… may change over time”! I am at a loss to imagine what is being suggested here in light of this paradox. It demands the question: what are the mechanics of this change? The point seems to be that parents should not intervene; it “may change over time”, but it “cannot be changed”. By the time we are done we will explore and question that idea. But let’s start with an aspect of the literature that is much better established at this stage than gender identity–sexual orientation.
Fluidity of Sexual Orientation
The literature on gender dysphoria or transsexualism extends back a number of decades. Harry Benjamin’s The Transsexual Phenomenon contains many of the same observations that modern studies do. However, the literature on gender dysphoria in children and adolescents is relatively recent. Studies on the fluidity of sexual orientation is much better established, and in light of the article conflating the two as things that do not change, it is to this that we turn our attention.
National Geographic says that sexual orientation does not change, but the literature on the sexual fluidity of lesbians, gays, and bisexuals strongly suggests otherwise. One of the pioneers on this subject is Ritch Savin-Williams. In 2006, Savin-Williams published a population-based longitudinal study of adolescents, comprising three waves over 6 years. He found that between 71.6 (for gay males) and 88.7 percent (for bisexual females) of sexual minority adolescents changed to exclusively heterosexual sex-behaviour over 6 years (Table 3). He states in his introduction, “researchers readily acknowledge the existence of such sexual groups (“gay youth”) with little evidence that these individuals will be in the same group a month, a year, or a decade henceforth”. He concludes on a similar note; “The instability of same-sex romantic attraction and behavior (plus sexual identity in previous investigations) presents a dilemma for sex researchers who portray nonheterosexuality as a stable trait of individuals.”
Neither are these findings limited to adolescents. More recently, Lisa Diamond has done an incredible amount of work in the area of sexual fluidity among adults (see also Sandfort, 1997). In an excellent and engaging presentation at Cornell University, she demonstrates a perhaps surprising amount of change and fluidity in attraction and orientation of all classes; heterosexual, bisexual, lesbian and even gay (though less so). She says at the very end of her presentation,
I feel that as a community, the queers have to stop saying, ‘Please help us. We were born this way and we can’t change’ as an argument for legal standing. I don’t think we need that argument and that argument is going to bite us in the ass. Now we know that there is enough data out there that the other side is aware as much as we are aware of it.
To state, as Nat Geo and HealthyChildren.org do, that sexual orientation doesn’t change is not in keeping with the latest data in the literature, and is probably a good 5 to 10 years behind what is accepted in the medical community, whether or not these realities always reach the mainstream media. It does, however, make for a convenient parallel to the idea that “gender is something we are born with”.
Desisting and Persisting
When it comes to the actual data on change in gender nonconforming children, Nat Geo is eerily silent. One almost gets the impression that a gender nonconforming child has a fifty-fifty chance of persisting in nonconformity into adulthood. The real numbers are that the vast majority do not. Singh (2012) says, “the rates of persistence of GID found across various studies have been variable, ranging from 2.3% to 30%”. This means that children with significant enough gender nonconformity/dysphoria to get the attention of researchers (usually those referred to gender clinics for treatment) change from incongruence with their natal sex to congruence 70 to 97.7% of the time.
But even these high numbers don’t fully present the reality of change in gender nonconforming children. The number of children who are referred to gender clinics is, as we have already considered, growing exponentially, but the group is still very, very small. The total amount of gender nonconforming children and adolescents has been estimated at over 1%, or even higher, depending on the criteria and the questions used (Clark, 2014). Although I know of no longitudinal population-based studies on gender identity similar to the one by Savin-Williams on sexual orientation cited above, it is a very safe assumption that the stronger the gender dysphoria, the greater the chances of persistence. This is only logical. So even this 70-99.7% “gender clinic” desistence number is probably lower than a more general “gender nonconformity” number would be.
Some trans-advocates, however, will push this point to the extreme. I have read articles that speak of a “desistence myth” and claim that children that actually meet the full DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria for Gender Identity Disorder do not desist, or at least that the desistence numbers are far lower. Their point seems to be that this fully diagnosed GID group can be safely transitioned, even before puberty, without fear that they may in fact desist.
This viewpoint faces two intractable problems. The first is that it simply isn’t representative of the literature. Wallien (2008), found that while the diagnosis of GID was a significant variable between persisters and desisters (all persisters had a GID diagnosis), of 23 who desisted in their gender dysphoria, 15 had a GID diagnosis as well, still a very significant majority (65%).
Devita Singh’s study is a virtual death-knell for the “desistence myth” viewpoint. She states,
Of the 88 participants [all natal males] who met the full diagnostic criteria for GID in childhood, 12 (13.6%) were gender dysphoric at follow-up and the remaining 76 (86.4%) were no longer gender dysphoric. Of the 51 participants who were subthreshold for the GID diagnosis in childhood, 5 (9.8%) were gender dysphoric at follow-up and the remaining 46 (90.2%) were not.
Interestingly, her findings in this male group differ from Wallien’s mixed-sex group, in that “… these rates of persistence across subthreshold (did not meet full GID diagnosis) and threshold groups (GID) did not differ significantly” (emphasis mine).
The second problem for the “desistence myth” viewpoint is that it creates an inevitable clash against the mainstream-media trans-narrative. It ought to be said, at least briefly, that for some trans-individuals or transsexuals this is not a problem. They believe that only those who meet the full criteria for GID, like themselves, should transition. But this position is very different than that pushed in the mass-media and in the pages of National Geographic! As I’ve pointed out in another article, the literature is clear that the prevalence of GID is exceptionally small, perhaps 0.02% of the population. The percentage of the population who claim to be transgendered, inclusive of transvestites and some gender-incongruent individuals, is 0.6%, according to the Williams Institute (2016). But the gender-nonconforming group is larger still, and among children and adolescents may be above 1 or even 2% (Clark, 2014).
Here’s the problem then: even if you could claim that fully GID-diagnosed trans-children don’t usually desist (though the literature says otherwise), you would have to give up many of the social, political and cultural projects that rely on the significant size of the trans population. Are we going to change social structures, open up women’s spaces and sports, and educate children in gender fluidity on the strength of a phenomenon that happens in 0.02% of the population? When it comes to political pressure and change, size usually equals strength. If desistence is a “myth” (which it isn’t) you debilitate the entire socio-political trans-movement.
Detransition
So does gender identity change? National Geographic are seemingly of two minds on the question, but we’ve shown that there is an enormous amount of change and fluidity in the gender identity of nonconforming children. What about with adults? Is there any change or fluidity after adolescence? Are there any who regret transitioning?
Until recently, an answer based on the literature would have shown that relatively few express regret with medical transition. “Regrets are rare (0.5–3.0%)”, says Gooren (2008). But new data is coming to light which has not yet been seen in the literature. In 2016, two informal surveys were completed which found over 200 detransitioned women by recruiting through social media. One of them asked about the nature of the detransition, with over 100 women stating they had medically transitioned before their detransition. A quick search of social media will reveal many of these stories. Only a short period of time ago “detransition” was thought to be a rarity, but in the years to come it may be that this burgeoning group will force the mainstream narrative to face very awkward questions, and the medical literature to issue new studies on this phenomenon. The “regrets are rare” theory is going to be heavily tested in the very near future, perhaps even in courts of law as we will consider in our next installment.
Something We Are Born With
In light of the general fluidity of identity and orientation in children and adolescence, clear data on desisters, and the revelation of significant numbers of detransitioners, the claim that gender identity is something we are born with is a severely strained one. This is surely more sophistry than science, more politics than pediatrics.
Is there change? Yes, and in significant amounts. But what about intervention? Can gender identity be changed? The Nat Geo article is very clear on the correct parental approach to a child’s gender nonconformity; “When your child discloses an identity to you, respond in an affirming, supportive way.” Simple, they suggest; just agree. The child knows more than the parent, seemingly, and parents are not to question.
But many researchers are not nearly so incautious as National Geographic. In the conclusion of Desisting and Persisting, Steensma (2011), says
Given our findings that some girls, who were almost (but not even entirely) living as boys in their childhood years, experienced great trouble when they wanted to return to the female gender role, we believe that parents and caregivers should fully realize the unpredictability of their child’s psychosexual outcome. They may help the child to handle their gender variance in a supportive way, but without taking social steps long before puberty, which are hard to reverse. This attitude may guide them through uncertain years without the risk of creating the difficulties that would occur if a transitioned child wants to revert to living in his/her original gender role.
Here Steensma is not speaking about medical, but social transition, and recommends that there not be social transition so that when the majority desist they won’t experience “great trouble” in socially detransitioning, an observed problem in some of their cases. What is particularly interesting for us and our mini-series is that this statement is in the very same study in which Steensma previously stated that there was a recognizable distinction between desisters and persisters in how they expressed the nature of their gender incongruence (whether they wished to be the other sex, or felt they were the other sex). In spite of this, he still takes a very cautious tone in the conclusion, and doesn’t seem to feel this distinction is reliable enough for transition purposes. Trans-advocates would do well, therefore, not to read more into Steensma’s statement than is warranted.
Caution does seem to be appropriate, often parents do know best, and the always-affirm approach in “Helping Families Talk About Gender” is not well-represented in the literature. In fact, it is likely dangerous. Bechard (2106), give us the case example of Hillary;
During an intake telephone interview with the mother, Hillary was reported to have an acute onset of gender dysphoria: “[It] literally happened overnight.” There was no developmental history of cross-gender identification that would be consistent with a diagnosis of GID. The mother noted that Hillary had had a long-standing history of social-relational difficulties, particularly with girls, which the mother attributed, in part, to her gifted IQ. The mother wondered if Hillary suffered from body dysmorphic disorder (BDD) and “other mental health conditions,” such as anxiety and depression. Regarding the BDD, the mother noted that, for the past few years, Hillary had been extremely preoccupied with her physical appearance, literally taking hundreds of “selfies” each day, trying to look just right. If she did not look right, she would refuse to leave the house. Mother noted that Hillary’s phenotypic social appearance had been very “feminine” throughout this time period. Hillary’s mother hypothesized that the gender dysphoria was a response to a recent relationship with a psychologically troubled boyfriend, who was gay. The mother wondered if Hillary developed the belief that the only way to retain this relationship was to become a boy herself.
Hillary’s mother reported that both she and her husband were both very liberal and progressive with regard to social issues. Hillary was, therefore, surprised that her parents did not, without question, accept her disclosure that she was a trans boy. She became very angry with them and, when they tried to explore matters with her, she would run away from home for several days.
A primary concern of the parents was that Hillary had sought out a physician in the community who was well known for working with the transgender population and, after a brief assessment and without any input from the parents, had already prescribed testosterone. They were concerned that the physician was not aware of Hillary’s history of social difficulties, that she had had a long history of physical appearance concerns, and that the gender dysphoria was clearly of a late-onset form, perhaps related to the romantic relationship with the boyfriend. Because this physician refused to meet with the parents, a second opinion was sought. (emphasis mine)
Sometimes parents do know best and are aware of some of the “social” factors that even Nat Geo admits, as we saw in the last installment. According to Nat Geo and HealthyChildren.org, parents are to be cheerleaders. You may cheer and support, but don’t step on the field. Don’t get involved. Leave that to the experts.
Here are the words of a young woman whose mother got involved– very involved:
Although at the time I didn’t appreciate it, the constant repetition of “you can’t be a boy” did me good. A lot of good. I had been spending too much time on the internet and I had got it into my head that somehow, biological girls could really be boys, if they “identified” as such (& vice versa).As someone who’s always had a mostly realistic grip on the world, for some reason I had been pulled into a world where boys could become girls and girls could become boys. I felt that because I said I was a boy, I was a boy.At the time, I felt that my mum not immediately calling me Jake and using male pronouns was horrible and transphobic. But in the long run, without her resistance, I probably wouldn’t be as happy as I am today, as I would still be thinking I was a boy and trying to “pass” as a boy (which I would never be able to do without body-altering hormones.)
In the end, page 14 of the National Geographic Gender Issue, “Helping Families Talk About Gender”, seems really to preach a whole lot of silence. Kids are right; they talk. Parents are not; they listen. But the only way to arrive at that conclusion is to ignore the science, to say nothing of common sense.