With transgender interventions on minors, aka “gender-affirming healthcare” (formerly transgender-affirming therapy), falling and failing under scrutiny in about half the U.S. states and numerous nations, it was predictable that proponents of gender transition ideology would double down on claiming it is proven to help adults with gender dysphoria/transgender identification. Well, it’s not, and a simple focus on first principles makes this evident.

 

1. Transgenderism is an ideology. Gender dysphoria/incongruence is a diagnosis (as is autogynephilia, the erotic arousal of men by thinking of or seeing themselves as women).

 

2. Decades of literature demonstrate the overwhelming probability in the gender dysphoric or trans-identified of underlying mental health issues, adverse childhood experiences, family problems and an overrepresentation of autism spectrum disorder, all of which precede the gender dysphoria/trans identification. These do not vanish with achieving age of majority. What the minor had, the adult likely still has.

 

A 2014 four-nation European study found almost 70 percent of adults and minors with gender identity disorder had “a current and lifetime diagnosis.” A 2015 report from Finland’s gender identity services found 75 percent of adolescents they saw were or had been undergoing psychiatric treatment for reasons other than gender dysphoria, and 26 percent had autism spectrum disorder. They concluded, “Treatment guidelines need to consider gender dysphoria in minors in the context of severe psychopathology and developmental difficulties.” Severe psychopathology in minors becomes such in adults. A 2018 Kaiser-Permanente study of transgender and gender non-conforming youth was gleaned from electronic medical records of 8.8 million members in California and Georgia. Incredibly high rates of psychiatric disorders and suicidal ideation were identified before gender non-congruence appeared.

 

A 2021 prospective study (rare in this field) from a multi-disciplinary pediatric gender service in Australia found high levels of distress, suicidal ideation (41.8 percent), self-harm (16.3 percent) and suicide attempts (10.1 percent); high rates of comorbid mental health disorders: anxiety (63.3 percent), depression (62.0 percent), behavioral disorders (35.4 percent) and autism (13.9 percent); and high rates of adverse childhood experiences, with family conflict (65.8 percent), parental mental illness (63.3 percent) and loss of important figures via separation (59.5 percent). Childhood issues become adult issues. They further stated that clinicians felt pressured to jettison a holistic approach of dealing with co-morbidities and just affirm transgenderism and transition, as did 35 psychologists who resigned from the United Kingdom’s former National Health Service (NHS) gender service.

 

Lisa Littman’s groundbreaking 2018 parental survey of rapid onset gender dysphoria children (note that surveys are of limited quality by definition) revealed that 62.5 percent of gender dysphoric adolescents had one or more psychiatric disorders or neurodevelopmental disability before the onset of gender dysphoria, a 12.3 percent prevalence of autism spectrum disorder (ASD) and 48.4 percent had experienced a traumatic or stressful prior event. A 2023 chart review of 68 “gender care” minors at Children’s National Hospital in the U.S. revealed a 47 percent rate of autism. Again, ASD children become ASD adults. A 2020 Australian systematic review asserted, “The few studies employing diagnostic criteria for ASD suggest a prevalence of 6-26% in transgender populations….” The article de Vries published in 2020 showed not only that most transgender identified individuals present as older adolescents or adults, but that the former had “more mental health difficulties” than children. A fine summary is offered by Withers (2020), “trans‐identification and its associated medical treatment can constitute an attempt to evade experiences of psychological distress.” Thus, it can be a dodge.

 

3. Desistance is the norm for gender dysphoria, unless it is affirmed. Conservatively, 85 percent will desist by adulthood. This is confirmed by the DSM-5 (p.455); the American Psychological Association Handbook on Sexuality and Psychology (2014); Singh, et al (2021); Cohen-Kettenis (2008); the Endocrine Society Guidelines (2017); Ristori, et al. (2016); and others. A 2024 longitudinal Dutch university psychiatric clinic study followed 2,772 “gender non-content” adolescents, 63 percent of whom desisted by 26 years of age (in a clinic that likely affirmed, no less). Canadian psychologist Zucker handily presents and defends the numerous studies showing desistance is common in his 2018 paper, “The myth of persistence.” Yes, only some of these sources speak of adult desistance, but there is more to consider.

 

4. Adult post-transition regret and detransition speak to the fact that desistance doesn’t stop at adulthood. Regret was already noted to manifest about eight years after surgical transition (as seen here and here). Yet, regret and detransition statistics, often claimed to be low in adulthood, are questionable. D’Angelo, et al (2018) observed, “However, these studies may understate true regret rates due to overly stringent definitions of regret (i.e., requiring an official application for reversal of the legal gender status), very high rates of participant loss to follow-up (22%-63%)…” Satisfaction surveys often come from non-standardized and highly subjective patient satisfaction questionnaires. This makes the usual cross-sectional, retrospective, convenience samples the literature provides particularly low-quality data sources. Regret studies often have far too short a follow up period, commonly one to two years. Regret and detransitioner stats tend to come from gender clinics, which both groups avoid. Lisa Littman’s 2021 survey of 100 medical and surgical detransitioners noted only 24 percent had informed their clinician of their detransition. A small Canadian sample of 28 adults (“18 years and older”) who had stopped or reversed a transition reported “health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs.” Apparently, pro-transition clinicians were unprepared to clean up the messes they helped make. Psychiatry professor Stephen Levine offers this, “There is much to suggest that the patient does not always know best—for example, post-transition depression, detransition, pre- and postsurgical suicide rates, and that researchers have concluded that postoperative patients need psychiatric care.” Entristle’s 2021 writing on detransitioners is worth mentioning as well.

 

5. Now to address the myth of suicide reduction through gender affirmation/transitioning.

 

Psychiatrist Stephen Levine warned, “The ‘transition or suicide’ narrative falsely implies that transition will prevent suicides.” The Cass Review stated, “Tragically deaths by suicide in trans people of all ages continue to be above the national average, but there is no evidence that gender-affirmative treatments reduce this,” (Cass Review, at 16.22).

 

A large 2024 American database study found, “Gender-affirming surgery is significantly associated with elevated suicide attempt risks, underlining the necessity for comprehensive post-procedure psychiatric support.” A 2021 review of all persons undergoing feminizing (vaginoplasty) and masculinizing (metoidioplasty/ phalloplasty) genital surgery in California from 2012 to 2018 observed, “The overall rates of suicide attempts doubled (3.3 vs 1.5%, p=0.017) after vaginoplasty (effect not observed after phalloplasty),” and phalloplasty did not reduce the risk of suicide. Famously, a 2011 Swedish study of all post-sex-reassignment-surgery adults in a 30-year population-based matched cohort showed a completed suicide rate 19 times that of the general population 10 years out, and nearly three times the rate of overall mortality and psychiatric inpatient care.

 

The 2020 update of the Amsterdam Cohort Study, a 35-year chart review of people undergoing transgender affirming treatment, reported that suicides didn’t improve overall with male to female transitioners having 2.8 times the completed suicide rate of general Dutch males, (artfully explained “rates decreased slightly over time”) and female to male transitioners at 4.8 times the completed suicide rate of general Dutch females (suicide rate “did not change in trans men”).

 

Simply put, transgender intervention (“gender-affirming healthcare”) is not the standard of care. It is experimentation with a poor track record presented as something better. The 2017 Endocrine Society Guidelines state their medical evidence rating adult genital surgery as “very low.” Their disclaimer (p. 3895) offers, “The guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The guidelines are not intended to dictate the treatment of a particular patient.” Zucker wrote in 2019, “…the field suffers from a vexing problem: There are no randomized controlled trials (RCT) of different treatment approaches, so the front-line clinician has to rely on lower-order levels of evidence in deciding on what the optimal approach to treatment might be. CMDA pediatric endocrinologist Paul Hruz alerted in 2020, “Limitations of the existing transgender literature include general lack of randomized prospective trial design, small sample size, recruitment bias, short study duration, high subject dropout rates, and reliance on “expert” opinion.” Stephen Levine wrote in 2020, “The fact that modern patterns of the treatment of trans individuals are not based on controlled or long-term comprehensive follow-up studies has allowed many ethical tensions to persist.” And psychologist James Cantor stated tellingly in a March 5, 2024 X/Twitter post, “Gender affirmative therapy is for affirming the therapist, not the client. It takes no talent, training, or skill to tell people what they want to hear…If need-for-affirmation is all you see, the need is yours.”

 

In my honest opinion, there is always a more honest way to treat gender dysphoria/incongruence than experimental chemical sterilization and surgical mutilation of healthy bodies that dodge the underlying issues awaiting addressal.