Ken Zucker on that landmark Finnish study; Italy sends inspectors into a gender clinic; Europe's paediatricians stand up for a child's 'open future'; and a new systematic review from Germany
Afraid not. Like Alexander Korte, these researchers are in the minority alarmed by Germany's headlong rush into gender-affirming medicalisation. Note that Zepf resigned in protest from the group developing Germany's new treatment guideline.
Please can we stop using the term 'Gender Dysphoria'? It's not real! It was invented by Trans activists working with the DSM. They literally created the condition out of thin air and then developed a 'treatment' regime that has NO empirical basis. I call it FNGD (Fake News/Factually Nonexistent Gender Dysphoria). Every time we use the term GD, we legitimise something that doesn't exist. As a clinical psychologist I have coined the term Harmful Transgender Ideations (HTIs). This is self explanatory. If FNGD6 were real, we would be seeing cases in African countries, China, Russia, the Caribbean, everywhere where kids don't have access to 'lifesaving healthcare'. There would also be clear historical evidence of it. By my very rough calculations, given a population of 1 billion in China, with 1% of youth having FNGD, there should be 100,000 suicides A MONTH of 'GD' kids. There isn't because GD is not real. It is the repackaging and monetisation of developmental, neurobiological and psycho-social conditions that children have had forever. It is a cynical money grab, with children's bodies being used like cash machines
Simply not true. The term "Gender Dysphoria" was the standard diagnostic term in the 1970s. It was popularized by Norman Fisk c. 1973 but had been around a few years before that. It arose as a diagnostic euphemism for transsexualism.
It had nothing to do with the DSM, did not appear in the DSM in the 1970s, 80s, 90s, or OOs. The recent DSM listing does not even correspond with the actual definition of 50+ years back. The person usually blamed as responsible for the new DSM listing is Kenneth Zucker, but I don't know his actual input. It does appear however that he was simply modifying his earlier definition for Gender Identity Disorder, which is a different animal altogether.
The current faddish, pop notion of GD may very well not be real, as you say. But under its strict definition it was a real diagnosis for adults and adolescents many years ago.
Addressing a problem that doesn't exist and ignoring one that does:
• For Aboriginal children aged 14 years and less, suicide is the second leading cause of death – and they are near 4 times more likely to die by suicide than their non-Aboriginal peers.
• In 2018, suicide was the leading cause of death for 5- to 17-year-olds (26.5%), and in 2015 it was the leading cause of death for young Aboriginal people aged 15 to 35 years (30%).
• Australia there has no documented suicide among the gender dysphoria cohort.
This is *almost* off-topic, but: Ken Zucker's main work was never with "gender dysphoria" (transsexualism) but rather with so-called "gender non-conforming" kids. In the old days, when anxiety about these mostly concerned natal males, they were said to have "sissy-boy syndrome." Beginning in the late 1960s at UCLA, Richard Green and others carried on formal studies of the syndrome, often coupled with behavioral modification therapy, with mixed results. One thing they discovered over the long run was that a lot of their subjects grew up to be homosexuals, which was not thought to be a favorable outcome. (Very few sought to change their physical sex; that was never a significant issue.) In recent years Zucker has attempted to muddy the waters by confusing gender non-conformity with "gender identity disorder" (his old term for GNC) and now with "gender dysphoria," a term that's been around a long time and does not describe either GID or GNC. Moreover, it could not, by its clinical definition, be diagnosed in children. And we can see why that is. Gender non-conformity may happen frequently in pre-adolescent children, but it usually does not indicate actual gender dysphoria.
NOW. The "trope" that Ken Zucker claims has been around now for a number of years—‘Would you rather have a trans kid or a dead kid?'—is something I've seen almost exclusively from people like Zucker and from "gender critical" activists and writers. If you do an internet search for paraphrases of that question, you find it sometimes attributed to parents and sometimes to unnamed therapists. But so far as I can tell, no serious, named physician has offered this claptrap when giving guidance or making a diagnosis. It's something picked up from the media, and often used as a strawman argument (as it is here) because we can disprove it so easily. It's hardly even worth refuting from a statistical basis. Common sense should tell us that a rare, probably undisclosed, condition will not show up in suicide statistics in the first place.
If anyone out there truly *is* invoking that "trope," and doing so seriously, it should be understood as a desperate plea for understanding, not medical consensus or confirmed statistics.
Really? Surely there is overlap between kids who are gender non-conforming & those with clinical distress about gender, whatever name is given to that condition. If Zucker is not one of the leading authorities on gender dysphoria, who has more expertise in this field?
I believe that "gender non-conformity" in children is a legitimate subject of study, and Zucker's work can be respected within boundaries. But if we know that most GNC kids "desist" from their GNC ways at adolescence, that's proof positive that we're dealing with apples and oranges: two different syndromes at least, one rather benign (if perhaps embarrassing) and the other serious, probably innate, and with lifelong consequences.
Yes, there is inevitably an overlap if we're just observing superficial behavior in these pre-pubescents. At the same time there's no reason to believe that all GD kids are also GNC. I would assume they'd often be inclined to hide their discomfort, in much the same way as pre-adolescent intersex kids know something was amiss but don't wish to discuss it, and wish to fit in as "normal." My knowledge of IS and TS people does not range far and wide, but I can't think of a single instance of someone who got reassigned in adolescence or adulthood and was "gender non-conforming" as a child.
The practical rule here should be to not take gender non-conformity too seriously. Most GNC kids will have no need or desire to seek physical alterations post-puberty. We should proceed with great caution and solemnity when considering things like "social transition" in children.
And yet the diagnostic criteria for Gender Identity Disorder, Gender Dysphoria & Gender Incongruence are all about (clinically significant) gender non-conformity.
Absolutely. You're talking about a current DSM definition of "Gender Dysphoria" which is not classical gender dysphoria (transsexualism) at all, which had little to do with "gender non-conformity."
GID, GD and GNC have all been confused and mushed together in current parlance and mass-media, so we must keep in mind they are three different things.
Surely the 'affirmative' (aka 'encouraging/endorsing') model of managing children who present as GD is counterproductive to the outcome for 'most kids' you reference.
Shut down the gender clinics and most of the dreadful interventions would cease go?
Get rid of the faddish cheering squads, yes. I don't know if that exactly equates to "gender clinics," which I suspect are mostly fictitious. There are GPs and pediatricians who take some continuing-education certification in "Gender Stuff," and those seem to be the "gender clinics." This is not an area most physicians should fool with.
In Australia we have a number of major State paediatric hospitals that have 'gender clinics' that address 'gender issues' including gender dysphoria.
The Royal Children's Hospital in Melbourne being the most prominent and, arguably, with most to lose from the high profile promotion of the affirmative approach to the interventional management of children with gender dysphoria. This includes includes referral for 'top' and 'bottom' surgical interventions.
Sometimes I wonder if these clinicians are overzealous because they know they were misdiagnosing and screwing up decades ago, so now they're overreaching and screwing up in the other direction. I knew someone who was treated in that town during her teens back in the 70s, and that was not a happy tale. But two wrongs don't make a right.
You claim: “no serious, named physician has offered this claptrap when giving guidance or making a diagnosis.”
You can’t possibly know that unless you attend all consultations that gender physicians have with their patients and parents.
The physicians are unlikely to admit to it but we have many parents and patients who have stated that the trope was used to put pressure on them to consent.
And I have seen serious physicians state publicly that these procedures are life saving.
Only a few weeks ago Prof Ian Hickie in Australia said on a Channel 7 program that studies had proven decreases in suicidality.
I believe the trope is used by many and it is completely unethical to bully parents with this false evidence.
You also claim that Gender non conformity and gender dysphoria are 2 completely different things with the former much more common and more likely to be transitory
What concerns us who are critical of the affirmation model is that there does not appear to be much effort to distinguish the 2 in many clinics in a headlong rush to affirm.
So we are not distinguishing between transitory Gender non conformity, we are unethically pushing parents into acquiescence and this is eventually leading to irreversible surgical procedures that many come to regret.
Perhaps I used a bit of hyperbole, but I don't know of any examples. So that's what I said.
Now, if this "trope" is truly being used by physicians, I'd like to see some instances. Personally I'm not convinced that a syndrome that occurred at a frequency of maybe 1:10,000 a few decades back is now rampant at 1:1000 or more. If a form of cancer were suddenly ten times as frequent we'd be asking questions about the cause, and more importantly the methodology behind the statistics.
And I'm interested in seeing the type of subject who is supposed to be at suicide risk, as well as the context. Is it a case of a probable (pubescent or post-pubescent) transsexual who is being actively denied hormones and other therapy (which definitely sounds like malpractice)? Or are we really talking about pre-pubescents who are eager to identify with a syndrome for which there is no medicalisation indicated, but which gets a lot of coverage in popular media?
>>What concerns us who are critical of the affirmation model is that there does not appear to be much effort to distinguish the 2 in many clinics in a headlong rush to affirm.
Yes, well I've implied before that these clinicians are subject to fads, and are seldom specialists. In the case of GNC pre-puberty, there is no medicalisation in the picture. If it seems to be GD post-puberty, medicalisation may be indicated, with caution.
Afraid not. Like Alexander Korte, these researchers are in the minority alarmed by Germany's headlong rush into gender-affirming medicalisation. Note that Zepf resigned in protest from the group developing Germany's new treatment guideline.
Ah, so it's a minority report. Thanks
Well, it's not a systematic review commissioned by any German government body. For Germany's Coalition government, the science is settled.
Please can we stop using the term 'Gender Dysphoria'? It's not real! It was invented by Trans activists working with the DSM. They literally created the condition out of thin air and then developed a 'treatment' regime that has NO empirical basis. I call it FNGD (Fake News/Factually Nonexistent Gender Dysphoria). Every time we use the term GD, we legitimise something that doesn't exist. As a clinical psychologist I have coined the term Harmful Transgender Ideations (HTIs). This is self explanatory. If FNGD6 were real, we would be seeing cases in African countries, China, Russia, the Caribbean, everywhere where kids don't have access to 'lifesaving healthcare'. There would also be clear historical evidence of it. By my very rough calculations, given a population of 1 billion in China, with 1% of youth having FNGD, there should be 100,000 suicides A MONTH of 'GD' kids. There isn't because GD is not real. It is the repackaging and monetisation of developmental, neurobiological and psycho-social conditions that children have had forever. It is a cynical money grab, with children's bodies being used like cash machines
Simply not true. The term "Gender Dysphoria" was the standard diagnostic term in the 1970s. It was popularized by Norman Fisk c. 1973 but had been around a few years before that. It arose as a diagnostic euphemism for transsexualism.
It had nothing to do with the DSM, did not appear in the DSM in the 1970s, 80s, 90s, or OOs. The recent DSM listing does not even correspond with the actual definition of 50+ years back. The person usually blamed as responsible for the new DSM listing is Kenneth Zucker, but I don't know his actual input. It does appear however that he was simply modifying his earlier definition for Gender Identity Disorder, which is a different animal altogether.
The current faddish, pop notion of GD may very well not be real, as you say. But under its strict definition it was a real diagnosis for adults and adolescents many years ago.
Addressing a problem that doesn't exist and ignoring one that does:
• For Aboriginal children aged 14 years and less, suicide is the second leading cause of death – and they are near 4 times more likely to die by suicide than their non-Aboriginal peers.
• In 2018, suicide was the leading cause of death for 5- to 17-year-olds (26.5%), and in 2015 it was the leading cause of death for young Aboriginal people aged 15 to 35 years (30%).
• Australia there has no documented suicide among the gender dysphoria cohort.
Exactly the kind of opportunity cost we should be conscious of.
So Germany is turning on a dime? Is that what I'm reading?
This is *almost* off-topic, but: Ken Zucker's main work was never with "gender dysphoria" (transsexualism) but rather with so-called "gender non-conforming" kids. In the old days, when anxiety about these mostly concerned natal males, they were said to have "sissy-boy syndrome." Beginning in the late 1960s at UCLA, Richard Green and others carried on formal studies of the syndrome, often coupled with behavioral modification therapy, with mixed results. One thing they discovered over the long run was that a lot of their subjects grew up to be homosexuals, which was not thought to be a favorable outcome. (Very few sought to change their physical sex; that was never a significant issue.) In recent years Zucker has attempted to muddy the waters by confusing gender non-conformity with "gender identity disorder" (his old term for GNC) and now with "gender dysphoria," a term that's been around a long time and does not describe either GID or GNC. Moreover, it could not, by its clinical definition, be diagnosed in children. And we can see why that is. Gender non-conformity may happen frequently in pre-adolescent children, but it usually does not indicate actual gender dysphoria.
NOW. The "trope" that Ken Zucker claims has been around now for a number of years—‘Would you rather have a trans kid or a dead kid?'—is something I've seen almost exclusively from people like Zucker and from "gender critical" activists and writers. If you do an internet search for paraphrases of that question, you find it sometimes attributed to parents and sometimes to unnamed therapists. But so far as I can tell, no serious, named physician has offered this claptrap when giving guidance or making a diagnosis. It's something picked up from the media, and often used as a strawman argument (as it is here) because we can disprove it so easily. It's hardly even worth refuting from a statistical basis. Common sense should tell us that a rare, probably undisclosed, condition will not show up in suicide statistics in the first place.
If anyone out there truly *is* invoking that "trope," and doing so seriously, it should be understood as a desperate plea for understanding, not medical consensus or confirmed statistics.
Really? Surely there is overlap between kids who are gender non-conforming & those with clinical distress about gender, whatever name is given to that condition. If Zucker is not one of the leading authorities on gender dysphoria, who has more expertise in this field?
I believe that "gender non-conformity" in children is a legitimate subject of study, and Zucker's work can be respected within boundaries. But if we know that most GNC kids "desist" from their GNC ways at adolescence, that's proof positive that we're dealing with apples and oranges: two different syndromes at least, one rather benign (if perhaps embarrassing) and the other serious, probably innate, and with lifelong consequences.
Yes, there is inevitably an overlap if we're just observing superficial behavior in these pre-pubescents. At the same time there's no reason to believe that all GD kids are also GNC. I would assume they'd often be inclined to hide their discomfort, in much the same way as pre-adolescent intersex kids know something was amiss but don't wish to discuss it, and wish to fit in as "normal." My knowledge of IS and TS people does not range far and wide, but I can't think of a single instance of someone who got reassigned in adolescence or adulthood and was "gender non-conforming" as a child.
The practical rule here should be to not take gender non-conformity too seriously. Most GNC kids will have no need or desire to seek physical alterations post-puberty. We should proceed with great caution and solemnity when considering things like "social transition" in children.
And yet the diagnostic criteria for Gender Identity Disorder, Gender Dysphoria & Gender Incongruence are all about (clinically significant) gender non-conformity.
Absolutely. You're talking about a current DSM definition of "Gender Dysphoria" which is not classical gender dysphoria (transsexualism) at all, which had little to do with "gender non-conformity."
GID, GD and GNC have all been confused and mushed together in current parlance and mass-media, so we must keep in mind they are three different things.
Surely the 'affirmative' (aka 'encouraging/endorsing') model of managing children who present as GD is counterproductive to the outcome for 'most kids' you reference.
Shut down the gender clinics and most of the dreadful interventions would cease go?
Get rid of the faddish cheering squads, yes. I don't know if that exactly equates to "gender clinics," which I suspect are mostly fictitious. There are GPs and pediatricians who take some continuing-education certification in "Gender Stuff," and those seem to be the "gender clinics." This is not an area most physicians should fool with.
In Australia we have a number of major State paediatric hospitals that have 'gender clinics' that address 'gender issues' including gender dysphoria.
The Royal Children's Hospital in Melbourne being the most prominent and, arguably, with most to lose from the high profile promotion of the affirmative approach to the interventional management of children with gender dysphoria. This includes includes referral for 'top' and 'bottom' surgical interventions.
Sometimes I wonder if these clinicians are overzealous because they know they were misdiagnosing and screwing up decades ago, so now they're overreaching and screwing up in the other direction. I knew someone who was treated in that town during her teens back in the 70s, and that was not a happy tale. But two wrongs don't make a right.
Dear Ms Burns,
You claim: “no serious, named physician has offered this claptrap when giving guidance or making a diagnosis.”
You can’t possibly know that unless you attend all consultations that gender physicians have with their patients and parents.
The physicians are unlikely to admit to it but we have many parents and patients who have stated that the trope was used to put pressure on them to consent.
And I have seen serious physicians state publicly that these procedures are life saving.
Only a few weeks ago Prof Ian Hickie in Australia said on a Channel 7 program that studies had proven decreases in suicidality.
I believe the trope is used by many and it is completely unethical to bully parents with this false evidence.
You also claim that Gender non conformity and gender dysphoria are 2 completely different things with the former much more common and more likely to be transitory
What concerns us who are critical of the affirmation model is that there does not appear to be much effort to distinguish the 2 in many clinics in a headlong rush to affirm.
So we are not distinguishing between transitory Gender non conformity, we are unethically pushing parents into acquiescence and this is eventually leading to irreversible surgical procedures that many come to regret.
Perhaps I used a bit of hyperbole, but I don't know of any examples. So that's what I said.
Now, if this "trope" is truly being used by physicians, I'd like to see some instances. Personally I'm not convinced that a syndrome that occurred at a frequency of maybe 1:10,000 a few decades back is now rampant at 1:1000 or more. If a form of cancer were suddenly ten times as frequent we'd be asking questions about the cause, and more importantly the methodology behind the statistics.
And I'm interested in seeing the type of subject who is supposed to be at suicide risk, as well as the context. Is it a case of a probable (pubescent or post-pubescent) transsexual who is being actively denied hormones and other therapy (which definitely sounds like malpractice)? Or are we really talking about pre-pubescents who are eager to identify with a syndrome for which there is no medicalisation indicated, but which gets a lot of coverage in popular media?
>>What concerns us who are critical of the affirmation model is that there does not appear to be much effort to distinguish the 2 in many clinics in a headlong rush to affirm.
Yes, well I've implied before that these clinicians are subject to fads, and are seldom specialists. In the case of GNC pre-puberty, there is no medicalisation in the picture. If it seems to be GD post-puberty, medicalisation may be indicated, with caution.