Primed for regret
Youth with neurodivergent brains cannot be expected to make safe decisions about irreversible gender medicalisation
Lisbon | Young people with ADHD and autism, already over-represented in gender clinic caseloads, are at higher risk of poor decisions and treatment regret because their capacity for mature judgment is delayed, the US paediatrician and medical scientist Dr Julia Mason has warned.
She pointed out that the brains of adolescents generally are still undergoing development towards the age of 25 and that “when conditions like ADHD or autism are present, full maturation can be delayed even past age 25, more like 30.”
Dr Mason, who observed in her medical practice the failure of transgender-identifying patients to accomplish the tasks of adolescence, was addressing Genspect’s third annual conference in Lisbon, Portugal, on Friday.1
In her presentation, she noted that the brain was the last organ to mature, doing so under the influence of sex hormones,2 and developing “somewhat unevenly” from back to front.
“The dorsolateral prefrontal cortex, important for controlling impulsive decisions, is among the last brain regions to mature, and it doesn’t reach adult dimensions until the 20s,” she said.
“Teens process information with the amygdala, and this is the emotional core of the brain. Young people feel things more intensely and are sometimes immune to logic.
“They will make a different decision when their emotions are running hot than they would when they are calm, cool and collected. This can lead to regret.
“Mature adults lean on the prefrontal cortex for making decisions, which gives them better awareness of things like the potential long-term consequences of a particular decision.
“The implications for pursuing a medical pathway with permanent bodily changes and potential loss of fertility are obvious.
“Human societies have restricted access to adult activities—such as marriage, voting, buying alcohol, tattoos, renting a car and adopting a child—to various ages between 16 and 25. It’s generally recognised that young people can’t always be trusted to make good decisions, particularly on hot-button issues.”
“It’s not medicine. The gender clinic is a scenario, it’s a backdrop against which you perform your identity. And it’s not just not medicine, it’s anti-medicine—it’s producing ill health and harm.”—author Helen Joyce of the group Sex Matters, presentation, Genspect in Lisbon, 28 September 2024
Room for doubt
Dr Mason, a founding board member of the Society for Evidence-based Gender Medicine who has campaigned for scientific honesty from the “affirmation-only” American Academy of Pediatrics, had some advice for the troubled parents of trans-identifying young people.
“You have to be quiet enough in your very legitimate concerns, so that your child can hear their own niggling doubts about what is the best course of action,” she said.
“If you are trying to stop them with all your might, then they will apply their usually formidable intellect towards the problem of getting past you, instead of taking ownership of their own decisions.”
Just over 80 per cent of attendees polled at an American Psychiatric Association meeting in Toronto said they “somewhat often or very often” saw “teens who seem to be influenced by social media in regards to their sexual and/or gender identity.”
“Sadly, 82 per cent of psychiatrists will say that in an anonymous poll at a meeting, but how many of them are getting up in public and talking about this?”—US psychiatry professor Dr Kristopher Kaliebe of the University of South Florida, presentation, Genspect in Lisbon, 27 September 2024
Video: The (missing) evidence for paediatric gender medicine
Gender panacea
In her Lisbon presentation, Dr Mason explained that the dilemma of legal adulthood arriving before a mature brain was compounded for young people with ADHD or on the autism spectrum.
“Just about everyone agrees that in ADHD, maturation of the prefrontal cortex is delayed, some say by about 30 per cent compared to same-age peers. The development of the prefrontal cortex was delayed five years in one study,” she said.
“This implies that young people with ADHD may not be making their best decisions until they’re around 30 years old. And because our lives aren’t complicated enough, up to 20-25 per cent of children with ADHD fall on the autism spectrum, and as many as 50-60 per cent or more of children on the autism spectrum have ADHD.
“Autism is a neurodevelopmental disorder that changes the development of the brain in more ways than just the timing. Executive function [necessary for complex decision-making and self-control] is impaired in autism as well as in ADHD, but it is not necessarily happening in the same way.
“Both types of neurodiverse kids can be drawn into gender ideology, either via ‘hyper focus’ or a ‘special interest.’
“Gender promises to explain why a young person isn’t fitting in with their peers, and it seems to have a plan to fix everything—if only you believe.
“I’m not the only one who was struck by the over-representation of autism in young people and adults in the trans community.
“It’s easier for me to understand how a girl with undiagnosed autism can discover trans and feel like it explains everything that has gone wrong for her and her life up to that point.”
“Detransition is ultimately an existential process, it is a grief process… Some issues [facing detransitioners] are transition-specific, namely the physical ones, but most are universal human problems… You may have been sold gender snake oil, but you are still just like any other trauma survivor—you are not especially fucked up.”—US detransitioner Laura Becker, presentation, Genspect in Lisbon, 29 September 2024
“[We formed the UK Clinical Advisory Network on Sex and Gender because] we were alarmed by the dearth of evidence [for the gender-affirming treatment model] and the seeming lack of concern among medical authorities about this. The exceptionalism of the approach to gender medicine was remarkable. It seemed nothing had been learned from previous medical scandals where life-changing interventions were embarked upon without evidence of safety or benefit.
“There seemed to be no real interest in the issue of child safeguarding… There was no forum where we could discuss these concerns and any attempt [to raise these concerns] in our professional bodies or just among colleagues was shut down with accusations of bigotry and transphobia.”—London general practitioner Dr Louise Irvine, co-chair of CAN-SG, presentation, Genspect in Lisbon, 28 September 2024
“As for a clinical trial of puberty blockers, planned in the UK, why is it needed? Who could it possibly benefit? The suicide [prevention] myth has been thoroughly debunked. That leaves only one supposed benefit… [blockers] help boys pass as female more easily as adults. But most of those demanding the blockers are girls, who can pass perfectly well [as adult males] if they delay any medical intervention until adulthood.
“Are we to inflict harm on hundreds more lesbian teens as a sacrifice for the supposed cosmetic benefit for some boys? Given that the known health risks are so serious, I question whether such a clinical trial would be in line with the precept ‘First, do no harm’.”—Bev Jackson, co-founder of the London-based LGB Alliance, presentation, Genspect in Lisbon, 27 September 2024
“The long-term effect [of paediatric gender medicine]? We don’t know anything at all, because it’s only since 10-20 years ago that teenagers have got hormone therapy… and they should then have high levels of testosterone, if you’re a girl, for 40-50-60-70 years [i.e., the rest of their lives.] What will happen? Nobody knows… I think this is one of the biggest medical scandals ever in history.”—Swedish child and adolescent psychiatrist Dr Sven Román, panel discussion, Genspect in Lisbon, 27 September 2024
“A medical professional’s view is a short-term perspective… Even if psychopathology is noted by the mental health professional, the professional typically does not consider the [trans-identifying] individual’s future ability to love or to work, which is what we parents are very concerned about. We’re trying to grow and launch a person who can be successful in these two domains of life… Parents’ values have the entire life cycle in mind, but doctors do not…”—US clinical professor of psychiatry Dr Stephen B Levine, presentation, Genspect in Lisbon, 28 September 2024
“[A healthy, supportive trans community] would foster resilience and self sufficiency in gender-questioning youth, rather than telling kids that anyone who disagrees with their worldview hates them or that exposure to ‘misgendering’ or ‘dead naming’ can lead to suicide. A healthy, open and supportive trans community would accept… that there are legitimate reasons to detransition and exit the community.
“[It] wouldn’t seek to drive a wedge between gender-questioning youth and family members or friends who sincerely want the best for them but question whether transition is the right answer. [It would] invite ethical research into transition outcomes, rather than trying to shut down inquiry, because trans-identifying people deserve high-quality care, not just ideologically compliant care.”—graduate student who goes by the name Eliza Mondegreen, presentation, Genspect in Lisbon, 29 September 2024
“The adolescent mental health ward was run by bullying gender zealots, who assured us that our daughter [with a history of mental health problems] was now a son, and would we rather have a live son than a dead daughter? We were belittled in front of our daughter. We were called transphobic and bigoted and told that we needed to teach our family ‘inclusion.’ We were told that [our daughter] needed an immediate referral to a paediatric endocrinologist for testosterone. She was 17 and we said no.
“They wrote up the discharge summary saying that we did agree to the referral. She turned 18 the following month and went to the appointment against our wishes. We could not stop her.”—Australian mother Jude Hunter, panel discussion, Genspect in Lisbon, 29 September 2024
“What happened a couple of months ago is strange—people that are trans came through the Beyond Trans website to get our support… The reason they approached us and ended up with me [as a counsellor] is that they wanted non-affirming therapy… They wanted to be able to trust that I wasn’t going to be sycophantic and just bow down to the trans god. So I did some really interesting work with those people and they moved on.”—Sweden-based counsellor Angelo Vincent Deboni of the group Beyond Trans, presentation, Genspect in Lisbon, 29 September 2024
“Something adolescents—and frankly adults—have a really hard time accepting is being misunderstood… [So, here’s what you could say to encourage acceptance in your gender-questioning child]: There is no curated aesthetic or carefully selected identity label that guarantees people will ‘get you.’ Some people will look at you and make snap judgments and get a lot of things wrong, whether or not you transition. Yes, some judgments come from cruelty, but many more come from ignorance. And you know what—that’s ok! It doesn’t mean you or the other person have failed or done something wrong.
“Being deeply known by another person is an intimate process that takes time, vulnerability and relationship. There’s no shortcut through gender labels or pronouns or cosmetic changes.”—US psychotherapist Sasha Ayad, presentation, Genspect in Lisbon, 28 September 2024
“The fact that the law and medicine of all professions fell to this [gender ideology] is utterly shameful because they of all professions have their fundamental ethical foundation based upon evidence, so I think we should be afraid at how quickly and how far they fell… The only parallel I can think of is the satanic ritual abuse panic but even that did not have the worldwide scope of contagion and reach of gender identity [ideology]… [This swift and near complete institutional capture] should never have happened in the first place…
“To me, it is a really sobering reminder that the structure and the safety I put my faith in and thought existed is not real, and it doesn’t take much to tip it over the edge. That’s a horribly sobering realisation for me now in my mid-50s… [I had thought] I could rely on the integrity and the professionalism of those in charge of such important areas as medicine and law. I no longer have that faith.”—UK barrister Sarah Phillimore, presentation, Genspect in Lisbon, 28 September 2024
“I’ve come to understand that gender dysphoria, the psychological drive to transition, is a maladaptive coping mechanism using the sexed body as a decoy for opting out of adolescent development… ‘Gender-affirmation’ is not therapeutic. It is anti-therapeutic. It colludes with the primitive defences of the child.”—Ireland-based clinical psychologist Jaco van Zyle, presentation, Genspect in Lisbon, 28 September 2024
On Sunday, the US Biden Administration’s senior health official Dr Rachel Levine gave a keynote presentation in Florida at the national conference of the American Academy of Pediatrics (AAP), which has a contentious 2018 “affirmation-only” treatment policy for gender-distressed minors. Dr Levine, a trans-identifying male, as well as the AAP, had exerted covert pressure on the World Professional Association for Transgender Health (WPATH) to abandon minimum ages for surgery on minors in its latest 2022 standards of care, according to email exchanges revealed in June during a court case. At the Florida AAP meeting on Sunday, Dr Levine was loudly challenged on paediatric gender medicine from the conference floor by a member of the LGBT Courage Coalition, Laura Leggieri. After Dr Levine referred to adolescence as “a critical period”, Ms Leggieri shouted: “Why did you pressure WPATH to remove age restrictions then? How does that help children? Most gender non-conforming kids grow up to be gay. Stop transing gay kids. You are all complicit in homosexual conversion.” Ms Leggieri was removed from the room.
Richard Levine has no business making decisions on, or otherwise becoming involved with, trans issues, especially youth gender medicine. As a man who claims to be a woman, he has an irremediable conflict of interest that precludes his participation. It is already well known that gender affirming physicians have breached or are at risk of breaching their ethical obligation to do no harm. Richard Levine cannot be counted upon to act in the patient's best interests when those interests conflict with the aims of gender identity ideology.
In a separate vein, I have been struck recently by the realization that our institutions, including ones such as legislative and executive bodies, which are governed according to democratic principles, embraced and implemented applied gender identity ideology without adequate free and open public debate and public approval. It seems as if gender identity ideology arrived on the scene with a predetermined cast of heroes and enemies and a list of preconceptions that precluded free and open public debate. From the outset it wasn't a question whether schools, city councils, health care organizations, businesses and the rest would accept the attitudes, beliefs and practices that flow from gender ideology but when and how rapidly.
Hence, comments such as this one, which is quoted in this essay, do not come as a surprise:
"“The fact that the law and medicine of all professions fell to this [gender ideology] is utterly shameful because they of all professions have their fundamental ethical foundation based upon evidence, so I think we should be afraid at how quickly and how far they fell… The only parallel I can think of is the satanic ritual abuse panic but even that did not have the worldwide scope of contagion and reach of gender identity [ideology]… [This swift and near complete institutional capture] should never have happened in the first place… "
Am I missing anything in my assessment of how gender ideology suddenly came to be everywhere all at once?
By now those institutions are fortresses that protect gender ideology from its critics. There seems to be no way for sex realists even to get a hearing. We've seen how trans allies in at least one medical association have manipulated the rules of governance to block sex realists from making their case to the membership. A judge hearing a challenge to the participation of boys who identify as girls in girls' sports has prohibited the girls' attorneys from referring to the boys as boys in his court room. I can't make any headway in my effort to make a health care organization stop reporting that I have a gender identity or that my sex was "assigned at birth." A queer reporter at The Washington Post recently misrepresented the case for banning boys from girls' teams egregiously.
I am better at describing problems than crafting solutions for them. I'm not convinced that exposing the public to the facts about the excesses of gender ideology activism will lead to reforms. What's certain is that gender identity ideology will only become more entrenched if we sex realists don't get the facts and the arguments against gender ideology before the public.
Thank you!
This is a great summary for those of us who could not attend! Also, it is great to have so many key points in one place to share.
For more about what happened at the aap with adm. Rachel Levine there is also a write up by Ben Ryan:
https://benryan.substack.com/p/stop-transing-gay-kids-biden-admin