Author’s note: This is Part Seven of a seven-part series about transgenderism. Nothing in the series is intended to disparage any transgender person, any gender non-conforming person, or any person attracted to members of the same sex. I write as a developmental biologist (Berkeley PhD), and I focus on evidence pertaining to transgender treatments for children.
WARNING: Parts of this series contain explicit language. Reader discretion is advised.
Teens who suffer from gender dysphoria are at much higher risk for suicide than other teens. Transgender advocates argue that the Dutch Protocol reduces this risk. Indeed, some advocates claim, “puberty blockers save lives.”
In 2019, psychologists Richard Bränström and John Pachankis published a study of 9,747,324 Swedes. The goal was to determine whether “gender-affirming [cross-sex] hormone and surgical treatment” improved the mental health of people with gender incongruence.
Bränström and Pachankis found no evidence of improvement from cross-sex hormones. But they concluded that the evidence “lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.” Critics objected that this conclusion was not warranted by the data. So the authors revised their article. The journal editor published a correction, stating that “the results demonstrated no advantage of surgery.”
The 2019 study involved transgender adults. What about children with gender dysphoria?
Puberty Blockers and Suicide
A 2020 study surveyed 20,619 transgender Americans between 18 and 36. They were asked if they had ever wanted puberty blockers as adolescents. About 17 percent said yes. Of these, only 2.5 percent actually received the medication. The goal of the study was to compare “adult mental health outcomes” of those who received puberty blockers with those who wanted them but didn’t get them. The authors adjusted the data to account for age, biological sex, and household income, among other things. They concluded that giving puberty blockers to teens who want them reduces the risk of suicidal thoughts.
The journal that published the 2020 study also published some comments about it. One comment, by pediatricians Scott Field and Den Trumbull, was very critical. They pointed out that the data were collected by survey. So “there is no way of knowing how many would-be participants in either group actually succumbed to suicide.”
Even worse, the adjusted data showed that those who received puberty blockers fared worse than those who didn’t. Field and Trumbull pointed out that the first group “actually had double (45.5 percent versus 22.8 percent) the rates of the control group for serious (resulting in inpatient care) suicide attempts.” The two pediatricians concluded, “The prevailing narrative that these interventions are necessary to prevent suicide is without reasonable evidence.”
A total of 6,793 people visited the gender clinic of the Vrije Universiteit Amsterdam from 1972 to 2015. A 2018 study reviewed their medical records for regrets about having “bottom surgery.” About 0.6 percent of the males regretted having their testicles removed. About 0.3 percent of the females regretted having their ovaries removed.
This evidence seems to suggest that regret is rare. But the evidence comes only from medical records kept by the professionals who recommended and performed the sex reassignments. How likely is it that sex-reassigned people would later report their regrets to those professionals? We don’t know. How much follow-up did those records include? We don’t know. So the quantitative evidence pertaining to regret is quite thin.
Yet there is growing anecdotal evidence for it.
American business executive Walt Heyer married in his mid twenties. He and his wife had two children. Yet for years he had secretly suffered from gender dysphoria. As a young boy his parents would often leave him with his grandmother. She started putting dresses on him when he was four (sound familiar?). When his parents found out they removed him from her care. But when he was seven his uncle sexually abused him. He told his parents, but they didn’t believe him.
In 1983, after 16 years of marriage, Heyer went to see a gender therapist. On his second visit, the therapist gave him a prescription for estrogen. The therapist also gave him an authorization for sex-reassignment surgery. He trusted the therapist, so he divorced his wife and had sex-reassignment surgery soon afterwards. He lived eight years as a woman, but he regretted having transitioned. At the age of fifty he “de-transitioned.”
According to Heyer, “experts” who encourage transitioning tend to ignore those who decide to de-transition. So Heyer has become an advocate for those who regret having transgender surgery. He says the numbers are growing. In 2019, he wrote about a young man who had visited a transgender specialist at the age of 15. As soon as he turned 18, the young man underwent sex-reassignment surgery.
A year later, he told Heyer, “Now that I’m all healed from the surgeries, I regret them. The result of the bottom surgery looks like a Frankenstein hack job at best, and that got me thinking critically about myself. I had turned myself into a plastic-surgery facsimile of a woman, but I knew I still wasn’t one. I became (and to an extent, still feel) deeply depressed.”
Summary and Conclusion
Over 99.98 percent of human babies are born unambiguously male or female. The idea that the other 0.02 percent should routinely have genital surgery was promoted by sexologist John Money. The idea that “gender” is different from biological sex also owes its popularity to John Money. The idea resulted in tragedy for David Reimer, though Money never publicly admitted it.
Although gender dysphoria is a mental disorder, common treatments are social, hormonal, and surgical. Children entering puberty are told they should take puberty blockers. But almost all of those who take puberty blockers move on to cross-sex hormones. And most of these move on to sex-reassignment surgeries.
Understanding the cause(s) of a condition is helpful in knowing how to treat it. Yet we do not understand the cause(s) of childhood gender dysphoria. Children suffering from it are at greater risk of suicide than others, but there is no convincing evidence that hormonal and surgical treatments reduce the risk.
Conclusion: Children with gender dysphoria need help. But transgender treatments for them are not based on good evidence. They are a giant step in the dark.