Too young to know their Gender? Constancy research in trans children

January 27, 2018January 27, 2018 / growinguptransgender / 2 Comments

The perception that trans children are ‘too young’ to know their gender identity is used as a basis for denying them a suite of rights, and has long been a corner stone of arguments against social transition or timely provision of puberty blockers.

Cisgender (not trans) children are generally considered to know if they are a boy or a girl by a young age. But, not so for transgender or gender questioning children, according to the latest paper written by experts from the UK Children’s Gender Service, including the head of service Carmichael.

Costa, R. Carmichael, P.; Colizzi, M. (2016) To treat or not to treat: puberty suppression in childhood-onset gender dysphoria Nature Reviews Urology 13, 456–462 (2016)

UK Children’s Gender Service experts’ view of Gender Constancy

The Costa (2016) paper has a section on gender identity development. It states that “research has shown that around the age of 3 years, children show a basic sense of self as male or female, owing to their inner experience of belonging to one gender”.

It goes on to note:

“Some research suggests that a developmental lag exists in gender constancy acquisition in children with gender variant behaviour” (reference number 16).

According to the paper “achieving gender constancy represents a cognitive-developmental milestone in gender identity development and is due to the understanding that being male or female is a biological characteristic that cannot be changed by altering superficial attributes, such as hairstyle or clothing”

The belief in trans children having a ‘developmental lag’ in gender constancy leads to this statement “treating prepubertal individuals with gender dysphoria is particularly controversial owing to their unstable pattern of gender variance compared with gender-dysphoric adolescents and adults”

The belief in trans children having ‘a developmental lag” in gender constancy feeds directly into the Tavistock’s treatment protocols, such as proposing puberty suppression only be prescribed to those aged at least 12 “safely above the gender constancy achievement”.

Only one reference is provided for the claim that transgender children achieve ‘gender constancy’ later than cisgender children, reference 16, which is the source of this key statement:

“Some research suggests that a developmental lag exists in gender constancy acquisition in children with gender variant behaviour (reference 16)

If this single reference underpins the Tavistock’s belief that trans children do not understand their gender at the same age as cisgender children, and if this claim has direct implications on the Tavistock’s approach to treating trans children, then it is vital we review this paper.

The paper in question is:

Zucker, K. J. et al.(1999) Gender constancy judgments in children with gender identity disorder: evidence for a developmental lag. Arch. Sex. Behav. 28, 475–502 (1999).

Zucker (1999)

Gender constancy in the Zucker paper is defined as “the understanding that ‘superficial’ or surface transformations in gender behaviour such as activity preferences or clothing style” do not change a person’s gender. The paper concludes that children referred to a Gender Clinic for ‘problems in identity development‘ have a ‘developmental lag in gender constancy‘. This conclusion merits further scrutiny.

Zucker et al.’s study focuses on a group of children who were referred to the Toronto Gender Clinic between 1978 and 1995.

The majority of the Gender Clinic children in this study were assigned males (207/236 = 88%). There were a small number of assigned females in the sample (12%). In order to simplify this blog post I have decided to focus the examples throughout on assigned males (noting that this editorial simplification perpetuates historical erasure of trans boys / assigned females).

The children registered at the Gender Clinic I will hereafter refer to as the ‘clinical sample’, to contrast with the study’s ‘control sample’ (a sample of children of the same age who were not registered at the gender clinic and were not known to have any gender issues).

It is known (and acknowledged in Zucker’s paper) that some of the clinical sample of assigned males were non-conforming boys rather than trans girls. How many were gender non-conforming (GNC) rather than trans is unknown as historical diagnoses focused on behaviour and interests more than on identity and Zucker did not believe in distinguishing between young gender non-conforming boys and trans girls.

The children in the clinical sample, together with a control group (aged 4-8 – average age 6 and a half) were put through three different types of test, which they either ‘passed’ or ‘failed’.

Zucker 1999, the tests

We will now look at the three tests, and see whether they do provide convincing evidence that transgender children (or children treated in the gender service) have a ‘developmental lag’, and understand their gender identity later than cisgender children.

Zucker 1999: Test 1: Slabey & Frey test

Test 1 Part A focused on Gender Discrimination

The children were shown dolls and photographs depicting a boy, girl, man, woman and asked to identify them. The children ‘passed’ if they got at least 12 out of 16 ‘correct’. 93% of the clinical sample ‘passed’ this test, compared to 98% of the control group.

Test 1 Part B: Gender Identity

The children were asked their own gender. The assigned-male-at-birth (amab) children ‘passed’ the test if they answered ‘boy’.

93% of the clinical sample ‘passed’ this test compared to 98% of the control group.

(The very high ‘pass’ rate for the clinical sample at first glance seems high as transgender children like my daughter would certainly ‘fail’ this test.

Perhaps the high ‘pass’ rate may add weight to suggestions that a large proportion of children referred to the Toronto gender clinic in the 1970s, 1980s and early 1990s were there for gender non-conformity (proto-gay cure….) rather than children with a gender identity different to their assigned sex.

The fact that a trans girl was considered to have ‘failed’ in her understanding of gender identity if she said she was a girl is an indication of the bias of the researchers.

Test 1 Part C: Gender Stability

The children were asked if their gender can change over time, for example if they were a different gender when they were born to their current gender. The children ‘passed’ if they said gender can never change over time.

80% of the clinical group ‘passed’ compared to 92% of the control group

Test 1 Part D: Gender Consistency

The amab children were asked questions like ‘if you wear a dress, are you a girl?’ ‘If you played with a doll would you be a girl?’. (the exact script, and the exact phrasing, is not provided so we cannot be sure exactly how the questions were worded)

66% of the clinical sample ‘failed’ this test, by stating that playing with dolls makes you a girl.

46% of the control group also ‘failed’, also thinking that playing with a doll made you a girl.

The fact that nearly half the control also think playing with a doll makes you a girl seems more an indication of the segregated and gendered restrictions on toys of Canadian children in the 70s, 80s and early 90s than any conclusion about gender identity. Given very few of the clinical group identified as trans in this study, it also brought to mind the limited freedom for boys to be feminine or play with perceived girls toys, and made me wonder how many assigned males had been told to ‘stop being a girl’ when playing with dolls or putting on a dress.

Zucker 1999 Test 1 – Conclusion

The data from test 1 parts A-D, and the fact that the clinical sample had a slightly lower ‘pass’ rate than the control sample, was interpreted by Zucker et al. as evidence that children at the gender clinic were more ‘confused’ about gender.

The researchers then take a further leap of faith, into a conclusion that the lower pass rate of the clinical group compared to the control group implied a ‘developmental lag’ in understanding of gender. However, the clinical sample and the control sample were the same age (ages 4-8, average age 6.5), and the clinical sample were not re-tested at a later point in time. How therefore can they claim a developmental lag? It is simply not possible to claim a ‘developmental lag’ based on this data. The assertion of a ‘developmental lag’ (with the implication that the clinical sample reach a similar level of understanding but at a later age than children not referred to a gender clinic) is pure speculation/fabrication.

Test 1 provides zero evidence that transgender children (those with a consistent, insistent, persistent identity different to their assigned sex) have a delayed understanding of gender.

Zucker 1999: Test 2 Boy-Girl Identity Test

The assigned male children were then shown a drawing of a boy. They were asked to give the child in the drawing a name. If they chose a girl’s name for the drawing they were corrected and given a boy’s name, eg ‘this is Tom’.

Zucker 1999 Test 2 Part 1:

The children were asked ‘If Tom really wants to be a girl, can he be a girl?’.

The children ‘fail’ this test if they say yes Tom can be a girl.

32% of the clinical sample ‘fail’ this task by stating Tom can be a girl vs 21% of the control group

(Interestingly there is not a huge difference between the clinical group and the control group, with 21% of the control group, children with no gender issues, thinking that yes, Tom can be a girl – Canadian 5 year olds from the 1970s, 1980s and early 1990s showing more sophisticated understanding of gender than their specialists…)

The children are asked to give a reason for their answer, and are defined as having reached ‘operational constancy’ if they justify their answer ‘No Tom can’t be a girl’ answer with the justification ‘because he was born a boy’.

This unethical line of questioning Zucker et al put trans children through is a form of coercive persuasion, tantamount to brainwashing, where the ‘wrong answer’ is corrected with the ‘right answer’ – ‘BECAUSE TOM WAS BORN A BOY’ until the child submits and agrees.

Zucker 1999 Test 2 Part 2:

A dress and or long hair is added to the picture of ‘Tom’ and the children are asked ‘If Tom puts on a dress, is he a girl?’ The expected ‘correct’ answer is ‘No’ and the expected justification is ‘because he was born a boy’.

71% of the clinical group ‘fail’ this test, as do 64% of the control group.

Again the control group is pretty similar to the clinical group in their openness to the possibility of Tom being a girl.

Zucker 1999 Test 2 Conclusion

Zucker 1999 Test 2 provides no evidence of a ‘developmental lag’ in understanding gender for trans children.

Zucker 1999 – Test 3 looks at ‘sex-typed behaviour’

Zucker 1999 Test 3 Part 1 asks children to draw a person, and then asks them if the person they have drawn is a boy or a girl.

The assigned male at birth children ‘pass’ if they opt to draw a boy and ‘fail’ if they opt to draw a girl.

66% of the clinical sample ‘fail’ by drawing a girl (in case of the assigned males). 54% of the control sample also ‘fail’ this test by drawing a girl (in case of the presumed cis boys).

Again the results of the control are fairly similar to the clinical group.

Again there is no evidence of trans children having a developmental lag in understanding gender.

Zucker 1999 Task 3 Part 2 has the children watched through a 1-way mirror in a room with ‘gender specific’ toys and or clothes and the researchers assess the amount of time the children spend with ‘appropriately gendered toys or clothes’. They are deemed to have ‘failed’ if they play too much with the ‘wrong’ gender toys or clothes.

This task has no place in today’s society in which children are not constrained by outdated gender stereotypes.

Zucker 1999 Task 3 Part 3 assesses what it calls ‘affected confusion’, assessing a child’s ‘desire’ to be a boy or a girl (rather than their identity). It asks assigned males (who have been referred to a gender clinic for non-conforming behaviour) questions like ‘is it better to be a boy or a girl’ and ‘do you ever wish you were a girl’. Assigned males are deemed ‘deviant’ if they state any wish to be a girl (perhaps because they are a trans girl or perhaps because they are a non-conforming boy who wants to be able to play with his dolls in peace without being taken to Dr Zucker every month/week…). Assigned males are also deemed ‘deviant’ if they acknowledge anything positive about girls or think that there are any ways in which it is better to be a girl than a boy.

64% of the clinical group are labelled ‘deviant’ due to their answers in this part, as are 50% of the control group (reminder the control group are ‘random’ children not being seen by the gender clinic and who are not known to have any gender issues and yet half are deemed by this test to be ‘deviant’).

Zucker 1999 Test 3 Conclusion

What on earth is going on, and how the heck is this research still being quoted in a 2016 journal article by the leading experts at the UK’s Children’s Gender Service!

The high ‘failure’ and ‘deviancy’ rate’ not only in the clinical group but also in the control group is perhaps indication that Canadian 5 years olds in the 70s, 80s and early 90s were did not have such ingrained stereotypes of gender, nor sexism, nor misogyny, as the ‘gender specialists’ who subjected them to such awful tests.

The Zucker 1999 article ends with a ‘blame the parents’ conclusion, proposing that parents of gender non-conforming boys or trans girls must have ‘actively’ encouraged ‘cross-dressing’ or appeared to ‘tolerate’ cross-gender behaviour. It highlights a view that “parental reinforcement of same-sex play was positively related to gender constancy in pre-schoolers”. It is pure ‘drop-the-barbie’ Zucker, more focused on installing out-dated gender conformity in non-conforming boys than any concern for how to help children who may be transgender.

Zucker 1999 in summary

To summarise, the Zucker 1999 research is deeply outdated, transphobic, stereotyped, homophobic, normative and unethical.

The clinical sample is known to contain at least some children who are non-conforming rather than trans and no effort is made to focus specifically on trans children.

The difference in answers between the clinical group and the control group are very small (the paper conducts regression analysis on a wide number of variables until it finds some that are considered statistically significant – this is an unsound approach to valid statistical analysis).

The study looks at a range of things that do not relate to gender identity (including toy preferences).

And most critical of all – the paper looks at the children at one moment in time – comparing the clinical group to a control group of children the same age (age range 4-8). There is no follow up at a later age and no comparison of children of different ages. Any claim to transgender children having a developmental lag (which I interpret to mean achieving a similar understanding of gender at a later age) is pure fabrication.

Given the obvious weaknesses of the the Zucker paper – why is it a core reference in the 2016 Costa paper from leading experts of the UK Children’s Gender Service

UK Children’s Gender Service

There are three major problems with the Tavistock’s view of gender constancy as shown in the Costa 2016 paper.

Problem 1 – Quoting fabricated conclusions as though evidence

The Costa 2016 paper states “Some research suggests that a developmental lag exists in gender constancy acquisition in children with gender variant behaviour”, referencing the Zucker 1999 paper.

As we’ve seen above, the Zucker 1999 research does not provide any evidence for this claim.

Problem 2 – Broadening the relevance of those unsound conclusions and applying them to clinical practice

The Zucker paper mentions a ‘developmental lag’, but does not mention any age at which transgender children reach ‘gender constancy’.

The Costa 2016 paper moves beyond even the conclusions claimed in Zucker 1999, taking a series of assumptions to extrapolate wider conclusions (for which no specific reference is provided). They move from the idea of ‘a developmental lag in gender constancy’ to the claim that “children with gender dysphoria are more likely to express an unstable pattern of gender variance”. They move from that unsupported statement to the claim that “treating prepubertal individuals with gender dysphoria is particularly controversial owing to their unstable pattern of gender variance compared with gender-dysphoric adolescents and adults”. And they shift further to arrive at the final statement that puberty suppression is unwise until at least age 12 “safely beyond the age of gender constancy”. It is important to recall that Zucker 1999 provides no information on the age at which trans children ‘achieve gender constancy’ and focuses on children aged 4-8 (where the Costa paper get the age 12 figure from for gender constancy is anyone’s guess).

The Zucker 1999 research bears no relevance to the question of whether trans children understand their gender. Yet Costa et al 2016 use this study as their basis to suggest that transgender children do not know their gender. They use it to support an argument that transgender children have ‘unstable gender variance’ up until puberty, and they extend this to argue against pubertal suppression for those starting puberty under the age of 12.

Problem 3 – Omitting reference to critical recent research

The third, and perhaps the biggest error, is one of omission. The Costa 2016 paper, in its section on gender identity development / gender constancy in transgender children, only mentions the Zucker research, omitting mentioning any other research on transgender children’s gender identity.

The Zucker 1999 research paper is now 19 years old. Surely in the last two decades there has been some other research on the gender identity of transgender children, ideally research that makes an effort to focus on transgender (rather than gender non-conforming) children, and research that focuses on the children’s gender identity rather than toy preference? The answer is a clear yes. There are important studies on this topic that the Costa 2016 paper fails to even mention.

So let’s take a brief review of recent research on this topic which are noticeable by their absence:

New research on transgender children’s gender identity

Olson 2015

Olson, K.; Key, A.; Eaton, N. (2015) Gender Cognition in Transgender Children Psychological Science OnlineFirst, published on March 5, 2015

The introduction to the Olson el al 2015 paper describes historical (and current) scepticism to the idea of transgender children knowing their gender:

“This scepticism takes many forms: concerns that these children are “confused” and that they therefore need therapy, that these children are “delay[ed]” in their understanding of gender in part because of the behaviour of their parents (Zucker et al., 1999: Gender constancy judgments in children with gender identity disorder: evidence for a developmental lag), or that these children are merely saying they are the “opposite” gender, much as they might say on any given day that they are a dinosaur or princess.”

Olson et al.’s research aimed:

“to investigate whether 5- to 12-year-old prepubescent transgender children (N = 32), who were presenting themselves according to their gender identity in everyday life, showed patterns of gender cognition more consistent with their expressed gender or their natal sex, or instead appeared to be confused about their gender identity.”

Results:

“When the transgender children’s responses were considered in light of their natal sex, their responses differed significantly from those of the two control groups on all measures. In contrast, when transgender children’s responses were evaluated in terms of their expressed gender, their response patterns did not differ significantly from those of the two control groups on any measure.”

Conclusion:

“Using implicit and explicit measures, we found that transgender children showed a clear pattern: They viewed themselves in terms of their expressed gender and showed preferences for their expressed gender, with response patterns mirroring those of two cisgender (nontransgender) control groups. These results provide evidence that, early in development, transgender youth are statistically indistinguishable from cisgender children of the same gender identity.

Our findings refute the assumption that transgender children are simply confused by the questions at hand, delayed, pretending, or being oppositional. They instead show responses entirely typical and expected for children with their gender identity.

The data reported here should serve as evidence that transgender children do indeed exist and that their identity is a deeply held one.”

See here for background and further details

Fast 2017

Fast, A & Olson, K. (2017) Gender Development in Transgender Preschool Children, Child Development

Abstract:

“An increasing number of transgender children—those who express a gender identity that is “opposite” their natal sex—are socially transitioning, or presenting as their gender identity in everyday life. This study asks whether these children differ from gender-typical peers on basic gender development tasks. Three- to 5-year-old socially transitioned transgender children (n = 36) did not differ from controls matched on age and expressed gender (n = 36), or siblings of transgender and gender nonconforming children (n = 24) on gender preference, behavior, and belief measures. However, transgender children were less likely than both control groups to believe that their gender at birth matches their current gender, whereas both transgender children and siblings were less likely than controls to believe that other people’s gender is stable.”

Summary

So what do we know about gender constancy/ gender identity in transgender children?

We know that some claims are balderdash (junk science):

The Zucker 1999 study holds no value in informing us about the gender identity development or constancy of transgender children.
The statement “a developmental lag exists in gender constancy acquisition in children with gender variant behaviour” is unsubstantiated and shouldn’t be quoted in future articles
Conclusions in the Costa (2016) report on “children with gender dysphoria are more likely to express an unstable pattern of gender variance” and “treating prepubertal individuals with gender dysphoria is particularly controversial owing to their unstable pattern of gender variance compared with gender-dysphoric adolescents and adults” are unsubstantiated and should be disregarded
Policy recommendations in the Costa (2016) report on withholding pubertal suppression until “at least the age of 12, safely beyond the age of gender constancy” are unsubstantiated and should be disregarded

We know that recent research (Olson 2015 and Fast 2017) shows that:

“Transgender children do indeed exist and their identity is a deeply held one.”
“Three- to 5-year-old socially transitioned transgender children did not differ from controls or siblings on gender preference, behaviour, and belief measures.”
“Transgender children aged 5-12 viewed themselves in terms of their expressed gender and showed preferences for their expressed gender, with response patterns mirroring those of two cisgender control groups.”
“These results provide evidence that, early in development, transgender youth are statistically indistinguishable from cisgender children of the same gender identity.”
Research “findings refute the assumption that transgender children are simply confused by the questions at hand, delayed, pretending, or being oppositional. They instead show responses entirely typical and expected for children with their gender identity.”

Trans power

January 27, 2018January 27, 2018 / growinguptransgender / Leave a comment

We were pleased to be recognised on Metro’s trans power list (@DadTrans)

Trans Power List: Top Activists and Influencers

But with the greatest love and respect to all the wonderful advocates on that list (and to the far greater number of amazing advocates who were not on that list) that has got to be the Worst Power list ever!

Where are the trans MPs?

Where are the trans judges?

Trans newspaper editors?

Trans media barons?

Trans billionaires?

The fact that a UK trans power list includes cis parents who blog and tweet anonymously is a great indication of where the power currently lies.

Unless we just haven’t yet been initiated into the ‘all powerful trans lobby’……

(hint hint can we join the secret lobby already?)

Happiness can wait

January 22, 2018January 22, 2018 / growinguptransgender / 1 Comment

Since 6-year-old Jazz Jennings appeared in a 2007 US documentary, the social transition of young transgender children has rarely been out of the media. With increasing awareness accompanied by increasing evidence of the mental health benefits of acceptance and affirmation, more parents across the world are supporting their transgender child to socially transition.

A social transition is defined by the American Academy of Pediatrics thus:

“COMMON STEPS IN SOCIAL TRANSITION

For children of any age, gender transition means allowing the child to choose how they express their gender. Children may:

Wear clothing that affirms their gender, such as skirts for transgender girls

Adopt a hairstyle that affirms their gender, such as a short haircut for transgender boys

Choose a name that affirms their gender

Ask others to call them by pronouns (such as “he” or “she” or “they”) that affirm their gender

Use bathrooms and other facilities that match their gender identity”

Social transition is completely reversible if the child determines it’s not right for them.”

Some ‘experts’ in Europe, in opposition to experts in North America and Australia, caution against social transition. A example of a European ‘expert’ cautioning against social transition is a 2017 Swedish publication on transgender children by Louise Frisen et al:

The Frisen article has some positive sections, but it does also include some outdated statements that I am weary of reading in journal articles:

“Follow-up studies show that no more than about 20 percent of pre-puberty children who meet diagnosis criteria for sex dysphoria will have a residual desire for gender confirmation [6-8].”

And I was shocked to see this recommendation:

“Restraint for the younger with early social transition

Since no more than about 20 percent of prepubertal children who meet gender diagnosis criteria will have a residual desire for gender confirmation [6-8], the recommendation for the younger children is restraint regarding early social transition (living as the perceived gender). It is important to discuss the social consequences and to be aware that the majority of the younger children will not have a remaining desire for gender confirmation.”

The recommendation against social transition, and the two statements quoted above rely on just three sources:

Drummond KD, Bradley SJ, Peterson-Badali M, et al. A follow-up study of girls with gender identity disorder.Dev Psychol. 2008: 44 (1): 34-45

Steensma TD, Biemond R, de Boer F, et al. Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study. Clin Child Psychol Psychiatry. 2011: 16 (4): 499-516

Wallien MSC, Cohen-Kettenis PT. Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry. 2008: 47 (12): 1413-23.

The above reference 6 (Drummond) and reference 8 (Wallien) are two discredited studies on desistance that have been widely criticised see here

Reference 7 (Steensma) is a study with totally unreliable conclusions, as discussed here:

The Swedish paper contains no acknowledgement that the data it quotes on the number of transgender children continuing to be transgender as adults are highly contested and could be completely wrong as discussed here

I am so tired of seeing these same unreliable (unscientific, unethical, unsound, shambolic) studies trotted out time and again in journal articles.

Parents of transgender children do not normally have the time, the access to the referenced literature (in inaccessible / expensive academic journals) or the capacity to fact check the advice they are given. And they should not have to. This is literally the job of the supposed experts writing papers like this latest Swedish one. The reliance on discredited studies and conclusions is deeply worrying.

And the advice against social transition can cause serious harm.

he Swedish study advising against social transition is worrying, not only due to the inclusion of unreliable/discredited research in their paper as discussed above, but also due to the exclusion of critical information that Swedish parents (and those caring for Swedish transgender children) have a right to know such as research demonstrating the benefits of social transition, and the positions of world leading experts from the American Academy of Pediatrics and ANZPATH, both of whom endorse social transition.

The Swedish paper does not mention the latest research study from Olson in the United States showing that socially transitioned and supported children have higher levels of mental well being than children who are living as their natal sex:

“Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group. Especially striking is the comparison with reports of children with GID; socially transitioned transgender children have notably lower rates of internalizing psychopathology than previously reported among children with GID living as their natal sex.”

The Swedish paper fails to mention the guidance from the American Academy of Pediatrics that social transition is positive:

“In many cases, the remedy for dysphoria is gender transition: taking steps to affirm the gender that feels comfortable and authentic to the child. It is important to understand that, for children who have not reached puberty, gender transition involves no medical interventions at all: it consists of social changes like name, pronoun and gender expression.

While acceptance and affirmation at home can help a great deal, children do not grow up in a vacuum, so even children with supportive families may experience dysphoria. Nonetheless, families and doctors of transgender children often report that the gender transition process is transformative — even life-saving. Often, parents and clinicians describe remarkable improvements in the child’s psychological well-being.

The American Academy of Pediatrics describes social transition as “transformative – even life saving”. They continue:

A child’s gender transition is almost always a positive event. Often, the child’s debilitating gender dysphoria symptoms lift, diminishing difficult behavior that came with them. Dr. Ehrensaft calls this the ex post facto (“after the fact”) test: a dramatic reduction in stress, and blossoming happiness for the child and family, indicate that social transition has been the right choice. Along with joy at this renewed well-being, families are often thrilled to find that gender transition removes the emphasis on gender in a child’s life. With their gender identity no longer in conflict, the child can focus on the important work of learning and growing alongside their peers. Many children feel relief, even euphoria, that the adults in their life have listened and understood them.

This describes exactly our experience. Over night our daughter went from incredibly sad and distressed to a happy, carefree child. She went from wanting to talk about gender every single night to completely losing interest in the topic once the world was set to rights as we had accepted her as a girl.

The American Academy of Pediatrics are also very clear why those who, like the Swedish experts, advocate for delayed transition for all children, are wrong:

Delayed Transition: Prolonging Dysphoria

“delayed transition prohibits gender transition until a child reaches adolescence or even older, regardless of their gender dysphoria symptoms.

There is evidence that both reparative therapy and delayed transition can have serious negative consequences for children”

Many children who are gender-expansive or have mild gender dysphoria do not grow up to be transgender — but these are not the children for whom competent clinicians recommend gender transition.”

Delayed-transition advocates treat unnecessary or mistaken gender transition as the worst-case scenario, rather than balancing this risk with the consequences of the delay.

Untreated gender dysphoria can drive depression, anxiety, social problems, school failure, self-harm and even suicide.

There is no evidence that another transition later on, either back to the original gender or to another gender altogether, would be harmful for a socially transitioned child — especially if the child had support in continuing to explore their gender identity.

While delaying a child’s gender exploration can cause serious harm, a deliberate approach is wise. Some children need more time to figure out their gender identity, and some do best by trying out changes more slowly. For these children, rushing into transition could be as harmful as putting it off. The problem with “delayed transition” is that it limits transition based on a child’s age rather than considering important signs of readiness, particularly the child’s wishes and experiences. A gender-affirmative approach uses this broader range of factors, with particular attention to avoiding stigma and shame.”

For children with mild gender dysphoria, the family and therapist’s affirmation of their gender expansive traits often relieves their distress. For this group, it appears that gender dysphoria — and even a moderate desire to change gender — can result from trouble reconciling their masculinity or femininity with being a girl or boy. Adolescents affirmed in their gender-expansive traits are happier and healthier, whether or not they grow up to identify as transgender.

Other children have an insistent, consistent and persistent transgender identity; they thrive only when living fully in a different gender than the one matching the sex assigned at birth. In differentiating these children from the gender-expansive children described above, clinicians use two general rules: They focus on a child’s statements about their sex and gender identity, not their gender expression (masculinity or femininity), and they look for “insistent, consistent and persistent” assertions about that identity. Clinicians help these children and their families socially affirm the child’s gender identity.

The latest ANZPATH (Australian Professional Association for Transgender Health) provides similar clear, evidence based guidance for those supporting transgender children:

“Increasing evidence demonstrates that with supportive, gender affirmative care during childhood and adolescence, harms can be ameliorated and mental health and well being outcomes can be significantly improved.

Social transition should be led by the child and does not have to take an all or nothing approach.

Social transition can reduce a child’s distress and improve their emotional functioning. Evidence suggest that trans children who have socially transitioned demonstrate levels of depression, anxiety and self-worth comparable to their cisgender peers.

The number of children in Australia who later socially transition back to their gender assigned at birth is not known, but anecdotally appears to be low, and no current evidence of harm in doing so exists”.

Acceptance = love. Rejection = shame

Remember, social transition is a fully reversible change involving a change of pronoun, perhaps accompanied by a change of hair style, clothing, name. Nothing medical at all.

At its heart, a social transition is a clear message to a child that they are OK, that they are accepted, that they are not wrong or broken, that they are loved.

The Swedish study takes the view that there is a paucity of evidence, therefore children should not be supported to socially transition.

I agree that there is a paucity of rigorous long-term scientific studies on the outcomes for children who from an early age are supported and accepted.

What does exist is a whole heap of anecdotal evidence of the huge benefit of social transition. I personally know of over a hundred families for whom social transition has been transformational for their child’s happiness. Experts in Australia and America have found the same.

I have met scores of families whose only regret is that they did not embrace and support their child earlier. This includes our child. She was miserable every day – in acute distress. Since social transition she is one of the happiest children you can find. Loving school. Loving her friends. Having a wonderful childhood. Time and again from parents all over the world I hear the exact same story. A story that I hadn’t even heard before I lived it with my child.

From these very many happy socially transitioned children, I know of 2 cases where after a few years of social transition, the child has said to their parent, I want to try living as my assigned gender. In these small number of cases, a second social transition occurred that was no more difficult than the first social transition. At all stages a child needs to feel loved and accepted, that their family are listening to and respecting them. I know of a few more children who have grown into embracing a more nuanced or complex non-binary identity as they have got older (perhaps as they grow more aware of the existence of space between two binaries). Again – no known harm to those children whose understanding of their identity expands over time – as long as they are loved, cared for and accepted.

What is very well evidenced is the great harm that is caused when children are rejected, forced to live a lie, told that who they are is wrong or disturbed or shameful or unacceptable. The message trans girls learn quickly when their parents refuse to call them a girl.

Parents of transgender children know all too well that there is not enough useful research out there. We know that we have been deeply let down by past decades of research on transgender children that is not useful. Let down through the transphobia, homophobia, cis-het-normativity and or sheer incompetence of past researchers who failed to distinguish between trans and gender non-conforming children, and failed to explore which options would lead to the best outcomes for transgender children – including of course the option to affirm, love and accept them.

Much transphobic research continues in this vein. A few researchers, like Kristina Olson from the Trans Youth Project at the University of Washington, are now tracking the outcomes of socially transitioned, affirmed, supported children.

The initial results are very promising, with a number of recent research studies documenting evidence that trans children do know who they are, even young children, and that the outcomes for trans children who are loved and accepted as their identified gender are positive.

But proper science takes time.

These longitudinal studies will be of enormous help to the next generation of transgender children – those children who are not yet born. But my child cannot wait.

In the meantime, loving parents of transgender children have to make the best possible decisions based on the limited evidence that we have now.

As stated in the American Academy of Pediatrics Guide: Supporting Transgender Children (that I recommend reading in full):

“Not treating people is not a neutral act. It will do harm”

And in the guidance from ANZPATH Treatment Guidelines for Trans and Gender Diverse Children (summarised here):

“withholding of gender affirming treatment is not considered a neutral option, and may exacerbate distress in a number of ways including depression, anxiety and suicidality, social withdrawal”

The suggestion that ‘do nothing’ is even an option for parents of insistent, consistent, persistent transgender children is a mis-characterisation of life with a distressed child. As I describe in an earlier blog post

People say: “The best course of action would be for parents not to make any decisions at all”

This shows little understanding of what it is like to parent a transgender child.

Life is full of decisions.

Before making the extremely difficult and heart-breaking decision to support my child, for months I made the decision to say ‘I love you, but no, you are not a girl you are a boy’ and watched their sad face.

For months later, when they said ‘I am a girl’ I decided to change the subject or look away.

For months further I avoided directly calling them a boy but decided to sit in silence as others called them a boy and I watched their shoulders hunch in and the sad look of rejection on their face.

For months further I sat with them at bedtime as they cried and listened to them say ‘but I am a girl’ and I decided not to say ‘that is OK, we love you whatever’.

Life with a very insistent transgender child is full of difficult and painful and troubling decisions for a parent who cares deeply for their child.

Making a decision finally to say ‘that’s OK, we love you whatever’ was the latest in a very long line of decisions.

Which eventually moved on to ‘OK, we’ll call you a girl’, and ‘OK, we’ll help others to call you a girl’ and ‘OK, we’ll help others to understand you are a girl’.

We do not wake up one morning and think, wouldn’t it be fun to choose this incredibly hard and traumatic path for our children.

The above are my words from a couple of years ago. My perspective and understanding has shifted a great deal over the past few years and I no longer see being transgender as a negative or scary thing (though I dearly wish my child would not have to face a transphobic world or deal with prejudice and hate). But at the time I was ignorant and very afraid.

Parents do not consider supporting their child to socially transition on a whim. Take a look at the first 5 mins of this video in this link and see the experience of one American family.

Parents working up the courage to support their transgender child already have to overcome their own transphobia and ignorance (the vast majority of the cis parents I know knew nothing at all about trans children before our own child).

Parents working up the courage to support their transgender child already face extreme hostility from wider society. We already face social isolation and losing friends and family. It is not easy, even when a parent knows in their heart it is what their child needs.

Parents in this situation need ‘experts’ who understand what is at stake, who present all the facts and all recent research including the evidence in favour of social transition. We need experts who are willing to offer support and guidance to families and children for whom extended delay, extended rejection, extended denial of identity is cruelty to our transgender child.

To force children to live as their assigned gender, when doing so is causing them deep distress; to tell them to ‘wait until we have long term data’, when we know anecdotally how many children benefit from social transition, when we know zero evidence of harm, is gross negligence.

The ‘experts’ telling families to ‘wait until we have long term data on the outcomes for those socially transitioned children who we know are currently happy and thriving’ are telling parents to keep their child in a state of deep distress for no good reason. These ‘experts’ like this Swedish author have presumably not spent night after night holding a deeply distressed miserable child. They presumably have not watched their child shrink and lose all enjoyment of life. They also can’t have spent much time around children like mine who absolutely shine with happiness now that they have socially transitioned.

On one level, supporting a child to socially transition seems like the biggest, scariest, most inconceivable step in the world. And, at the time, for a family surrounded by a sceptical and transphobic community, it is.

But, on another level, it is just a change of pronoun. It is the smallest change in the world, and the biggest bargain out there. For this small change I got my happy child back. For this small change my child found love and acceptance instead of rejection and shame. For this small change my child got a carefree childhood full of games and play and friends and fun.

Yet “Just wait” they say.

Reminds me of this tweet from @charllandsberg:

It also brings to mind this quote from the inspirational Sarah McBride:

“When we ask people to wait patiently for their rights, we ask them watch their one life pass by without the dignity they deserve”

These children, children like my daughter, only get one childhood.

They can spend it happy, supported, loved and accepted –

or miserable, rejected, shamed.

We need to stop letting transgender children down.

Childhood is now.

Happiness cannot wait

Gender Recognition for Under 16s – Consultation on the Scottish Gender Recognition Act

January 18, 2018January 21, 2018 / growinguptransgender / 1 Comment

Scotland is currently holding a consultation on reforming their Gender Recognition Act. This proposes options to simplify the process for transgender people in Scotland to obtain full legal gender recognition (acquiring a Gender Recognition Certificate and amending their birth certificate).

This consultation seeks views on reforming the 2004 Act. The Scottish Government proposes to streamline the process for obtaining legal recognition and also to allow people aged 16 and over to apply. We are also seeking views about the options for people under 16 and for recognition of non-binary people.

We are inviting responses to this consultation by 5pm on 1 March 2018. 1.07. Please respond to this consultation using the Scottish Government’s consultation platform, Citizen Space. You can view and respond to this consultation online at: https://consult.scotland.gov.uk/family-law/reviewof-the-gender-recognition-act-2004.

Key information:

The consultation provides key information on the Gender Recognition Act. It is critical to note however that even without a Gender Recognition Certificate, transgender people are legally protected under the 2010 Equality Act and have rights to change identity markers in systems including schools, the NHS and their passports, and have the right to use facilities matching gender identity. The Gender Recognition Act is however the only route to updating a birth certificate.

“GRC” – a gender recognition certificate. Under the 2004 Act, a full GRC provides legal recognition of an applicant’s acquired gender. When a GRC is issued under the 2004 Act, the applicant’s legal sex also changes to male or female. ”

“The 2004 Act allows transgender people aged 18 and over to apply for legal recognition of their acquired gender and to change their legal sex accordingly”

The consultation considers two main models for gender recognition, the current system of an assessment model (where a doctor, psychologist and or court ‘evidences’ a person’s gender identity) or a self-declaration model (as already applied in Norway, Denmark, Malta, Colombia, Argentina, and the Republic of Ireland).

For an example of how this is working in practice, this article provides a useful overview of how a self-declaration based process is already in action in the Republic of Ireland.

I won’t focus here on the proposed options for how the gender recognition system will operate, but will instead give attention to eligibility based on age – namely whether trans youth and trans children are permitted to get a Gender Recognition Certificate and change their birth certificate.

Under 18s.

At present in Scotland, as elsewhere in the UK, trans youth and trans children under 18 are not eligible for a Gender Recognition Certificate, meaning under 18s cannot update their birth certificate. Trans children and youth are however given legal protections under the 2010 Equality Act, and already have the right to change their gender marker in almost all other documentation, without the need for a Gender Recognition Certificate (including a right to change their gender marker in their passport, and in systems including schools and the NHS) (*as with adults options for identity recognition for trans youth/children with non-binary identities are extremely limited).

The consultation questions:

The survey starts with 4 questions for how GRC should work for adults including:

Question 1 The Scottish Government proposes to bring forward legislation to introduce a self-declaratory system for legal gender recognition instead. Do you agree or disagree with this proposal?

16-17 year olds.

The consultation proceeds to focus on 16-17 year olds:

“The Scottish Government considers that people aged 16 or older should be able to apply for legal recognition of their acquired gender using the proposed self-declaration process.

4.05. There is clear evidence that people aged 16 do live full time in their acquired gender and want this to be legally recognised. For example, the Women and Equalities Select Committee heard evidence from LGBT Youth Scotland to this effect. In the Republic of Ireland, 8 people aged 16 and 17 have received a GRC31 after obtaining a court order permitting them to apply under their self-declaration system. The court in the Republic of Ireland is required to consider evidence about the young person’s transition to their acquired gender. ”

Question 5 The Scottish Government proposes that people aged 16 and 17 should be able to apply for and obtain legal recognition of their acquired gender. Do you agree or disagree?

It is curious that the report notes the “clear evidence that people aged 16 do live full time in their acquired gender and want this to be legally recognised” and yet in subsequent sections does not similarly note the existence of transgender children under the age of 16. Parents of transgender children, and other groups supporting transgender young people were perhaps overlooked in the preparatory consultations? This oversight makes it especially important that parents and supporters of transgender children and young people provide feedback during this consultation that transgender children do indeed exist, and those under the age of 16 both want and need full legal recognition. Inputs from any under transgender young people themselves might also be an important addition to this consultation.

Under 16s

The consultation moves on to consider under 16s:

“4.08. The Scottish Government’s view is that there is a careful balance to be struck in relation to people under 16. On the one hand, we should treat children with dignity and respect, giving weight to their views and wishes in line with their individual capacity. On the other hand, we should ensure that children have the right protection and care. 4.09. People who are under 16 years of age can act on their own behalf in relation to a range of matters. Annex E contains further information about this. The CRWIA at Annex M refers to research evidence about children who identify as transgender. 4.10. The Scottish Government considers that there are five broad options in relation to people under 16 being able to apply for legal gender recognition.”

The consultation proceeds to outline 5 potential options for transgender children under the age of 16. I’ve quoted these here in full, following which I’ve outlined my thoughts on each option:

Under 16s – option 1 – nothing for those under 16

4.11. Under this option, applicants would have to be at least 16 to apply for legal recognition of their acquired gender. This would be straightforward, but would stop those under 16 with a clear view of their gender identity from obtaining legal gender recognition.

Under 16s – option 2 – court process

4.12. Option 2 would be for Scotland to adopt a court based process.

4.14. Any court based process, whether instigated by a child’s parents or by the child themself, would focus on the assessment of the child’s welfare. We would also consider specifying the matters the court would have to have regard to in determining what was in the child’s best interests. 4.15. Under this option, a court action could be raised by the child if they had sufficient capacity to do so, or if they did not, by a person or persons who had PRRs (parental responsibilities and rights) for them acting on their behalf.

4.19. Malta has a court based process of legal gender recognition for those under 18. Those with parental authority for a child may file an application in the court. The court must consider the best interests of the child and give due weight to the views of the child depending on their age and maturity

4.20. In the Republic of Ireland, applications cannot be made by those aged under 16. However, applications by 16 and 17 year olds require to be accompanied by a court order permitting the application to be made. The court may only grant the order if the child’s parents, surviving parent or guardian consents. Two medical certificates must also be produced to the court. The medical certificates must confirm that: · the child has a sufficient degree of maturity to decide to apply for gender recognition; · the child is aware of, has considered and fully understands, the consequences of that decision; · the child’s decision is freely and independently made; and · the child has transitioned, or is transitioning to, their preferred gender.

4.21. Under option 2, a child who may not have reached puberty might apply to the court or a person with PRRs for such a child might apply.

Under 16s – option 3 – parental application

4.22. Option 3 would be to permit an application to be made on behalf of a person under 16 by someone with PRRs (parental responsibilities and rights) for them. Typically, this would be the child’s parents. Further information about PRRs, when parents get them and who else may have PRRs is in Annex F. 4.23. Usually, where more than one person has parental rights in relation to a child, each can exercise their rights without the consent of the other or any of the others.36 4.24. Where a person with PRRs is reaching a major decision regarding the fulfilling or exercise of PRRs, the person is under a duty to have regard to any views the child expresses, taking account of the child’s age and maturity. The person making the decision must also have regard to any views expressed by any other person with PRRs for the child concerned.37 The Scottish Government considers that seeking legal recognition in an acquired gender is an example of a major decision. 4.25. One possibility under this option would be to require the application to be made by all parents with PRRs for a child. This would mean that a person who had PRRs for the child but was not their parent would not require to be involved. However, we would still expect the person(s) applying on the child’s behalf to have regard to the views of such a person. 4.26. Another possibility under this option would be to require all people with PRRs to apply, not just a parent or parents with PRRs. This may mean that a local authority that had PRRs for a child would need to be involved in the application process. 4.27. If all the people who required to be involved in the application did not agree38, then a court order could be sought under existing arrangements. Section 11(1) of the Children (Scotland) Act 1995 allows the Sheriff Court or the Court of Session to make an order in relation to PRRs. The court could then make a decision based on the child’s welfare. 4.28. There are some children for whom no one has PRRs. One option might be for a person who has an interest to obtain PRRs from the court and then apply for legal gender recognition on behalf of the child.

4.30. In summary, therefore, under this option all parents with PRRs (or, perhaps, everybody with PRRs) would have to apply, having had regard to the child’s views. If there is a dispute amongst those with PRRs, an application could be made to the court to resolve the matter. There may be restrictions on the role of a person with limited PRRs. 4.31. Under this option, applications could be made on behalf of very young children, including both those who lack legal capacity and who have not reached puberty.

Under 16s – option 4 – minimum age of 12

4.32. Option 4 would permit children aged 12 and above to apply in the same way as those aged 16 or above

4.34. However, this option would take no account of a child’s capacity to take decisions nor their physical maturity.

4.36. The Scottish Government does not favour this option as it would allow a child to apply irrespective of their capacity to understand the nature and consequences of their decision.

Under 16s – option 5 – application by capable child

4.37. Option 5 would permit a person under 16 to apply in the same manner as an adult, provided they had capacity to understand the consequences of recognition in their acquired gender.

4.38. Under this option, someone would have to test the child’s capacity. This could potentially be done, for example, by a registered medical practitioner, or by a practising solicitor.

4.40. A person under 16 has legal capacity to instruct a solicitor, in connection with any civil matter, where the person has a general understanding of what it means to do so. Someone aged 12 or more is presumed to be old and mature enough to have such understanding.

The section ends with question number 6, which asks consultation respondents to state which of the 5 potential options for transgender children under 16 they most favour.

Question 6

Which of the identified options for children under 16 do you most favour? Please select only one answer.

option 1 – nothing for those under 16

option 2 – court process

option 3 – parental application

option 4 – minimum age of 12

option 5 – application by capable child

My response to the consultation

My initial thoughts to the above is as follows:

Option 1 – nothing for under 16s, is unacceptable. Many of our trans children are living as their identified gender from primary school, including changing their gender marker in other systems including on their passport. Why then should they have to wait until 16 to have who they are fully recognised in law? When they have been living for years with a passport and other markers in their gender identity, why should their birth certificate be out of sync? Inability to update birth certificate adds to stress for trans children that their identity will be unwillingly disclosed and presents to them the reality that the state does not fully respect them until adulthood. Trans children exist, and waiting until 16 or 18 for proper legal recognition is denial of basic rights for these young citizens.

Denying rights to under 16s is at odds with the recent WPATH (World Professional Association for Transgender Health) statement on identity:

“WPATH advocates that appropriate gender recognition should be available to transgender youth, including those who are under the age of majority,”

Option 2 – court process seems like an expensive, bureaucratic, stressful and unneccessary requirement. I would like to learn more from Ireland, who has a similar requirement for 16-17 year olds which is currently under review. Australia, which has just got rid of a requirement for trans youth to go to court for hormone treatment, provides a useful case study of this process.

CASE STUDY: Australian experience of a court based process

Australia until very recently required under 16s to go to court to gain approval for gender related medical care. Families and transgender children in Australia found the process of going to court stressful and upsetting. When one family were told that the requirement to go to court was being removed, one family reportedly “were unable to contain their tears of relief” with their child commenting “No longer will young transgender young people have to keep justifying who they were“.

World leading specialist in supporting transgender children, Dr Telfer, Director of the Gender Service at the Royal Children’s Hospital in Melbourne described the amount of time gender specialists were having to devote to guiding families through the court proceedings:

“Gender Clinic staff have had to spend considerable time on counselling families on what the court process would be like, Dr Telfer said.

“No-one wants to be in a courtroom. Usually it’s a place where you go when something is wrong.

The requirement for transgender youth to go to court was described as “costly, traumatic and unnecessary”.

The director of legal advocacy at the Human Rights Law Centre, Anna Brown, described the decision to stop forcing transgender children in Australia to go to court as a “stunning victory” for young transgender people.

“This will make a profound difference to the lives of many young trans people who will now be relieved of the burden of a costly and unnecessary court process”

“This bizarre legal anomaly was born of outdated attitudes to trans young people”

“Importantly, also, for the young people themselves, going to court can be hugely taxing,”

“This decision is a huge victory for so many young people and their families. The latest research shows that there are probably around 45,000 trans and gender-diverse young people in Australia, and this will save them enormous amounts of money, time and heartache.”

Australia has made the decision to move away from requiring transgender children to go to court. Why then would Scotland wish to impose this on Scottish trans children? Based upon the Australian experience, the Option 2 court process, is not the right decision for our children.

Option 3 – parental application seems instinctively a sensible option. With parental approval children like my daughter could get their identities fully legally recognised. This would however limit options for youth who do not have parental support, and such youth would either need to wait until 16 or would need to have recourse to an alternative option eg to the court option. I wonder whether there are many youth without any parental support for whom gaining a GRC pre 16 would be a major priority? I’d welcome feedback from trans youth or organisations working with trans youth.

Option 4 – minimum age of 12 is largely ruled out by the Scottish consultation, and I would agree that basing declaration on age, rather than capacity for decision-making, would be unworkable.

Option 5 – application by capable child is attractive in theory but I question how it would work in practice. It would require an administration layer including professional gate keepers, requiring our children to submit to an assessment, and I wonder who would be willing to test a child’s capacity for this purpose. This might result in a very small number of medicalised gate-keepers and subject to waiting lists, delays and arbitrary protocols. There’s also a very serious question about how to ensure such professional are able to assess a child’s capacity in a sensitive and appropriate manner – those of us with trans children are well aware of the level of transphobia and ignorance about trans children so common across the UK.

Seeking another opinion

I decided to reach out to the Scottish Trans Alliance who provided their view on the options for under 16s

Scottish Trans Alliance:

“We’re currently in favour of Option 3 – the ‘parental application‘ option – where under 16s would be allowed to change gender on birth certificate on submission of a simple statutory declaration with signed parental consent. This would mirror how name changes on official documents are already done for under 16s.

We think that if a young trans person under 16 has unsupportive parents then the most urgent problems they will be facing are likely to be whether they are safe from transphobic emotional abuse at home and whether they are able to wear clothes they want and use the verbal pronouns they want. We think that it is rare that a child under 16 with unsupportive parents will be in a confident and safe enough position to risk trying to change their birth certificate against the wishes of their parents.

We think that nearly all under 16s who have been able to successfully start living fully in their gender identity (and therefore are at the point where it would make sense to change their birth certificate to improve their privacy) will have at least one supportive parent. However, it is important that there is a way of ensuring that an unsupportive parent is not able to block the wishes of the young person and their supportive parent. If a court process is needed to resolve a family dispute about whether a young person should be granted a GRC, then we think the court ought to be obliged to uphold the wishes of the young person provided they have capacity to understand the consequences of legal gender recognition.

While Option 5 – the ‘application by capable child’ option – sounds on the surface like a more empowering option than parental application, we have concerns that it may lead to problematic gatekeeping by doctors/solicitors who could be scared to approve the capacity of individual trans young people. It could result in say a 13 year old with supportive parents having to try to prove their capacity to a trans-ignorant doctor only to be told they are too young to understand the consequences and that they have to wait as their parent can’t give consent on their behalf. That could be a very stressful and disempowering experience.

Not allowing under 16s to change the gender on their birth certificate leaves them at risk of schools not taking their gender identity and right to privacy of their gender history seriously. Under 16s usually don’t have bank accounts or many letters sent to them so proving their identity without showing a birth certificate is harder for under 16s than for trans adults. This means trans people under 16 are at greater risk than adults of privacy violation, and transphobic harassment as a result, due to their birth certificate outing them as trans. The intensity of media hostility and resulting negative social attitudes towards trans youth and their families makes privacy rights particularly essential.

Changing birth certificate would have no impact on ability to access hormone blockers but could make a life enhancing difference to moving to a new school without being outed.

It’s worth noting that parents of trans young people under 16 can already change their child’s gender on their passport and medical records so it makes sense to bring birth certificates into alignment with these other official documents.”

Preferred option

Having reviewed the proposed options, and consulted with other stakeholders, the best option for under 16s seems to be Option 3 – parental application.

Flawed research evidence underpinning the consultation

Before concluding, I would also like to share my views on the annexes to the consultation which contain some worryingly flawed ‘evidence’ that if accepted as presented could seriously undermine trans children’s rights.

The Scottish consultation document presents ‘research evidence’ on transgender children in annex M part 4.

ANNEX M: PARTIAL CHILD RIGHTS AND WELLBEING IMPACT ASSESSMENT

What research evidence is available?

4.1 There is evidence that children can experience incongruence between their assigned gender and their gender identity early in life. One study indicates the average age was 8.

4.2 There is a limited evidence base about whether children will continue to experience these feelings in the longer term. Follow-up studies indicate overall that for 85.2% of the children, their distress discontinued either before or early in puberty. 8 However, the rates in the individual studies varied widely. For instance, a 2008 study indicated that in 39% of children the feelings did continue beyond the onset of puberty9 whereas older studies from before 2000 had very much lower rates for children continuing to experience distress after the onset of puberty. It is thought that pre-2000 studies have included children who would not now be considered to be experiencing gender dysphoria. The studies may also be affected by the small clinical population of children with gender dysphoria – studies looking at whether gender dysphoric feelings persisted had a total population of 317 people.

Part 4.2 in particular misrepresents the current body of evidence and is danger of undermining the Scottish consultation through establishing a prejudicial approach to children gaining legal recognition.

It refers to two deeply flawed studies:

Ristori, J and Steensma T.D “Gender dysphoria in childhood” in International Review of Psychiatry, Gender dysphoria and gender incongruence, Vol 28, 2016 Issue 1.

Wallien and Cohen-Kettenis “Psychosexual outcome of gender-dysphoric children” Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1413–1423

We have previously addressed and demonstrated the lack of credibility of these exact studies here.

Conversely, new evidence, that has not been presented in the consultation Annex, suggests a very significantly higher rate of transgender children continuing to identify as transgender as adults and has been reviewed by us here.

4.3 There is also evidence that the more extreme a child’s gender dysphoria was before puberty, the less likely it was that their feelings will recede with the onset of puberty. For those who have reached puberty and continue to experience distress, evidence indicates that their distress then tends to intensify and that depression or self-harming behaviours are also more common in ages 12 and over. It is understood that physical changes caused by puberty may intensify the levels of distress experienced.

4.4 Available evidence suggests that factors arising around the ages of 10 to 13 may help explain changes in how a child feels about their gender: · the changes in social roles between boys and girls as their gender role become more distinct; · the anticipation or experience of physical changes as a result of puberty; and · their first experience of experiencing falling in love and discovering their sexual identity.

4.5. Evidence indicates that there is a difference of experience between boys and girls. 13 Although more boys are referred to gender identity clinics, some studies suggest that gender dysphoria is more prominent in girls.

Part 4.4 relies on one specific flawed study that absolutely does not evidence the claim presented here.

“Steensma T.D et al (2011) “Desisting and persisting gender dysphoria after childhood; A qualitative follow up study” Clinical Child Psychology and Psychiatry Vol16 issue 4”

There is no evidence in this single referenced study that a transgender child changes identity between the ages of 10 and 13 as misrepresented here. This is grossly misleading and risks undermining support for trans children in Scotland gaining legal recognition. We have previously discussed the flaws of this specific paper in some detail here.

4.6 There is evidence that transgender young people are more than twice as likely as non-trans people to be diagnosed with depression (50.6% compared to 20.6%14) and with anxiety (26.7% compared to 10%). There is evidence that this most likely arises due to their experience of discrimination, lack of acceptance, and the abuse they may face and is not an inherent feature of their being transgender. 15 There is also evidence that transition to living in their preferred gender and being supported with gender confirming medical interventions may help improve mental health, in many cases reaching levels experienced in the general population.

It is clear that discrimination and lack of acceptance is damaging to trans youth. The government has a responsibility to tackle this, including through enabling trans children like my daughter to gain full legal recognition. Not allowing full legal recognition to children also sends out a damaging signal to those children and to wider society that transgender children are not worthy of respect or rights.

4.7 Scottish Government officials met members of LGBT Youth Scotland groups aged 13 and over. Their view was that legal gender recognition must be made available to people younger than 16. A person should be able to transition and live in their acquired gender before they have to take their qualifications or go to university. They felt that this would better support their rights not to be discriminated against, for example, at school. A high proportion expressed the desire for their parents (or other people with responsibility for them) to be involved and supporting them through the recognition process.

4.8 LGBT Youth Scotland gave evidence to the Women and Equality Select Committee inquiry into Transgender Equality which setting out the views of transgender people aged under 1817 about the benefits of legal gender recognition in terms of reducing discrimination and improving their mental health.

There is a concerted effort in the UK, as elsewhere, to deny transgender people basic human rights. This campaign is particularly targeting transgender children, the most vulnerable of transgender people, and those with the least power and voice. It is critical that this consultation focuses on listening to transgender children and to those families who support them. Trans children are a small and very marginalised group, and their voices must not get lost in the wider consultation. It is not acceptable to tell transgender children that they have to wait until they are adults before they can be recognised in law.

Appendix A TRANSGENDER CHILDREN – EVIDENCE OF NUMBERS EXPERIENCING GENDER DYSPHORIA OR DISCOMFORT WITH THEIR ASSIGNED GENDER

Appendix A presents a confused view of the difference between transgender children, and children who are gender non-conforming. It alarmingly includes reference to studies from the discredited Zucker, and makes multiple references to “opposite sex behaviour”. It is worrying that a public consultation on gender recognition should have included such a muddled understanding.

Conclusion

Transgender children are one of the most marginalised, voiceless and powerless groups in society. I encourage all who care for transgender children to complete this consultation, and for question 6 I recommend selecting Option C – parental application.

Additionally, in the accompanying comments box for the consultation it would be useful to mention some basic facts:

a) transgender children exist

b) transgender children have legal rights and need legal recognition

c) transgender children face enough challenges, discrimination and hostility already – legal recognition should not be an additional burden for them

The consultation documents mention the “clear evidence that people aged 16 do live full time in their acquired gender and want this to be legally recognised” and yet are silent on on the existence of transgender children or their desire and need for full legal recognition under the age of 16 year.

This right, if enabled, would not be pursued by every transgender child. Parents would not take this option on a whim. This option would be most appropriate for transgender children who have already been living in their identified gender for many years, who likely already have all other identity documents including their passport updated to their identified gender. To deny these children full legal recognition until 16 is a gross betrayal of their rights.

Yet transgender children are one of the least powerful and most marginalised groups in our society. We know that transphobic groups are actively campaigning against the provision of rights to transgender children. The needs and the voices of transgender children may not be heard in this consultation.

It is vital that families of transgender children feed in to this consultation, including those outside of Scotland, making it clear that transgender children do indeed exist and do deserve full legal recognition. Inputs from transgender adults and allies who care for transgender children will also be critical, as supportive families of transgender children are already overwhelmed with the barriers we have to overcome to enable our children to get the rights and the protections that other children take for granted.

Input from any transgender children and young people who are willing to share their thoughts and words would be especially valuable, perhaps explaining what an updated birth certificate would mean to them, or how they feel about being denied the right to full legal recognition.

The consultation can be completed here. It closes on March 1st 2018

Growing Up Transgender

Raising our trans child

Month: January 2018