Editor’s note: Shortly after this article was published, an anonymous reader submitted a rebuttal piece.
In the five years since Lisa Littman’s paper gave us the term rapid onset gender dysphoria (ROGD) to describe the phenomenon of adolescents wanting medication to imitate the opposite sex, those of us working in this field have learned a great deal about the aetiology of this presentation. The ailment affecting our children is not caused by rapid onset – nor can it be attributed to gender dysphoria – but rather develops through prolonged rumination.
Transgender ideation is the term we have started using to describe the thoughts of a person who considers themselves to be transgender, and we consider it very similar to suicidal ideation in that it is a maladaptive coping mechanism.
Gender dysphoria is defined in the DSM as a list of feelings. It is neither a sound basis for diagnosis nor a diagnosable condition. We have long known (it was reported in the Irish Independent in 2019) that these feelings are readily faked by those desperate to have their desire to imitate the opposite sex realised.
While the justification for medicalising what has also been called gender incongruence is “clinically significant distress”, such distress, when it is not a pretence, does not arise out of these feelings defined in the DSM. Instead, it comes from an overwhelming desire to have one’s own way. To have a delusion validated. What we see is not actual distress but rather a toddler tantrum. A young person with transgender ideation has had their identity formation corrupted in such a way that their coping mechanism is the same as a tired preschooler denied their candy in the supermarket aisle. We know this because many parents have negotiated with their child ‘no medication until you are 18’, and the child acquiesces. Try that trick if they require morphine for a badly broken leg!
For a young person to give serious consideration to the idea that they might be transgender, first the idea must be presented as a reason for their normal adolescent angst; they then must be susceptible to taking it seriously. And the idea itself must be seen as valid and reasonable. We know that susceptibilities include autism (about 35% of cases presenting to the Tavistock) and the vast majority have same-sex attraction. However, anything that can make a young person feel like they do not fit in can make them susceptible – including trauma, family dynamics, even left-handedness.
Susceptible children do need protection from the idea that transgenderism is a solution to their social anxiety, and they also need protection from that idea being reinforced. Unfortunately, society is saturated with messages that promote trans as being both valid and trendy. While it is inexplicably cool, it is just a social affiliation. Dr Az Hakeem, Britain’s leading specialist on transgenderism, has described it as “Goth Mark V” in his book Detrans – When transition is not the solution. Presenting trans as some innate characteristic is not just plain wrong, it is railroading rumination. Frankly, it is indoctrination of the worst kind.
Transgender ideation can disappear or be rejected by a resilient child. Rumination on transgender ideation can lead to psychosomatic dysphoric feelings or the desire to fake dysphoric feelings in those who crave medication.
The massive rise in adolescents, 70% girls, presenting with transgender ideation became apparent in 2015. Decent research is scant and frequently suppressed as it is not politically correct. As the NHS seeks to modernise its treatment for gender dysphoria while contemplating renaming it gender incongruence, it is way behind the curve. Instead, it should be looking at preventing, curing, and treating transgender ideation. Prevention requires societal change, cure requires early intervention (before rumination has become habitual), and treatment requires supportive waiting (watchful waiting with added timely, targeted counselling interventions).
The unwillingness to objectively study and discuss the underpinnings and motivations of transgender ideation in adolescents does a disservice to those struggling with their identity and mental health. We have ample accounts now of young people who plunged into gender transition only to deeply regret it later. The permanent effects of puberty blockers and hormones, not to mention surgery, make detransition excruciating. And the suicide rate of those identifying as transgender remains tragically high after transition. We must bring compassion and facts together to find better ways to truly help young people. This requires loosening the grip of ideological zealotry in favour of open-minded inquiry aimed at finding real solutions. Our children deserve no less if we are to steer them safely through these turbulent waters.
We know this is how it is because we have been doing it for five years. It is a crazy world where an unfunded, amateur coalition of traumatised parents is achieving better healthcare results than those “professionals” we pay handsomely to deliver it.