A parent and child at an LGBT event. Getty
Show Hide image

Transgender Kids: why doctors are right to be cautious about childhood transition

Just as it's cruel to deny treatment to trans people who need it, so it's unethical to railroad youngsters into decisions they later regret.

 

The BBC Two documentary Transgender Kids: Who Knows Best? won’t be broadcast until 9pm this evening, but that hasn’t stopped a lot of people from forming very firm opinions about it. There has been the inevitable petition, and yesterday, the Guardian published a critical article stating that “the transgender community is ‘very scared and very worried’” by a programme that no one interviewed had, as yet, seen. The focus of that concern is a Canadian doctor called Ken Zucker, who, according to his critics, is a discredited proponent of “conversion therapy” who has prevented trans children from obtaining appropriate treatment and was fired for gross misconduct.

But in his decades-long career, Zucker supported hundred of children and adolescents with gender identity disorder (GID), some of whom went on to live happily in their birth sex and some of whom eventually had sex reassignment surgery (SRS). The allegations against him stem from an external review commissioned by his employer, the Centre for Addiction and Mental Health in Toronto (CAMH) – a review which was withdrawn from CAMH’s website after investigations showed that many claims were unsubstantiated and one key charge was demonstrably false. As the journalist Jesse Singal wrote: “it’s hard not to come to an uncomfortable, politically incorrect conclusion: Zucker’s defenders are right. This was a show trial.”

Even so, these claims continue to recycled by those who endorse a “gender affirmative” approach to trans children - where the child's assertion of their identity is accepted immediately and uncritically - and reject Zucker’s more critical practice. Such claims are very hard to reconcile with the thoughtful Zucker who appears in the BBC documentary, who exudes neither the sinister bigotry his detractors credit him with nor the bitterness that might seem reasonable in the victim of an intellectual witch hunt. However, this much is clear: he’s adamant that reflexively deferring to children who say their physical sex is wrong risks not only putting children on an inappropriate pathway to surgery, but also missing the varied issues and strains that might be behind such feelings.

In other words, children who present as trans might not simply be “girls born in boys’ bodies” and “boys born in girls’ bodies”, and appropriate treatment might involve far more subtle approaches than altering a child’s body to match their “true” gender. Highlighting this view makes Transgender Kids: Who Knows Best? an oddity in coverage of trans issues, and a valuable one. Trans people are more prominent than ever before in news, factual programming and drama; but presentation of the underlying causes is, almost without exception, extremely basic. For example, a 2015 item on trans children for the BBC’s Victoria Derbyshire show begins with images of fashion dolls overlaid with a child’s voice saying: “I didn’t want to be a boy. I feel like I’m in the wrong body.” (The charity Mermaids, which offers support for families with trans children and has criticised tonight’s documentary, recommends this video on its “resources for parents” page.)

Trans campaigners are often at pains to distinguish gender stereotypes from gender identity, and yet parents of trans children consistently refer to their child’s behaviour and tastes when they’re supplying backstories. The segue in sexism here is obvious. At one point in Transgender Children: Who Knows Best?, the father of a socially and surgically transitioned teenage transgender girl tells the documentary that he knew his family had made the right decision when he saw his child running, and thought “that’s just like a girl running” rather than “look at my son, he runs like a girl”.

Stories from the other side, though, can be similarly as disquieting: the father of a teenage girl who vehemently identified as a boy but ultimately desisted (as approximately 80% of children with GID eventually do) sounds ragged with anger as he talks about battling the girl’s wish to have short hair and dress in boyish clothes. Watching the programme, one wonders whether the care the girl received at CAMH wasn’t as much about adjusting her family’s ideas about how to be female as it was about treating her dysphoria. Context, after all, is everything. As the neuroscientist Gina Rippon puts it in the documentary, briskly dismissing beliefs in inherently sexed brains: “We live in a gendered world […] A gendered world produced a gendered brain.”

The costs of putting a child on the wrong path can be huge. We hear a lot about the dangers of suicide for trans children who don’t receive affirming treatment (although Zucker points out that his research has found suicidality among trans children is no higher than among children with depression, anxiety or ADHD), but inappropriate affirmation is no less damaging. A young woman called Lou, who started hormone treatment and had a double mastectomy before realising she didn’t want to be a man, tells the documentary that she now feels “grotesque”. The female body that had horrified her so much during puberty now seems normal to her. The flat-chested, bearded self she has now appears to her as grotesque.

It’s a deeply upsetting sequence, but an important one because it’s a reminder that there is no one simple answer here. Having to live in a body that you know is not right is surely a profound and terrible anguish: that’s true whether you think you’ve been denied vital gender-affirming treatments, or if your body has been irreversibly altered by operations you now regret. The challenge for doctors is to recognise which is which, and give children the right support. The attacks on Zucker have been effective. Around the world, clinicians now keep their concerns about gender affirmation to themselves: they know what the price of speaking out might be. But, as this documentary shows, the price of stifling that discussion can be almost unimaginable harm.

Sarah Ditum is a journalist who writes regularly for the Guardian, New Statesman and others. Her website is here.

Photo: Getty
Show Hide image

The rise of the green mayor – Sadiq Khan and the politics of clean energy

At an event at Tate Modern, Sadiq Khan pledged to clean up London's act.

On Thursday night, deep in the bowls of Tate Modern’s turbine hall, London Mayor Sadiq Khan renewed his promise to make the capital a world leader in clean energy and air. Yet his focus was as much on people as power plants – in particular, the need for local authorities to lead where central governments will not.

Khan was there to introduce the screening of a new documentary, From the Ashes, about the demise of the American coal industry. As he noted, Britain continues to battle against the legacy of fossil fuels: “In London today we burn very little coal but we are facing new air pollution challenges brought about for different reasons." 

At a time when the world's leaders are struggling to keep international agreements on climate change afloat, what can mayors do? Khan has pledged to buy only hybrid and zero-emissions buses from next year, and is working towards London becoming a zero carbon city.

Khan has, of course, also gained heroic status for being a bête noire of climate-change-denier-in-chief Donald Trump. On the US president's withdrawal from the Paris Agreement, Khan quipped: “If only he had withdrawn from Twitter.” He had more favourable things to say about the former mayor of New York and climate change activist Michael Bloomberg, who Khan said hailed from “the second greatest city in the world.”

Yet behind his humour was a serious point. Local authorities are having to pick up where both countries' central governments are leaving a void – in improving our air and supporting renewable technology and jobs. Most concerning of all, perhaps, is the way that interest groups representing business are slashing away at the regulations which protect public health, and claiming it as a virtue.

In the UK, documents leaked to Greenpeace’s energy desk show that a government-backed initiative considered proposals for reducing EU rules on fire-safety on the very day of the Grenfell Tower fire. The director of this Red Tape Initiative, Nick Tyrone, told the Guardian that these proposals were rejected. Yet government attempts to water down other EU regulations, such as the energy efficiency directive, still stand.

In America, this blame-game is even more highly charged. Republicans have sworn to replace what they describe as Obama’s “war on coal” with a war on regulation. “I am taking historic steps to lift the restrictions on American energy, to reverse government intrusion, and to cancel job-killing regulations,” Trump announced in March. While he has vowed “to promote clean air and clear water,” he has almost simultaneously signed an order to unravel the Clean Water Rule.

This rhetoric is hurting the very people it claims to protect: miners. From the Ashes shows the many ways that the industry harms wider public health, from water contamination, to air pollution. It also makes a strong case that the American coal industry is in terminal decline, regardless of possibile interventions from government or carbon capture.

Charities like Bloomberg can only do so much to pick up the pieces. The foundation, which helped fund the film, now not only helps support job training programs in coal communities after the Trump administration pulled their funding, but in recent weeks it also promised $15m to UN efforts to tackle climate change – again to help cover Trump's withdrawal from Paris Agreement. “I'm a bit worried about how many cards we're going to have to keep adding to the end of the film”, joked Antha Williams, a Bloomberg representative at the screening, with gallows humour.

Hope also lies with local governments and mayors. The publication of the mayor’s own environment strategy is coming “soon”. Speaking in panel discussion after the film, his deputy mayor for environment and energy, Shirley Rodrigues, described the move to a cleaner future as "an inevitable transition".

Confronting the troubled legacies of our fossil fuel past will not be easy. "We have our own experiences here of our coal mining communities being devastated by the closure of their mines," said Khan. But clean air begins with clean politics; maintaining old ways at the price of health is not one any government must pay. 

'From The Ashes' will premiere on National Geograhpic in the United Kingdom at 9pm on Tuesday, June 27th.

India Bourke is an environment writer and editorial assistant at the New Statesman.

0800 7318496