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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review commissioned by his employer, the Centre for Addiction and Mental Health in Toronto (CAMH) – a review which was withdrawn from CAMH’s website after investigations showed that many claims were unsubstantiated and one key charge was demonstrably false.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.

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The beggar used to be friendly – now he was ranting at everyone

What was I doing, dismissing him with maximal curtness – and not caring?

The first beggar was walking but still wretched. Probably in his early twenties, clearly ravaged by more than just alcohol, he made a beeline for me, as if he had an appointment. He was not to know that I was in a mood from hell, though the look on my face would have told him, if he’d been in any kind of state to register it.

“Excuse me, have you got 10p for…”

“No.” And I walked on.

Why? I am almost invariably a soft touch for this kind of thing. But as I said, I was in the foulest of tempers.

Also, this was East Finchley. For those who do not know London, East Finchley is a northern suburb, which at one end hosts the wealthiest street in the country – the Bishops Avenue, where multimillionaires tear down houses and erect new ones even uglier than those they have replaced – and at the other end a typically seedy, dull collection of terraced houses.

The main supermarket is Budgens, a name so ungainly that it could only have belonged to a real person, either too proud or unimaginative to think of something else.

But what, I asked myself, was someone this wretched doing in East Finchley? And what was I doing, dismissing him with maximal curtness – and not caring?

The second beggar, further up the street, I met the next day: much older and clearly mad, rather than chemically poisoned. He asked how I was doing.

“Not so well, as it happens,” I replied.

“Would you like me to say a prayer for you?”

“Why not?” I said, and he placed a clenched fist to my forehead and made a brief incantation, something like an exorcism, and then kissed the large white plastic crucifix hanging from his neck.

I half-expected to feel a jolt of faith, some kind of divine restructuring. This time I gave him money: a pound coin and a 50p coin. But then later I thought: why didn’t I give him more? I’d been doing some tidying earlier and had retrieved a heavy pocketful of change; I could have given him a generous handful.

The third beggar was in Shepherd’s Bush. I knew him from the days when I lived there: a skinny, middle-aged guy who would occasionally stop and rant in a friendly way at me, just sane enough not to ignore. That was ten years ago. Now he was raging at everyone, accusing the teenagers queueing in the kebab shop of being batty boys and saying “bloodclaat” a lot. (Batty boy: homosexual. Bloodclaat: tampon.)

The people he was addressing knew perfectly well what he was saying. They shrugged it off. I got on the bus; so did he, and the whole bus knew about it. There was nothing friendly in him now, and I wondered through which hole in the increasingly threadbare welfare safety net he had been allowed to slip.

That’s it, I thought. I’m getting out of London, its pampered core oblivious to the surrounding anguish. The world in a nutshell. Luckily, my great friend S— had asked if I could cat-sit for her in Brighton. I know her cat, and I know Brighton. Also, I know about a dozen people there who I keep meaning to see, so why not? London was making me ill, and possibly a bad person. So S— invited me down a couple of days before she was due to go on her holidays, and I took the first train I could.

And now I find myself sitting on a sunlounger in a tiny backyard, in a charming house just abutting the North Laine, and the mood is palpably different to the capital’s. It is like a city ought to be: compact, diverse and funky. There is no reek of High Capitalism. It is healthily decadent. It would appear to be full of people who have rejected the idea of London. It still has an enormous number of beggars, but more people were dropping money for them than I ever saw do so in W1, W12 or N2.

So this is what it’s like to fall out of love with the city of one’s birth. What most surprised me was the speed and force with which it happened. I’d made my mind up over a nice lunch that my friend N— was buying me, to cheer me up.

“Don’t you have to stay in London? You know, for book launches and things like that?”

“I don’t go to fucking book launches any more,” I said. I was taken aback by the vigour of my reply. I’m only here for ten days but I have plenty of people to see and dozens of memories, all good, to bump into. I’m already feeling better. 

Nicholas Lezard is a literary critic for the Guardian and also writes for the Independent. He writes the Down and Out in London column for the New Statesman.

This article first appeared in the 14 September 2017 issue of the New Statesman, The German problem