Transgender boom among Teenagers: Perils of rapid-onset gender dysphoria

Abigail Shrier, a journalist for The Wall Street Journal, has written a book on the massive “gender dysphoria” among teenage girls and was consequently labelled a transphobe. However, the issue might not seem so black and white. Kids are not allowed to drink alcohol till they are 21 but have the right to change their gender at the age of 14. So, while making simple decisions is deemed too heavy for teenagers, going through a very complicated and pretty irreversible surgery is considered okay.

Who am I? Do I fit into the society I live in? Is there any controversy between the way I feel about myself and the way I look? We all ask ourselves these types of questions at a specific time in our lives. With conventional social and gender roles, self-identification is a vital step on the way to personality formation. Usually, when it comes to gender, it does not take much effort to find your identity — your natural characteristics and upbringing shape it.

We tend to think of sex and gender as virtually the same thing. In reality, those are two distinct notions. According to the World Health Organization, sex is a set of biologically defined characteristics, whereas gender is socially constructed. The organisation recognises people can perceive their gender in different ways. Furthermore, gender identity might differ from naturally assigned sex.

Transgender people have a gender identity that differs from their natural sex assigned at birth. While some of them prefer to adopt behavioural practices of the gender they believe to belong to, others go further to change their natural sex surgically.

Transgenderism is a practice that should result from a well-thought decision. This is why, when it comes to gender transition at a young age, some significant concerns are raised.

“Transgender craze”

In her book “Irreversible Damage: Transgender Craze Seducing Our Daughters”, Abigail Shrier claims Western societies face an epidemic of poorly considered gender transitions among teenage girls. According to Ms Shrier, thousands of adolescent girls in the Western world not only misdiagnosed themselves as transgender but also underwent hormone therapy and surgical changes after a very cursory diagnosis. Teachers, therapists, surgeons, and medical organisations automatically endorse these actions — often out of fear of being accused of “transphobia”. Meanwhile, mounting evidence most young people who claim to be trans later reconsider their gender identity, shows that transition-related medical interventions are questionable.

Evidence shows Shrier’s concerns are pretty well-grounded. In recent years there’s been a sharp increase in the number of children identified as transgender in the US and other Western countries. Furthermore, the number of children and adult women seeking surgical gender transition has also skyrocketed. The first transgender youth clinic in the US was founded in Massachusetts in 2007. Since then, 40 other specialised medical centres have opened to help teens “become who they want to be”.

A “craze”, Abigail Shrier says, “is a technical term in sociology, not a pejorative term.” And she believes that it is precisely the term that describes the current situation.

To Schrier’s great surprise, several publishing houses refused to publish her book. The reviews by other journalists after massive protests by transgender activists were critical. Amazon declined to advertise the book, while readily agreeing to promote books advocating gender transitions at an early age.

Ashton Lummin from Kent, UK, is 13 years old. At the age of three, that is — as soon as he learned to speak, he realised he was born in the wrong body and should be a girl. As a child, Ashton was obsessed with pink and princess-style dresses.

At the age of eight, Ashton changed his name to Ashley, and since then her parents call her only that. When she went to school, the headmaster encouraged her mom to allow Ashley to wear girls’ uniforms to feel more comfortable.

At the age of 12, Ashley began to receive puberty blockers at an NHS hospital. By the age of 13, she has become one of the youngest transgender children in Britain, but it doesn’t seem like the girl is happy. According to her mom, Ashley often feels uncomfortable, becomes confused, suffers from anxiety and expresses suicidal thoughts. 

A new diagnosis

Until recently, it was believed people with such conditions generally manifested distinct signs of dissatisfaction with their naturally assigned gender in childhood.

A few years ago, a new term was coined by Dr Lisa Littman, a researcher at Brown University — rapid-onset gender dysphoria (ROGD). The name’s new component implies the disorder appears in teenage years out of the blue, with no previous signs. Clinicians report this type of dysphoria to be on the rise, particularly among adolescent girls. 

Dr Littman carried out a study surveying parents of transgender or “gender sceptical” children. It turned out that most of the participants believed their children came out as transgender unexpectedly and had previously been entirely comfortable with their gender. They also claimed their children’s transgender identity was linked to mental health issues and social media’s intensive use. At the same time, many parents said their children’s mental state and social adjustment deteriorated after their coming-outs. 

The study’s publication spurred outrage by trans activists who labelled Littman as transphobic and called her findings hate speech. At first, Brown publicly praised the paper as “providing bold new insights into transgender issues,” but then removed it from its catalogue.

Though rapid-onset gender dysphoria has not been studied in detail, the very fact of such hasty gender identity decisions makes researchers think about the possible causes, since it’s quickly gaining momentum among teenagers.

Why is transgenderism on the rise?

Nowadays, young people are under the strong influence of social media that advocates specific ways of life and suggest dubious solutions to most teenage problems, like insecurity, anxiety, or distorted body image. Many of these solutions lead to body dysmorphia, eating disorders, and transgenderism.

“Like a virus.” This is how one of the book characters described her transgender identity in a social media post. The girl swapped pro-anorexia sites for trans communities’ web pages and decided to change her life. Together with four close friends, she resorted to breast binding and switched from diet pills to testosterone. But she never became happy with this life-changing decision. And nor did her friends.

They’re stuck in bedrooms with their smartphones looking for ways out of the feeling of insecurity or the dissatisfaction with their body. And trans activists, who are conquering social media, are quick to suggest you are probably not a girl if you somehow don’t feel comfortable.

Reports and survey results obtained by Dr Littman, show a teenager’s coming out as transgender often follows an increased social media use or a coming out of a friend or a peer. Thus, rapid-onset gender dysphoria does spread like a virus, mainly through social networks and peer groups.

Apart from social media, there is another source — educational and therapist organisations, that seem to be encouraging every child’s spur of the moment desires when it comes to gender identity. Schools have on-site clinics eager to provide students with the irreversible gender transition, and therapists are ready to give 12-year-old girls puberty blockers at first demand. Most of the girls whose experience was analysed by Lisa Littman were white and upper-middle-class. Many of them felt perfectly alright about their gender just months before coming out as transgender. But most of them meet little or no resistance from the part of their parents and therapists and undergo irreversible treatment, turning a teenage passing fancy into a life-changing decision.

Transgender issues seem to be the only field where such an “affirmative care” model has been so popular — medical specialists agree with whatever their patient says regarding their gender for fear of being accused of transphobia. Imagine, Shrier says, if a black girl wanted to have her nose narrowed and her skin colour changed because she didn’t identify herself as “black”. “I can’t think,” says one of the therapists Shrier quotes in her book “of any branches of medicine outside of cosmetic surgery where the patient makes the diagnosis and prescribes the treatment.” Although such an approach might help children find themselves, it also might harm others.

Irreversible changes

In March 2020, a BBC piece told about Keira Bell from Cambridge, UK, who was facing psychological problems as a teenager. She developed depression and decided her gender identification was the leading cause. She made an appointment at the London Tavistock and Portman NHS Foundation, which is considered the largest English centre providing gender-reassignment services.

Specialists at the clinic decided that Keira perceived herself as a guy and prescribed her puberty blockers. Sometime later, she underwent a course of testosterone, which made her hair grow on her body and face, and her voice became rough. In 2017, she had her breasts removed.

She stopped taking medication and finally realised she didn’t want to change her gender — if the doctors at the Tavistock had challenged her more, she would never have made the decision. But it was too late — the long years of hormone therapy had done their job, and her body now looks more like a man’s than a woman’s. Three years have passed since Keira changed her mind, she is 23, but the changes made to her body can no longer be reversed.

The girl filed a lawsuit against the Tavistock and Portman NHS Foundation seeking to have the medical institution banned from prescribing puberty blockers to children under 12. According to Keira, there are many young people among her supporters who regret changing sex. Among them is Charlie Evans, who founded the Detransition Advocacy Network. Evans herself underwent gender-reassignment surgery and lived as a man for almost ten years but then had a second operation and again became a woman. Evans says her organisation has been contacted by hundreds of young people, claiming gender reassignment did not solve their problems.

In December 2020, UK High Court Judges ruled that children under 16 could not give informed consent to gender reassignment involving puberty blockers. The Tavistock and Portman NHS Trust had to suspend treatment of under-16s immediately. Though Bell and Evans’s goal was much more ambitious, the first step of drawing public attention to the issue was made. 

A solution to teenage problems or a disturbing trend?

Trans activists and “affirmative” therapists claim the very notion of rapid-onset gender dysphoria to be “a poisonous lie” that “discredited” trans people. Dr Jack Turban, a medical journalist, and child and adolescent psychiatry fellow at Stanford University School of Medicine suggests Abigail Shrier’s book is full of misinformation and “can hurt transgender youth”. 

Meanwhile, there is sufficient evidence showing not all transgender people follow Keira Bell or Charlie Evans’s path — many of them didn’t doubt their decision later. Recent research by scientists from the University of Washington has shown rates of depression and anxiety of transgender children are no higher than those of their siblings and peers comfortable with their sex and gender. Furthermore, their depression and anxiety rates turned out to be lower than children who failed to identify with any gender at all. Thus, Khristina Olson, the leading researcher, came to challenge the long-standing assumption that transgenderism was inevitably related to mental disorders or was one of those itself. 

Though puberty blockers, used as a first step towards gender reassignment, are commonly described as “100% reversible”, the treatment usually involves feeding young teenagers with potent drugs such as Lupron for a long time. Such medication might harm bone development and prevent the release of endogenous hormones that influence brain development. Though puberty seems to resume if blocking therapy stops, numerous studies show that nearly 100% of children taking puberty blockers undergo hormonal therapy, which often has irreversible effects, including voice change, facial and body hair, and breast growth. Although the treatment is relatively new and there is not much reliable evidence about its long-term effects, specialists agree that puberty blockers followed by cross-sex hormones cause infertility in 100% of cases.

The stories of Keira Bell, Charlie Evans, and other young transgender community members show the decision to undergo gender transition has to be well-considered – a task of paramount complexity for a 14-year-old teenager that needs to be handled with great caution and consideration.