Letter submitted by Margaret Wetzel

“Minors are not transitioning,” insisted the professor sitting across from me.

“But I have multiple sources that bring up minors receiving hormones and surgeries.”

“Irreversible Damage is not a reliable source.”

A favorite retort of hers.  Had she read the book?  No.  But she sure knew how to sit there and keep repeating that Abigail Shrier was motivated by transphobia and just looking to take down an easy target – it didn’t matter when I pointed out that Shrier enjoyed speaking with trans adults, that queer people held quite a bit of social power, or that Shrier was primarily focused on a demographic likely to regret transitioning.  Wanting to scale the looming brick wall, I began pulling out my secret stash of tools: “I have other sources too. Gender therapists openly admit to helping minors medically transition in their books. Peer-reviewed research articles that support affirmation-only openly mention that hormones and surgeries have been provided to minors. I can pull one up if you’d like.”

“No.  Minors are not transitioning.”

The brick wall extended higher than I’d expected.  I failed to scale it.  

The professor isn’t the only one who spent 2021 in denial. I still find tweets and TikToks claiming that kids aren’t transitioning.  In response to Matt Walsh’s Johnny the Walrus, transgender YouTuber Samatha Lux claimed, “children don’t have affirming surgeries, that’s just propaganda” (Samantha, 2021, 5:46-5:49). This Book is Gay writes: “It can’t have escaped your attention that the media is obsessed with the idea of transgender children right now,  Some people have their panties in a right old bunch about it because apparently us powerful trans media types are brainwashing your people into having ‘sex changes.’  All together now: LOLOLOLOLOLOLOLLOLOLOLOL times infinity.  Sure, Jan.  There is no such thing as ‘sex changes for kids.’  It doesn’t happen.” (Dawson, 2021, 155). The professor, random social media users, Lux, and Dawson don’t cite any sources to show that this isn’t happening to minors. 

For those who find themselves in this weird position where their conversation partner is making the verifiably false claim that minors aren’t transitioning, this article lists trans-friendly sources to prove that when it comes to the question of whether minors are transitioning, the answer is “Yes” and this is a matter of fact.  This article won’t dive too deeply into the debate over whether kids should transition, but before sharing the summaries I’ve listed, I should disclose that for reasons discussed in my book Picking Up the Pieces: Puzzling Through Autism in the wake of “Gender,” I strongly oppose minors transitioning. 

• There was a reality TV show where a young boy had his puberty blocked at age 11, started estrogen around the time he started high school, and began a vaginoplasty at age 17.

• In Supporting Transgender Autistic Youth and Adults the author, a neuroqueer-identified therapist, describes how she helped talk hesitant parents into allowing their 17-year-old autistic daughter to have a double mastectomy (Gratton, 2020).

• In gender therapist Diane Ehrensaft’s (2016) The Gender Creative Child, she helps multiple minors obtain hormones and surgeries.  One case that really stuck out to me was a 14-year-old boy who had been on puberty blockers for four years.  He was frustrated by not developing with his classmates, but his doctor wouldn’t prescribe estrogen to a minor.  Rather than question why a ten-year-old’s puberty had been blocked in the first place, Ehrensaft searches for someone who will prescribe estrogen to him as a minor.

• In an article discussing the rising demand for transgender “medical care,” it was mentioned that youths were receiving both GnRh agonists (puberty blockers) and cross-sex hormones with the claim that 14-15 years old is “‘too late’” to begin transitioning (McFarling, 2016, 14).

• In 2016, 136 females between the ages of 13 and 25 who identified as transmasculine and ended up in an ambulatory clinic for transgender youth were studied to see how their “chest dysphoria” correlated with whether they’d undergone a double mastectomy (Olson-Kennedy et al., 2018a).  Of those surveyed, 50% had already had a mastectomy and at the time of taking the survey, their average age was 19 with a standard deviation of 2.5 years.  Considering the standard deviation and that the mastectomy could have occurred anytime before the survey, some of them were minors when they lost their breasts.  The average age of those who hadn’t undergone surgery was 17 with a standard deviation of 2.5 years.  For every month members of this cohort spent on testosterone, their breast-related dysphoria worsened.  It seemed so rough for this young cohort on testosterone – 94% of them saw a double mastectomy as very important!  Rather than suggest that girls shouldn’t be on testosterone if it’s just going to make dysphoria surrounding breasts worse, the researchers call to do away with age-based guidelines for double mastectomies.  This was a peer-reviewed research paper from JAMA Pediatrics. Pediatrics.

• In another study by Johanna Olson-Kennedy (et al., 2018b), the physiologic response that youths had to cross-sex hormones was studied.  Youths were recruited between 2011-2013 with 101 initial participants and 59 of these participants completing the follow-up.  The 59 participants had ages ranging from 12 to 23 at the beginning of the study.  This was also a peer-reviewed research paper, this time appearing in The Journal of Adolescent Health. Adolescent.

• In a study looking at trends in referrals to a pediatric transgender clinic between 2015 and 2018, 417 patients between the ages of 3 and 17 were identified with 15 being the average age (Handler et al., 2019).  Of the 417 youths, 14% had surgery before turning 18.  Of those in the 14-17 cohort, ~42% had been referred to the clinic for surgery and ~36% were referred to the clinic for hormones (cross-sex and/or puberty blockers).  Of those in the 9-13 cohort, ~9% had been referred to the clinic for surgery and ~39% were referred to the clinic for hormones.  For those 8 and under, none had been referred to the clinic for surgeries, but ~12% were referred to the clinic for hormones.  Of those referred for surgeries, almost ⅔ of them underwent surgery before turning 18.  Of the completed surgeries that minors had been referred for (~⅓ occurred after the minor turned 18), mastectomies were the most common at 77%, but hysterectomies, vaginoplasties, and phalloplasties/metiodplasties also took place.  Predictions were made that the demand for early surgery would rise.  This was a peer-reviewed research article appearing in a journal simply titled Pediatrics.

While I strongly believe that the answer is “NO,” I do acknowledge that there is a debate over whether children should transition.  But to claim that children aren’t medically transitioning… that’s just a lie, a lack of research, or blinding levels of denial about objective, verifiably true facts.  It gets even more confusing as the denial can be selective… the professor who insisted that minors aren’t medically transitioning later told me that she knew of and supported families who were moving across states so their children would have easier access to medical transitioning.  She knew what was going on.  With this article, now y’all know too.  

Hopefully, this article is enough that future debates over whether children should transition can start off with an agreement that it’s happening, it’s been happening, and a large chunk of evidence comes from those who support this happening.  For those at WOLF and others who challenge the medicalization of children in the name of “gender,” I also hope it provides motivation and a base to build up arguments that this shouldn’t be happening

References

Gratton, F. V. (2020) Supporting transgender autistic youth and adults: A guide for professionals and families. Jessica Kingsley Publishers.

Ehrensaft, D. (2016). The gender creative child: Pathways for nurturing and supporting children who live outside gender boxes. The Experiment.

Handler, T., Hojilla J. C., Varghese, R., Wellenstein, W., Satre, D. D., & Zaritsky, E. (2019). Trends in referrals to a pediatric transgender clinic. Pediatrics. 144(5). https://doi.org/10.1542/peds.2019-1368.    

McFarling, U. L. (2016). Demand for transgender medical care is exploding. Insider. https://www.businessinsider.com/demand-for-transgender-medical-care-is-exploding-2016-12. 

Olson-Kennedy, J., Warus, J., Okonta, V., Belzer, M., & Clark, L. F. (2018a). Chest reconstruction and chest dysphoria in transmasculine minors and young adults: Comparisons of nonsurgical and postsurgical cohorts. JAMA Pediatr. 172(5):431-436. https://doi.org/10.1001/jamapediatrics.2017.5440. 

Olson-Kennedy, J., Okonta, V., Clark, L. F., & Belzer, M. (2018b). Physiologic Response to Gender-Affirming Hormones Among Transgender Youth. The Journal of Adolescent Health. 62(4), 397–401. https://doi.org/10.1016/j.jadohealth.2017.08.005  

Shrier, A. (2020). Irreversible damage: The transgender craze seducing our daughters. Regnery Publishing.

Wetzel, M. J. (2022). Picking up the pieces: Puzzling through autism in the wake of “gender.” Kindle Direct Publishing.