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The moral panic arising from unproven concepts such as rapid onset gender dysphoria (ROGD) has made trans lives unliveable. Despite the lack of scientific evidence, ROGD has bolstered claims that coming out as trans during adolescence is a sudden unhappiness about your birth-assigned gender brought on by a social trend, writes Noah Lubinsky.
I've had a Shabbos dinner (a Jewish tradition of prayer and rest) with my family every Friday evening since the day I was born.
I’m 26 now, so that's more than a thousand get-togethers in which my dad said the kiddush prayers over bread and wine, mostly followed by a comment about how quickly the week had flown by.
But this year, one Friday night in early July stands out.
My parents had invited three of my best friends to join us. It was a get-together of laughter and warmth, not least because of my mother's turmeric and sweet potato soup.
I left my childhood home that evening feeling teary with happiness.
Four years ago, I wasn't sure that such a dinner would have been possible.
My three friends and I are all openly transgender.
I came out as a transgender man to my parents in 2018 when I was 22 years old. I was classified as female at birth, but I have always been a man.
I was convinced this news would mean the end of family Shabbos dinners and that I would lose the feeling of togetherness the gatherings bring (even though I’m no longer religious).
As a transgender man, I took up hormone therapy in the form of twice-monthly testosterone injections. This type of treatment gives people like me a deeper voice, facial hair and muscles to make us look more like the men we've always known we are. (In the case of transwomen, hormone treatment would mean taking oestrogen.)
My parents were, understandably, confused and concerned. From interviews with pairs of transgender children and a parent, researchers found that parents can feel taken by surprise when their child comes out if they were unaware that their offspring was questioning the gender they were assigned at birth. So by the time the child is ready to affirm their identity, parents are often not equipped to deal with it because they’ve not been preparing for the change as long as the child has.
READ | 'I wish my parents would trust me more' - trans teen on the support he needed when he first came out
My mom and dad worried that I was making a radical and harmful decision about my identity and my body, so they searched online for more information.
For my mom, in particular, the internet offered a dark hole where all of her deepest fears were validated. She anxiously shared some of the (mis)information — for example, that many transgender people mistakingly think they're a different gender and then have to go through steps to "detransition" — with my brother. He promptly (and a bit grumpily) told her: "Ma, stop looking at that stuff."
I'm grateful that he did.
Today, my parents and I have a fantastic relationship, largely because they can see how much happier I am in my own skin. Studies show that for parents coming to terms with their child's identity it’s just as much of a process as it is for the child — and that accurate information and support from others can help to strengthen family connections.
But I shudder at the thought of what might have been left of my family ties had my parents stumbled upon a book such as Abigail Shrier’s Irreversible Damage: The Transgender Craze Seducing our Daughters, which has been selling widely since 2020. (It also goes by the title Irreversible Damage: Teenage Girls and the Transgender Craze.)
An unqualified argument
There have been transgender people for centuries, even though the term "transgender" was only coined in the 1960s.
James Barry, an Irish military surgeon, born in 1795, is one example of someone who lived incognito. He spent most of his adult life in Cape Town, where he's said to have performed one of the first caesarean sections in which mother and infant both survived. That he was assigned female at birth was discovered only 70 years later when his body was prepared for burial in London.
Today, people like my three friends and me have far more information about our identities and others like us.
A book such as Irreversible Damage, however, popularises the idea of rapid onset gender dysphoria (ROGD) — a concept that asserts coming out as trans during adolescence is sudden unhappiness about your birth-assigned gender brought on by a social trend.
Yet it's not — scientists around the world argue that there is no credible scientific evidence that the condition exists or that ROGD aligns with the experiences of transgender teens. More than 60 United States-based psychological associations and programmes, for instance, published a statement in 2021 in opposition to ROGD therapy because they say it's unscientific.
In fact, research reveals that getting to the point of openly expressing who you are doesn't happen in the same way for all gender-questioning children. Some know from their early childhood that they don't feel comfortable in their bodies and also express their feelings about it early on. Others are uncomfortable from a young age but don’t say anything until (usually) puberty. And some feel fairly ambivalent about their gender during childhood but realise their discomfort only during puberty or even later.
Those siding with the ROGD philosophy argue that teenagers seeking gender-affirming medical care such as hormone therapy will harm their bodies permanently, citing, for example, concerns about building strong bones (most of your adult bone mass is gained during adolescence). But the jury is still out, with some analyses showing lower than expected bone mass after starting hormone treatment and other studies finding it doesn't differ significantly or that it's unclear whether any changes in bone mass will lead to more fractures later in life.
READ | Some children as young as 3 can have clear sense of their gender identity, says psychologist
ROGD supporters further argue that because the feeling will pass, teenagers will regret their decision later.
Research used in putting together the most current standards of care for transgender people emphasises that gender identity is not as stable in childhood as in adolescence, and so some pre-teens who are unhappy with their gender may decide not to go through with formal transition later.
But, studies show, most teenagers who voice their discomfort with their bodies will stick to their decision to change their gender. This, researchers say, could be because puberty is the development stage in someone’s life when cognitive, emotional and social thinking start to mature, including gender identity.
Moreover, results from large surveys in the United States and the United Kingdom among trans people older than 18 found that less than 1% went back to living as the gender they were assigned at birth because they've changed their minds (called “detransitioning”).
Handle with care
So, how does a transition work?
The guidelines of the World Professional Association for Transgender Health say that transitioning should happen in stages, with the help of health professionals and preferably also the support of parents or legal guardians of children and adolescents.
The first step for a young person who wants to transition is to start taking puberty blockers. These are medicines that prevent the body from producing sex hormones such as testosterone (a male hormone) or oestrogen (a female hormone) so that someone doesn't develop the physical traits (say, breasts or a deep voice and facial hair) associated with adult women or men.
The treatment pauses the body from going into puberty and so is reversible. The idea behind starting with puberty-pausing hormones is that it can buy teens and their families more time to explore the social, emotional and legal issues that come with gender change and also make the physical transitioning process easier if a person decides to go through with it.
The guidelines recommend that a young person wanting to transition should keep consulting their healthcare team while they're on puberty blockers (so before they start taking cross-sex hormones). And once they've started with hormone therapy, they should do so for at least a year before going for any surgery.
In South Africa, hormone therapy for transgender people (taking either testosterone or oestrogen) is on the essential medicines list for tertiary and district hospitals. This means the health department buys the drugs for these government facilities, and it’s available for free to people who use the state health service.
But that doesn't mean anyone asking for the medication will get it. Although the Children's Act states that anyone older than 12 years has the right to consent to medical treatment, local guidelines advise that teenagers who want to start gender-affirming treatment such as puberty blockers, hormone therapy or surgery should ideally have their parents' and a psychologist's support.
Damage that is difficult to undo
Refusing to explore a questioning child's gender identity with them can — unlike hormone treatment that gives someone time to become at ease with who they are — have serious permanent consequences.
Not only can developed physical sex characteristics complicate later steps in the transitioning process, but having to experience this during puberty can lead to feelings of body discomfort — called gender dysphoria — becoming so intense that someone's mental wellbeing is affected.
An analysis of many studies shows that people with dysphoria experience mental health problems like anxiety and depression more often than the cisgender population, but that once trans people have started with gender-affirming medical treatment, including hormone therapy, anxiety and depression often decrease among this group of people to similar levels as in the cisgender population.
READ | 'I grieved': Mom of trans teen shares conflicting feelings of support and sadness
Cisgender people are people whose gender identity matches the sex they were assigned at birth. Mental distress, though, can be made worse by society's reactions and stigma towards gender-transitioning people, which can lead to prejudice and discrimination. In fact, discrimination against transgender people is one of the biggest reasons people opt out of puberty blockers. In a survey of over 27 000 transfolk in the United States, 31% of participants said they abandoned their choice to transition because of bad attitudes towards them.
On the positive side, gender-affirming care as a teenager can turn things around. A 2020 survey of about 20 000 transgender adults in the United States, published in the journal Pediatrics, revealed that adults who got puberty blockers as teens were less likely to have suicidal thoughts as grown-ups.
ROGD, which is not included as a legitimate mental health condition in the handbook used by healthcare professionals around the world to diagnose mental disorders, has already had real-world consequences for young transgender people.
The Texas family code now allows the American state to investigate parents of transgender children for child abuse if they allow their children to undergo gender-affirming treatments such as puberty blockers, hormone therapy or surgery.
There are no such rules in South Africa. In fact, our Constitution specifically prohibits discrimination against people because of their gender or sexual orientation, but the attitudes towards trans folk that play out in real life are often the opposite, results from the South African leg of the Global Attitudes toward Transgender People survey showed.
Moreover, in a survey among more than 2 000 LGBT (lesbian, gay, bisexual and trans) South Africans in 2016, four in 10 said that they knew of someone who had been murdered because of their sexual orientation.
We're not a social fad
If you are the parent of a trans child reading this, I want to thank you for trying to understand them.
Lean into the love you have for your kid and set out to find accurate information about the changes they want to make.
Advocates for transgender rights, such as historian Jules Gill-Peterson, argue that politicians use children's issues to serve their own agenda (think of abstinence being pushed in sex education even though there's little evidence that such lessons prevent children from having sex ). And now transgender young people, in particular, have become pawns for political rhetoric as well.
Listening to your son or daughter and rising above your own fear can not only lead to a stronger bond between the two of you but also help to make them happier. Research shows transgender children whose parents support them report better quality of life and fewer symptoms of depression.
Big changes can be difficult, but it helps to be surrounded by people who care.
There would have been no warm Shabbos dinner in July had I not had supportive friends and attentive parents.
It's through love and connection that we can forge a better life together, not mistrust and denial.
Don't give in to the cultural backlash that wants to make trans lives unliveable.
To use the words of another transgender friend of mine, Shane: "I am not a social fad."
- Noah Lubinsky is an independent researcher and Palestinian rights activist. He completed his master’s degree in sociology at the University of the Witwatersrand, where he focussed on the history of transgender life in South Africa. He’s currently researching state capture and mass political organising.
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
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