We felt it would be useful to answer some common questions that arise from parents who struggle when their children come out, and from those who argue against affirmative approaches.
1. Why do you, as scientists, support the affirming model?
Because the science says affirmative approaches are the best way we can help. The research listed on our site HEREvery clearly backs affirmative approaches, and the practices we follow are all endorsed by the American Medical Association, the American Psychological Association, the American Psychiatric Association, the Endocrine Society, and the American Academy of Pediatrics. These organizations have arrived at similar conclusions.
Together we have seen thousands of children, adolescents, and adults who have come to us with questions about their gender. We know just how much they suffer, and what helps. We also know how challenging this can be for their families… and we hope to help them as well.
The affirmative model simply allows youth space to discover their gender for themselves. It doesn’t push them forward, or hold them back. It starts by respecting what they say they feel, and then providing them the safety and freedom to explore… with no predetermined outcome. We all recognize how difficult it is, and no provider wants to ‘make children trans’. But we know that youth can only thrive when they get support.
2. What about the best interests of children?
We all what want what's best for them, and we know how deeply parents care. Our goals are the same as those of their parents… happy, successful children whose mental health is equal to that of their cisgender (non-transgender) peers. The science shows that affirming methods have had the most success in making that happen.
To show a little of what is known (more can be found HERE):
A 2012 study found that “almost all participants reported improvements in their quality of life compared to before they transitioned,” that “most participants reported feeling more emotionally stable after transition. Additionally, about two‐thirds reported feeling less depression, anxiety, and excessive anger…” and"the majority of participants reported feeling more joy, hope, love and safety, and less sadness, despair, anger, and fear.”
A 2016 studyfound that youth who get family support showed just as good mental health as their cisgender (non-transgender) peers, whilethose who did not receive family support did far worse.
A 2018 studyby Cornell University reported that 93% of the studies showed that transitioning helps, and could not find any studies showing that transition is harmful.
And there are many more on our BLOG page.
3. What about social contagion or Rapid Onset Gender Dysphoria (ROGD)?
Truth is: there isn’t any solid evidence of social contagion. The one single studybeing used to argue in favor of social contagion has countless flaws and was produced using a biased sample.The study only really showed that parents often have difficulty when their kids come out… the researchers never spoke to the youth themselves. And Brown University removed the study from their website, saying it was “ ‘the most responsible course of action’ after the scientific journal that published the research decided to seek further review of the study’s methodology.”
What’s more, most of what the author said they ‘discovered’, which the author used to argue for ‘caution’, has been widely known for decades: it can be challenging for youth to come out, so they often hide it. It takes courage for them to share their feelings, and when they do, it is often shocking and difficult for those around them to accept. And sometimes youth need to see it in others to finally ‘put the pieces together’ in themselves.
Similarly, in the past people opposed to lesbians and gays being accepted in society promoted the notion (without evidence) that homosexuality was caused by social contagion.
The ‘social contagion’ being reported is really just youth getting support from other youth who feel the same. (We all do this, even as adults.) There’s no evidence this ‘makes these children trans’.
4. Is the affirmative approach based on solid, peer reviewed evidence and research? Where is it?
The affirmative approach is very much science based, and there are links to the research above. Dozens upon dozens of high-quality studies demonstrate that affirmative approaches lead to happier children, less depression, lower anxiety, and fewer suicide attempts… which was the goal in the first place.
BUT… there is also a very large body of evidence showing that parental rejection and lack of social support produces the opposite effects. Stigma, rejection, and "reparative/conversion" therapies all have been demonstrated to lead to worse outcomes.
One study foundthat "Children not allowed these freedoms… are at later risk for developing… depressive symptoms, low life satisfaction, self-harm, isolation, homelessness, incarceration, posttraumatic stress, and suicide ideation and attempts.”
And another showed just how important family support can be: "42.3% of [transgender adults] reported a suicide attempt and 26.3% reported misusing drugs or alcohol to cope with transgender-related discrimination… family rejection was associated with increased odds of both behaviors. Odds increased significantly with increasing levels of family rejection."
We also know that peer support is one of the most helpful factors in a youth having a positive outcome.
The American Educator, the journal of the American Federation of Teachers, outlined the benefits of LGBTQ+ students having access to their peers through GSAs, stating:“Students in schools with GSAs report lower mental and physical health concerns, greater overall well-being, less drug use, less truancy, and greater perceived school safety than students in schools without GSAs.These findings now have been documented across a range of studies at local and national levels. Other studies have recorded feedback from GSA members who attribute instances of personal growth and empowerment, as well as a range of other positive experiences, to their GSA involvement.”
A project sponsored by the American Counseling Association wrote: “… the presence of GSAs in schools leads to both short- and long-term benefits to students, for both lesbian, gay, bisexual, or transgender (LGBT) students and their heterosexual allies… GSAs provide a safe space for students to develop positive relationships. GSA members reported being able to connect with classmates dealing with similar issues… [and in] developing coping strategies… This openness translated to more genuine relationships outside of the GSA with heterosexual peers and teachers…”
5. What about hormones? Puberty blockers? Fertility issues later in life?
We know these decisions can be painful and complicated. We want to assure everyone that these steps are never taken lightly.
That said, no one is rushing to give youth any medication, and the science shows that people who do change rarely want to ‘go back’.
The affirmative model is about listening to the childrenand giving them time to ‘figure it out’ for themselves. The affirmative approach suggests that many steps happen before even considering medication, including allowing a youth to explore their gender without making any physical changes. We talk with them and to the parents, we may suggest resources, we help them as they find what’s right for themselves. We may help them experiment with clothes, or names, but at their own pace. We don’t push them forward, or hold them back.
If everyone involved (youth, parents, providers) feels medication is appropriate, these medications give the child a ‘time out’ to think before their body changes one way or the other. The blockers do exactly what they say… temporarily block puberty from progressing… without causing the body to change in ‘the other direction.’ If the child stops the puberty blockers, puberty restarts. Social transition before puberty has no physical effect, and the Endocrine Society considers puberty blockers “reversible”, and do not significantly affect long term fertility.
In fact, there are many stories of adults who did transition but later stopped the medications and were able to have biological children! One famous example is Thomas Beadie, who was featured many times on Oprah. This is happening more and more.
6.What if they change their minds later on?
People who do transition only very rarely regret it or ‘detransition’ (go back). Studies show that rates of ‘desistence’ – people going back to their biological gender – are extremely low. For example:
Even in the study being used to argue for social contagion,only “2.7% seemed to be backing away from transgender-identification,” and that was true when they were in unsupportive environments.
The National Health Service records in Australiashowed “96 per cent of all patients who were assessed and received a diagnosis of Gender Dysphoria… from 2003 to 2017 continued to identify as transgender or gender diverse into late adolescence. No patient who had commenced stage 2 treatment [the use of testosterone or estrogen] had sought to transition back to their birth assigned sex” .
Another study looking at over 40 years of people (6,793!) who had transitioned in Amsterdam showed that only 0.6% of people who went from male to female, and 0.3% of those who went from female to male, showed any regret.
As professionals who have worked with thousands of transgender people of all ages, we know just how painful it can be to grow up in a body that doesn’t match how you feel inside. We know that when someone does decide to start changing their body, it involves a great deal of thought about what they want their life to be, and that the process is slow… giving them a lot of time to consider the impact of their decisions.
And given how clearly the science shows affirmative care improves their quality of life, we think we are following the only safe, honest, and ethical path.