The mother was desperate. Seemingly out of the blue, her 14-year-old daughter had announced she was actually a boy and wanted to immediately begin the process of transitioning to meet her new gender identity. She had picked out a new name, and wanted to be referred to by male pronouns. Unsure of what to do and afraid she was losing her daughter, she turned to me for help. I had no choice but to say yes, as I had known the patient since birth and the mother for several years prior.
As much as I wanted to help and was willing to do so I was extremely nervous about the visit. The treatment of children with gender identity concerns has become a philosophical and political minefield and doctors who try to navigate the minefield do so at their peril. A single misstep can have devastating repercussions.
As a family physician who tries to “get it right” in every encounter and who regularly searches the medical literature to stay up to date with the current guidelines for diagnosing and treating my patients, I quickly learned that the treatment recommendations for patients who presented with gender dysphoria were different that those for any other condition I treat.
In the not-too-distant past gender dysphoria was an extremely rare condition. The incidence of males identifying as females was estimated to be somewhere between 1/10,000 and 1/30,000 individuals. Females identifying as males were an even rarer phenomenon, estimated to be from 1/30,000 to 1/100,000. Primary Care Physicians could expect to pass their entire careers without being asked to care for a single gender dysphoric patient. As the condition was so exceedingly rare the standard of care was to refer all gender dysphoric patients to a psychiatrist. The statistics I was taught, and which were unquestionably accepted, declared that 85% of adolescents with gender dysphoria, if left alone, would eventually identify with the sex they were assigned at birth.
When I went to review the current guidelines on the subject, I discovered that everything had changed, and had changed over a very short period of time. In a Pew survey conducted in 2022, 1.6% of adults and 2% of people under the age of 30 identified as transgender. If we add in those who consider themselves “non-binary”, the incidence increases to 5%. To put it another way, the incidence of gender dysphoria has increased by a factor of somewhere between 60,000% to 500,000%. My personal experience reflects this. From the day I started practice in 1993 until 2020, I did not encounter a single transgender individual. Since then, I have encountered 4 transgender patients in my practice and 2 within my own family.
When I read these numbers, a single question jumped to the front of my brain. “What happened?”
If the incidence of any other condition of disease had increased by such an amount an epidemic would have been declared and millions of dollars spent searching out the cause. When I read the available medical data on the subject, I discovered the world of academic medicine was remarkably uninterested in explaining or understanding the reasons for the dramatic change. Every article I found simply declared transgenderism as “normal” and something to be affirmed in every patient.
Given the lack of scientific evidence to support the medical establishment’s recommendations about gender dysphoria and my understanding of the mental and emotional history of the 14-year-old girl I was about to see, I did not feel comfortable affirming her new identity. I knew she battled depression and struggled in school, I knew she was the child of divorce, and I knew her parents loathed each other. It seemed to me she was struggling with a multitude of issues in her life and had somehow mistakenly decided her gender was the root of her problems.
While I had read the guidelines calling for “gender affirming care” for young people in such circumstances, the lack of serious investigation into the trans epidemic led me to question the wisdom of affirming her declaration of maleness. While I knew “experts” in the field often called for name and pronoun changes, puberty blockers, testosterone injections, breast binders and even mastectomies, I was worried these things would result in irreversible changes. I was also aware of the consequences I could face if I didn’t use her new pronouns and support her new identity. I had read about doctors and mental health practitioners who had their reputations destroyed on social media and review platforms such as Yelp for “misgendering” or “deadnaming” a patient. There was so much at stake.
When the day of her appointment with me arrived I was nervous, and I entered the exam room with a significant amount fear and trepidation, as I was taking an approach that would place me at neither end of the gender ideology spectrum. Instead of challenging her sexual identity and saying she was mistaken or affirming her identity and working to help her mother accept it, I would encourage her to work on other aspects of her life before addressing such a momentous issue.
I encouraged her to consider how difficult it was for any parent to process a child’s new gender identity and encouraged her to give her mother grace and as she worked through feelings. Her mom would almost certainly use female proteins and the name she had been given at birth, and not necessarily because her mom was not supportive of her feelings.
As there were very few treatments she could pursue without her mother’s support, I encouraged her to work with a therapist to become as emotionally healthy as she could. “Your parents will be much more likely to support your thoughts and feelings when they know you are coming from a healthy place,” I told her. I suggested she work on her depression, on being a better friend and daughter, and doing better in her schoolwork. “You will be a better, happier person by working on these things, regardless of your gender identity,” I said.
I don’t know if it was because of the therapeutic relationship I had achieved over the years, the simple truth in my words, or the fact I did not argue with her about her gender identity or try to talk her out of it, (I told her several times I was not questioning the validity of her feelings in any way), but she accepted my recommendations readily.
A year passed before I received an update on how she was doing, though I thought of her often. Her mother came to see me for an unrelated issue and doing the visit joyfully told me, “You will never guess what happened. Last weak Suzy came to me and said, ‘Mom I was so stupid last year. I’m not a boy.’ Can you believe it?”
After the mother left the office, I found myself wondering how the outcome might have been different if her daughter had seen a different provider, a doctor who has accepted the new recommendations on how to treat children who present with gender dysphoria without pausing to critically assess the shaky foundation on which these recommendations have been build.
Finally, I grieve over the failure of my profession to stand against the tide of political opinion and protect children, especially young women, against what has become an assault on womanhood. This attack takes many forms, from television shows and movies that deny basic biology, to misled educators who seek to teach our children to question that which is normal and accept that which is not, to massive corporations and retailers who propagate falsehoods about gender in the pursuit of profits.
As a Family Physician who cares for families, this issue has been heavy on my heart for a long time. I have resisted the urge to write about it for fear my words could be misconstrued or taken out of context. After reading about recent controversy with Target marketing trans clothing to young children, I decided to write this post from a very personal perspective. I am motivated by a simple question. If Family Doctors to not speak out in defense of our children, who will?
Bart
PS: There a few sources I have found quite helpful-
Irreversible Damage, by Abigail Shrier
When Harry Became Sally, by Ryan Anderson
