YA misinformed and fast tracked on hormones

Our adult teen recently told us he had dysphoria, on top of his other significant struggles.  We were relieved to hear he was going to talk with a therapist to help figure himself out, and started educating ourselves.  We learned that the number of people whose dysphoria becomes distressingly painful, in our son’s age group, is exploding(“ROGD” for some), and that for this group the necessity, effectiveness and safety of different possible treatments, hormones, for instance, is unknown.  It’s complicated, and often unclear what will help.  For hormones in particular, treatment guidelines advise that other issues should first be evaluated and/or managed, as studies show that many other issues (including his) can even cause dysphoria or make transitioning much more difficult.  It’s also sadly become political, to the point where studying or discussing people who  “detransition” is controversial. We found some helpful leads here, here, here, here (person who resigned from UK national gender clinic), here (research background list), here and at www.segm.org .

In this information chaos, our son became convinced from being online that he should start hormones immediately, telling us hormones were the only way to feel better, so that he needed them as soon as possible (false), that risks are low (false, not much is known, they are used off label so drug companies cannot usually be held liable, and have dangerous side effects), that only 2.2% of people who transition regret it (irrelevant, from a study not about hormones).  When I asked a parent of a very happy trans young adult for advice, I was told these same untruths, plus lectured on how my son would commit suicide unless he got medication right away (also false, thankfully).  We also learned that people are told to immediately affirm someone who is questioning their own gender, as any exploration of gender identity is “conversion therapy.”  (There are issues with this claim!).

What happened next shocked us--a psychologist quickly agreed to start him on medication, even saying, with no justification, that his other problems could perhaps improve with cross-sex hormones.   Our young adult believed the trained professional (which in a sane world would be the right thing to do).  So on top of everything else on his plate, he is now on dangerous medication with irreversible consequences.  It will throw a wrench (it produces a “second puberty”, what could go wrong?) into his already severely distressed system; he is young for his age and vulnerable.   

I would like advice on how to help him get the support he needs, from us and elsewhere, including exploring his gender identity. We also can't figure out how to be there for him, especially while he does something we think is very dangerous and unwise.

(If you want to attack me because I want my son to be supported, to have careful informed medical care and to be informed himself, please don’t bother.  And don't worry, we are of course using his preferred pronouns.  Thank you.)

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I'm experiencing a similar situation and feeling whiplashed between trying to be accepting and feeling very worried. Will my son turn out to be a happier man or will he regret giving up being a woman and continue to feel self-hatred and shame and also find being out in the world even harder? My kid also has many co-occurring mental health issues and is possibly on the spectrum. Most of the debate out there is very polarized and hard to navigate. I feel like the scientific research and the therapeutic interventions are at a very early stage and the whole thing also feels like a cultural moment with echo chamber like distortions. It's really tough and I have no answers but I empathize with you. Once our kids are young adults we have few alternatives besides support if we want to maintain our relationships with them. Cutting them off won't change their minds and will just mean we won't be able to stay connected. This is what I tell myself. I wish I had more wisdom to offer. Unfortunately, I think it will take 10 or 20 years before we really see the fallout from this moment. Please take good care of yourself. 

You might want to check into Gender Diversity. http://www.genderdiversity.org/contact/ This group is in Seattle, but they have on-line support groups for all ages and also parents. When my son was younger, he questioned his gender identity and we received support from them. Aiden Key is an amazing person and a wealth of knowledge. If the support group isn't the right fit for you, I am sure they can recommend some resources in California.

I've been thinking about this topic a LOT recently. I'm a middle-aged lesbian and noticed an uptick in butch women deciding to transition beginning in the late 90's. Now, 25 years later, it's my niece and my friends' daughters! I find it curious that while one nephew and a couple young men in my circle have come-out as bi-, pan- or gay.. none have transitioned. Our family went through many of the questions you raise when our family member transitioned. He'd just begun college, had experienced some recent trauma and had never expressed gender dysphoria to us. We, too, were dismayed by the speed of hormones and surgery. However, he's happier than I've ever seen him and that is wonderful to see. This is a very difficult topic to discuss and I appreciate the perspective in some of the links you included. Thank you and I wish you and your child the best.     

You clearly think your adult child is making the wrong decision for their mental and physical health and are struggling with how to influence their decision. Welcome to a long line of parents who struggle with that issue—sometimes they are right and sometimes there are wrong but in either case, almost certainly, they have to decide whether forcing their will (which is ultimately never successful) is worth ruining their relationship with their child. As a queer adult parent of a queer identifying teen I will say a couple of things content wise. One, you can always certainly find studies and opinions that support your POV on this topic. It is a still evolving topic and per your point the jury is still out on some impacts of hormones on health. And should you choose to search and look for studies that exclusively support your son’s POV you would find those too. But it sounds like you are cherry picking to support your own proposition. What is clear from all research related to gender issues is that feeling loved and supported by friends, family and communities is a key contributor to happiness and mental health. And I can tell you that if you use the same attitude, language and approach with your adult son that you did in this post you will do more harm than hormones ever could. Your adult son is going to be able to make better choices if they feel supported and loved by you, and less dug in if they feel like they have to defend against you, both short and long term. They should have you as an ally not someone figuring out how to make them change their mind. 

For better or for worse, here are my thoughts, as a doctor trained in family medicine who works in addiction medicine (& as a mom of a teen). One of the hardest parts of my job is speaking with parents about their distress, fear and concern about their children and the choices they are making.
I’d like to share with you what I have learned, even though I recognize that the context is very different, and that you may have already taken these steps.
first of all: make sure that you have a therapist for you who supports you, and your concerns. It sounds very distressing, and you are trying to protect your child as best you can. 
 

It sounds like the horse is out of the barn regarding starting hormones, so I think that all you can do is

1) listen again to what your child is telling you, with as much authentic curiosity as you can. When he stops, say “please tell me more“

2) ask your child to hear you out, then express your concerns in “I” statements. Also tell him how you are feeling (“I am feeling that you are taking a risk” isn’t a feeling — “I am afraid for your health and well-being” is more like it)

3) tell your child that whatever he chooses, you will support him emotionally. The last thing you want to do right now is alienate your child. 
 

I wish you well, 

Ava

I just want to say I'm wishing you a positive outcome, for everyone - this sounds so hard, and I feel much compassion for you - it sounds to me like you are doing ALL of the right things. I'm sorry for your struggle. I hope you will hear from some good experienced parents who can help.

Dear fellow parent of a gender non-conforming child,

I can tell you are a caring and concerned parent. Because you say "adult teen" I assume your child is 18 or 19 and not at the age where puberty blockers—a low-risk, reversible treatment that can make a huge difference for giving younger trans kids some space to safely explore their gender identity—are the main treatment in question. Because you have obviously done a lot of research, you may have already come across this organization, but I cannot recommend highly enough Gender Spectrum https://genderspectrum.org/

They are an organization that supports families with gender non-conforming children, and they run an amazing annual conference. It was cancelled last summer due to COVID but hopefully will be back in action in 2021. It is a national organization but we are lucky that the conference is in the Bay Area. I learned so much by getting to hear expert speakers and be with other families experiencing the joys and challenges we were facing.

Best of luck to your child, and to you in learning how to be the best parent you can be to them.

Original poster here, thank you all so much for these valuable viewpoints, advice and information.  This is very challenging!

As far as POV, there are blogs and popular articles saying all sorts of things, I surely agree!  Thousands of people have stopped using hormones, many claiming they were misled and harmed, while thousands of others say hormones helped them.  

In contrast, the studies don’t seem to contradict each other (aside from a few that have been corrected, e.g. the Fact-Checking of AAP Policy, text here).  For example, the studies agree that most kids who exhibit strong gender dysphoria before puberty stop being dysphoric, without medication or transitioning.  For these people, drugs are certainly not the only way to get better.  For people developing strong gender dysphoria in my son’s age group, studies agree not much is known about what helps.  My son is misinformed about facts.   No studies say/show what he says; that is, that the only way for people in his age group to heal from gender dysphoria is by taking medication.  None.  Some actually say that people like him should do other specific steps first.  He is mistaken in facts, not points of view. He has made a serious medical decision based on misinformation.  It is hard to figure out how to be an ally.

We thought puberty blockers might help, but then learned the blocked hormones play a big role in brain development at puberty.  I wish the companies would do studies to put these on label with the FDA. 

There is truly a lot of misinformation out there and the vast majority is being spread by those opposed to lgbtq+ identities, most especially these days trans folks. There is irrefutable evidence that lack of support by parents and loved ones is a huge stressor and yes that trans young people especially without family support have hugely increased rates of suicidal ideation and death. Trying to find evidence to support your view is not in the best interest of your child who I must point out is a legal adult. Hormones are not surgical and are primarily reversible at that age. Furthermore it’s his body and his choice regardless of how you feel about it. This is a truth of being a parent. Please take the time to speak with and learn from the trans community. The Pacific Center in Berkeley is a wonderful resource. I truly hope you show your son you love him not in spite of his trans identity but fully and without reservation and find your own peace. No therapist would prescribe hormones without good evidence that they are needed.

Sorry for the late reply, just want to say how much I empathize with your post. After a lifetime of identifying strongly with his assigned-at-birth gender, our child transitioned suddenly as a teen. He has mental health issues, including anxiety and depression. We've been supportive from day 1, and immediately switched to his new name and pronouns. He hopes to medically transition when he is older. It's been our private opinion -- never expressed to our child -- that he was suffering due to his mental health issues, and saw transitioning as an answer that would fix everything. I hate to say, but we're doubtful that he would have arrived at this solution without social media and peer influence. Unfortunately, his transition has only intensified his mental health struggles. It's hard to tell whether the transition has been the cause, or whether his mental health would have been even worse otherwise. (Our child has been seeing a therapist throughout.) This has been unbelievably hard for us. Parents are told that anything other than total affirmation may result in suicide. Within days of our child's announcement, we had other parents telling us we should ask for hormone therapy right away, while we were still trying to wrap our heads around the whole thing. I want to be my child's strongest ally, and I hope that is what he sees every day, but I am also a parent with very real worries and fears.  Finding unbiased studies or articles on this topic has been incredibly challenging. (That Atlantic article has been shown as problematic, for example.) Rapid Onset Gender Dysphoria, as a term, is also problematic -- yet the term describes our experience. Articles on ROGD are often promoted by TERF groups and people like J.K. Rowling, who believe that transgender men are not men. That could not be further from our beliefs -- we're appalled by JKR's recent statements and we're passionate supporters of transgender rights. But it's very hard to research these issues without walking into a minefield. (Even now as I write this response I'm worrying that I have accidentally said something offensive or inflammatory.) I wish I had advice -- just lots of sympathy and understanding.  Right now, we're just focusing on our child's mental health. We only want him to be happy and healthy, and we'll continue to do whatever it takes to make that happen. But it feels like this is uncharted territory for all of us.

The Atlantic article criticism you mention seems to be that "Where desisters meet with a concern of the community at large is that desisters are often used in bad faith to say that being transgender is not a real medical issue." But the article talks about some people who transition happily, some who transition and regret it, and others who realize their dysphoria is secondary before transitioning and get better without transitioning.  It doesn't say people shouldn't transition, just that you should work through issues carefully in case there is something else that is confusing things. At least one expert in the Atlantic article actually has the article on their own web page. It sounds like your kid has a lot going on and I hope you can find someone who can help them work through it and get what they need to be better as soon as possible.  There are parent groups (all political stances) trying to figure out what their kids need at

https://genderdysphoriasupportnetwork.com/ ,

https://www.transgendertrend.com/ ,

https://gendercriticalresources.com/ ,

https://4thwavenow.com/

I hope your kid is doing better soon!

I appreciate all the thoughtful responses, since I am in a similar situation. It's good to know I'm not alone. This blog post really spoke to me https://4w.pub/autism-puberty-gender-dysphoria-view-from-an-autistic-des...

If anyone else who posted wants to get in touch I would welcome it. Please contact me via my user name. 

Wishig everyone well. 

Parents should know that the websites mentioned in recent comments are considered to be anti-transgender by the trans community, in particular 4thWaveNow, Gender Critical, 4WPub and TransgenderTrend. The terms "gender critical" and "radical feminist" are dog whistles for the TERF community. Please educate yourself about these seemingly "unbiased" sources with "all political stances" -- they are not unbiased. Many of these sites have expressed support for JK Rowling, who has been the center of recent controversy because she believes that transgender women threaten her own identity as a woman. She published a highly transphobic manifesto on her website and continues to argue in favor of TERF viewpoints. In short, if you want to be an ally to your transgender child, these sites are not the place to start.