PUBERTY BLOCKERS VS. COUNSELING

by John Spritzler

May 5, 2023

The URL for sharing this article is https://www.pdrboston.org/puberty-blockers-vs-counseling-1

[Very relevant: "Vast Majority of Gender Dysphoric Boys Desist, Long-Term Study Finds" ]

[Very relevant: "Gender dysphoria is rising—and so is professional disagreement"]

["Chloe’s story: puberty blockers at 13, a double mastectomy at 15

Laying bare the iniquity of doctors and psychologists who exploit the confusion of children and adolescents."]

["Gender-affirming care for transgender kids is going to backfire: experts"]

[Please read this: "Yes, Europe Is Restricting “Gender-Affirming Care”]

[The woman interviewed in this video (see more about this in footnote *****) is married to a trans-man and not opposed to gender transition in all cases. She discusses how the United States (as opposed to Europe) does more harm than good in its gender clinics for young children, specifically starting young prepubescent children who think their body doesn't match their gender on gender transition (puberty blockers, testosterone, etc.) in the name of "gender affirmation" instead of initially providing psychiatric therapy by a therapist who may or may not (depending on the child) recommend gender transition. A book about this is also of interest, by Abigail Shrier, who gives a speech on this video titled "Science, the Transgender Phenomenon, and the Young."]

Video: "What's Causing the Trans Explosion?" - Helen Joyce

Please read:

["The Transgender Industry Is Culling Tomboys Out Of Existence"]

["Kid gender guidelines not driven by science"]

["The Swedish U-Turn on Gender Transitioning for Children"]

["Current Concerns About Gender-Affirming Therapy in Adolescents" in Curr Sex Health Rep (2023). https://doi.org/10.1007/s11930-023-00358-x]

[An endocrinologist asks why the U.S. is not following the science: https://www.dailyherald.com/discuss/20230616/guest-columnist-roy-eappen-america-should-follow-other-countries-on-trans-treatments-for-children ]

New Mayo Clinic study finds mild to severe atrophy in testes of boys on puberty blockers: The authors of the preprint study express doubt in 'reversibility' claims of puberty blockers for gender dysphoric children.

When even trans pioneers denounce the "gender affirmation" absurdity, then maybe it's time, you know, to say, "Yes, it is indeed an absurdity--and one that HARMS children." [ https://quillette.com/2022/01/06/a-transgender-pioneer-explains-why-she-stepped-down-from-uspath-and-wpath/ ]

Drug used to halt puberty in children may cause lasting health problems [ https://www.statnews.com/2017/02/02/lupron-puberty-children-health-problems/ ]

Kayla Lovdahl has already transitioned and detransitioned at 18 — and now she’s taking her doctors to court [ https://nypost.com/2023/06/20/kids-shouldnt-undergo-irreversible-gender-transition-surgeries/amp/?fbclid=IwAR30fWL01FbGhnaEv4d_h16WiD5vNCJFyFGshJpfb6-saal5xbyz3jGhwi8 ]

"Sex is NOT 'Assigned' at Birth"

Today in the United States, there is a growing number of pre-pubescent children who express a concern that their body does not conform to their perceived gender. (For why this may be happening, read the **** footnote.) What kind of children does this "gender-concerned" demographic include?

It includes a tomboy--tomboyism is extremely common**--little girl who prefers to play with other little boys and announces she is a boy too; and it includes a little boy who is annoyed because it seems his younger little sister is getting all the attention and who thinks the solution is to declare that he is a girl too. And it includes children who believe that if they change their gender the problems in life they are experiencing will disappear, and so they declare that they are the gender that doesn't match their body. And it also includes children with very rare gender-related brain abnormalities.

A Dutch scientific study of 2772 adolescents (53% male) found that the prevalence of gender non-contentedness (defined as saying "I wish to be of the opposite sex") declined in prevalence, from early adolescence to follow up age of around 26, from 11% to 4%. This indicates that most adolescents who request gender affirmation medical/surgical procedures but who do not receive them will, by age 26 be glad they did not receive them.

These children are all too often affirmed in their opinion (that they need to change their gender) by the medical profession and given puberty blockers (read about their side effects below***) instead of psychiatric counseling****** that could a) help those children who do NOT have a rare gender-related brain abnormality understand that they are not in the wrong type of body, and b) help the rare children with a gender-related brain abnormality possibly handle some kind of gender transition. These children are then typically led down a path that often includes drastic surgery and sex hormones to make the body appear to be of the desired sex, treatments that produce sterility and pose other serious risks.

The reason for the lack of proper psychiatric counseling (as described in the paragraph above) is that the U.S. Department of Health and Human Services tells medical professionals that it is positively wrong to counsel a child to see that the way to address the mental problem they have just might be something different than medically changing their body with a drastic and potentially harmful medical intervention. Such proper counseling is condemned as "conversion therapy."

The U.S. Department of Health and Human Services (HHS) in a 2015 report titled "Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth" * (PDF) asserts (pg. 9):

" • There is limited research on conversion therapy efforts among children and adolescents; however, none of the existing research supports the premise that mental or behavioral health interventions can alter gender identity or sexual orientation.

• Interventions aimed at a fixed outcome, such as gender conformity or heterosexual orientation, including those aimed at changing gender identity, gender expression, and sexual orientation are coercive, can be harmful, and should not be part of behavioral health treatment. (American Psychiatric Association, 2013b; American Psychological Association, 2010; National Association of Social Workers, 2008)."

This is the basis on which hospitals and clinics in the United States do not provide proper psychiatric therapy to youth with gender dysphoria and instead adopt a "gender affirming" policy (such as this one from Seattle Children's Hospital) of relying only on medical interventions such as puberty blocking drugs and "sex-change" surgery, despite the fact children sometimes regret undergoing such medical procedures.

According (read it here) to the American Psychiatric Association, "gender-affirming therapy is a therapeutic stance that focuses on affirming a patient’s gender identity and does not try to 'repair' it." Think about what this means when a nine-year-old tomboy girl who says "I am a boy" receives such gender-affirming therapy, or what it means when a five-year-old boy, who thinks he is not getting enough attention because his younger sister seems to be getting it all because she is a girl, says "I am a girl" and receives such therapy. Think about what this means when a fourteen-year-old girl, who thinks that gender transition will solve all sorts of problems in her life and who has a circle of friends who feel likewise and who says "I am a boy," receives such therapy.

Note that the great majority (about 85%) of children who express gender discordance (i.e., say they are a gender that doesn't match their body's sex) will, without any medical (e.g., puberty blocker drug) or societal (e.g, the child's school using a gender-changed name and gender-changed pronouns) intervention, stop experiencing gender discordance by the time of puberty. This is reported in a scientific journal article with these words:

"In children who express gender discordance, the majority will experience reintegration of gender identity with biological sex by the time of puberty in the absence of directed medical or societal intervention. This is supported by nearly a dozen published studies over the past forty years. Many of the earlier studies included a small number of subjects and used definitions of gender discordance (e.g., gender identity disorder) that differ from current criteria for gender dysphoria as listed in the DSM-V (APA 2013). In some studies, loss of patients to follow-up hinders determination of desistance (Wallien and Cohen-Kettenis 2008). The most recent studies report desistance rates near 85 percent (Steensma et al. 2011; Drummond et al. 2008)."

[ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016442/ ]

Note that this 85% figure is about dysphoric children who are left alone ("in the absence of directed medical or societal intervention") and do not have sex-change medical treatments, and therefore this figure is not contradicted by claims (perhaps true) that most children who do have sex-change surgery do not regret it. Apples and oranges!

An AP article that emphasizes that it is rare for a child to regret medical sex-change intervention cites the reason for this being "comprehensive psychological counseling before starting treatment":

"Research suggests that comprehensive psychological counseling before starting treatment, along with family support, can reduce chances for regret and detransitioning."

But with guidelines such as that of the HHS, such "comprehensive psychological counseling" is vanishing from clinical practice. Now we are seeing reports of children who regret having undergone puberty blocking and sex-change surgery (see here for some.)

Furthermore, there is evidence that the recent sharp increase in the number of children expressing the belief that their gender is different from the sex of their body is due in substantial part to peer pressure, exactly the kind of thing that would be most usefully dealt with by psychological counseling and not medical procedures. Here is some evidence of this:

A PLOS ONE research article (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330) titled, "Parent reports of adolescents and young adults perceived to show signs of rapid onset of gender dysphoria," in its Abstract, Purpose begins:

"In on-line forums, parents have reported that their children seemed to experience a sudden or rapid onset of gender dysphoria, appearing the first time during puberty or even after its completion. Parents describe that the onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity."

This science.org article ( https://www.science.org/content/article/new-paper-ignites-storm-over-whether-teens-experience-rapid-onset-transgender-identity) discusses the above article. The article reports:

"The most explosive of Littman's findings may be that among the young people reported on—83% of whom were designated female at birth—more than one-third had friendship groups in which 50% or more of the youths began to identify as transgender in a similar time frame. This, she writes, was more than 70 times the expected prevalence of transgender identity in young adults, which she reports is 0.7%. Littman hypothesizes that "social contagion" may be a key driver of the purportedly rapid onset dysphoria. To trans activists, such a suggestion risks both stigmatizing and further isolating transgender young people from their peers and from the resources that could support them."

An informative Quora post about the transsexualism phenomenon says:

"Transsexualism has become today some kind of a fashionary self-diagnosis, as Asperger’s was in 2000s and 2010s, and it is quite clear only a fraction of those really are genuine cases - the Dutch estimate the frequency for genuine transsexualism is around 1:10,000." [from https://www.quora.com/The-Tavistock-youth-gender-clinic-in-London-was-shut-down-after-doctors-expressed-concerned-about-the-increase-in-numbers-as-well-as-the-dearth-of-data-on-long-term-safety-and-outcomes-of-medical-transitions-Do-you/answer/Susanna-Viljanen?ch=17&oid=1477743653604735&share=107df1c0&srid=Muxc&target_type=answer&fbclid=IwAR0f7VHXbj1CN0RNbHqLu_Ci3RIyv1hOSG0e39-bevG1SKo37-LPmFz-5KQ]

A Reuters article reports:

"For this article, Reuters spoke to 17 people who began medical transition as minors and said they now regretted some or all of their transition. Many said they realized only after transitioning that they were homosexual, or they always knew they were lesbian or gay but felt, as adolescents, that it was safer or more desirable to transition to a gender that made them heterosexual." from "Why detransitioners are crucial to the science of gender care" at https://www.reuters.com/investigates/special-report/usa-transyouth-outcomes/ .

Additionally, there is growing evidence of harm caused by puberty blockers (not to mention sex-change surgery when the child later regrets it!): See reports of this harm here (NYT) and here (The Economist).

What About Suicide?

"Further, suicide risk is often used as the rationale for easy access to medical transition for trans-identified children and adults. Pro-transition advocates consider the need for assessments and screening to be dehumanizing and unnecessary. Clearly, the data from the Swedish NBHW does not support this position. People who commit suicide have an underlying mental illness that requires expert treatment and care. It would be medically negligent to avoid psychiatric assessment and/or deny corresponding psychological services to provide treatment for this population where the risk of suicide is elevated due to these comorbidities." from https://genderreport.ca/the-swedish-u-turn-on-gender-transitioning/ .

"This difference [in suicide rates] did not reach the threshold of statistical significance, but the apparent doubling in serious suicide attempts among surgically transitioned individuals, as compared to gender-dysphoric controls who did not have surgery, is clinically meaningful and problematic." from https://link.springer.com/article/10.1007/s11930-023-00358-x?s=08 .

WHY IS THIS HAPPENING?

The reason absurd things are happening in the name of being 'woke' (i.e., of being not transphobic) is the same as the reason why absurd things are being done in the name of 'woke' (i.e., of being "anti-racism"). What is this reason? The reason is this. The ruling upper class, using both its liberal wing and media in conjunction with its conservative wing and media, is promoting things with its liberal media and institutions that are absurd and telling liberals they must defend them in order to be woke, while at the same using its conservative media to make sure that its conservative audience is aware of the absurd things and convinced that the people who support such absurdities are dangerous idiots. This is how the ruling class divide-and-rules we the have-nots. I have written about this in the following articles about a) trans 'bathroom' laws; b) Drag Queen Story Hours; c) preferential treatment for non-whites in a Boston hospital; d) Affirmative Action and e) the general divide-and-rule strategy.

-------------------

* The HHS, in its infinite wisdom (and deceitfulness, in my opinion) lumps psychiatric therapy for gender-body (trans) issues with psychiatric therapy for sexual orientation (gay) issues and refers to them both, without distinction, as "conversion therapy." The point of this (my) article, however, is that medical professionals dealing with the trans issue use the HHS report as the basis for not offering proper psychiatric counseling to children with a trans issue. This (my) article is not in any way about the question of conversion therapy for the gay issue.

Page 51 of the HHS document, Summary and Conclusion, makes the same point as the point made on page 9 by the text quoted above. Regarding the text on this page 51:

HHS's recommended "Health and behavioral health care providers" is not psychiatric counseling, and certainly not counseling that potentially could result in a boy child deciding that he is not a girl, or vice versa; such psychiatric counseling is labeled "conversion therapy" by HHS and the entire thrust of the HHS article to to condemn such "conversion therapy" as harmful and never beneficial.

Notice these words in the document:

"Being a sexual or gender minority, or identifying as LGBTQ, is not a mental disorder."

But sometimes it is indeed a mental disorder when a little boy thinks he's a girl or a little girl thinks she's a boy!

Sometimes when a very young boy says he is a girl it's because of something like, for example, that he has a young sister who is getting (as it seems to him) all the attention and he thinks if he were a girl he'd get more attention. Sometimes when a very young girl is a tomboy and prefers hanging out with other little boys more than with girls, she decides she is a boy too.

These are examples of children who should NOT be affirmed in their gender confusion (as I hope you would agree.) These children are indeed suffering from a kind of mental disorder, and not from some physiological abnormality in their brain, and they need psychiatric counseling that aims to help them see that they are indeed the gender that matches their body, and in no way in need of puberty blockers or sex-change surgery (as I hope you would agree.) But HHS does NOT agree.

Read the box at the end of the page:

"It is nearly impossible to describe walking into a therapist’s office after surviving conversion therapy. The problem is that we need help from a system we have only known to hurt us. Hearing that I would be okay and that my new therapist could help me learn to cope with the pain of my conversion therapy experience was like getting a second chance at life. ”

The "good" therapy is ONLY about helping the child learn to "cope with the pain of [gender] conversion therapy and experience."

The entire thrust of the HHS article is [gender] AFFIRMATION: the title of the document is "Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth." Affirming means never telling a boy child that he is NOT a girl if he thinks he may be, and never telling a girl child that she is NOT a boy if she thinks she may be. It means to affirm what the child believes, period.

This policy of the HHS (and U.S. professional organizations and clinicians) is the reason that very young children in the United States are getting the drastic, life-changing and medically risky puberty blocking drugs, which so many people (including medical professionals in Europe) think is just terribly terribly wrong (and I agree.)

** In this study, 67% of women aged 17 to 94 reported having been tomboys in their childhood: https://link.springer.com/article/10.1023/A:1018816319376

Here's another study of the prevalence of tomboyism, at https://journals.sagepub.com/doi/abs/10.1111/j.1471-6402.1977.tb00574.x?journalCode=pwqa . It reports:

"The meager research available on tomboyism is based on the assumption that it is rare and abnormal. Following an initial observation that 78% of a group of undergraduate women reported having been tomboys in childhood, the frequency of tomboyism was assessed in two samples, one of junior-high girls, the other of adult women. In the junior-high sample, 63% reported being tomboys, while 51% of the adult women reported having been tomboys in childhood. Tomboyish behaviors such as a preference for active, outdoor games, playing with boys, and wearing jeans were also very frequent. It was concluded that tomboyism is statistically quite common and there is little indication that it is abnormal."

It is absurd to believe that all of these women who were tomboys in childhood were really boys trapped in a girls body. And yet this absurd idea is now being promoted, as discussed in this article titled, "The Transgender Industry Is Culling Tomboys Out Of Existence" at https://eppc.org/publication/the-transgender-industry-is-culling-tomboys-out-of-existence/ .

***

#1. A website ( https://pharma.nridigital.com/pharma_sept20/puberty_blockers_transgender_children) that favors the use of puberty blockers nonetheless says the following about its possible side effects:

“Puberty blockers are safe as far as can be determined from the experience of non-transgender children who take them or women undergoing fertility treatments who take them,” says Mount Sinai Center for Transgender Medicine and Surgery executive director Dr Joshua Safer. Like all medications, the blockers are still known to have some side effects, including weight gain, hot flashes, headaches and swelling at the site of injection.

There also may be more long-term effects on bone density, which is part of the reason the drugs aren’t supposed to be prescribed for too long. Safer explains: “The primary concern is that bones might be at greater risk of osteoporosis because bones depend on sex hormones for maintenance. That need is part of the reason that women typically are at risk for osteoporosis earlier than men, as women go through menopause and suffer a loss of sex hormones while men don’t typically have a similar significant hormone change. But the risk is hard to see when only taking puberty blockers for a year or two.”

It’s also worth noting that there is a relationship between puberty blockers and fertility. Sperm production typically begins between 13 to 14, and egg maturation between 12 to 13, and the vast majority of trans children will begin puberty blocker treatment after these processes have already occurred. In these cases, sperm or eggs can be frozen before treatment and may be used to conceive a child in later life. If a young person decides not to transition after all and ceases puberty blocker treatment, the Endocrine Society advises that no studies have reported long-term, adverse effects on ovarian function.

For people with testicles, sperm numbers can fall below the normal range in some cases.

#2. "FDA adds new warning for commonly used puberty blockers" ( https://1819news.com/news/item/fda-adds-new-warning-to-commonly-used-puberty-blockers#:~:text=The%20warning%20informs%20users%20of,those%20of%20a%20brain%20tumor ) reports, among other things:

The Food and Drug Administration is warning of potential side effects in certain puberty-blocking drugs used in transgender treatments.

The FDA has added a warning to the labeling for gonadotropin-releasing hormone (GnRH) agonists such as Lupron.

GnRH agonists have several uses. Developed to treat certain types of cancer, GnRH agonists are also used to treat endometriosis, delay early puberty, and halt or eliminate puberty for pediatric patients who identify as transgender.

According to the Cleveland Clinic, GnRH agonists are also used to accomplish chemical castration, sometimes called medical castration.

According to the FDA, the warning will only apply to the GnRH agonists used in pediatric patients to delay or stop puberty. The warning informs users of the possibility of developing something called a pseudotumor cerebri.

According to Mayo Clinic, pseudotumor cerebri happens when there is increased pressure inside the skull “for no obvious reason.” Symptoms mimic those of a brain tumor. The increased intracranial pressure can cause swelling of the optic nerve and result in vision loss.

Through a study of several patients prescribed GnRH agonists, the FDA determined there was “a plausible association between GnRH agonist use and pseudotumor cerebri.”

Six cases were identified that supported a plausible association between GnRH agonist use and pseudotumor cerebri. All six cases were reported in females ages 5 to 12 years. Five were undergoing treatment for central precocious puberty and one for transgender care.

For years, patients who have been prescribed GnRH agonists have complained of adverse effects from the drugs.

In 2017, Stat News reported that several women experienced multiple adverse reactions to the drug after being prescribed it at a young age. Many women described bone disease, depression, mood swings, muscle spasms, seizures and other problems that developed in their 20s.

“A 20-year-old from South Carolina was diagnosed with osteopenia, a thinning of the bones, while a 25-year-old from Pennsylvania has osteoporosis and a cracked spine,” the article read. “A 26-year-old in Massachusetts needed a total hip replacement. A 25-year-old in Wisconsin has chronic pain and degenerative disc disease.”

In a 2011 article in The Journal of Pediatrics, research physicians found that even minor delays in puberty reduce children’s bone density.

While there are many GnRH agonist drugs used to delay puberty in pediatric patients, Lupron has the lion’s share of the market.

The only FDA-approved use of Lupron is to treat central precocious puberty, commonly called early puberty, defined by the FDA as occurring in boys younger than nine and girls younger than eight.

The FDA lists the side effects of Lupron as:

Injection site reactions such as pain, swelling, and abscess
Weight gain
Pain throughout body
Headache
Acne or red, itchy rash and white scales (seborrhea)
Serious skin rash (erythema multiforme)
Mood changes
Swelling of vagina (vaginitis), vaginal bleeding, and vaginal discharge

The Lupron website lists additional possible side effects, such as:

Crying
Irritability
Restlessness (impatience)
Anger
Acting aggressive

Off-label prescribing is a common practice, but some in the medical field have suggested caution when it comes to prescribing pediatric patients with GnRH agonists. [my emphases--J.S.]

#3. The FDA warning discussed in #2 above is on the FDA's website at https://www.fda.gov/media/159663/download#:~:text=The%20Food%20and%20Drug%20Administration%20(FDA)%20has%20added%20a%20warning,precocious%20puberty%20in%20pediatric%20patients.

**** Are a substantial number of adolescents and young adults developing gender dysphoria due to social and cultural influences--peer pressure--rather than due to innate pre-existing gender dysphoria? Does this explain the sharp rise in gender dysphoria among adolescents and young adults lately?

Here is a PLOS ONE research article (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330) titled, "Parent reports of adolescents and young adults perceived to show signs of rapid onset of gender dysphoria." The Abstract, Purpose begins:

A Sexual Health journal review article at https://www.publish.csiro.au/sh/sh17067 titled, "Epidemiology of gender dysphoria and transgender identity" reports:

"This review provides an update on the epidemiology of gender dysphoria and transgender identity in children, adolescents and adults. Although the prevalence of gender dysphoria, as it is operationalised in the fifth edtion of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), remains a relatively ‘rare’ or ‘uncommon’ diagnosis, there is evidence that it has increased in the past couple of decades, perhaps reflected in the large increase in referral rates to specialised gender identity clinics. In childhood, the sex ratio continues to favour birth-assigned males, but in adolescents, there has been a recent inversion in the sex ratio from one favouring birth-assigned males to one favouring birth-assigned females." [emphasis added--J.S.]

While the recent increase in the number of gender identity clinics may help explain the increased prevalence of reported gender dysphoria, it does not explain the reason for the sex ratio inversion. Why, all of a sudden, is there a greater increase in the number of birth-assigned female adolescents compared to birth-assigned male adolescents with gender dysphoria, and why is this difference only among adolescents?

A very likely explanation is that there is a recent cultural phenomenon--a fad--among adolescent girls in which they adopt a "gender dysphoria" identity for purely cultural reasons having to do with wanting to gain acceptance or attention or something similar.

Here are scientific journal reports of how the sex ratio of youths seeking gender transition has flipped recently. What do you think could explain this other than social/cultural factors?

https://pubmed.ncbi.nlm.nih.gov/25612159/

https://pubmed.ncbi.nlm.nih.gov/32624407/

https://www.tandfonline.com/doi/abs/10.1080/0092623X.2018.1437580?journalCode=usmt20

A change in the demographic seeking gender change is hard to explain except as a socially/culturally induced change, right?

If lots more young girls now than in the past (relative to the number of young boys saying they are girls trapped in a boy's body) are saying they are boys trapped in a girls body, doesn't that imply that lots more of girls who say they are gender dysphoric are not gender dysphoric for innate biological brain abnormality reasons, but rather for reasons such as social/cultural inducement?

Here's some context about how symptoms spread by social means:

“Edward Shorter, a historian of mental illness, coined the term ‘symptom pool’ for the medical presentations regarded as legitimate in a given culture. When a doctor sees a patient with psychosomatic symptoms–ones that are physical, but produced by mental states–these are moulded by patient and doctor together into a recognised illness. ‘Mental-health syndromes are always a kind of fiction, shaped by culture and expectations,’ says Marchiano. ‘Our emotional lives, and the ways they can become disrupted, are protean.’ A new medical paradigm, therefore, may do something more profound than give doctors a new way to understand what they see: it can change what they see. Sometimes, a new condition is born–and sometimes it gains sudden popularity. The history of medicine is scattered with psychosomatic diseases that appeared, spread like wildfire and died away as medical thinking changed again. One sign a new condition may fall into this category is that it mainly affects teenage girls and young women. They are more likely than other demographics to indulge in ‘co-rumination’: repetitive discussion and speculation within a peer group. That can lead to internalising problems, and thence to anxiety, depression and self-harm. Girls are also often more empathetic than boys, and better at reading moods, which means emotions spread faster in a female peer group than in a male one. That is why self-harm and eating disorders can run through female friends, and why historical episodes of mass hysteria, such as fainting fits, uncontrollable laughter or crying, and outbreaks of paralysis or tremors, have so often occurred in convents and girls’ schools.”

— Trans: Gender Identity and the New Battle for Women's Rights by Helen Joyce

https://a.co/7Gh5AGb

The spread of anorexia among young women suggests why dysphoria may be spreading among adolescent girls:

“Our hyper-connected world makes it easier than ever for culture-bound syndromes to break their bounds. In his excellent book, Crazy Like Us: The Globalisation of the American Psyche, journalist Ethan Watters argues that this is particularly likely to happen with American culture-bound syndromes, because of the country’s cultural dominance. One of his case studies is the arrival of Western-style anorexia in Hong Kong. The few self-starving young women seen by doctors in the territory before the mid-1990s did not have distorted body images or a pathological fear of being fat, but spoke instead of a feeling of bloating, a blockage in the throat, or simply a total lack of appetite. Then, in 1994, a teenage girl who had stopped eating some months earlier collapsed and died on a busy street. Journalists seeking to explain the unprecedented event turned to international sources–and unintentionally presented to Hong Kong’s teenage girls a possibility hitherto undreamt of: that distress and self-hatred could be expressed by self-starvation. Sing Lee, a doctor who had been perhaps Hong Kong’s sole specialist in self-starvation, went from seeing two or three cases a year to two or three cases a week.”

— Trans: Gender Identity and the New Battle for Women's Rights by Helen Joyce

https://a.co/58bDU4Q

***** An article (at https://nymag.com/intelligencer/2023/03/jamie-reeds-claims-about-transgender-care-are-under-fire.html ) about this whistle-blower titled "Whistleblower’s Claims About a St. Louis Transgender Center Are Under Fire"

reported that some parents of children treated in the clinic (at the St. Louis Children's Hospital) supported the clinic. One paragraph in the article, however, reads:

"One parent who was skeptical of the need for transgender centers to begin with told the Post-Dispatch that though they did feel pressured by the center to proceed with unspecified treatment, “they have not forced us to do anything.” The parent was vague about any treatment that the center recommended or that the teenager was receiving, saying only they believed more therapy may resolve the teenager’s issues. Even so, the parent “does not want the Transgender Center shut down but said the approach should be broader, with extended psychotherapy for patients,” according to the Post-Dispatch."

This parent's (paraphrased in the article) statement--"they did feel pressured by the center to proceed with unspecified treatment" --essentially supports the whistle-blower's claims. Yes, this parent said "they have not forced us to do anything," but the whistleblower never said anybody was forced to do something; what would that even mean: forced with a court injunction, forced at gun point?

The article quotes other parents saying that the whistle-blower's claims are not true, such as this paragraph:

“The idea that nobody got information, that everybody was pushed toward treatment, is just not true,” parent Kim Hutton told the Post-Dispatch. “It’s devastating. I’m baffled by it.”

Note that the whistle-blower worked at the clinic and observed what happened to lots of children, whereas the parents interviewed by the nymag.com/intelligencer article a) only knew what happened to their own child, and b) may have been cherry picked by the article's author to refute the whistle-blower.

Furthermore, none of the interviewed parents reported that the clinic provided counseling that recommended that the child NOT have a gender transition (one simply said not to do surgery too quickly.) Only reports of such do-not-have-gender-transition counseling would refute what the whistle-blower said. The interviewed parents' statements all seem to show merely that the clinic was very good at persuading parents that their child needed gender transition. See the comments on this nymag/intelligencer article; some are very good.

Note also that it does not seem to be the case that this gender clinic is a rogue clinic, unrepresentative of U.S. approved practices. It is part of the St. Louis Children's Hospital-Washington University, described at https://health.usnews.com/best-hospitals/area/mo/st-louis-childrens-hospital-6631180 this way:

"St. Louis Children's Hospital-Washington University in Saint Louis, MO is nationally ranked in 10 pediatric specialties. It is a children's general medical and surgical facility. It is a teaching hospital."

****** To see what kind of psychiatric counseling has been outlawed (by falsely characterizing it as "conversion therapy"), please read this 2016 petition/open letter (at https://www.ipetitions.com/petition/boardoftrustees-CAMH?fbclid=IwAR28eXfcJtUVe4isLBPCQlnTqwIc1umgbQ4ZOx5vZG3PvXgUvkc9xWSml0w ) supporting a leading gender psychiatrist who was fired for not being "gender affirmative"; this firing led the way to the eventual monopolization of gender therapy by exclusively "gender affirmation" therapy in gender clinics in much of the world. Here is a key part of the open letter:

"The essence of the trans activists’ complaint appears to be Dr. Zucker’s position that the first line of approach with younger gender-dysphoric children is to help them accept their anatomic sex. This complaint of course overlooks that, in cases of older children whose cross-gender identity proved persistent, Dr. Zucker actually recommended medical interventions paving the way to sex reassignment. Furthermore, although Dr. Zucker’s attackers deliberately (mis)-applied the phrase “conversion therapy” to refer to Dr. Zucker’s approach, he never, in fact, attempted to influence children’s eventual sexual orientation—a fact acknowledged by the CAMH itself.[2]"