Gender Transition in Children: A Dialogue Continued

From The Huffington Post:


I had a very poignant experience in May when I taught Penn Med students during their first course on trans health, touching because 38 years earlier I had sat where they were sitting in the John Morgan building and had been lectured that I was mentally ill due to a sexual perversion. Now I was the one doing the lecturing, transmitting the science and lived reality of the trans experience of the past 38 years.

Since my medical school years, not only have the numbers of successful social and medical transitions skyrocketed in America and around the globe, but our understanding of human sexual development has exploded as well. Today all our medical associations, from the broad-based American Medical Association (AMA) to the brain-related mental health organizations, such as the American Psychological Association (APA) and the American Psychiatric Association (APA), recognize the trans experience as a normal human variation and no longer characterize it in pathologizing terms. The process isn’t complete yet, even with the reconceptualization of the transgender experience in the DSM 5, the manual developed by the American Psychiatric Association and used widely throughout the medical and legal professions. It won’t be complete until there is no category of gender identity variance left in the DSM, just as gay people were not completely liberated until homosexuality was completely removed several decades ago.

So today we have professional medical acceptance of adult trans persons and increasing acceptance of trans adolescents. Gender clinics are flourishing in Boston (including the Gender Management Service Clinic, which was founded by Dr. Norman Spack), Los Angeles and Chicago, with new ones in development in Pittsburgh, Philadelphia and elsewhere. The controversy in the profession is now focused on children, particularly gender-variant children assigned male at birth who desire to socially transition. Let me make it clear: There is no surgical intervention done in this country before the age of consent, at 18. And hormonal treatment, with puberty-blocking hormones, a completely reversible process, is not prescribed until the onset of puberty. The controversy relates fully to the social aspects of gender transition.

This past Sunday The New York Times published a letter from Dr. Jack Drescher, a renowned psychiatrist and specialist in gender issues, who served on the DSM 5 Workgroup on Sexual and Gender Identity Disorders, relating to the case of Coy Mathis, an 8-year-old trans girl in Colorado. Coy’s case related to her use of the girl’s bathroom, which the school had banned out of fear that some parents would be concerned about her doing so. Steven Chavez, the division director of the Colorado Civil Rights Division, ruled, quite emphatically, that telling Coy “that she must disregard her identity while performing one of the most essential human functions constitutes severe and pervasive treatment, and creates an environment that is objectively and subjectively hostile, intimidating or offensive.”

Dr. Drescher’s letter was the kickoff to a “dialogue” in the Sunday Times and includes an abbreviated letter from me. This is my unedited response:

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