dinsdag 18 mei 2021

Media reports about gender transitions of teenagers are not critical enough

More and more adolescent girls are registering at gender clinics. Dutch media should also highlight the downside, says Peter Vasterman.

Published in NRC,  May 17, 2021.

Dutch version here

At the Gender Talks helpline launched in March, peer supporters will talk to young people who have questions about gender issues, NRC wrote earlier this month. According to the report, transgender care institutions are inundated with applications, leaving 2,000 people on a waiting list: "Explanations for the increased medical need are the increased visibility and acceptance of trans people, and the improved care."


The report is typical of the coverage in many Dutch media about transgender issues. The tone is generally positive, the human interest stories dominate and the transgender advocacy organizations are the most important sources of information. It is all very empathic, as in the numerous programs, series and reports on television about transgender people.

But considering what is going on in the transgender world, it is remarkable that the media hardly pay any attention to the problematic sides of the gender transitions.

Indeed, more and more young people are registering at the gender clinics, but nowadays the vast majority are adolescent girls, not only in the Netherlands, but also in England, Sweden and the United States, for example. In the past there were more boys than girls, nowadays there are three times as many girls as boys at the clinics. This is evident from figures from gender clinics in many countries and from scientific research.

In addition, this new group deviates strongly from the classical profile of children with gender dysphoria, who often have a strong sense of unease about their biological sex from an early age - an important criterion for treatment. Many of those teenage girls have no history of gender dysphoria, but appear to discover quite suddenly that they actually want to be boys.

There is much discussion and controversy abroad about this remarkable development, but the Dutch media remain silent. One of the possible explanations is that the sudden increase in the number of girls is a result of social contamination, via peer groups at school, or via social media where popular transgender people can act as role models. The tipping point in the registrations (from 2012) exactly coincides with the breakthrough of social media among young people. And then there is also a striking overrepresentation of girls with autism spectrum disorders in this group. There may be other explanations for the increase, but there is not much research yet.

The international controversy not only relates to the question of where this suddenly emerging gender dysphoria comes from, but especially also to the question whether the gender clinics should immediately initiate the transition desired by these girls with puberty blockers (from the age of 11) and hormone treatments (from the age of 15 years).

The experts in the Dutch gender clinics also point to the problem that the usual treatment of years of counseling and making careful choices (after all, gender dysphoria disappears in a majority of young children), no longer suits this new group of transgender people.

Thomas Steensma of the gender team at VUmc, for example, explained in the Algemeen Dagblad (27 February): “We do not know whether studies we have done in the past are still applicable to this time. Many more children are applying, and also a different type. […] Why are so many girls suddenly experiencing dissatisfaction with their gender? That really needs to be investigated. ”

There are a lot of diverging views among practitioners: even regarding the most fundamental issues such as what explains gender dysphoria and the need for medical interventions at a young age, there is no consensus, according to a 2015 Leiden study among 34 practitioners in 17 gender clinics in ten different countries.

Dutch media have barely covered the controversial lawsuit against the Tavistock gender dysphoria clinic in London, filed by a mother who wanted to prevent her now 16-year-old daughter with autism from receiving hormone treatments and a 23-year-old woman who tried to transition back to being female. She blames the clinic for deciding on irreversible treatment too fast when she was 16 years old.

The British judge decided on December 1 last year that it is doubtful whether children under the age of 16 understand the long-term effects of this radical medication. As a result, they are unable to consent to this in a deliberate way. The Tavistock clinic is now no longer allowed to prescribe puberty inhibitors for children under the age of 16, and the administration of hormones to children under the age of 18 must also meet strict requirements. The main gender clinic in Sweden has meanwhile decided - also through Tavistock - to stop puberty blockers and hormone treatments for children under the age of 16. Here, too, an important argument is that the medical consequences of this experimental treatment have not been properly investigated (risks of infertility, osteoporosis, cardiovascular disease, etc.).

The coverage in the Netherlands about the Tavistock case was limited to the previously quoted AD article and a few pieces in the Christian newspapers. It is as if all the other media, including TV journalism, are ignoring this controversy for fear of, yes, of what? Fear of stirring up transphobic reactions? Fear of being blamed for transphobia yourself? Possibly, but in the meantime it is the task of journalism to report critically about the problems and dilemmas in transgender clinics and the causes and consequences of the striking increase in the number of girls who suddenly report gender dysphoria. That is not transphobic.

Peter Vasterman is a media sociologist.


Sources

Graaf de, N. M. (2020). Gender Trends: Developments in Clinical Care for Gender Diverse Young People. (Proefschrift) 

Arnoldussen, Marijn , Thomas D. Steensma, Arne Popma, Anna I. R. van der Miesen, Jos W. R. Twisk, Annelou L. C. de Vries. Re-evaluation of the Dutch approach: are recently referred transgender youth different compared to earlier referrals? European Child & Adolescent Psychiatry (2020) 29:803–811

Steensma, Thomas D. Peggy T. Cohen-Kettenis & Kenneth J. Zucker (2018). Evidence for a Change in the Sex Ratio of Children Referred for Gender Dysphoria: Data from the Center of Expertise on Gender Dysphoria in Amsterdam (1988–2016), Journal of Sex & Marital Therapy, 44:7, 713-715

NHS Tavistock and Portman (2019). Referrals to the Gender Identity Development Service (GIDS) level off in 2018-19

Riittakerttu Kaltiala-Heino, Hannah Bergman, Marja Työläjärvi, Louise Frisén (2018) Gender dysphoria in adolescence: current perspectives. Adolescent Health, Medicine and Therapeutics 2018:9 31–41

Vries de, ALC. (2020). Challenges in Timing Puberty Suppression for Gender-Nonconforming Adolescents. Pediatrics. 2020;146(4)

Tetelepta, Berendien (2021). Dringend meer onderzoek nodig naar transgenderzorg aan jongeren: ‘Waar komt de grote stroom kinderen vandaan?’ Algemeen Dagblad, 27-02-21

Littman L (2018) Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS ONE 13(8): e0202330

Marchiano, Lisa  (2017) Outbreak: On Transgender Teens and Psychic Epidemics, Psychological Perspectives, 60:3, 345-366

Shrier, Abigail  (2020). Irreversible Damage: The Transgender Craze Seducing Our Daughters. Regnery Publishing

Warrier, Varun, David M. Greenberg, Elizabeth Weir, Clara Buckingham, Paula Smith, Meng-Chuan Lai, Carrie Allison & Simon Baron-Cohen (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. NATURE COMMUNICATIONS | (2020)11:3959.

Kaltiala-Heino, Riittakerttu, Maria Sumia, Marja Työläjärvi and Nina Lindberg (2015). Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health (2015) 9:9

Zucker, Kenneth J.  (2019). Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues. Archives of Sexual Behavior · October 2019

Balleur-van Rijn, Anouk (2017). Klinische richtlijnen voor comorbide genderdysforie en autisme. Het Tijdschrift Kinder- & Jeugdpsychotherapie, nummer 1 2017 

Giordano, Simona & Søren Holm (2020) Is puberty delaying treatment ‘experimental treatment’?, International Journal of Transgender Health, 21:2, 113-121

Turban, Jack L. and Diane Ehrensaft (2018). Research Review: Gender identity in youth: treatment paradigms and controversies. Journal of Child Psychology and Psychiatry 59:12 (2018).

Vrouenraets, Lieke, A. Miranda Fredriks, M.D., Sabine E. Hannema, Peggy T. Cohen-Kettenis, and Martine C. de Vries (2015). Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study. Journal for Adolescent Health, 57, 2015, 367-373.

Daily Mail  (2020) 'I went behind my 16-year-old autistic daughter's back to stop the Tavistock clinic giving her puberty blocking drugs.’ Daily Mail Online, 12 december 2020 

The Times (2019). Tavistock clinic: My daughter can’t understand the risk, says mother. October 12 2019.

Keira Bell: My Story 7 april 2021. 

Royal Courts of Justice Strand, London, WC2A 2LL Bell-v-Tavistock-Judgment.pdf 

Policy Change Regarding Hormonal Treatment of Minors with Gender Dysphoria at Tema Barn - Astrid Lindgren Children’s Hospital. April 1, 2021

The Economist, (2021). Doubts are growing about therapy for gender-dysphoric children. Drug treatments seem to do little good, and may be harmful. May 15, 2021

Broersen, Sophie (2013). Genderdysforie bij kinderen gaat meestal over. Medisch Contact  8 mei 2013. 

Hartley, Emma (2020). Why do so many teenage girls want to change gender? Prospect March 3, 2020

SBU policy support (2019). Gender dysphoria in children and adolescents: an inventory of the literature. A systematic scoping review. December 2019