Rick Fitzgibbons, M.D.
Catholic parents are often stunned when a daughter relates that she believes she is actually a male trapped in a female's body and has thought this way from early in her childhood.
This article focuses on females, in part, because adolescent females constituted the largest group of patients who underwent sexual reassignment surgery in a Boston study. This study of 180 youth revealed the surgery was performed on 106 females and 74 males. The majority of the adolescent females were from divorced families and the median age when treatment was initiated was nine years of age.
At follow up, these youth later had a twofold to threefold increased risk of psychiatric disorders, including depression, anxiety disorder, suicidal ideation and suicide attempt compared to a control group of youth.(1)
Initial parental response
Upon learning this parents often experience intense fears about fear their child’s future, many become depressed, can’t sleep, lose weight and feel overwhelmed. At the same time powerful cultural pressures that are meant to influence them are at work to normalize transsexual attractions in youth in the media, schools, peer relationships and governments. In the midst of what has been described as the transgender agenda in the culture, the search for reliable information about this conflict in youth can be challenging, as well as finding health professionals who are knowledgeable and experienced.
Unfortunately, most pediatricians, doctors and mental health professionals have yielded to the enormous transgender advocacy and propaganda in their professional organizations. Additional stress can occur in the lives of parents when youth announce at school that they are transgender and receive the support of uninformed teachers whose national organization is actively advancing the transgender agenda for youth.
This article offers parents an approach to understanding the psychological conflicts that have been identified in these youth and in their parents and a successful treatment approaches to help them that does not involve the use of puberty blocking drugs, hormones or mutilating surgery.
The use of drugs in preparation for "transitioning" has been described is experimental without the provision of adequate safeguards, such as carefully controlled clinical trials, as well as long-term follow-up studies. Such information is essential in helping parents and their children make the most appropriate decisions for the future health of their children based on science and not on feelings or confused thinking.
Effective Treatment Approaches
Dr. Kenneth Zucker, a renowned and internationally recognized psychological expert treated over 1,000 youth with gender dysphoria over his 30-year career. He and Dr. Susan Bradley in Toronto have been recognized as leaders in the study of gender dysphoria in youth and are the authors of Gender Identity Disorder in Children.
He has written numerous papers on the origins and treatment of psychological conflicts in parents and in youth with gender dysphoria. His papers have described how his approach helped youth to accept and identify with their biological masculinity or femininity.
Because his group found that gender dysphoria is usually rooted in profound and complex disturbances within the family, his group only recommended medical interventions if the psychotherapy was not successful. An important BBC documentary, https://archive.org/details/BBC-trans-kids presents his work and the current controversy surrounding approaches to youth with transsexual attractions. This documentary is highly recommended for parents and youth with gender dysphoria.
In 2015, Zucker was forced to resign from his practice and his clinic was closed. Over 500 health professionals from around the world signed a petition protesting this politically correct action against a highly respected child psychologist and scholar.
Conflicts in Parents
Zucker and Bradley have identified a number of conflicts in the families of children with GID that included: (1) the mother’s psychological conflicts correlated quite strongly with their children’s measure of behavior problems. The rate of the mother's psychiatric illnesses was high by any standard and included depression and bipolar disorder.
The parents often had difficulty resolving the conflicts they experienced in their own marital relations, and failed to provide support to each other. These men (fathers) were often easily threatened and felt inadequate themselves. These qualities appeared to make it very difficult for them to connect with children. Fathers also demonstrated depression and substance abuse disorder. They observed that the parental psychological conflicts among the parents of children with gender dysphoria deserve thoughtful consideration.(2)
Zucker and colleagues also found that these youth had high rates of general behavior problems and poor peer relations.(3) It should be noted that these observations are not derived from controlled studies. As such, there is no comparison to the prevalence of such conflicts among control groups. Thus the specificity of these conflicts (or their prevalence in children with gender dysphoria) is not clear. There is no conclusive evidence of the role of such conflicts in the development of gender dysphoria, or whether treatment aimed at correcting these leads to improvement. However, the comments of Zucker and Bradley do seem relevant to understanding the development of gender dysphoria.
Additional conflicts that we have seen while engaging in the family therapy, which has been recommended by Dr. Paul McHugh the former chair of psychiatry at Johns Hopkins University for 25 years, include:
Observed conflicts with their fathers are:
- An excessive fear of the father's anger or his controlling behaviors, leading to a fear of being hurt as a female, coupled with a belief that being a male would help her feel safer in relationships;
- Severe mistrust of the father because of his mistrust of female love arising from traumatic expereinces with his mother, insensitive and angry treatment of the mother, of his harming the family by abandonment, or of his emotional, personality, or behavioral conflicts;
- The father's failure to attach to attach securely to his daughter and to affirm her feminine goodness, beauty and gifts;
- Anger with the father with pleasure in upsetting and punishing him by rejecting her femininity;
- The failure to communicate that fulfillment and happiness can be found in embracing the goodness of femininity and in being a psychologically healthy female;
- The unconscious belief that a daughter might gain acceptance and love from a rejecting, cold, unloving father by being a male rather than a female;
- The failure to critique and protect a daughter from gender theory errors.
In one family session with a young woman who was taking testosterone and was planning on sexual reassignment surgery, the father expressed to his daughter his belief that his excessive anger in the home throughout her childhood from modeling after an angry father had made her fearful of trusting males. He believed her anxiety and severe fear of being hurt by males led her to think she might feel safer in the world if she had a masculine appearance and identity. His daughter was reflective for several moments and then responded to him, “You could be right.”
Observed conflicts with their mothers are:
- A controlling, emotionally distant, angry, selfish, depressed, or critical mother who failed to bond closely with her daughter;
- The failure to affirm the daughter's goodness and special gifts because of the mother's deep insecurities and unhappiness;
- The rejection of the mother as a role model;
- Pleasure in venting anger at the mother by rejecting femininity;
- The failure to support and encourage same sex friendships and play in childhood;
- The failure to criticize excessive identification with and modeling after the opposite sex
- A failure to communicate that fulfillment and happiness can be found in being a psychologically healthy female
- The failure to a failure to critique and protect her daughter from gender theory errors.
Observed conflicts with peers and siblings are:
- The absence of close female friendships, and a sense of not fitting into the female world; a subsequent belief that one would be less lonely and happier as a male;
- A need for attention and acceptance, which could come from a transgender identity;
- A poor body image or a sense of failure as a female and a belief that one would be more attractive if she were of the opposite sex;
- In strong, young females, a love for what is perceived as male strength, and preferential treatment for males, together with the desire to become what she loves;
- In very athletic and strong young females, an intense bonding and identification with young males through athletic activities;
- Pressure from a significant other in a homosexual relationship or peers to cross dress, take hormones, and move toward SRS;
- An identification with peers who identify as transgendered;
- A sense of pleasure in rejecting and expressing anger at the values and moral code of her parents;
- An acceptance of gender theory that her sex is not a gift but a constraint that must be overcome;
- A delusional belief that she can create herself as she wants.
The exposure of youth to gender theory in college can result in their embrace of post-modern philosophies, focused on freedom as an end in and of itself. Such ideas come from various sources, including the writings of Friedrich Nietzsche and Jean-Paul Sartre. If freedom (some would call it license) is the greatest good in the world, then why should anyone be constrained by biology that must be overcome.
Rapid Onset Gender Dsyphoria
Parents not infrequently report their children experiencing a rapid onset of gender dysphoia which appears for the first time in their daughters during or after puberty. In our clinical experience, these daughters previously identified with their femininity, enjoyed playing with dolls and had secure attachment relationships with each parent. However, the history revealed that these females often did not have a best female friend or a close group of female friends.
In a 2017 study of 164 adolescents with rapid onset gender dysphoria, 93% were females with average age of 15 when they announced that they were transgender. Contrary to early research findings, arent-child relationships were worse in 75.7% of the families two years after the announcement. Where popularity status was known, 64.2% of adolescents had an increase in popularity within the friend group after announcing that they were transgender. In these youth 37.3% received online advice that parents who didn't agree with their taking hormones were abusive and transphobic and 46.5% of youth withdrew from their families. Also, in this study, 53.1% of youth only trusted information about gender dysphoria from transgender sources. Parents reported a worsening in the mental health in 51.2% of their children and an improvement in 13.6% two years after announcement.
The author recommended the need for more research to understand this phenomenon and the worsening mental well-being and parent-child relationship.(5)
Other Treatment Approaches
Given the identified conflicts in the families of youth with gender dysphoria, family therapy should be an essential aspect of the treatment plan for these youth with a focus in identifying psychological difficulties in each parent, as well as in the child. The uncovering process is followed by recommendations for working on the identified issues.
The major goal of treatment is to help the girl/teenager with the help of her parents and others to grow to appreciate her goodness, gifts and beauty as a female. An essential aspect of healthy psychological development in early childhood is the establishment of same peer friendships.
A twelve year old female, who expressed a desire to be male, to cut her hair very short and to wear clothing favored by males, worked to uncover difficulties she had in establishing friendships with other girls. The basic conflicts were twofold - she was so involved in a demanding competitive sport that she had no time after school for friendships and she lost trust in female friendships because of the intense competitive and jealousy of girls with whom she competed. When she decided to let go of this sport, with her mother's encouragement she began to work on female friendships. This led to greater identification with new female friends and to a resolution of the desire to be male.
Each parent should regularly compliment their daughter and affirm her goodness as a female that enriches their lives. Those with Faith can also express the belief that God has a special plan for her as a female.
Parents can be particularly helpful in encouraging the pursuit of a best friend with those of same sex and, if necessary, discouraging the pursuit of a best friend with those of the opposite sex.
Significant anger is often uncovered in these youth toward a parent, sibling or peer. The process of forgiveness is recommended which has been demonstrated empirically to decrease sadness, excessive anger and anxiety, as well as increase confidence. The forgiveness process is particularly challenging when the girl has intense anger with an insensitive parent or rejecting, angry peers or siblings.
Children who seek Sexual Reassignment Surgery should be evaluated for psychological conflicts, but regularly are not. A Dutch researcher and clinician, who specializes in treating such youth, Dr. Peggy T. Cohen-Kettenis, has written in this regard:
The percentage of children coming into our clinic with GID as adolescents wanting sex-reassignment is much higher than the reported percentages in the literature. We believe (psychological) treatment should be available for all children with GID, regardless of their eventual sexual orientation. (5.)
Reasons for Hope
A 2017 research study, led by Dr. Paul Hruz, a pediatric endocrinologist and an associate professor of cell biology and physiology at Washington University School of Medicine, St. Louis, that reviewed 50 articles on transsexual conflict in youth "Growing Pains: Problems With Puberty Suppression in Treating Gender Dysphoria," stated,
“Young people with gender dysphoria constitute a singularly vulnerable group and experience high rates of depression, self-harm and even suicide. Moreover, children are not fully capable of understanding what it means to be a man or a woman. Most children with gender identity problems go on to accept the gender associated with their sex and stop identifying as the opposite sex.”
Dr. Zucker and Bradley wrote of their work:
The fantasy solution provides relief but at a cost. They are unhappy children who are using their cross-gender behaviors to deal with their distress. The treatment goal is to develop same-sex skills and friendships.
In general, we concur with those who believe that the earlier treatment begins, the better. It has been our experience that a sizable number of children and their families can achieve a great deal of change. In these cases, the gender identity disorder resolves fully and nothing in the children behavior or fantasy suggest that gender identity remain problematic.
All things considered, however, we take the position that in such cases, clinicians should be optimistic, not nihilistic, about the possibility of helping children become secure in their gender identity.(6)
This author believes that, given the severe cultural pressures to normalize transsexual attractions, experimental hormonal use on youth and sexual reassignment surgery on them, consideration should be given to the establishment of a presidential commission with experts such as Drs. Hruz, McHugh, Mayer and Zucker to evaluate the science and risks involved with this issue. https://www.thecatholicthing.org/2017/06/28/the-transgender-agenda-vs-the-science/
Helpful resources for parents include:
Transgender Kids: Who Knows Best? by BBC : Free Download ... Describes Dr. Zucker's work with over 1,000 youth with gender dyspphoria.
American College of Pediatricians statement, 2017.
Mayer, L., S. & McHugh, P.R. (2016). Sexuality and Gender: Findings from the Biological, Psychological and Social Sciences. http://www.thenewatlantis.com
www.hprweb.com/2016/08/transsexual-attractions-and-sexual... Homiletic and Pastoral Review online, Dr. Rick Fitzgibbons
The Role of Faith
In Catholic families the role of faith can be helpful in this process by encouraging gratitude daily for the girl’s/teenager’s God given gifts and beauty, as well as God’s good plan for her life.
In addition some females report being helped by reflecting upon the scripture passage, “I give you thanks, for I am fearfully, wonderfully made,” Ps 139:14 and by reading scripture regularly to deepen their friendship with the Lord.
Pope Benedict XVI spoke on this issue in 2008:
It (the Church) has a responsibility for the created order and ought to make this responsibility prevail, even in public. And in so doing, it ought to safeguard not only the earth, water, and air as gifts of creation, belonging to everyone. It ought also to protect man against the destruction of himself. That which is often expressed and understood by the term Gender, results finally in the self-emancipation of man from creation and from the Creator. Man wishes to act alone and to dispose ever and exclusively of that alone which concerns him. But in this way he is living contrary to the truth, he is living contrary to the Spirit Creator.
The tropical forests are deserving, yes, of our protection, but man merits no less than the creature, in which there is written a message which does not mean a contradiction of our liberty, but its condition.(6)
Youth have the right to be provided informed consent about gender confusion and the successful treatment options that are available, as well the serious medical and psychiatric risks associated with hormone treatment and sexual reassignment surgery. Pediatricians, mental health professionals, physicians, nurses and school counselors have a clear legal responsibility to do so and parents, family members, teachers, politicians and clergy have a moral responsibility to protect youth.
1. Reisner, S. et al. (2015). Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study. Journal of Adolescent Health 56: 274ˇV79.
2. Zucker, K., Bradley, S., et al. (2003) Psychopathology in the parents of boys with gender identity disorder. Journal of the American Academy of Child and Adolescent Psychiatry 42: 2ˇV4.
3. Zucker, K. & Bradley, A., et al. (2012). Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism. Journal of Sex & Marital Therapy 38: 151ˇV 89.
4. Littman, L. (2017). Rapid Onset of Gender Dysphoria in Adolescents and Young Adults: A Descriptive Study. Poster Abstracts/ 60 (2017) S95-6.
5. Cohen-Kettenis, P (2001). Gender identity disorder in the DSM? Journal of the American Academy of Child and Adolescent Psychiatry 40: 391.
6. Zucker, K. & Bradley, S.A. (1995) Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Publications. 281-2.
7. Benedict XVI, Pope. 2008. Address “To the members of the Roman Curia for the traditional exchange of Christmas greetings.” December 22. w2.vatican.va/content/benedict-xvi/en/speeches/2008/december/ documents/hf_ben-xvi_spe_20081222_curia-romana.html.