Lisa Marchiano on the trouble with transing kids

Image: Veer Images

A couple of decades ago, progressives would have celebrated a child who didn’t “fit” within the sexist stereotypes imposed on boys and girls. But it seems the days of “Free to be… You and Me” are long gone. Instead of saying to kids, “You’re fine just the way you are,” more and more frequently, we are saying, “Maybe you were born in the wrong body.”

The recently popularized phenomenon of “transitioning” kids who claim their bodies are “wrong,” or who gravitate towards the gender roles traditionally associated with the opposite sex, has been widely celebrated and supported by liberals and progressives alike. But are we moving too quickly? What are the consequences of transitioning children?

With many questions left unanswered (and many questions not being asked in the first place), the “trans kids” trend surely needs more interrogation.

Lisa Marchiano, LCSW, is a clinical social worker and Jungian analyst. She is concerned that we are moving too fast and too uncritically towards transitioning kids. Her article, “Layers of meaning: A Jungian analyst questions the identity model for trans-identified youth” can be found at 4thWaveNow. For more on her work, visit The Jung Soul.

This interview was originally aired on the Feminist Current podcast in 2016.


MEGHAN MURPHY: First, can you tell me a bit about your background and what led you to look more critically at the increasing numbers of trans kids and this push to affirm “gender identity”?

LISA MARCHIANO: I am a licensed clinical social worker, a Jungian analyst, and I have a private practice. It started coming to my attention that this was happening more and more. I began hearing about it through some of my clients, who had family members who either were transitioning or knew someone who was transitioning. When I first heard about it, I thought it was a great thing kids were doing — challenging gender norms, breaking down the way things have always been. I thought this could yield some fascinating life experiences, with some part of your young adulthood living as the opposite sex. I just thought of it as an “Oh, kids these days” kind of thing.

But then, when I realized that people were permanently changing their bodies, that little romance I had with this concept was immediately over. To me, it seems like such common sense that a young person changing their body permanently is a bad idea. It’s hard to believe that it’s open to debate. Then it became obvious to me that it’s now everywhere in our culture. You can’t really turn on the news without hearing a story about a transgender kid. And I started seeing it in my community, with high school aged kids. I live in a mid-Atlantic, major metropolitan area, and a lot of the schools around have this going on. It’s being celebrated as wonderfully progressive, and meanwhile, something didn’t seem right to me.

I started educating myself and realized that there are communities of detransitioners, and parents who are bereft over what’s happening to their kids, and got drawn into it that way.

M: I get the sense that people just really want to “support kids”. So families, teachers, therapists, media, seem to have very quickly accepted the idea of “trans kids.” I think they see this approach as open-minded and supportive, saying things like, “Kids know what they are; we should just trust them,” which translates into validating the so-called gender identity of kids immediately, no questions asked. What’s the problem with this approach?

L: I don’t know if you have kids yourself, but there are very few things that a kid would ask us where parents would ordinarily say, “Well, okay, honey.” I know 13-year-olds who would insist that it was a literally a question of life and death whether or not they got an iPhone. As adults, we know that’s not true. We know you’re not going to die if you don’t get an iPhone. I know kids who’ve lived as cats for months at a time. But it would be ludicrous to take them at their word and tell them that yes, they are in fact a cat. So part of parenting is empathically, with attunement, knowing when to say no to our kids, when to set them off down a different road, and when to help them adjust to something that may be uncomfortable to them in that moment, but is part of the world they need to adjust to.

Where did we get this idea to just rubber stamp whatever a kid tells us? We don’t let them eat whatever they want, we make them bathe, we make them wear clothes… There are all kinds of things we do to our kids — it’s called parenting.

M: In your article over at 4thWaveNow, you wrote about what you called the “identity model.” What is that, and what is your perspective on the identity model when it comes to working with people who identify as transgender?

L: The identity model tells us that when someone comes in to our office explaining that they think they are transgender or that they’re a boy trapped in a girl’s body, or however they phrase it, the rule is that people get to claim their own identity. No one else gets to do that for them. The other rule is that you can’t question them. If you question someone’s identity, you’re not validating them — you’re not believing them. There may be some validity to that in some spheres, although I would say it’s not really my job to validate a person. If you tell me you’re a great knitter, it’s not my job to affirm that for you. But you can have that, even if you’ve never knitted. You can identify as a great knitter — you’re not hurting anybody.

I would say there’s a kind of tyranny that goes along with an identity model. In the case of transgenderism, it tyrannizes people because you cannot question, explore, or suggest there might be alternative reasons for these feelings. You cannot suggest there may be alternative ways of dealing with them, because doing any of that is tantamount to invalidating someone’s identity. And that is not allowed. Somehow, this agenda has got hooked on really well to the gay and lesbian rights movement; I think through liberals.

When we ask a young woman with dysphoria who is claiming she is transgender, how it is she thinks she is a boy, the shot that gets fired back is, “This is conversion therapy! You’re trying to make me be something I’m not.” But, in fact, they couldn’t be more different. I would say, “Who’s trying to convert whom to what here?” Patients that come to therapists looking for treatment such as hormones or surgery are looking to be converted. And it is absurd to think that a therapist wouldn’t explore that and want to ask some questions about it. The kind of social justice/identity approach that privileges the self-diagnosis of the person sitting across from us runs completely counter to the way a mental health model has always worked, where we take in the information about a person’s lived experience, not necessarily the conclusions they’ve drawn about it. We listen, assess, and consider different possibilities, then we share with them what we think is going on and what they might want to do about it.

M: You mentioned earlier that you’ve done a lot of work with detransitioners — people who’ve transitioned and then changed their minds. (Is it accurate to describe them that way?)

L: Yes. I want to clarify that when I say “work,” I had the privilege of getting to know many of these people and learning from them. It’s not clinical work that I’ve done with them, but it’s me being educated by them and them sharing their experience with me, outside of a clinical context.

M: Great, thanks. So, can you share what you’ve learned about our current understanding of transgenderism, based on your experiences with people who have detransitioned?

L: Sure. There’s very little research on this — it’s informal, but it’s pretty compelling information. A lot of this is coming from personal stories of people who’ve transitioned. It is a lot of what I would have expected, frankly. In some cases, it’s young women who were having a difficult time, perhaps because they had experienced trauma. Many of them had been raped, and had been suffering from the symptoms of post-traumatic stress disorder, including disassociation. Some of them were bullied, some were socially isolated, some had a lot of internalized homophobia — many of them identified as lesbians. It’s becoming pretty obvious that it’s much cooler to be a straight boy than a lesbian girl, for many of today’s young lesbians. They came to believe that they were transgender and did not get help from therapists in unraveling what was really going on. No therapists asked questions about whether or not they might be lesbians. No therapists assured them that most young women go through a period of hating their bodies, which is incredibly common in our culture, and not just for young women.

Part of the danger of self-diagnosis is that if you’ve spent some time on the internet looking at the sites for kids getting information about whether or not they could be trans, the symptoms are so vague. “Do you hate to wear a dress? Well then, maybe you’re trans. Do you hate your body? Maybe you’re trans.” So, in many cases, these young women that I’ve come to know — although I’ve talked to some detransitioned men as well — were struggling with normal things that a lot of young women struggle with, especially lesbian or bisexual women. And no one helped them interpret it that way. They got help interpreting it from social media sites. The people on the sites assured them that they were transgender. When they took it to a therapist in many cases, the therapist didn’t help them hone that, and be curious about it.

M: I want to talk about the medical aspect of transitioning for kids. A lot of people are concerned about the impact of hormones and hormone blockers on kids. What are the hormone treatments that are being offered to so-called trans kids right now?

L: Just a caveat that I’m not a physician and not an expert in these medications, so I’m sort of an informed lay person. I don’t have all the data at my fingertips.

It’s becoming more common to prescribe hormone blockers such as Lupron to children who have been socially transitioned. As they enter puberty, sometimes parents and medical professionals make the decision to arrest pubertal development, supposedly to give the young person more time to sort out what they want to do. The problem appears to be that the endogenous hormones released at puberty have a significant impact on brain development, and not going through that definitely has an effect. Hormone blockers have been presented as a neutral intervention, but I just don’t think there’s any way that can be true. For one thing, kids are likely not keeping up with their peers who are going through pubertal changes, so there’s immediately a social factor where the kid is different than their peers. In addition, there’s kind of a rewiring that occurs in adolescence as a result of the hormones, and part of that is sexuality and sexual desire. So you have a kid who socially transitioned pre-puberty and then goes on blockers, who never had that experience of his or her own sexuality as a newly sexual person, going through puberty. And then they’re supposed to make a decision about something that really affects their sexuality.

I think there’s one case in the literature — one known kid who did not continue to cross-sex hormones after being on puberty blockers. So, in other words, being on blockers likely solidifies cross-sex identification. And of course, as I said in the article, I hope people realize this: if you’ve gone on blockers and then continued on to cross-sex hormones, that is guaranteed sterility 100 per cent of the time.

M: For males and females?

L: Yes, because the gametes never develop.

M: And it’s not just medical transition and puberty blockers that you are concerned about, with regard to transitioning and the potential to detransition if somebody changes their mind… You also argue that social transition can have negative impacts. Can you talk about that?

L: Sure. There is a great deal that is not known and there is a great deal that hasn’t been researched yet. But I want to talk about this in two different categories.

There’s the young children, who often begin in very early childhood, saying they are the opposite sex or they wish they were the opposite sex, or “Mommy, when are you going to put me back in and I’m going to come out a girl?” The research shows that 80 per cent of those kids will desist by adulthood — it’s probably puberty that helps them desist. As you probably know, most of that 80 per cent will come to identify as gay or lesbian in adulthood. So we’re probably transing a lot of gays and lesbians when we do this with young kids. However, some 20 per cent will persist in their cross-sex identification and want to transition in adulthood.

If we could know for sure who is the 20 per cent, would it make sense to transition them? In some ways, you get better cosmetic outcomes if you transition early. I’m not arguing you ought to be doing that, I’m just saying that if we had a way to know for sure, then we might be able to talk about that making sense. But at this time, even the top gender doctors across the world will tell you we have no idea who’s going to persist and who’s going to desist.

So I think if you have a young child who’s allowed to socially transition, they may not have any idea what it feels like to live as their natal gender. And then if you put them on blockers, how are they supposed to know what is at stake? So I think that’s a very difficult needle to thread. I’m not saying I have the answers. Some of those kids are very insistent and persistent. And I would say even some of the insistent, persistent, and consistent ones will desist; we know this for a fact. But nevertheless, I can see that there are certainly dilemmas there.

There’s another group, however, for which I think things are even more clear. These are kids, many of them girls, who are coming to identify as transgender in either the tween or teen years, without having had childhood dysphoria. This is a new presentation — it wasn’t seen until very recently. And all of a sudden, it has exploded. Five or ten years ago, it was very unusual to have a kid who had [gone through] nothing out of the ordinary in terms of their gender preferences or presentation in early childhood, to suddenly come out as trans at age 13, 14, or 15. Now it’s happening all the time. And to me, this is clearly a case of social contagion.

There’s this wonderful blogger, Max, who writes this great blog, Born Wrong. She’s a detransitioned young woman and she makes this great point that I’m going to reference here. It’s not like the internet made them trans. But for ever and ever, young girls going through adolescence have been struggling. If you look up Wikipedia’s mass hysteria article, among a couple dozen cases, something like 95 per cent involve predominantly teenage girls. This is just something that we know. They struggle, and they struggle in ways that have some similarities, but are sort of culturally determined. About a hundred years ago, psychiatric hospitals were filled with young women who had “hysteria.” And they did things like throw themselves around the room in fits and smear feces on the wall. I mean, really, who does that?! People don’t do that anymore. But about a generation or so ago, kids started cutting, and before that it was eating disorders. In other words, it’s hard to be an adolescent girl. Adolescent girls today are dealing with porn culture, rigid gender expectations, body hatred that’s intense, and they are bombarded with all these images in the media that make it very hard to just accept themselves, especially if they are wondering if they might be lesbian or bisexual. So, it isn’t that the internet makes them trans, but seeing the way that transgenderism is lionized in the mainstream media, it becomes a really appealing way of dealing with these difficult feelings.

The other thing about teenagers is they all want to be special and want to belong to a group. And coming out as transgender in many school environments today immediately does both. It gives you a group of people and it makes you special.

M: You mentioned cutting. I don’t want to call it “trendy,” because it’s obviously a serious and harmful thing. But I noticed that a lot of the pro-transitioning agenda, especially around youth, is connected to statistics that say that trans kids are more likely to self-harm or are in danger of suicide, even, if their identities are not validated, and if they aren’t allowed to and supported in transitioning. What do you know about that information?

L: The suicide statistics are definitely frightening. The study that gets quoted most often is one that says 41 per cent of transgender people will attempt suicide at some point. If you look at the study, its authors are clear that that number is probably a little high. It’s inflated because of the way the study was done, most likely. It’s also worth mentioning that gay, lesbian, and bisexual youth have suicide attempt statistics at around 38 per cent, I believe. So as you can see, it’s hard to be gender non-conforming. The thing about the suicide statistics that’s really important is that yes, it’s true that these kids are suffering and in pain. But we have no good information anywhere, to my knowledge, which says that transitioning alleviates that. The Williams Institute statistic of 41 per cent does not speak to whether the attempt occurred before or after the transition. There are some very good studies out there that indicate that suicide may be higher after transition. I’m not saying transition causes suicide; I imagine it must be much more complicated than that, likely that the people who transitioned felt worse to begin with, and therefore are more likely to attempt suicide. However, it is clearly true that transition is not a panacea and does not, in and of itself, prevent suicide. So I’m afraid that the activists have kind of manipulated the statistic to frighten parents.

There is a good deal of good evidence that kids who identify as transgender come with other serious mental health issues, a lot of the time. And this is what we’re seeing, again and again — that these kids are socially isolated, anxious and depressed. I think I am seeing that there is a higher percentage of academically gifted kids that are identifying as transgender. And sometimes those kids struggle to fit in more — have a harder time finding peers and feeling like they’re part of a group. Some of these kids have more serious issues — many are on the Asperger’s spectrum. I’ve talked to parents whose kids have diagnoses of bipolar disorder andwhose kids have had psychotic episodes, and then presented as transgender. So, there’s this complicated, sticky thing that we’re trying to unravel here. Do the suicidality and self-harm come before identifying as transgender and wanting to transition, or do they come because a kid isn’t allowed to transition, or do they come after? It’s just not very clear. However, there is a lot of evidence that the psychopathology presents before the kid comes out as transgender, in very many of these cases.

M: I’m troubled by the way people who question the idea of gender identity — or who simply don’t think our first response should be to unequivocally support a child who claims to be the opposite sex to transition — are persecuted or lose their jobs. There was such a situation with Dr. Kenneth Zucker (did you follow that?), who was fired as the head of the gender identity clinic at Toronto’s Centre for Addiction and Mental Health, because he felt that the first approach should be to try to get kids to feel comfortable with their bodies instead of immediately transitioning them. That situation is really frightening to me. So, I wonder, what has your experience speaking out about these issues been like? And how have you seen it affect your field and your colleagues?

L: Well, I’ve had many many therapists contact me quietly, often wanting to stay anonymous, telling me they cannot speak out for fear of losing their jobs or having their careers affected negatively. Some of them have been working at gender identity clinics and are very concerned. I think concern is more widespread among people now. But it’s like an emperor’s new clothes situation — nobody wants to say anything, because nobody wants to lose their head. I’ve decided to speak out because I feel like what’s happening is wrong. I think it’s important to say something, and I’m not really in a position where I have a job to lose, because I’m in private practice. If you see something and you know it’s wrong and you don’t speak out… To me, we just have to do something.

You had that great piece recently about how we need to be braver, and that’s where I’m coming from too. I’m sympathetic to people who can’t speak out for whatever reason. But if you can speak out, I think you should.

M: I agree. I’m in a position where I felt able to because I’m an independent writer and journalist. I have a platform. Obviously there are repercussions for me in numerous ways, including career-wise, but I just started to feel like you did — that things were getting out of hand, and that what was happening was wrong, and so I felt I had to say something. And I feel like more people are starting to speak out.

L: I think so too. The more of us who speak out, the more courage we’ll give others to also speak out.

M: Exactly. So, this change in public discourse and this approach to transgenderism has happened really quickly, and, from my perspective, without much critical thought in terms of social impact, impact on women’s rights, individuals, discourse, and human rights. Why do you think that’s the case — what can we do to pump the brakes?

L: That is such a big question. I don’t know. I’ve wondered about that myself — it’s pretty baffling. For one thing, it’s been framed as a civil rights issue, and this relates to whether we think of it as an identity or a mental health issue. If it’s a mental health issue, we can explore it and treat it in a variety of ways, including, possibly, transition. But if it’s an identity, suddenly we’ve turned it into a human rights issue, and all we can do is affirm and validate.

Progressivism is collapsing on itself and now there’s no room for free speech. I think that is occurring in lots of different places in our culture. Ken Wilber said this great thing once about how liberalism will eventually feed on itself, because there’s no firm place to stand and say, “Well, no — this is wrong, actually.” We are just supposed to accept everything and say everything is ok. And I’m a lifelong liberal — I get it! My first instinct was to say, “Yeah, if that works for them, that’s fine.” In other words, we don’t bring our critical thinking to bear on it, because that would be tantamount to judgement, and we don’t want to do that — we want to be supportive of people’s differences. But at some point — I mean certainly I hit this point, where I had to go, “Well, wait a second. Sterilizing kids?! Because they won’t wear a dress? This is not okay.”

M: Why do you think all of this has happened so quickly?

L: I think there are a lot of adults who transition — in particular, later-life transitioning males, and it’s important for them to be seen and validated as women. I personally don’t think they are women, but this is the cry of the transgender activist movement: that transwomen are women and always have been. So we’re to accept that Caitlyn Jenner is a woman and always has been… Which is an absurd conundrum, if you think about it. I think many of these later-life transitioning male-to-females are wealthy and have put money behind this — they are significant sources of funding for transgender activist organizations. And I think it’s important to them that kids transition, maybe, for some of them, because they suffered a great deal as kids, and they are projecting their own experience on kids they see today. But also because if kids are trans or transitioned, then it validates the narrative that [these men], in fact, have always been women and were born in the wrong body. Which is not really a good reason to transition kids — to validate someone else’s narrative.

M: Thank you so much for your courage and for speaking out, and for sharing your perspective, your work, and your analysis with me. It’s been really interesting and informative.

L: Thank you so much.

Meghan Murphy

Founder & Editor

Meghan Murphy is a freelance writer and journalist from Vancouver, BC. She has been podcasting and writing about feminism since 2010 and has published work in numerous national and international publications, including The Spectator, UnHerd, Quillette, the CBC, New Statesman, Vice, Al Jazeera, The Globe and Mail, and more. Meghan completed a Masters degree in the department of Gender, Sexuality and Women’s Studies at Simon Fraser University in 2012 and is now exiled in Mexico with her very photogenic dog.