Response to ‘Transgender Kids:Who Knows Best’


Fair Play for Women would like to state our support for the BBC, who, despite co-ordinated efforts to prevent the broadcast, aired the documentary Transgender Kids: Who Knows Best? on BBC2 this week.

The subject of gender identity and the attendant push to ratify gender identity rights into UK law, has become a politically sensitive area. Add children into the mix, and you have an issue that is inflammatory in the extreme, so it was refreshing to watch a documentary presenting a balanced approach to what has become a very difficult topic to debate. John Conroy’s documentary focused on the work of Dr Kenneth Zucker and his work treating gender questioning children in Canada, at CAMH (the Centre for Addiction and Mental Health in Toronto). The clinic was shut down under review in 2015 and Dr Zucker fired, amid (since discredited) accusations of ‘reparative therapy’ for transgender children.

Despite the negative publicity surrounding the programme, Dr Zucker’s approach was presented as both measured and eminently sensible. He advocated a ‘watch and wait’ approach, working slowly with children to explore their emotional and psychological base and to unpack where their feelings of gender discomfort originated; not in an attempt to undermine them, but to gently tease out those children suffering from genuine dysphoria from those among the 80% of gender questioning youth who simply grow out of their unease and in the majority of cases, emerge as gay or lesbian.

We know that there are increasing numbers of children who experience gender confusion and a smaller number who are experiencing acute dysphoria. It goes without saying that these children need access to every avenue of support available. In the case of gender dysphoric young people, this may sometimes involve treatment with ‘blockers’, in order to halt puberty. This pathway, commenced no earlier than the age of 9, generally leads to the later prescription of cross-sex hormones at 18. Once on these, the young person can go through an artificial puberty to develop the secondary characteristics of the sex that they wish to adopt.

This may well turn out to be the best course of treatment for that young person, and the documentary certainly included both a teenage trans girl and an adult trans man, who had successfully transitioned and were living full time as their acquired sex. However, Zucker rightly advised caution before embarking on this pathway, due to not only the side effects of so called ‘puberty blockers’, (the medications are GnRH analogues, designed to treat prostate and breast cancer, with side effects including depression and osteoporosis) but the fact that cross-sex hormones, once commenced, are irreversible and in most cases, cause sterility. There are no long term studies into the effects of these medications on the developing brain or physiognomy of children.

With such high stakes, it is absolutely right that caution be applied when counselling children and this treatment only embarked upon if the clinic is absolutely sure that it is the correct pathway. For two of the case studies followed, this turned out not to be the case. Alex, a teenage girl, expressed a deep seated desire to be a boy at the age of 6. Her concerned parents however, resisted the prevailing trans narrative that the ‘child knows best’ and persisted in supporting their daughter and allowed her to explore her identity, while affirming that she was biologically female. She eventually desisted from her gender confusion, explaining that as she went through puberty, she became more at ease with her body and found groups of girls to socialise with that shared her interests, that were not stereotypically feminine. Heartbreakingly, we were also introduced to ’Lou’, a trans man, who had grown up with dysphoria, and been advised that due to the severity of their suffering, transition was the most appropriate option. Having undergone a mastectomy and hormonal therapy as part of treatment, they later came to realise that their dysphoria was not permanent. For Lou however, it is too late and the physical effects on their body are irreversible.

While clearly the voices of our children need to be heard, for the parents of many young children, this often means the rejection of socially imposed gender markers. A boy who likes Barbie dolls and sparkly things or a girl who like football and hates dresses shouldn’t be considered unusual, but in a society that has become increasingly gendered, to parents these can appear to be confusing, abnormal even.

The documentary observed that child referrals to gender identity clinics have increased ten fold over the last four years, but none of the transgender community interviewed were able to offer an explanation why. While we know that there are genuine instances of dysphoria among children, there appears to be a deliberate attempt, by activists and politicians alike, to ignore the growth in heavily gendered products for children and the increasingly stringent gender identities that are emerging alongside them. What many younger parents of gender questioning children may not realise, is that most of these gender roles are driven by consumerism.

The 1999 creation of the Disney Princess brand by ex Nike executive Andy Mooney, is a case in point. Previously a collection of relatively non gendered character products, Disney are now sitting on a phenomenally successful £3 billion annual turnover, based on rigid gender stereotypes; Princesses for girls and Superheroes for boys. Following the acquisition of Marvel and Star Wars, Disney now ‘do’ Gender. So does Lego. So do the Early Learning Centre and almost any other retailer on the high street. What seems innate, has in fact, been pushed and consolidated very heavily and it is precisely because of this, that it is vital that clinicians treating gender diverse kids are given the space and time to deconstruct this area of social conditioning.

The World Health Organisation defines gender as ‘the socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for men and women’. This is separate from biological sex, which WHO define as ‘the biological and physiological characteristics that define men and women’. When looking at gender dysphoria and any attendant treatment pathways it is vital that this distinction is made.

Another observation by Dr Zucker, was the relatively high proportion of gender questioning children with Autism Spectrum Disorders. One study found that children with Gender Identity Disorder are seven times more likely to be on the autistic spectrum than children from the general population. Clearly this is an area that warrants serious further investigation. Living with a neurologically atypical child throws into harsh relief how easily information disseminated by schools around gender diversity, can be misunderstood by an autistic child, and parents of autistic children are expressing concern. One parent told us ‘My daughter has already been given information about the ability to ‘change gender’ which has been immensely confusing for her. I’m not remotely surprised by the link made between autism and gender questioning behaviour, having seen first-hand, the very rigid thought processes my daughter displays’.

While there clearly are children who suffer with genuine dysphoria, who deserve all the compassion and support we can give, many other children are simply confused by the rigid messages our society is promoting about gender roles. Puberty can be an extremely unsettling time for young people, and it is common for young girls to reject both the changes occurring in their bodies and the external reaction to that, by wider society.

Young girls are placed under a huge amount of pressure in terms of appearance, emerging sexuality and the performance of femininity. It is perhaps unsurprising then, that four times more girls than boys are currently presenting to gender identity clinics. However, there seems to be a lack of will to investigate what social factors may be influencing this.
Puberty is a necessarily difficult time for young people and as adults, we have a duty to be extremely cautious about giving any messages to them that they may interpret as an ability to ‘identify’ out of a process that may well be traumatic but is ultimately part of growing up.

Alongside this, it is worth noting that while 44% of LGBT youth have considered suicide this sits within the context of 32% of all young people in the UK have experienced suicideal ideation. When faced with the message that you either have a trans child or a dead child, parents understandably reach out to organisations who wish to support them. However, we are in the midst of a mental health crisis that is affecting all our children, so now more than ever, we must exercise care when trying to understand what lies behind these shocking statistics and the attendant rise in referrals to psychological services.

Later in the programme Neuroscientist Professor Gina Rippon, neatly offered a scientific explanation of brain neuroplasticity and how this may affect perceptions of gender identity. The idea of ‘pink and blue brains’ and the ‘born in the wrong body’ narrative is at the very core of the transgender ideology. The BBC have previously included this as a simplistic mechanism for explaining gender confusion to young children in the CBBC program ‘I am Leo’. However, these ideas have no basis in scientific fact. The minute differences in form of male and female brains on MRI scans, that have been frequently cited by the trans community as proof of innate gender, have subsequently been explained by these neuroplastic changes, that takes place as a result of repeated exposure to differing social behaviours.

As long as we perpetuate the ideology that gender identity is a ‘feeling’ and with the mental and physical health of our young people at stake, it is vital that public service organisations like the BBC are able to continue broadcasting impartial, evidence based documentaries like this, in order to contribute valuable scientific information to an important debate. There is no other area of medicine or healthcare that relies upon unproven anecdotal evidence as a diagnostic tool. There is no other area in which such permanent and life changing treatment is promoted on the basis of subjective feelings. It is essential that best practice treatment pathways for our children are based on scientific, peer reviewed evidence and not a one sided, prescriptive, set of directions, given to us by a vocal minority who wish to avoid engaging in open, honest debate.

As feminist and academic Julia Long states, ‘Many of us – parents, teachers, academics, youth workers, service providers – have been trying to raise concerns on this issue for several years now, but have been denied the platforms granted to trans activists. Indeed, many of us have been subjected to the most extraordinary threats, misogyny and attempts at censorship from trans activists: this has had personal consequences for a number of feminist activists and academics’. She has observed first hand, the rise in media coverage of transgender issues and has noted that, ‘very little of it has been balanced or offered any kind of critical view’. Debate has been continuously shut down amidst accusations of transphobia, and while the UK government are considering bringing in laws of self-identification, which would effectively wipe out sex based protections for women in favour of gender based protection, it is becoming increasingly difficult to offer an alternative view.

One clinician featured in the documentary, admitted that professionals working in practice with trans youth are simply too scared to voice dissent, for fear of losing their jobs. In this climate, where the stakes are so high, our children, and their wellbeing, must be placed front and centre of this debate. In deciding to go ahead with the broadcasting of this important documentary, the BBC has finally begun to do that.

Stephanie Davies-Arai has published a thorough review of Transgender Kids: Who Knows Best? with some more excellent talking points:


7 thoughts on “Response to ‘Transgender Kids:Who Knows Best’

  • 2017.01.14 at 18:25

    Excellent article providing a useful,perspective on this topic and the current ‘state of play’. Certainly contributes to understanding the context of the programme.

  • 2017.01.14 at 21:28

    “A boy who likes Barbie dolls and sparkly things or a girl who like football and hates dresses shouldn’t be considered unusual, but in a society that has become increasingly gendered, to parents these can appear to be confusing, abnormal even.”

    It’s terribly upsetting to see that children are being subjected to medical alteration, and their long-term health risked, for what is effectively a marketing campaign by commercial and pharmaceutical interests. The fact that so many professionals are actually afraid to voice doubts should give some clue to just how powerful those interests are.

    This is a strong, balanced review – thank you. I hope it lends courage to some more questioning voices.

  • 2017.01.14 at 21:59

    Thank you for writing this excellent review, this is a sane antidote to the hyperbolic reactions of organisations such as Stonewall. Thank you for standing up for children.

  • 2017.01.15 at 13:53

    Exceedingly well written! Brava!

  • 2017.01.15 at 22:27

    Really good article. Im not sure about this bit though “The minute differences in form of male and female brains on MRI scans, that have been frequently cited by the trans community as proof of innate gender, have subsequently been explained by these neuroplastic changes, that takes place as a result of repeated exposure to differing social behaviours.”

    Is there a citation for that because the main studies showing the differences in the BSTc have not as far as I know been proved to be shown to be the result of different social behaviours. That’s not to say there couldnt be. As most sites with science studies are pro the concept of innate gender identity any study which refuted that evidence may have been ommitted.

    I think there is a tendency in the gender critical side to dismiss any differences as the cause of nuture, which in many cases it may be. However there does appear to be evidence to show that there is the potential for trans people to have had atypical hormone exposure in utero some due to genetic factors which influence the number of function of hormone receptors.

    It is unclear whether this results in a part of the brain telling someone they are the opposite sex or whether it is simply the brain interpreting the result of the hormonal differences – for example more or less aggression and concluding that they do not fit the stereotypes closely enough so must be the opposite sex.

    For other children there may be an entirely different aetiology such as history of abuse, unhappiness with gender role, mental health issues and so on. There is currently no way of knowing the cause in a particular child so I wholly support the more cautious approach of investigating all avenues before any suggestion of transition rather than a one size fits all approach which seems so beloved at the mment.

    • 2017.01.15 at 22:54

      I believe the the BSTc has been shown to be sexually dimorphic only in adulthood. That is to say, that this area is very plastic, responding to sex hormones, the sexually dimorphic structure being an “activation effect”. The differences found by Zhou and Kruijver were influenced by exogenous hormones as a result of treating gender dyshoria, not because of gender dysphoria.

      See this essay and further links from it:

    • 2017.01.16 at 01:44

      I’ve already replied to you with informative points for consideration, but this is bugging me! … a part of the brain telling someone they are the opposite sex or whether it is simply the brain interpreting the result of the hormonal differences – for example more or less aggression and concluding that they do not fit the stereotypes closely enough so must be the opposite sex.

      Firstly, there are conditions of bodily ‘integrity’ or dysmorphia that are still under investigation but most likely to be pyschological problems. In some cases there may be associated brain damage or disordered development. As someone who suffered BDD in the past for psychological reasons, I find it easy to believe that some people genuinely feel they have, or should have had, a body that is not what others observe. A tiny percentage of those may have an unusually configured brain that renders this intractable; the kindest thing for them may be to alter the body.

      Such a thing, however, could not possibly result from either imbalanced sex hormones or a mismatch between hormone production and receptors. Bodies are too clever for that – please remember the brain is just part of the body. The two things don’t exist separately; each of us is an integrated system, brain and all. If a brain isn’t receiving the expected complement of neurotransmitters or other endogenous chemicals, it compensates by a variety of means. It also routinely changes itself according to environmental factors both external & internal. Women, for instance, go through dramatic changes both at puberty and menopause, during pregnancy, post-birth and through the oestrus cycle. These changes are big. They affect the brain – each and every time. I’ve seen no evidence that any such changes could mysteriously ‘stick’ to the extent the brain-body system did not adapt. This only occurs when an injury or genetic malformation impairs production of certain hormones. That is not what you’re postulating here.

      Secondly, you can’t possibly believe that all highly aggressive women believe they are men or, conversely, that all compassionate & gentle men believe they are women! You seem to have fallen into the trap of sex-role stereotypes (gender) here. There are no uniquely feminine or masculine character traits, as a cursory appraisal of any human group will confirm.

      I vigorously agree with your conclusion that we’re not looking at a single issue with a ‘one size fits all’ explanation or cure. Humans are nothing if not gloriously complicated 😉


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