ALTHOUGH public outcry over gender ideology has often focused on such issues as transvestite men reading to children in public libraries and biological men competing in women's sports, a much more prevalent issue has received considerably less attention: namely, peer-group pressure on teenage girls to identify as boys.

Trans a Threat to my Daughter

https://mercatornet.com/trans-a-threat-to-my-daughter-my-family-and-womens-healthcare/80261/

AS the Executive Medical Director for Women’s Services for my organization, the email landed like a punch to the gut.  

I am an OBGYN and leader in my organization, where we take great pride in the respectful, high-quality care we provide patients.  We are especially proud of our partnership with community organizations in our efforts towards reducing disparities in birth outcomes.  Our efforts towards inclusivity include sensitivity to different family configurations and use of pronouns with our patients.  But now—will we no longer be identified as caring for women or mothers?

My sensitivity to issues involving transgender individuals started as these issues began to seep into the media. I wondered: Why are people fussing over what bathroom is used?  Don’t they have something more important to think about?  If a child’s path to self-acceptance is through transition to the other gender, why would we object? After all, it’s a rare situation.

This all changed when the gender storm hit my family.  My daughter was bright, and social with adults from an early age. She had always been a typical girl.  Her friends were virtually all girls. She begged for Cinderella dresses and preferred to wear purple and pink.  She ignored her older brother’s books and toys, instead preferring crafty activities. She never asked to wear his hand-me-downs.  In early high school, she started going by a gender-neutral name.  I laughed when I started receiving emails addressed to the mother of “X”.  I assumed it was just another one of my independent daughter’s quirky pranks.  

This was followed by her hair getting shorter and shorter, finally culminating in a shaved head.   I know now that is a typical foreshadowing of what was to come but, at the time, I was naïve. It simply never occurred to me that this was anything beyond a teenager trying on different styles.  A year into the pandemic, her mental health deteriorated.  She would fly into rages easily, and became intolerant of any request or slightly negative comment. It became more difficult for her to attend on-line classes and she began missing commitments.  Finally came the statement: “Mom, I am a boy.”

My first response was a deep sigh as I braced myself for a shared struggle to figure this out. I took responsibility for communicating this news with my family. I reiterated my support for my daughter. Despite my initial affirming response, her anger at me only grew.

My husband and I met with an on-line support group for families of trans-identified kids.  There we heard similar stories of previously gender-conforming girls whose declining mental health was not reversed when they began testosterone.  One family of a 5-year-old natal male shared, “We are a gender expansive family.  We asked our child if they are a boy or a girl.  She said a girl and we are here to learn how to support her.” This announcement was met with accolades from the group. My husband and I got off the call and turned to each other.  What on earth is happening?  Are they really willing to engage in this social experiment with their child?

The 14 months since then have been a whirlwind of learning and crisis.  I have since immersed myself in understanding the literature as it relates to the care of gender dysphoric children and young adults. I now know the science doesn’t support transition as a path to well-being. I recognize the steps of my daughter’s journey into the cult of transgender ideology.  I see how her middle-school body dysmorphia and conflicted relationship with her dad set her up for this.  While I spent those years watching for signs of an eating disorder, I now see that I should have been on the lookout for the “new anorexia”, gender dysphoria.  As things became even stormier at home during these months after her announcement, my daughter moved out and into the home of a friend.  She has since graduated from high school, started college, dropped out of college and spent three weeks in a psychiatric facility.  I have periodically raged at her, raged at the world and always raged at myself.

My grief has been dominated by a deep fear for her future.  The 60 Minutes segment featuring detransitioners was aired in the same month she shared her news with me.  The tragedy of the detransitioners’ regret has always been front and center for me.  I grieve the loss of the beautiful young woman with a passion for singing that my daughter used to be, now replaced by this unkempt, angry, gravelly-voiced stranger.  Grief has often been mixed with self-hatred.  Why didn’t I catch this sooner?  How did I not protect her from the harm that put her at risk?  What kind of a woman am I that my daughter would want to be a man?  My grief has been tinged with a deep sense of betrayal.  How can you just quit the team?

Through all the turmoil and my great despair, I have had great support.  My husband is a rock.  My family has wrapped their arms around me and are bravely, persistently positive to my daughter.  

And I have taken tremendous refuge in work.  As I berate myself for my apparent failure parenting a daughter, I take comfort that I am contributing to an organization that provides for women.  I take joy in the work, knowing that we support women as they grow into young adults, as some of them become mothers and throughout their lifespans.  

Many times, in the depths of my anguish over my daughter’s wellbeing and our damaged relationship, I had been pulled into a position of equanimity by the sense of accomplishment or good that had been done as part of the woman’s health team I work with.

The afternoon the email arrived I had left the office for a haircut.  As I waited in the lobby, I quickly checked my phone for any needs that had arisen in the past hour, and my heart started pounding as I digested the message.  When my hairdresser called me back and I laid my head back into the sink, the shock of the email washed over me. Tears crept out of the corners of my eyes and mixed with the soapy water.  By the time I returned to my inbox, several colleagues had responded to the email with messages of support for the effort. I felt alienated from the team with whom I work so closely. I spent the evening in a new state of grief—not only has trans ideology taken my daughter, but now it is threatening my vocation and sense of self as a provider of women’s healthcare.

Subsequently, the team acquiesced to my plea that the needs of women to have sex-specific medical care should not be subjugated to the needs of men, even when those “men” have female reproductive parts. We are setting aside renaming our services for now and are instead considering sensitivity training to ensure our staff are well prepared to accommodate transmen in our care settings.  

I was able to influence the direction for two reasons only: 1. I have a position of power and 2. my colleagues know the situation my daughter is in and are trying to treat me gently. But I have only kicked the can down the road.  Either I will ultimately decide I am not the right leader for the organization at this moment in time or, hopefully, others will see the pendulum has swung too far and attitudes will settle into a more moderate position. For the sake of the women we serve, I desperately wish for the latter.

Validity of the Gender Dysphoria diagnosis and incidence trends in Sweden: a nationwide register study

·Malin Indremo, Richard White, Thomas Frisell, Sven Cnattingius, Alkistis Skalkidou, Johan Isaksson & Fotios C. Papadopoulos 

Scientific Reports volume 11, Article number: 16168 (2021) Cite this article

The aim of this study was to examine the validity of the Gender Dysphoria (GD) diagnoses in the Swedish National Patient Register (NPR), to discuss different register-based definitions of GD and to investigate incidence trends. We collected data on all individuals with registered GD diagnoses between 2001 and 2016 as well as data on the coverage in the NPR. We regarded gender confirming medical intervention (GCMI) as one proxy for a clinically valid diagnosis and calculated the positive predictive value (PPV) for receiving GCMI for increasing number of registered GD diagnoses. We assessed crude and coverage-adjusted time trends of GD during 2004–2015 with a Poisson regression, using assigned sex and age as interaction terms. The PPV for receiving GCMI was 68% for ≥ 1 and 79% for ≥ 4 GD-diagnoses. The incidence of GD was on average 35% higher with the definition of ≥ 1 compared to the definition of ≥ 4 diagnoses. The incidence of GD, defined as ≥ 4 diagnoses increased significantly during the study period and mostly in the age categories 10–17 and 18–30 years, even after adjusting for register coverage. We concluded that the validity of a single ICD code denoting clinical GD in the Swedish NPR can be questioned. For future research, we propose to carefully weight the advantages and disadvantages of different register-based definitions according to the individual study’s needs, the time periods involved and the age-groups under study.

During the last decades, an increasing number of individuals with Gender Dysphoria (GD) have sought gender confirming health care^1,2. According to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)³ GD is a condition that involves distress due to incongruence between an individual’s birth-assigned sex and gender identity. In the latest version of the International Classification of Diseases (ICD-11)⁴, Gender Incongruence has replaced the previous diagnoses Transsexualism and Gender Identity Disorders, and has been moved from the chapters of mental and behavioural disorders to a new chapter on conditions related to sexual health⁵. The DSM-5 term “Gender Dysphoria (GD)” will be mainly used throughout the article, except when referring to literature published when earlier versions of the DSM/ICD classification systems were in use.

Comparing estimates of prevalence and incidence rates of GD is challenging, due to differences in terminology, definitions, and methodology between studies⁶.

In a meta-analysis, including a broad range of prevalence studies on transsexualism from Europe, USA and Australia, Arcelus et al.¹ found an overall prevalence of 0.46/10,000; 0.68 for birth assigned males (aM) and 0.26 for birth assigned females (aF).

The time trend analysis revealed an increase in reported prevalence over the last 50 years. The studies included in the meta-analysis used different means of identifying cases, including referrals to gender identity clinics, sex reassignment surgery, or gender confirming hormonal treatments, as well as medical records from governmental organizations and patient registers.

In one of the largest cohort studies, including all individuals in the Netherlands assessed for GD between 1972 and 2015, the national prevalence in 2015 was estimated to 3.64/10,000 in aM and 1.93/10,000 in aF⁷.

In Sweden, previous incidence rates of GD have been based on the applications for change of legal sex and permission to undergo surgical sex reassignment 8, and on the registered ICD diagnoses in the Swedish Patient Register 9. The incidence of transsexualism, defined by applications for legal sex change and surgical sex reassignment, increased from 0.016 to 0.042/10,000 per year for aF and from 0.023 to 0.073/10,000 per year for aM from 1960 to 2010⁸.

Regarding diagnoses in the Swedish registers, the Swedish National Board of Health and Welfare reported that 0.1/10,000 were diagnosed with GD for the first time in 2005 compared with 0.8/10,000 in 2015⁹. The most salient increase was visible among young individuals, 18–29 years of age.

These estimates do not necessarily reflect the prevalence of individuals who experience GD in the general population. In a population-based study conducted in Sweden in 2014, feeling like someone of a different gender was reported by 2.3%, whereas at least a partial desire for gender confirming hormones or surgery was reported by 0.5% of the participants¹⁰. In a previous study in the Netherlands, 0.6% of aM and 0.2% of aF reported an “incongruent gender identity” combined with a dislike of their body and a wish to obtain gender confirming hormones and/or surgery¹¹. These findings vastly exceed previous incidence and prevalence estimates of GD, as defined by referrals, diagnoses, legal sex changes and received gender confirming treatments. Hence, the definition and inclusion criteria of GD greatly influence reports of incidence and prevalence trends, and may be confusing when not clearly stated.

Aims of the study

Given the increase of GD the last decades, it is of crucial importance to correctly estimate the incidence and prevalence of GD in order to set priorities in health care development and policymaking. Even though official Swedish estimates employ data from the Swedish National Patient Register (NPR), no gold standard for a register-based definition of GD exists. The usefulness of diagnoses in patient registers for research purposes is dependent on diagnostic validity. The objectives of this study were to explore the validity of the GD diagnosis in the Swedish NPR, to discuss different register-based definitions of GD and to investigate incidence trends for GD in Sweden during 2001–2015.

We obtained data on all individuals aged 10 years or more at their first registered GD diagnosis from the NPR for the period 2001–2016. In order to discuss the most appropriate GD definition for the incidence calculations, we performed a register-based validation of the GD diagnosis during 2006–2014, including data from the Prescribed Drugs Register (PDR), which started in July 2005. We examined the impact of the coverage in the NPR on our definitions, as there has been underreporting of visits in specialized psychiatric outpatient care the first years of the study period. Crude and coverage-adjusted incidence rates of GD were calculated for the period 2004–2015, thus allowing for 1-year observation period after 2015.

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