In our current climate, it takes courage to write a book critiquing the transgender movement. But that is what Wall Street Journal journalist Abigail Shrier has done. I confess that I was sceptical when approaching the book given the title: ‘Irreversible Damage – The Transgender Craze Seducing Our Daughters.’ Why? Because strong opinions in this realm so often lead to echo chambers of accusation, calls to be ‘cancelled’ and insult-throwing rather than reasoned, intelligent debate. And yet Schrier writes in a disarming and compassionate way which meant that I emerged with greater understanding and empathy for those involved and more conversant with the arguments in both directions. As a parent and a paediatrician however, I also emerged feeling disturbed that something is very wrong indeed.
So, what is the story here? Before 2012 ‘there was no scientific literature on girls aged eleven to twenty-one ever having developed gender dysphoria at all’. But this has all changed. As well as a 4,000 per cent increase in referrals over the last decade, last year 77 per cent of referrals between ages 12-16 to the UK’s Gender Identity Development Service were for females, reversing a trend of ten years ago when the ratio was similar but for males. We have simultaneously seen an explosion of depression and mental ill-health, with the worst hit being teenage girls (Jean Twenge in her seminal book iGEN reports boys’ depression increasing by 21 per cent between 2012 and 2015 and girls’ by 50 per cent). Shrier’s task is to ask what has happened and why this dramatic change.
Meticulously researched, we hear from, among others, several of ‘the girls’ involved, as well as their parents, schoolteachers, the social media influencers, ‘the shrinks’ and those who have detransitioned. We are painted a humanising picture of people with real hopes and dreams, but simultaneously a disturbing theme of ‘cult-like’ internet subcultures preying on vulnerable girls open to suggestion (and rapidly, coercion) that they might be men trapped in a woman’s body. As Shrier summarises, ‘for these girls, trans identification offers freedom from anxiety’s relentless pursuit; it satisfies the deepest need for acceptance, the thrill of transgression, the seductive lilt of belonging.’
Shrier concludes that we are witnessing a social contagion, a hysteria akin to multiple personality disorder and anorexia, with ‘disturbed young women convincing themselves they possess an ailment and then manifesting the symptoms.’ Troubling themes focus on the propaganda in school curriculums (‘your parental rights ended when you enrolled your children in public school’ says one fifth grade public school teacher), the driving force of social media (hint to parents: giving your teenagers unfettered access online for hours on end is a bad idea) and on the power of identity politics (Shrier notes that around 90 per cent of these girls are white, middle class, high-achieving girls raising the intriguing possibility that a trans identity offers these girls the status of an oppressed class that has so far eluded them).
I will finish, however, with perhaps the most disturbing part of this book – the betrayal of our own profession by those who claim to be healthcare professionals. The betrayal of children who at the drop of a hat can obtain testosterone (‘T’) on American campuses with minimal evaluation. Of girls who after a few months of taking it will have irreversibly deep voices, body, and facial hair and much more.
‘I can’t think of any branch of medicine outside of cosmetic surgery where the patient makes the diagnosis and prescribes the treatment. This doesn’t exist. The doctor makes the diagnosis, the doctor prescribes the treatment. Somehow, by some word magic or word trickery gender [activists] have somehow made this a political issue…this absolves the physician, the psychiatrist, and the surgeon from the responsibility of making the decision’, says Ray Blanchard, a prominent authority on paraphilias and sexual orientation and one of Shrier’s ‘dissidents.’ Shrier notes that physicians are not merchants; ‘the shop owner lives by the conceit that the customer is always right; the physician trains to acquire a critical understanding of a patient’s needs…(instead) doctors behave like a vendor, rushing to meet an existing demand rather than evaluating its appropriateness…’
As Blanchard notes, ‘Trans activists do this kind of lobbying, I mean…that’s what activists do…and I say to my colleagues, yeah, yeah, that’s what patients say. That’s what patients do. What’s wrong with us?’ Lisa Marchiano, another prominent (and ‘dissident’) therapist adds, ‘Affirmation is the exact opposite of curiosity. It’s saying, I already know what this is. It’s taking things at face value…we don’t treat suicide by giving people exactly what they want. We treat suicide first of all by keeping people safe, and by helping them to become more resilient’. We ought to treat gender dysphoria that way too.
Interviews with some leading gender-affirming therapists have to be read to be believed. ‘I tell them (teenagers) that we can’t change the mind and so we have to change the body’, says Dr Randi Kaufman of the Ackerman Institute for the Family in New York City. Kaufman is joined by many therapists who claim that teenagers will commit suicide unless we go along with their self-diagnosed new identity and yet, as Marchiano says ‘When you tell highly suggestible adolescent females that if they don’t get a certain thing they are going to feel suicidal, they’re going to feel suicidal…that’s suggestion, and then you’re actually spreading suicide contagion’.
So, what will we say to our teenage girls? ‘Will we give in to the activists who – both transgender and, just as often, not – exploit an honest struggle that besets this group of girls to bully and harass any who might point out the sudden craze captivating our despairing young?’ Paul McHugh summarises, ‘Some of these teenage girls will wake up at age twenty-three, twenty-four, and say, “Here I am. I’ve got a five o’clock shadow, I’m mutilated, and I’m sterile, and I’m not what I ought to be. How did this happen?”’
Whilst Shrier reports from America, it’s happening here in the UK too. How will history judge our profession? Will we live up to our calling and training to practise real medicine in the face of political ideology, or will we capitulate and leave our legacy as those who abandoned our girls in their time of need?