by Mauro Sifuentes, doctoral candidate in Education & community-based educator
During late July this past summer, Stephen Rosenthal, M.D., medical director of the UCSF Child and Adolescent Gender Center, a professional collaborative of medical and advocacy experts, presented recommendations to a group of over a hundred parents of transgender youth who showed up to hear the most recent findings from a field of research that seeks to identify a biological basis for transgender identities; most of the adults present were parents of children or youth who receive clinical care from this center. Dr. Rosenthal is a professor of pediatrics at UCSF who specializes in pediatric endocrinology and who has served as a consultant for pharmaceutical corporations who develop and market hormones and hormone blockers. On this particular day, he was attempting to address parents’ concerns regarding difficult decisions they may have to make, or have already made: the choice to give consent for their children’s bodies to be altered through puberty blockers and hormone therapy.
The presentation was part of a weekend-long conference hosted by Gender Spectrum, a Bay Area-based education and advocacy non-profit, that prioritizes “gender sensitive and inclusive environments for all children and teens.” The conference, which attracts families, presenters, and participants from all over the Bay Area (and some traveling much longer distances to attend), provides a unique meeting place for medical and mental health professionals, educators, advocates, youth, and parents. For some participants, including youth, this conference is their first time speaking openly with others who may have similar experiences navigating the terrain of transgender identities, and the challenges that come with it. The annual Gender Spectrum conference grew out of a need to break the isolation of parents who are made to face difficult decisions in a world that is only growing incrementally more hospitable for transgender children and youth, and hardly so for those who appear more androgynous or do not live in supportive communities or families.
One of these particular challenges falls on parents, and their decision-making power over their children. While it is still portrayed as a controversial choice for an adult to decide to medically transition genders, often through hormones and surgeries, it is an even more contentious choice when parents are making life-changing decisions about their children’s access to hormones or surgeries. Because of the stigma often attached to making such a choice, Dr. Rosenthal’s presentation may help lessen parents’ concerns about whether or not they are making the right choice in moving ahead with either puberty blockers (which block the hormones that will lead to the puberty of sex-assigned-at-birth) or so-called cross-sex hormones (which promote the development of secondary sex characteristics associated with the gender with which a child identifies or resonates). However, presenting research in an attempt to prove a biological basis for transgender identities has been met with mixed responses.
Dr. Rosenthal is one of the pioneers in this controversial field of transgender pediatric and adolescent health, and work like his has come under criticism from peers in the medical field, as well as from another unlikely group of critics – transgender people themselves, in addition to intersex, de-transitioned adults, and non-binary people who identify as neither male nor female. These groups of people worry that hormones and surgeries will be used to mask young people’s queer and transgender identities, and gender diversity more broadly. Many transgender people choose to live without medical interventions on their bodies. Intersex adults – people who cannot or should not be classified as male or female – often have experienced the long-term consequences of adult decision-making power over their bodies and genders, and do not want others to have that choice taken away. There is also a growing movement of adults who medically transitioned genders before the age of eighteen who now call themselves “de-trans” and believe they were coerced into making decisions that were not appropriate for them, while others believe that medical gender transition was appropriate for them at the time, but that their gender identity has shifted again in late adolescence or adulthood. Non-binary adults are people who may pursue medical gender transition, but who do not necessarily identify as either male or female. These diverse stakeholders are often skeptical of early medical interventions on children’s bodies and identities, particularly when the primary goal is to secure a “normal” life, a goal that often feeds unrealistic expectations resulting in long-term negative consequences, such as depression, or, a lack of connection to queer communities as an adolescent or adult.
These groups have voiced concerns about the drive behind the search for a genetic basis for transgender identities, drawing upon lessons learned from the now-discredited “reparative” therapies for intersex, gay, lesbian, bisexual, and queer youth and adults that sought to “correct” and erase queer genders and sexualities during times of intense stigma, including today. In addition to stigma, laws were crafted in the 19th and early 20th centuries that made it illegal to wear clothes of “another sex” or to engage in homosexuality. Interestingly, and of concern to those who have studied the covert reinventions of eugenics, California reformers who were interested in white racial purity also became interested in how mothers and fathers, in their portrayals of polarized masculinity and femininity, could craft “fitter” children that would prevent the degeneracy of the white race.
Lewis Terman was a leading figure in the California eugenics movement who invented and popularized the Stanford-Binet intelligence test, a tool used to assess “feeblemindedness” and identify young people for forced sterilization. Terman also developed the “M-F” test, which was used – and to some extent is still used – to predict homosexuality and gender diversity in youth and young adults, and to channel them into so-called reparative therapies to prevent the further development of diverse genders and sexualities. Here, we can see that the impulse to draw clear lines around racial groupings is intimately linked to the desire to have clear lines between male/female, even as standards for men and woman are often in flux, changing across time and place. Many advocates for transgender youth – including transgender adults – feel pressure to justify challenging and controversial decisions, often relying on research that reproduces a certain logic known to harm the very interests of people they seek to support.
And yet, the research seeking a genetic basis for transgender identities is forging ahead. A team of international researchers from the U.S. and Europe have already begun to collect DNA samples from thousands of transgender people in an effort to identify genomic markers that could be used to predict the development of transgender identities, something researchers themselves have inadequately defined because they are not trained in gender or cultural studies. As this work develops, we must continue to ask ourselves questions about what ethics and understandings are driving this research, as well as all the potential outcomes and consequences for transgender children and youth, many of whom are often making decisions in a crucible of medical and psychological experimentation, binary gender coercion, inconclusive data, misinformation, and immense discrimination. Even with the good intentions of parents, and physicians like Dr. Rosenthal, without a more robust discussion that puts the interests of transgender children, youth, and adults in a larger social and historical context, we may be repeating missteps of the past. These important deliberations would benefit from refusing simplistic resolutions, and instead, foregrounding the priorities and needs of diverse children, youth, and families, rather than physicians and researchers.
I am someone who made the difficult and complex choice to pursue medical gender transition as an adult. As a youth advocate who has been blessed to know many self-actualized young people who are intelligent and capable enough to make decisions about their own bodily self-determination, I am also not advocating that these options be taken away from youth. Instead, I would ask that we ask under what circumstances, in which kinds of communities, and with what support are young people seeking clinical psychological and medical care that helps them explore new possibilities for gender? They are not sick, unfortunate, helpless victims of a psychiatric condition. How do we come to see youth not as overly genetically pre-determined, but as creative individuals embedded within cultural contexts that shape life’s possibilities, and that many of these possibilities – or constraints – warrant expansion or resistance? So much of my process was shaped by the ways I’ve grown through queer communities, and how I’ve been supported in making sense of gender, sexuality, family, and community in queered ways because of this cultural embeddedness. All youth, regardless of whether or not they identify as both trans and queer, deserve to know about alternative ways to craft a sustainable, meaningful, and supported life, beyond clinical diagnoses and solutions. Our world today needs more creativity around gender, not less.