{"id":35795,"date":"2025-08-26T14:31:09","date_gmt":"2025-08-26T18:31:09","guid":{"rendered":"https:\/\/www.thenewatlantis.com\/?post_type=article&#038;p=35795"},"modified":"2025-10-14T15:24:49","modified_gmt":"2025-10-14T19:24:49","slug":"what-comes-after-gender-affirmation","status":"publish","type":"article","link":"https:\/\/www.thenewatlantis.com\/publications\/what-comes-after-gender-affirmation","title":{"rendered":"What Comes After Gender Affirmation?"},"content":{"rendered":"\n<style>\n.gutenberg-content .block-tna-editors-note {\n    color: #333366;\n    background: none;\n}\n.block-tna-editors-note .text-lg {\n    font-size: 1.75rem;\n}\n<\/style>\n\n\n\n<p class=\"has-drop-cap\">One day in the summer of 2023, when Irene\u2019s sixteen-year-old daughter had come home so drunk she was slurring her words, she told her mother that she was questioning her gender, that \u201cI might want to be a boy.\u201d Irene had been through adolescence with an older child and met this confession with equanimity. \u201cIt\u2019s very common to explore identities, we love you whatever you are,\u201d she told the teen.<\/p>\n\n\n\n<p>Their relationship in the preceding months had become \u201cextremely bad,\u201d says Irene, who asked to use her first name only to protect the identity of her family. The girl had attempted suicide with pills; there had been weeks in a psych ward, a new therapist, medications for ADHD and depression. The summer was erupting with slammed doors and heavy drinking and pot vaping.<\/p>\n\n\n\n<p>As autumn set in, Irene was growing more concerned about the drug use, skipped classes, falling grades, homework undone, aggression in the home. By this time the teen was demanding to be called by male pronouns. Irene, whose upbringing in the Eastern bloc occasionally reveals itself in her phrasing, was hesitant. Gender had never been an issue for her child. And she suspected there was a social component: \u201cI had noticed that all the friends she had at this time were questioning their gender. Like about eight of them \u2014 they all used different names.\u201d Irene felt this was beyond the current therapist\u2019s skills and begged a program near their home in New York City to take her kid.<\/p>\n\n\n\n<p>Irene was still referring to her child as her \u201cdaughter,\u201d but at the first appointment the counselor told her she \u201cneeded to be educated\u201d on transgender issues. A few sessions in, the counselor recommended socially transitioning: accepting the teen\u2019s new chosen name and male pronouns, and facilitating whatever else was needed \u2014 typically wardrobe revisions, a new haircut, and chest binders. \u201cThis is the way you\u2019ll build the relationship,\u201d the counselor told Irene.<\/p>\n\n\n\n<p>Irene was amenable to anything that would help get her struggling kid on better footing. But it didn\u2019t seem to. \u201cShe lost almost thirty pounds, she started refusing to go to school, was always getting sick,\u201d Irene recalls. Then, in the spring of 2024, the teen went on a full strike. \u201cShe refused to go to any therapist, refused to take any pills, said I\u2019m not going to do any of that unless you bring me to a gender clinic for testosterone.\u201d This went on until it became, \u201c\u2018If you\u2019re not taking me to the clinic, I\u2019m going to kill myself.\u2019\u201d<\/p>\n\n\n<div class=\"lazyblock-section-break-ZbNeoH wp-block-lazyblock-section-break\"><div class=\"block-tna-section-break mt-12 pt-2 mb-6\">\r\n  <div class=\"mb-12 pb-2 flex justify-center\">\r\n    <svg class=\"fill-current\" height=\"1\" width=\"91\" viewBox=\"0 0 91 1\">\r\n      <path d=\"M91 .5L62.706 1H28.447L0 .5 28.447 0h34.259L91 .5z\"\/>\r\n    <\/svg>\r\n  <\/div>\r\n\t<h5 class=\"leading-none font-callunasans font-bold text-center text-almost-black text-lg\">\r\n\t\tIf Not Affirmative Care, Then What?\t<\/h5>\r\n<\/div><\/div>\n\n\n<p class=\"has-drop-cap\">The debate over providing medical transition treatments for young people who identify as trans, or who have a diagnosis of gender dysphoria, has focused on puberty blockers, cross-sex hormones, and surgeries. As of this writing, 27 U.S. states have restricted some or all of these procedures for minors. In June, the Supreme Court upheld states\u2019 rights to do so.<\/p>\n\n\n\n<p>Among the camp that has been pushing the medical community to, at a minimum, take a more cautious approach, psychotherapy is taking an increasingly prominent position as the most appropriate, least risky first-line treatment for youth. This change follows the lead of the national health agencies of Finland and Sweden. In <a href=\"https:\/\/palveluvalikoima.fi\/documents\/1237350\/22895008\/Summary_minors_en+(1).pdf\/fa2054c5-8c35-8492-59d6-b3de1c00de49\/Summary_minors_en+(1).pdf?t=1631773838474\" target=\"_blank\" rel=\"noreferrer noopener\">2020<\/a> and <a href=\"https:\/\/www.socialstyrelsen.se\/contentassets\/444af6c0a5fb429c9b56fd51b931a816\/2023-1-8330.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">2022<\/a>, respectively, they recommended psychotherapy as the first-line treatment, after evidence reviews found that the risks of medicalization outweigh the presumed benefits. England\u2019s four-year Cass Review, published last year, made the same call, urging \u201cextreme caution\u201d on cross-sex hormones for minors. Following its publication, the National Health Service restricted puberty blockers nationwide for people under eighteen, making exceptions only for patients already receiving them and for participants in a clinical trial (which has yet to <a href=\"https:\/\/www.bmj.com\/content\/388\/bmj.r504\" target=\"_blank\" rel=\"noreferrer noopener\">secure approval<\/a>).<\/p>\n\n\n\n<p>Advocates often frame criticism of what is called \u201cgender-affirming care\u201d as an incendiary front in the culture war: transphobic reactionaries versus the trans-rights-supporting Left. I\u2019ve been reporting on this topic for three years and have interviewed scores of clinicians, researchers, ethicists, parents, and activists. Some skeptics are politically conservative, but many are coming straight out of a liberal, feminist, \u201cin this home we believe in science\u201d worldview. They believe in protecting kids from what they see as medical overreach, but don\u2019t necessarily support legislative remedies. Nor are they celebrating President Trump\u2019s inflammatory executive orders calling treatments \u201c<a href=\"https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/01\/protecting-children-from-chemical-and-surgical-mutilation\/\" target=\"_blank\" rel=\"noreferrer noopener\">chemical and surgical mutilation<\/a>\u201d and <a href=\"https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/01\/prioritizing-military-excellence-and-readiness\/\" target=\"_blank\" rel=\"noreferrer noopener\">expelling trans service members<\/a> from the military.<\/p>\n\n\n\n<figure class=\"wp-block-image alignwide size-large\"><img decoding=\"async\" loading=\"lazy\" width=\"1920\" height=\"1280\" src=\"https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-protest-1-1920x1280.jpg\" alt=\"\" class=\"wp-image-35910\" srcset=\"https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-protest-1-1920x1280.jpg 1920w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-protest-1-1280x853.jpg 1280w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-protest-1-640x427.jpg 640w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-protest-1-1536x1024.jpg 1536w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-protest-1-2048x1365.jpg 2048w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><figcaption class=\"wp-element-caption\"><a href=\"https:\/\/www.shutterstock.com\/editorial\/image-editorial\/edmonton-canada---february-11-protesters-gathered-14366529j\" target=\"_blank\" rel=\"noreferrer noopener\"><cite>Artur Widak \/ NurPhoto \/ Shutterstock<\/cite><\/a><\/figcaption><\/figure>\n\n\n\n<p>For the broad coalition agitating against irreversible medical transition in minors, \u201ctherapy first\u201d has turned into a shorthand as well as a rallying cry, the answer to the question <em>If not affirmative care, then what?<\/em><em><\/em><\/p>\n\n\n\n<p>\u201cBased on the current state of knowledge and evidence in the field of pediatric gender medicine, we\u2019ve basically got no idea what type of effect hormonal interventions are going to have on these kids\u2019 mental health and psychosocial functioning,\u201d says Dr. Kathleen McDeavitt, assistant professor of psychiatry at Baylor College of Medicine, who recently presented on the topic at the annual conference of the American Psychiatric Association. The long-awaited results of a multi-million dollar NIH study are <a href=\"https:\/\/www.medrxiv.org\/content\/10.1101\/2025.05.14.25327614v1\" target=\"_blank\" rel=\"noreferrer noopener\">now in preprint<\/a>: among 94 kids given puberty blockers and followed for two years, mental health outcomes were unchanged. In the U.K., <a href=\"https:\/\/journals.plos.org\/plosone\/article?id=10.1371\/journal.pone.0243894\" target=\"_blank\" rel=\"noreferrer noopener\">a 2021 study<\/a> of 44 young people treated at the now-shuttered Gender Identity Development Service clinic found that after two years, overall mood for one third of the kids improved, and for one third got worse.<\/p>\n\n\n<div class=\"lazyblock-epigraph-2pdgNa wp-block-lazyblock-epigraph\"><div class=\"block-tna-editors-note md:mx-6 lg:mx-16 py-8 px-10 mb-6 bg-almost-white\">\r\n  \t<div class=\"text-lg leading-relaxed\">\r\n\t  <p style=\"text-align: center;\"><strong>\u201cWe\u2019ve basically got no idea what type of effect hormonal interventions are going to have on these kids\u2019 mental health and psychosocial functioning.\u201d<\/strong><\/p>\t<\/div>\r\n\t<\/div><\/div>\n\n\n<p>While the evidence is inconclusive, says McDeavitt, \u201cwe do understand as physicians that these interventions pose significant risks \u2014 to fertility, bone density, sexual function. On the other hand, we have evidence-based psychotherapeutic tools that we can use to help kids manage distress.\u201d Though there may not be a strong evidence base for using those tools specifically to treat gender-related distress, because they have not been studied, techniques like dialectical behavioral therapy have far fewer risks than medication or a mastectomy, she argues. \u201cWhy wouldn\u2019t that be our standard recommended approach?\u201d Furthermore, she points out, history has not looked kindly on medical practices that disproportionately affected vulnerable populations\u2019 sexual functioning and fertility.<\/p>\n\n\n\n<p>England\u2019s National Health Service is in the process of re-training therapists to meet this moment. But in the United States, every professional organization in the mental health field \u2014 the American Psychiatric Association, the American Psychological Association, the corresponding groups for psychoanalysts, therapists, counselors, and social workers \u2014 all continue to stand behind the affirmative model: accept a patient\u2019s gender identity as innate and off-limits for exploratory discussion, regardless of the patient\u2019s age or general mental health.<\/p>\n\n\n\n<p>This, says Paul Garcia-Ryan, executive director of a small but growing organization for mental health professionals called Therapy First, has put his colleagues in an unprecedented \u2014 and unfortunate \u2014 position, asking them to treat trans patients in an exceptional way that precludes the precepts of therapy itself: asking questions and exploring emotions so that their clients may better know themselves. In the context of young people, he says, the model disregards the fluid nature of adolescent identity formation. \u201cI was trained in a gender-affirming way and practiced in a gender-affirming way, and you don\u2019t really get much discussion around developmental considerations,\u201d he says. \u201cWe have younger therapists coming in and expressing real concerns about how this is taught to them.\u201d<\/p>\n\n\n\n<figure class=\"wp-block-image alignwide size-full\"><img decoding=\"async\" loading=\"lazy\" width=\"1500\" height=\"1162\" src=\"https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-protest-2-crop.jpg\" alt=\"\" class=\"wp-image-36122\" srcset=\"https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-protest-2-crop.jpg 1500w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-protest-2-crop-1280x992.jpg 1280w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-protest-2-crop-640x496.jpg 640w\" sizes=\"(max-width: 1500px) 100vw, 1500px\" \/><figcaption class=\"wp-element-caption\"><a href=\"https:\/\/www.alamy.com\/washington-district-of-columbia-usa-4th-dec-2024-supporters-of-gender-affirming-care-for-transgender-youth-rally-outside-the-us-supreme-court-as-it-heard-oral-arguments-on-whether-tennessee-can-ban-puberty-blockers-and-hormone-therapy-for-transgender-teens-the-key-issue-in-united-states-v-skremetti-is-whether-banning-health-care-for-one-group-violates-the-14th-amendments-equal-protection-clause-currently-26-states-have-passed-such-laws-credit-image-sue-dorfmanzuma-press-wire-editorial-usage-only!-not-for-commercial-usage!-image634266025.html?imageid=70B1A1BB-F2C9-4047-AD7C-9F846C01E81E&amp;pn=3&amp;searchId=d24e50256727f4f37fc738cd256cc234&amp;searchtype=0\" target=\"_blank\" rel=\"noreferrer noopener\"><cite>ZUMA Press, Inc. \/ Alamy<\/cite><\/a><\/figcaption><\/figure>\n\n\n<div class=\"lazyblock-section-break-S5F34 wp-block-lazyblock-section-break\"><div class=\"block-tna-section-break mt-12 pt-2 mb-6\">\r\n  <div class=\"mb-12 pb-2 flex justify-center\">\r\n    <svg class=\"fill-current\" height=\"1\" width=\"91\" viewBox=\"0 0 91 1\">\r\n      <path d=\"M91 .5L62.706 1H28.447L0 .5 28.447 0h34.259L91 .5z\"\/>\r\n    <\/svg>\r\n  <\/div>\r\n\t<h5 class=\"leading-none font-callunasans font-bold text-center text-almost-black text-lg\">\r\n\t\t\u2018We Don\u2019t Have a Brain Scan or a Blood Test\u2019\t<\/h5>\r\n<\/div><\/div>\n\n\n<p class=\"has-drop-cap\">Psychology was the field from which childhood medical transition originated in the 1990s. Practitioners in the Netherlands thought that puberty suppression could alleviate psychological distress in children and, if they later underwent surgery, help them to pass more convincingly as their felt gender.<\/p>\n\n\n\n<p>As what came to be known as the Dutch Protocol developed, mental health professionals had a central role in conducting an extensive assessment to determine whether the young person in front of them was a good candidate for blocking puberty. That process took a minimum of six months.<\/p>\n\n\n\n<p>Laura Edwards-Leeper, an American psychologist, was sent to the Netherlands in the mid-2000s to learn this methodology and bring it back to Boston Children\u2019s Hospital, which launched the nation\u2019s first pediatric gender clinic. The protocol contracted upon import, shrinking from months to weeks to mere hours. Last year <a href=\"https:\/\/www.nysun.com\/article\/shocking-and-reckless-top-gender-clinic-assesses-children-for-gender-altering-medical-treatments-in-just-2-hours-lawsuit-lays-bare?member_gift=CUZ5qwd3crq4pmz-xrd\" target=\"_blank\" rel=\"noreferrer noopener\">a lawsuit revealed<\/a> that by 2018 (long after Edwards-Leeper had moved on) patients were getting a green light for treatment after only two hours of assessment.<\/p>\n\n\n\n<p>When I first spoke with her three years ago, Edwards-Leeper lamented how gender clinicians had come to downplay the importance of mental health professionals, \u201clargely because they believe if the young person says they\u2019re trans, they\u2019re trans,\u201d <a href=\"https:\/\/www.bostonglobe.com\/2023\/11\/07\/opinion\/gender-affirming-care-trans-kids\/\" target=\"_blank\" rel=\"noreferrer noopener\">she said<\/a>. Meanwhile, she said, the term \u201cconversion therapy\u201d \u2014 which describes the widely condemned practice of trying to enforce heterosexuality, often through coercion and violence \u2014 was being \u201chijacked\u201d to denigrate therapy itself. Since then, <a href=\"https:\/\/www.youtube.com\/watch?v=FhzoXgrYa9g\" target=\"_blank\" rel=\"noreferrer noopener\">charges<\/a> <a href=\"https:\/\/www.nytimes.com\/2025\/05\/01\/health\/federal-report-denounces-gender-treatments-for-adolescents.html\" target=\"_blank\" rel=\"noreferrer noopener\">of<\/a> \u201cconversion therapy\u201d have become commonplace among advocates of gender affirmation.<\/p>\n\n\n<div class=\"lazyblock-epigraph-Z2ejJBn wp-block-lazyblock-epigraph\"><div class=\"block-tna-editors-note md:mx-6 lg:mx-16 py-8 px-10 mb-6 bg-almost-white\">\r\n  \t<div class=\"text-lg leading-relaxed\">\r\n\t  <p style=\"text-align: center;\"><strong>\u201cI was trained in a gender-affirming way and practiced in a gender-affirming way, and you don\u2019t really get much discussion around developmental considerations.\u201d<\/strong><\/p>\t<\/div>\r\n\t<\/div><\/div>\n\n\n<p>One leading thinker behind applying this label is Florence Ashley, a University of Alberta law professor and bioethicist. Ashley wrote in <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10018052\/\" target=\"_blank\" rel=\"noreferrer noopener\">a 2022 paper<\/a> that \u201cproponents of gender-exploratory therapy situate their approach as neutral, agenda-free, and more in line with foundational principles of psychotherapy,\u201d yet they also view \u201ctrans identities and gender dysphoria from a position of suspicion.\u201d The piece concludes, \u201cWhen you begin from the premise that trans identities are suspect and often rooted in pathology, your therapeutic approach soon becomes indistinguishable from conversion practices.\u201d<\/p>\n\n\n\n<p>Most advocates of the cautious approach have since replaced the term \u201cgender-exploratory therapy\u201d with, simply, \u201ctherapy.\u201d \u201cThe idea of exploring gender, exploring where the dysphoria came from, exploring what your hopes and expectations are for an intervention \u2014 all of that was really critical\u201d in the Dutch model, Edwards-Leeper told me. There can be external reasons for distress, like body image concerns, a history of trauma or abuse, or just feeling different and wanting to fit in, she said.&nbsp; \u201cIf it turns out that the young person is just very distressed about puberty and anxious, or maybe they\u2019re gender-nonconforming, it doesn\u2019t necessarily mean that they need to transition,\u201d she told me recently. \u201cIn fact, the best thing for them to do would be to face their anxiety and have support in going through puberty.\u201d<\/p>\n\n\n\n<p>Edwards-Leeper, a former chair of the committee on adolescents within WPATH, the World Professional Association for Transgender Health, was among the first from within the gender medicine establishment to suggest that transition is not always the best treatment. And it set her and others apart from the thrust of advocates for affirmation, like physician Johanna Olson-Kennedy, head of the now-shuttered gender clinic at the Los Angeles Children\u2019s Hospital and lead investigator of the large NIH study, who <a href=\"https:\/\/www.theatlantic.com\/magazine\/archive\/2018\/07\/when-a-child-says-shes-trans\/561749\/\" target=\"_blank\" rel=\"noreferrer noopener\">told <em>The Atlantic<\/em> in 2018<\/a>: \u201cI don\u2019t send someone to a therapist when I\u2019m going to start them on insulin.\u201d Even the American Academy of Pediatrics, in <a href=\"https:\/\/publications.aap.org\/pediatrics\/article\/142\/4\/e20182162\/37381\/Ensuring-Comprehensive-Care-and-Support-for?autologincheck=redirected\" target=\"_blank\" rel=\"noreferrer noopener\">its 2018 policy statement<\/a>, asserted that kids \u201cknow their gender\u201d and can be offered \u201cmany medical interventions.\u201d<\/p>\n\n\n\n<p>Edwards-Leeper and others argued that given the research showing that a majority of gender-dysphoric kids resolve their incongruence during puberty, and given also the presence of de-transitioners who have been harmed by treatment, sometimes irreparably, it is incumbent upon pediatric clinics to go slowly and assess carefully. \u201cWe don\u2019t have a brain scan or a blood test to determine who will with 99.9 percent certainty benefit. All we have is a psychological assessment that is done by people trained in the mental health field,\u201d she told me. And perhaps one reason the assessment has mostly fallen away is that \u201cgenerally speaking, medical providers don\u2019t really have an interest in taking their marching orders from a mental health clinician. Which is basically, in this field, what really should happen.\u201d<\/p>\n\n\n\n<p>But Paul Garcia-Ryan and others are staking out a different position: that asking mental health specialists to determine whether a child is likely to persist in their trans identity and benefit from irreversible treatment puts them in a role that\u2019s far outside their scope of practice. \u201cThe diagnosis of gender dysphoria, which can only be made through a mental health professional, is what\u2019s used to justify the initiation of medical treatments. And so at least in the United States, it\u2019s really placed therapists in this position of assessing whether those treatments are medically necessary, which is unprecedented. You don\u2019t see that anywhere else.\u201d<\/p>\n\n\n\n<p>Therapy, in fact, played a large role in the treatment he received as a gender-nonconforming teen: \u201cWhen I was 15, a therapist affirmed my conviction that I was born in the wrong body. After more than a decade of hormonal and surgical interventions, I detransitioned at age 30,\u201d he wrote in <a href=\"https:\/\/www.washingtonpost.com\/opinions\/2024\/04\/18\/cass-review-young-people-gender-transition\/\" target=\"_blank\" rel=\"noreferrer noopener\">a 2024 <em>Washington Post<\/em> op-ed<\/a>. \u201cI had come to realize that my transition was motivated by my difficulty reconciling with being gay.\u201d<\/p>\n\n\n\n<p>The gender-affirming model as applied to mental health, he told me, \u201cis leading to therapy that\u2019s not really therapy. I would definitely say that I did not get adequate therapy.\u201d<\/p>\n\n\n\n<figure class=\"wp-block-image alignwide size-large\"><img decoding=\"async\" loading=\"lazy\" width=\"1920\" height=\"1921\" src=\"https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-2-square-1920x1921.jpg\" alt=\"\" class=\"wp-image-35900\" srcset=\"https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-2-square-1920x1921.jpg 1920w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-2-square-1280x1281.jpg 1280w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-2-square-640x640.jpg 640w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-2-square-1536x1536.jpg 1536w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-2-square-2048x2048.jpg 2048w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-2-square-600x600.jpg 600w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><figcaption class=\"wp-element-caption\"><a href=\"https:\/\/ploom.tv\" target=\"_blank\" rel=\"noreferrer noopener\"><cite>Eiko Ojala<\/cite><\/a><\/figcaption><\/figure>\n\n\n<div class=\"lazyblock-section-break-Z28BoM2 wp-block-lazyblock-section-break\"><div class=\"block-tna-section-break mt-12 pt-2 mb-6\">\r\n  <div class=\"mb-12 pb-2 flex justify-center\">\r\n    <svg class=\"fill-current\" height=\"1\" width=\"91\" viewBox=\"0 0 91 1\">\r\n      <path d=\"M91 .5L62.706 1H28.447L0 .5 28.447 0h34.259L91 .5z\"\/>\r\n    <\/svg>\r\n  <\/div>\r\n\t<h5 class=\"leading-none font-callunasans font-bold text-center text-almost-black text-lg\">\r\n\t\t\u2018Oh My God, What Have I Done?\u2019\t<\/h5>\r\n<\/div><\/div>\n\n\n<p class=\"has-drop-cap\">Last year, Irene\u2019s teen was referred by a therapist to a gender clinic, and the system worked as the Dutch Protocol intended: given the unresolved mental health issues, the clinic would not prescribe testosterone. Meanwhile, Irene entered a group therapy program through Columbia University for parents dealing with all kinds of issues. She was the only one whose child was questioning their gender. When it was her turn to share, her peers were supportive, not dogmatic: perhaps this is a developmental stage, said one parent. Another shared that she had gone through something similar as a child herself and had come out the other side.<\/p>\n\n\n\n<p>Irene opened up about the concerns nagging at her: Were the treatments reversible? How would testosterone affect her child\u2019s body? At this point, the group leader interjected that these topics were veering beyond the scope of the group and urged Irene to discuss them with the treating physician.<\/p>\n\n\n\n<p>\u201cI was neutral at the time,\u201d she tells me, still open to socially confirming her child\u2019s male identity, pronouns and all. But at the next session, the leader referred to the child she still thought of as her daughter as her \u201cson.\u201d<\/p>\n\n\n\n<p>\u201cThat hurt me so much,\u201d Irene tells me, her voice cracking. \u201cI couldn\u2019t handle hearing \u2018son\u2019 and not \u2018daughter\u2019 from this person who\u2019s never seen my kid. That was my turning point of thinking that I have to explore this topic deeper, I have to know much more about this, before I\u2019m doing something stupid.\u201d<\/p>\n\n\n\n<p>The next day, she devoted herself to the computer. She found the podcast Gender: A Wider Lens by therapists Stella O\u2019Malley and Sasha Ayad. She found their book<em> When Kids Say They\u2019re Trans: A Guide for Thoughtful Parents<\/em>, coauthored with Lisa Marchiano, a psychoanalyst who was among the first to raise the possibility of peer influence, especially in girls. Irene joined Ayad\u2019s parents group.<\/p>\n\n\n\n<p>Soon, her neutrality gave way to the acute nightmare of parental regret. \u201cOh my God, what have I done?\u201d she recalls thinking, choking on a sob. \u201cHow can I go back and tell my daughter that I disagree with what was previously said by me?\u201d<\/p>\n\n\n\n<p>First, she kept reading. She read about WPATH, which <a href=\"https:\/\/segm.org\/The-Economist-WPATH-Research-Trans-Medicine-Manipulated\" target=\"_blank\" rel=\"noreferrer noopener\">suppressed critical evidence<\/a> as it put together its 2022 guidelines for gender-affirming care, and whose leadership admitted in internal messaging forums to the gaps in data. She read about the Cass Review, and read the review itself, which concludes that the affirming model is based on \u201cremarkably weak\u201d evidence, and that there is no strong evidence that hormonal intervention improves mental health or reduces suicidality. \u201cI kind of started to understand what\u2019s actually going on here in this country,\u201d she tells me. \u201cI grew up under communism. I saw how propaganda works.\u201d<\/p>\n\n\n\n<p>By way of example, Irene texts me a snapshot of the poster hanging up just inside the entrance of the high school her teen was attending. It reads:<\/p>\n\n\n\n<blockquote class=\"wp-block-quote\">\n<p class=\"has-text-align-center\">I DECIDE<br>WHAT MY GENDER IS<br>MY NAME &amp; MY PRONOUNS<br>WHAT MY BODY MEANS<br>HOW TO CHANGE &nbsp;\u2014 &nbsp;OR<br>NOT CHANGE &nbsp;\u2014 &nbsp;MY BODY<br>TRANS RIGHTS ARE HUMAN RIGHTS<\/p>\n<\/blockquote>\n\n\n<div class=\"lazyblock-section-break-sVTMC wp-block-lazyblock-section-break\"><div class=\"block-tna-section-break mt-12 pt-2 mb-6\">\r\n  <div class=\"mb-12 pb-2 flex justify-center\">\r\n    <svg class=\"fill-current\" height=\"1\" width=\"91\" viewBox=\"0 0 91 1\">\r\n      <path d=\"M91 .5L62.706 1H28.447L0 .5 28.447 0h34.259L91 .5z\"\/>\r\n    <\/svg>\r\n  <\/div>\r\n\t<h5 class=\"leading-none font-callunasans font-bold text-center text-almost-black text-lg\">\r\n\t\t\u2018A Very Dangerous Thing\u2019\t<\/h5>\r\n<\/div><\/div>\n\n\n<p class=\"has-drop-cap\">Zander Keig is a licensed clinical social worker who has been vocal that \u201cyoung people with gender distress probably shouldn\u2019t be going through a medical transition,\u201d as he told me in a phone call.<\/p>\n\n\n\n<p>Keig rejects the notion that trans is a state of being, and directs me to identify him as transsexual, not transgender. \u201cMy gender (masculine) has not changed since childhood,\u201d he clarified in a follow-up email. But at age 39 he went through a process that changed his secondary sex characteristics, official identification, and social presentation from lesbian woman to man. \u201cI\u2019m still female, but look, sound, and navigate society as a man.\u201d<\/p>\n\n\n\n<p>Keig, who has two podcasts in which he expresses opinions at times unpopular with some trans activists, is concerned about the assumptions behind the concept of the \u201ctrans kid.\u201d \u201cThere\u2019s no way to determine which of these kids is just a gender-nonconforming kid who\u2019s going to grow up to be gay or straight or something else, versus the kids that are going to grow up to do what I did,\u201d he says. Some gays and lesbians charge that gender clinicians are \u201ctransing the gays away,\u201d he says, \u201cand I don\u2019t dispute that.\u201d<\/p>\n\n\n\n<p>In the case of a child who is in some sort of discomfort or distress about their bodies, he says, \u201cI don\u2019t even think psychotherapy is the first line of intervention.\u201d Rather, it should be psychosocial support, that is, \u201cgetting everybody on the same page to find out, like, why is this kid so distressed? What kind of messages are they getting from the family? What kind of messages are they getting from the school? What kind of messages are they getting that the kind of girl or the kind of boy they are is wrong or bad? Is it the religion? Is it the culture?\u201d In other words, are they simply pushing up against gender expectations or homophobia? In which case, they don\u2019t need psychotherapy as much as to be allowed to play and dress how they please. \u201cThese are just children, for God\u2019s sake!\u201d says Keig. Distress doesn\u2019t necessarily mean \u201cthat they have a desire to be the other sex or to live as the other sex. I think that comes from the interpretation of the adults.\u201d<\/p>\n\n\n\n<p>Sasha Ayad, the therapist whose parents group Irene joined, told me \u201cI think the place we might miss the mark is that we fail to appreciate the metaphor of gender.\u201d Sometimes a kid who expresses distress about their body is just communicating that \u201csometimes I feel like I don\u2019t fit in.\u201d<\/p>\n\n\n\n<p>Ayad has been working with gender-distressed young people for a decade. In 2021, she cofounded the Gender Exploratory Therapy Association \u2014 exploration as a response to the affirmation model \u2014 and it was promptly embroiled in accusations of promoting \u201cconversion therapy,\u201d a charge that has stuck on its Wikipedia page, in spite of its rebranding as Therapy First. \u201cThe best way to describe it is we\u2019re just doing therapy,\u201d says Kristin Farrell-Turner, a psychologist and one of its board members.<\/p>\n\n\n\n<p>The field has gotten caught up in a metaphysical debate over whether a person is born with an incongruent soul and body, Ayad says. Whether or not that\u2019s what it means to be trans, it doesn\u2019t need to lead to medicalization, at least not in minors, she argues. \u201cI think the problem that these therapeutic governing agencies and groups have gotten themselves into is that they\u2019ve tied affirming someone\u2019s sense of identity with accessing hormones and surgery. That\u2019s a major split we can make now.\u201d<\/p>\n\n\n\n<p>As Keig sees it, the trans adult who in retrospect says, \u201cI knew when I was a little kid, and it would have been so much better if I wouldn\u2019t have had to have gone through all of that pain and suffering\u201d presents a \u201ccompelling argument.\u201d But to superimpose that on all prepubescent children who are rejecting gender stereotypes has sent the wrong message to people in positions of authority over kids. It\u2019s led teachers and school counselors \u2014 who, Keig wants to point out, are not trained in psychology or in therapy \u2014 to use a kid\u2019s preferred pronouns and name and believe that keeping this from the parents puts them on the right side of history and social justice. \u201cThat is a very dangerous thing, to create a rift, a gap between a child and their parent,\u201d he says. \u201cIf they\u2019re truly abusive parents, then you should call child welfare.\u201d<\/p>\n\n\n<div class=\"lazyblock-section-break-Z25DPlI wp-block-lazyblock-section-break\"><div class=\"block-tna-section-break mt-12 pt-2 mb-6\">\r\n  <div class=\"mb-12 pb-2 flex justify-center\">\r\n    <svg class=\"fill-current\" height=\"1\" width=\"91\" viewBox=\"0 0 91 1\">\r\n      <path d=\"M91 .5L62.706 1H28.447L0 .5 28.447 0h34.259L91 .5z\"\/>\r\n    <\/svg>\r\n  <\/div>\r\n\t<h5 class=\"leading-none font-callunasans font-bold text-center text-almost-black text-lg\">\r\n\t\t\u2018Trading Off a Cosmetic Success Against Sexual Satisfaction\u2019\t<\/h5>\r\n<\/div><\/div>\n\n\n<p class=\"has-drop-cap\">In her review of gender-transition treatments, Dr. Hilary Cass called on clinicians and parents to view social transition as an \u201cactive intervention\u201d that may have \u201csignificant effects\u201d on the child\u2019s psychological well-being and future outcomes. The review found that kids whose cross-sex identity was facilitated at an early age were more likely to proceed to medical intervention.<\/p>\n\n\n\n<p>\u201cChildren will believe what adults tell them,\u201d says Sasha Ayad. \u201cWe have to keep in mind how concrete their thinking is.\u201d In other words, if a parent agrees to a new name or pronouns for a young kid, they \u201cdon\u2019t understand you\u2019re being polite. You\u2019re setting them up to be at war with reality.\u201d Meanwhile, in an adolescent, she sees an opportunity for families to ask, \u201cWhat does it mean that my child needs medication to be authentic?\u201d<\/p>\n\n\n\n<p>\u201cMaintaining flexibility and keeping options open by helping the child to understand their body as well as their feelings is likely to be advantageous,\u201d wrote Cass in her review. For both young children and adolescents, \u201cthe clinician should help families to recognise normal developmental variation in gender role behaviour and expression.\u201d<\/p>\n\n\n<div class=\"lazyblock-epigraph-Z22Dn5k wp-block-lazyblock-epigraph\"><div class=\"block-tna-editors-note md:mx-6 lg:mx-16 py-8 px-10 mb-6 bg-almost-white\">\r\n  \t<div class=\"text-lg leading-relaxed\">\r\n\t  <p style=\"text-align: center;\"><strong>\u201cWhat does it mean that my child needs medication to be authentic?\u201d<\/strong><\/p>\t<\/div>\r\n\t<\/div><\/div>\n\n\n<p>\u201cSocial transition is a major psychological intervention,\u201d says psychiatry professor Kathleen McDeavitt, \u201cbut it\u2019s not seen as such.\u201d Families are being encouraged to affirm their small children, \u201cand these are the ones that I worry about the most because the endocrinologist watches these kids like hawks\u201d for the first sign of puberty to begin blockers.<\/p>\n\n\n\n<p>Three years ago, a video of gender surgeon and WPATH president Dr. Marci Bowers <a href=\"https:\/\/x.com\/sullydish\/status\/1569724961073369091\" target=\"_blank\" rel=\"noreferrer noopener\">went viral<\/a>. In it, she shared her observation that the male patients she treated whose puberty had been blocked at an early stage never developed the ability for orgasm. \u201cAre they going to be able to achieve sexual satisfaction? It\u2019s important in relationships,\u201d she said. For McDeavitt, this was a stunning admission of how high the stakes are in putting a young person on a medical pathway.<\/p>\n\n\n\n<p>Some physical side effects of early medical transition are not a new concern: <a href=\"https:\/\/www.jpagonline.org\/article\/S1083-3188(16)30174-7\/abstract\" target=\"_blank\" rel=\"noreferrer noopener\">one participant<\/a> in the original Dutch studies died from a bacterial infection after vaginoplasty that was complicated as a direct result of stunted growth: lacking adequate penile tissue, surgeons had to use part of the colon. Yet there is a dearth of published research on the cognitive and sexual side effects, and an apparent squeamishness in communicating to the public what\u2019s known and what isn\u2019t: In the <em>New York Times<\/em> podcast The Protocol, concerned parties raise the issue of harms several times, but the prospect of a life without sexual intimacy is never articulated, nor are the ethics of adults consenting to such for a minor who has no point of reference \u2014 particularly in a population that historically is skewed toward being same-sex attracted.<\/p>\n\n\n\n<p>The word \u201corgasm\u201d appears nowhere in the 388 pages of the Cass Review, although Hilary Cass brought it up when I interviewed her in person. \u201cThere is no question that sexual function may be quite compromised by the treatments. It may not be possible to orgasm subsequently, depending on what medical and surgical treatments you have,\u201d she told me. \u201cAnd so some people have said, yes, there was a trading off a cosmetic success against sexual satisfaction and sexual success. And that\u2019s before we talk about things like not being able to have children in some instances, and other things that people need really careful counseling about, like, you know, the impact that treatment is going to have &#8230; in terms of vaginal atrophy. So this is not something to be entered into lightly.\u201d<\/p>\n\n\n\n<p>Providing the information necessary for a patient to give informed consent is typically the responsibility of the treating physician. However, in the case of gender-affirming care, this is often left to the mental health specialist to cover during the assessment, if there is one.<\/p>\n\n\n\n<p>Laura Edwards-Leeper told me she carefully walks young patients and families through what\u2019s known and unknown and asks them to think through the implications, but that ultimately it\u2019s for the family to decide. In a <a href=\"https:\/\/www.city-journal.org\/article\/pediatric-gender-medicine-laura-edwards-leeper\" target=\"_blank\" rel=\"noreferrer noopener\">July interview<\/a> with Leor Sapir of the Manhattan Institute, she was more blunt: \u201cI tell them that they are guinea pigs and they have to decide if they are okay with that.\u201d She persists out of pragmatism and because, for some, she believes transition to be lifesaving.<\/p>\n\n\n\n<p>For Paul Garcia-Ryan, that\u2019s a level of patient risk he\u2019s not willing to bear. The purpose of comprehensive assessments should be for therapists \u201cto better understand the unique individual they\u2019re responsible for treating,\u201d he told me, not rubber-stamping puberty blockers. \u201cI don\u2019t think any clinician or assessment can determine whose gender dysphoria will persist or desist, or who will be helped or harmed by medical transition. I don\u2019t think it\u2019s the therapist\u2019s job to assess for that, and I don\u2019t think it\u2019s appropriate for therapists to be in the role of approving medical interventions.\u201d<\/p>\n\n\n\n<figure class=\"wp-block-image alignwide size-large\"><img decoding=\"async\" loading=\"lazy\" width=\"1920\" height=\"1920\" src=\"https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-3-square-1920x1920.jpg\" alt=\"\" class=\"wp-image-35904\" srcset=\"https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-3-square-1920x1920.jpg 1920w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-3-square-1280x1280.jpg 1280w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-3-square-640x640.jpg 640w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-3-square-1536x1536.jpg 1536w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-3-square-2048x2048.jpg 2048w, https:\/\/www.thenewatlantis.com\/wp-content\/uploads\/2025\/09\/Block-illustration-3-square-600x600.jpg 600w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><figcaption class=\"wp-element-caption\"><a href=\"https:\/\/ploom.tv\" target=\"_blank\" rel=\"noreferrer noopener\"><cite>Eiko Ojala<\/cite><\/a><\/figcaption><\/figure>\n\n\n<div class=\"lazyblock-section-break-Z1Lo0su wp-block-lazyblock-section-break\"><div class=\"block-tna-section-break mt-12 pt-2 mb-6\">\r\n  <div class=\"mb-12 pb-2 flex justify-center\">\r\n    <svg class=\"fill-current\" height=\"1\" width=\"91\" viewBox=\"0 0 91 1\">\r\n      <path d=\"M91 .5L62.706 1H28.447L0 .5 28.447 0h34.259L91 .5z\"\/>\r\n    <\/svg>\r\n  <\/div>\r\n\t<h5 class=\"leading-none font-callunasans font-bold text-center text-almost-black text-lg\">\r\n\t\t\u2018I Have to, This Is the School\u2019s Policy\u2019\t<\/h5>\r\n<\/div><\/div>\n\n\n<p class=\"has-drop-cap\">Not long ago, Irene decided to stop using the male name or pronouns for her kid. \u201cI said to her, \u2018I did my research, I\u2019m very regretful about using pronouns, I\u2019m not going to do this anymore.\u2019\u201d To keep the peace, she finds linguistic workarounds. \u201cI say \u2018my child,\u2019 \u2018my sweetie,\u2019 whatever comes to my mind.\u201d She also helped get birth control pills to stop her teen\u2019s periods \u2014 one of the main triggers of dysphoria \u2014 which has seemed to help with coping. \u201cI also told her whatever happens I see her as my daughter, nothing is going to change the biological body and situation.\u201d She added that if someday, when her child is a grown adult, \u201cyou tell me \u2018I\u2019m trans and want to be a man,\u2019 then I will deal with that, but until that time, you are my daughter, and I\u2019m going to talk with other people about you as my daughter, and I have the right to do that. I\u2019m your mom, I gave you birth, I\u2019m here to protect you.\u201d<\/p>\n\n\n<div class=\"lazyblock-epigraph-1LPSAA wp-block-lazyblock-epigraph\"><div class=\"block-tna-editors-note md:mx-6 lg:mx-16 py-8 px-10 mb-6 bg-almost-white\">\r\n  \t<div class=\"text-lg leading-relaxed\">\r\n\t  <p style=\"text-align: center;\"><b>\u201cTherapists now don\u2019t even consider questioning this theory of gender affirmation, because they\u2019ve been taught it\u2019s the only compassionate way to be.\u201d<\/b><\/p>\t<\/div>\r\n\t<\/div><\/div>\n\n\n<p>Irene skipped the final two sessions of the parents group after it became clear that the group leader would continue to use male pronouns for her child. A psychologist from the program reached out to offer an individual session and suggested a new group specifically for parents dealing with sexuality and gender issues, and that experts in gender-affirming care would be invited to speak at several sessions.<\/p>\n\n\n\n<p>But halfway through the sessions there were no experts, and Irene felt she was the only one raising questions. For instance, she shared her concern about the uncertainties around outcomes of hormonal treatments, and that other countries were shifting to a more cautious approach with adolescents as a result. One of the parents said looking at the science was outside their purview as parents. \u201cWe love our kids, and we trust the doctors.\u201d<\/p>\n\n\n\n<p>Days before we spoke, the psychologist had contacted Irene to say that some of the parents were complaining about her contributions, and that maybe this wasn\u2019t the right group for her. \u201cWhat I\u2019m trying to understand is why the affirmative approach is the only one provided and there is no alternative,\u201d she told the group leader, who didn\u2019t have an answer, but reiterated that if Irene wanted to stay in the group, she\u2019d need to keep such musings to herself. And she encouraged Irene to apologize for using terms like \u201ccastration\u201d and \u201cbrainwashing.\u201d Irene agreed that \u201cI said maybe too much.\u201d But two sessions later,<strong> <\/strong>Irene was asked directly to leave. The clinician\u2019s notes, which Irene obtained and shared with me, state that the client was given information about alternative groups. Irene told me none were ever offered.<\/p>\n\n\n\n<p>The reason she stayed in the group as long as she did was because, looking back at her learning curve, she wishes it had been easier to access critical information. Wherever she turned, the world was reinforcing gender transition \u2014 at school, online, on every clinic health form with boxes for multiple gender identities. Each week when she met with the teen\u2019s school therapist, Irene referred to her \u201cdaughter\u201d in conversation, while the therapist referred to her \u201cson.\u201d<\/p>\n\n\n\n<p>\u201cI asked, why are you doing that, you\u2019re one-on-one with me. He told me \u2018I have to, this is the school\u2019s policy.\u2019\u201d<\/p>\n\n\n<div class=\"lazyblock-section-break-ZRDH3w wp-block-lazyblock-section-break\"><div class=\"block-tna-section-break mt-12 pt-2 mb-6\">\r\n  <div class=\"mb-12 pb-2 flex justify-center\">\r\n    <svg class=\"fill-current\" height=\"1\" width=\"91\" viewBox=\"0 0 91 1\">\r\n      <path d=\"M91 .5L62.706 1H28.447L0 .5 28.447 0h34.259L91 .5z\"\/>\r\n    <\/svg>\r\n  <\/div>\r\n\t<h5 class=\"leading-none font-callunasans font-bold text-center text-almost-black text-lg\">\r\n\t\t\u2018Basic Chilling of Dissent\u2019\t<\/h5>\r\n<\/div><\/div>\n\n\n<p class=\"has-drop-cap\">\u201cGender affirmation is taught as an absolute non-questionable standard of practice,\u201d says Sasha Ayad, pointing to 2015 American Psychological Association <a href=\"https:\/\/www.apa.org\/practice\/guidelines\/transgender.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">guidelines<\/a> that encourage practitioners \u201cto facilitate access to and provide trans-affirmative care,\u201d including \u201cthrough assisting clients to access hormone therapy or surgery.\u201d \u201cThat\u2019s very different from how I was trained, which is that as a therapist you are supposed to remain clinically neutral. Therapists now don\u2019t even consider questioning this theory of gender affirmation, because they\u2019ve been taught it\u2019s the only compassionate way to be.\u201d<\/p>\n\n\n\n<p>In his op-ed for the <em>Washington Post<\/em>, Paul Garcia-Ryan gave several examples of mental health professionals who had suffered professional and public sanction for sharing \u201ctransphobic\u201d information, such as the link to a Therapy First webinar. They were reported to their licensing boards or had private information revealed on activist websites.<\/p>\n\n\n\n<p>There are about 300 therapists on Therapy First\u2019s membership list. A qualitative study of 89 members found that about half had experienced professional hostility for their questions or views, and a third had experienced or witnessed formal complaints. One respondent, a student at the time, was threatened with a \u201cremediation plan\u201d for sharing articles about European countries shifting policy in response to evidence reviews.<\/p>\n\n\n<div class=\"lazyblock-epigraph-ZvFR2h wp-block-lazyblock-epigraph\"><div class=\"block-tna-editors-note md:mx-6 lg:mx-16 py-8 px-10 mb-6 bg-almost-white\">\r\n  \t<div class=\"text-lg leading-relaxed\">\r\n\t  <p style=\"text-align: center;\"><strong>\u201cI think there are a lot of therapists who could do great work with these young people if they felt they had permission to genuinely explore what this identity distress means rather than feeling like their hands are tied.\u201d<\/strong><\/p>\t<\/div>\r\n\t<\/div><\/div>\n\n\n<p>I, too, spoke with several therapists and psychologists who are quietly resisting but are not ready to speak out. \u201cI still see basic chilling of dissent and many folks (myself included) afraid to say anything for fear of a licensing complaint if not toeing the line of APA and other large organizations,\u201d one wrote. \u201cWithin those large organizations there is (growing?) dissent, but many psych organizations are adept at swiftly silencing it.\u201d<\/p>\n\n\n\n<p>\u201cThe professional medical organizations are like Mount Olympus\u201d in U.S. medical culture, says Kathleen McDeavitt, the Baylor psychiatry professor. \u201cThey are so super important to us. If just one of these respected organizations came out and made a policy that said the standard of care approach to pediatric patients with gender-related distress should be psychotherapeutic techniques and we support research into which are going to benefit these kids the most, I think that would rapidly and significantly change the practice in this country. I don\u2019t think anything else is going to do it.\u201d<\/p>\n\n\n\n<p>In the meantime, clinicians like Sasha Ayad want to affirm their colleagues\u2019 capabilities: \u201cI think there are a lot of therapists who could do great work with these young people if they felt they had permission to genuinely explore what this identity distress means rather than feeling like their hands are tied,\u201d she says. \u201cI think maybe we can do a better job of communicating this message to other clinicians that, hey, you absolutely have the skills to work with this population, you just can\u2019t be afraid to ask questions and probe and of course do it with compassion, but you have to be willing to go there.\u201d<\/p>\n\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"is-layout-flex wp-block-buttons justify-center\">\n<div class=\"wp-block-button aligncenter font-callunasans uppercase font-bold text-lg tracking-wider is-style-outline\"><a class=\"wp-block-button__link has-background wp-element-button\" href=\"\/subscribe\" style=\"border-radius:0px;background-color:#004d8f\" target=\"_blank\" rel=\"noreferrer noopener\">Subscribe<\/a><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>One day in the summer of 2023, when Irene\u2019s sixteen-year-old daughter had come home so drunk she was slurring her words, she told her mother that she was questioning her gender, that \u201cI might want to be a boy.\u201d Irene had been through adolescence with an older child and met this confession with equanimity. \u201cIt\u2019s very common to explore identities, we love you whatever you are,\u201d she told the teen. Their relationship in the preceding months had become \u201cextremely bad,\u201d says Irene, who asked to use her first name only to protect the identity of her family. The girl had&#8230;<\/p>\n","protected":false},"author":19,"featured_media":35891,"template":"","article_type":[13],"noteworthy_people":[],"topics":[5027,5013,5014],"_links":{"self":[{"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/article\/35795"}],"collection":[{"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/article"}],"about":[{"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/types\/article"}],"author":[{"embeddable":true,"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/users\/19"}],"version-history":[{"count":45,"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/article\/35795\/revisions"}],"predecessor-version":[{"id":36223,"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/article\/35795\/revisions\/36223"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/media\/35891"}],"wp:attachment":[{"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/media?parent=35795"}],"wp:term":[{"taxonomy":"article_type","embeddable":true,"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/article_type?post=35795"},{"taxonomy":"noteworthy_people","embeddable":true,"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/noteworthy_people?post=35795"},{"taxonomy":"topics","embeddable":true,"href":"https:\/\/www.thenewatlantis.com\/wp-json\/wp\/v2\/topics?post=35795"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}