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December 2021 Pulse

In 2018, Lisa Littman, Assistant Professor of the Practice at the Brown University School of Public Health, published an article in the journal Public Library of Science (PLOS ONE) ‘Rapid-Onset Gender Dysphoria in Adolescents and Young Adults: A Study of Parental Reports’, which examines the reasons behind the spike in the number of adolescent girls who identified as transgender.

Retitled from the original under pressure from trans activists to signal that the phenomenon is one reported by mere parents instead of ostensibly more authoritative sources, neither the article nor Litmman herself have had any reprieve, continuing to draw intense criticism from trans activists.

In an interview with Quilette, Littman explains what prompted her to do this research:

I became interested in studying gender dysphoria when I observed, in my own community, an unusual pattern whereby teens from the same friend group began announcing transgender identities on social media. I searched online and found several narratives of parents describing this type of pattern happening with their teen and young adult kids who have no history of gender dysphoria in their childhoods.

Littman also pointed out that the clinicians that these parents consulted were only interested in proceeding with the transition, without adequately investigating the mental health of the teens. She reports, ‘They also said that the clinicians they saw were only interested in fast-tracking gender-affirmation and transition and were resistant to even evaluating the child’s pre-existing and current mental health issues.’

Prospect Magazine reported that the number of teens under 18 in the UK referred to the NHS because they wanted to change their sex had shot up from 77 in 2009 to 2,590 in 2018-19. What is also of note is that, according to The Guardian, in 2017, 70 percent of the referrals for sex change were female. This is highly unusual because statistics from the previous 10 years had shown the opposite trend of 75 percent males seeking to be female.

Fuelling this present trend is the work of trans activists who are aggressively promoting their gender ideology and labelling those who oppose it as transphobic and as belonging to ‘hate groups’. Medical clinics and doctors attending to children with gender dissonance are similarly under a lot of pressure to adopt the new gender dogma and assist young people who wish to transition.

Through the influence of social media, children and teens – many of whom had not displayed any symptoms of gender dysphoria prior – are coerced into identifying as trans and into taking steps towards transition. Marcus Evans, a psychoanalyst and former governor of Tavistock and Portman NHS Foundation Trust, resigned in 2019 because he disagrees with the institutional rush to prescribe puberty-blockers to treat children who experience gender ambiguity. Reflecting on this trend, he says:

Over the last five to 10 years there has been a complete change in the profile of the people presenting. These children believe that they are in the wrong body and they are very persistent and forceful in saying that they want a solution – and that solution is physical intervention. But I’ve been in psychiatry for 40 years and when people are in a distressed state, they often narrow things down and fix on one thing as a solution, putting pressure on clinicians for a magic bullet.



Writers such as Ryan Anderson and Abigail Shrier have argued that this sudden surge of young teens – especially girls – identifying as trans and taking steps to transition is due to trans activism. Its influence is evident in the educational system and school policies in many jurisdictions in the United States.

In some schools, children are taught that their choice of gender is fluid, and that it may change ‘by the day, hour or minute.’ Through materials and instructions provided by school-based clinics or mental health counselling, they are led to think that hormonal treatments and sex-assignment surgeries are normal. These materials are provided by LGBT activist groups such as GLSEN (Gay Lesbian Straight Educational Network) which sponsors in-school educational events aimed at changing children’s understanding of sexuality and gender.

Under the Obama administration, schools are required to allow transgender students to use facilities according to their self-identified genders. The guideline states that:

A school may not require transgender students to use facilities inconsistent with their gender identity or to use individual-use facilities when other students are not required to do so.

In other words, even a compromise arrangement such as a single-occupancy, gender-neutral restroom is considered a form of discrimination. According to the trans activists, such a requirement smacks of transphobia!

Schools are therefore pressured to accommodate transgender students by allowing them free access to bathrooms, locker rooms, and showers based on the gender they identify, which is usually the opposite of their biological sex. They must also allow transgender students to participate in the sports team of their choice. Schools that refuse to put these policies in place are often threatened with the withdrawal of Federal Funding.

The fact that these policies have been shaped by the transgender ideology, which says that gender has to do with an individual’s inner sense of self, is also evident in the policy which states that:

[a] school may not require transgender students to have a medical diagnosis, undergo any treatment, or produce a birth certificate or other identification document before treating them consistent with their gender identity.

In Oregon, the Health Evidence Review Committee (HERC) voted to allow children at the age of 15 years to access Transgender Conditioning (Sex Change) without their parents’ permission. This policy is not based on solid science but on evidence provided by the special interest group that calls itself the TransActive Gender Centre of Portland, Oregon.

These policies and the enormous peer pressure that comes through social media have resulted in a growing trend among adolescents who self-diagnose as transgender. Some of these adolescents have self-identified as transgender without ever displaying any signs of genuine gender dysphoria before.

Teens who seek the help of therapists are often led astray because many therapists operate according to the dictates of the new dogma, which forbids them to question their clients’ gender identities.

Worryingly, the diagnoses of writers like Anderson and Shrier appear to be sound. The current trend is the result of the wide-scale social conditioning of teens through the efforts of transgender activists, who have succeeded in effecting radical changes in policies in public schools. The trend suggests the presence of what some authors have described as a ‘psychic epidemic’, a social contagion.



In 2007, Dr Norman Spack, a paediatric endocrinologist and founder of the first gender clinic in America at the Boston Children’s Hospital, pioneered the first puberty suppression programme.

The programme aids the transition of children whose self-identified gender is the opposite of their biological sex. There are three stages. In the first stage, affirmation is given to the child’s self-identified gender. This is done by introducing name and pronoun changes, and by helping the child behave in the gender they have identified with within and outside the home. This process is described as social transitioning.

In the second stage, the puberty of the child is suppressed with the use of GnRH agonists such as buserelin, gondorelin, leuproretin and nafarelin. Children as young as 11 years of age are put on the regime of puberty-blockers. And finally, at age 16, the teen will receive cross-sex hormones which will prepare him for sex-reassignment surgery when he becomes adult.

This gender-affirming protocol has received support from the Biden administration. According to NBC News, 12 states and the District of Columbia offer Medicaid programmes covering transition-related care. More US Hospitals are also offering gender-transition services and surgeries, including Mount Sinai Hospital, which has a Centre for Transgender Medicine and Surgery.

Some doctors and medical associations have warned of the danger of using puberty-blockers on teens, especially when they show no evidence of gender dysphoria. For example, in a statement about gender ideology, the American College of Paediatricians (ACP) clearly warns against taking this approach:

Reversible or not, puberty-blocking hormones induce a state of disease – the absence of puberty – and inhibit the growth and fertility in a previously biologically healthy child.

Children who are given puberty-blockers will eventually require cross-sex hormones in late adolescence. The force of an ideology results in puberty being treated as a disease when it is the normal biological process that every child undergoes.

Putting children on puberty-blockers and then cross-sex hormones when they become teens would subject them to considerable health risks and result in disabilities that are irreversible. According to ACP,

These children will never be able to conceive any genetically related children even via artificial reproductive technology. In addition, cross-sex hormones (testosterone and estrogen) are associated with dangerous health risks including but not limited to cardiac disease, high blood pressure, blood clots, stroke, diabetes, and cancer.

The effectiveness of these treatments of gender dysphoric children and adults is also inconclusive at this point. In an extensive review and evaluation of the scientific literature on the treatment of GD children and adults, Hayes, Inc., an internationally recognised research firm that evaluates medical treatments and technology states that:

Statistically significant improvements have not been consistently demonstrated by multiple studies for most outcomes. Evidence regarding quality of life and function in male-to-female (MtF) adults was very sparse. Evidence for less comprehensive measures of well-being in adult recipients of cross-sex hormone therapy was directly applicable to GD patients but was sparse and/or conflicting. The study designs do not permit conclusions of causality and studies generally had weaknesses associated with study execution as well. There are potentially long-term safety risks associated with hormone therapy but none have been proven or conclusively ruled out.

Yet, despite the jury still being out on the efficacy of the current protocol, gender clinics continue to offer such ‘treatments’ across the United States.

Additionally, studies have shown that the suicide rates among adults who have received treatment using sex-hormones and who have undergone sex-reassignment surgery are substantially higher than in the normal population. Some reports indicate that it’s up to twenty times higher!

Activists have long argued that this high rate of suicide is due to the public discrimination, stigmatisation and pressure that trans people have to face. But this broad assertion is not supported by the research. The suicide rates of trans people in LGBTQ-affirming countries like Sweden, for example, are not substantially different from that of other countries.



Studies have shown that normally 80 percent to 95 percent of pre-pubertal children who experience some kind of gender dysphoria will not persist in it. They will experience resolution by late adolescent if they are not subjected to social conditioning and medical intervention.

Given these facts, it is quite unconscionable to subject every child who experiences gender incongruence to social transitioning and medical interventions. ‘To have 100 percent of pre-pubertal children choose cross—sex hormones,’ the ACP states, ‘suggests that the protocol itself inevitably leads the individual to identify as transgender.’

However, some medical organisations and societies in the US have chosen to ignore these facts and insist in supporting a doctrine of gender for which there is no scientific basis whatsoever. For example, the Endocrine Society regards it reasonable to affirm children who persist in their gender dysphoria beyond puberty, and to proceed with cross-sex hormones when they are 16 years of age.

ACP has strongly registered its disagreement to such an approach. It argues that not all adolescents with gender dysphoria will inevitably identify as transgender. It adds that adolescents are not mature enough to make medical decisions, especially for procedures that would result in changes that are irreversible.

ACP rightly understands this to be an ethical issue and not just a medical one. It states that ‘There is a serious ethical problem with allowing minors to receive life-altering medical interventions including cross-sex hormones and, in the case of natal girls, bilateral mastectomy, when they are incapable of providing informed consent for themselves.’

ACP therefore condemns such approaches in the strongest possible terms, describing it as nothing less than child abuse.

Conditioning children into believing a lifetime of chemical and surgical impersonation of the opposite sex is normal and healthful is child abuse. Endorsing gender discordance as normal via public education and legal policies will confuse children and parents, leading more children to present to ‘gender clinics’ where they will be given puberty-blocking drugs. This, in turn, virtually ensures they will ‘choose’ a lifetime of carcinogenic and otherwise toxic cross-sex hormones, and likely consider unnecessary surgical mutilation of their healthy body parts as young adults.

One of the most important principles of Christian medical ethics is ‘nonmaleficence’. Physicians have the sacred duty not to harm the patient. In the confusion and chaos of the transgender revolution, however, the medical community’s understanding of what constitutes ‘harm’ has been twisted and perverted by a toxic ideology.

It is time for the medical profession and indeed for society as a whole to recognise what the trans activists are doing to our children, and how they are shaping our future. We must not be swayed by their rhetoric or cowed by their hegemonic politics. We must resist the pressure to conform. Instead, we must expose the destructive nonsense that these trans activists are forcing everyone to embrace.

As theologian Gerald Bray observes, ‘We shall be unpopular right now, but future generations may thank us for standing up for what is obvious at a time when doing so was costly and unwelcome.’

We must do this for the sake of our children.

Dr Roland Chia is Chew Hock Hin Professor at Trinity Theological College (Singapore) and Theological and Research Advisor of the Ethos Institute for Public Christianity.