Gender Dysphoria, Transsexual Attractions, Sexual Reassignment Surgery and Informed Consent


Gender dysphoria, previously identified as Gender Identity Disorder in the psychiatric diagnostic manual, transsexual issues and sexual reassignment surgery are receiving a great deal of attention and support in the media, schools, government and in health professionals today. 

Dr. Paul McHugh, former Chairperson of Psychiatry at Johns Hopkins Hospital has written that, "The idea that one's sex is fluid and a matter open to choice runs unquestioned through our culture and is reflected everywhere in the media, the theater, the classroom, and in many medical clinics. It has taken on cult-like features: its own special lingo, internet chat rooms providing slick answers to new recruits, and clubs for easy access to dresses and styles supporting the sex change.  It is doing much damage to families, adolescents, and children and should be confronted as an opinion without biological foundation wherever it emerges."[1]

Transsexual issues are creating new controversy in our elementary and high schools today as a result of youth and their parents asserting a right to identify the sex of their child without regard to the biological and genetic realities. The parents and child may insist that the child’s name be changed to one of the opposite sex and that the child be allowed to wear clothing of the opposite sex and use opposite sex bathrooms. 

These families are often preparing their children for sexual reassignment surgery (SRS) without being given the knowledge of the serious documented risks associated with such surgery.  Endocrinologists who are puberty blocking drugs and hormones to these youth, mental health professionals who are affirming the surgery and surgeons have a professional responsibility to warn parents and youth of the documented risks associated with both the drugs given and the surgery. 

Documentary on Youth with Gender Dysphoria

A BBC documentary, Transgender Kids: Who Knows Best, tells the story of Dr. Kenneth Zucker, a leading, internationally respected Canadian researcher and psychologist who treated over 1,000 children with gender dysphoria over his 30 year career in Ontario. He encouraged his patients to realign their gender with their biological sex and only approved medical interventions when the initial therapy proved unsuccessful.  The treatment provided was not identified as reparative therapy.

Transgender Kids: Who Knows Best - BBC Documentary ... - Vimeo


In 2015, Zucker was forced to resign from his practice and the treatment center for youth with gender dysphoria was closed. Over 500 health professionals worldwide signed a petition protesting this action against a highly respected child psychologist.

2017 Research Paper and Puberty Blocking Drugs

Paul Hruz, a pediatric endocrinologist and an associate professor of cell biology and physiology at Washington University School of Medicine, St. Louis, led a 2017 research study, “Growing Pains: Problems With Puberty Suppression in Treating Gender Dysphoria, that raises serious questions about the current treatment of children with gender dysphoria.

The report states, “Of particular concern is the management of gender dysphoria children. Young people with gender dysphoria constitute a singularly vulnerable group and experience high rates of depression, self-harm, and even suicide. Moreover, children are not fully capable of understanding what it means to be a man or a woman. Most children with gender identity problems eventually come to accept the gender associated with their sex and stop identifying as the opposite sex.”

The report went on, “In light of the many uncertainties and unknowns, it would be appropriate to describe the use of puberty-blocking treatments in children for gender dysphoria as experimental.” This new treatment has been offered to youth without the usual safeguards that govern the provision of experimental therapies, such as carefully controlled clinical trials, as well as long-term follow-up studies.

Hormonal Use Risks in Male Youth and and Informed Consent

Several important new research articles on the serious risks to young women for depression and suicide from the use of hormonal contraceptives should be presented to male youth and adults who are considering or who are using hormones in preparation for sexual reassignment surgery.

In a nationwide prospective cohort study published in October 2016 of more than 1 million women living in Denmark, an increased risk for first use of an antidepressant and first diagnosis of depression was found among users of different types of hormonal contraception, with the highest rates among adolescents with a two fold risk compared to adults. This study found a 70% higher risk of depression among users of hormonal contraception compared with never-users.The mean of the women was age 24.4. This study found a 70% higher risk of depression among users of hormonal contraception compared with never-users. 

A November 2017 study has shown even more serious psychiatric consequences from the use of hormonal contraceptives. Nearly half a million women who used hormonal contraceptives compared with women who never used them were at two times greater for suicide attempt and at three times greater for suicide.

Endocrinologists, surgeons and mental health professionals should be aware of these risks to males with gender dysphoria who request hormones and sexual reassignment surgery and should provide them informed consent about them, which is required by law.  These new research findings may contribute to the markedly elevated risk of suicide from sexual reassignment surgery and should be studied.

Meanwhile, when a male with Gender Dysphoria who is taking hormones develops depressive illness, the role of hormones needs to be considered as a possible major factor in the development of his illness.  If the depressive illness in these males, does not respond to appropriate treatment, then cessation of the hormonal therapy should be considered.

2016 Research Papers

The important research paper, Sexuality and Gender: Findings from the Biological, Psychogical and Social Sciences, is an exhaustive review of the scientific literature concerning gender identity and sexual orientation. It is significant in that over 500 scientific articles were reviewed by two notable scholars: Dr. Lawrence Mayer, professor of statistics and biostatistics at Arizona State University and a self-described liberal citizen who supports LGBQT rights, and Dr. Paul McHugh who was the psychiatrist-in-chief at John Hopkins from 1975 to 2001. Among the many significant findings is that both doctors concur that neither sexual orientation nor gender identity is innate or immutable (no one is born gay or transgender, and both are fluid). Additionally, both doctors find no evidence to support encouraging children to identify as transgender.

American College of Pediatricians issued a report on Gender Dysphoria in children in August 2016. The summary stated that Gender dysphoria (GD) of childhood describes a psychological condition in which children experience a marked incongruence between their experienced gender and the gender associated with their biological sex. When this occurs in the pre-pubertal child, GD resolves in the vast majority of patients by late adolescence. Currently there is a vigorous, albeit suppressed, debate among physicians, therapists, and academics regarding what is fast becoming the new treatment standard for GD in children. This new paradigm is rooted in the assumption that GD is innate, and involves pubertal suppression with gonadotropin releasing hormone (GnRH) agonists followed by the use of cross-sex hormones a combination that results in the sterility of minors. A review of the current literature suggests that this protocol is founded upon an unscientific gender ideology, lacks an evidence base, and violates the long-standing ethical principle of First do no harm.

A list of summary points without reference:

The Risks Associated with Sexual Reassignment Surgery

The importance of providing informed consent to parents and youth was demonstrated in a recent study of youth who underwent SRS.  In this 2015 study reported from Boston, 180 transsexual youth (106 female-to-male; 74 male-to-female) had a twofold to threefold increased risk of psychiatric disorders, including depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment compared to a control group of youth.[2]

An important research study would be that of determining how many of these youth were given informed consent about the psychiatric risks associated with this surgery which is described in the mental health literature and which should be known by the treating health professionals.  Since the mean age at which youth presented for consideration for SRS surgery was age 9, providing informed consent would be challenging but nonetheless could be done in regard to discussing the risk of psychiatric illness and of alternative successful treatment for gender dysphoria, the primary childhood psychological conflict that interferes with the appreciation of the goodness of a child's masculinity or femininity.   

The largest study was an analysis of over 300 people who had undergone SRS in Sweden over the past 30 years. The 2011 study demonstrated that persons after sex reassignment, have considerably higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population.[3]

Dr. Paul McHugh wrote in the Wall St. Journal on June 12, 2014 about this research that, “Most shockingly, their suicide mortality rose almost 20-fold above the comparable non-transgender population. This disturbing result has as yet no explanation but probably reflects the growing sense of isolation reported by the aging transgendered after surgery. The high suicide rate certainly challenges the surgery prescription.”

Dr. Paul McHugh has also described his study of people with gender confusion over the past 40 years, 26 of which he spent as the Psychiatrist in Chief of Johns Hopkins Hospital in a 2014 article.  He wrote, "In fact, gender dysphoria - the official psychiatric term for feeling oneself to be of the opposite sex - belongs in the family of similarly disordered assumptions about the body, such as anorexia nervosa and body dysmorphic disorder.  Its treatment should not be directed at the body as with surgery and hormones any more than one treats obesity-fearing anorexic patients with liposuction."

He went on, "The treatment should strive to correct the false, problematic nature of the assumption and to resolve the psychological conflicts provoking it.  With youngsters, this is best done in family therapy."[4]

A study of 11 years of VHA electronic medical records of veterans from 2000 through 2011 revealed that Gender Identity Disorder prevalence was higher (22.9/100 000 persons) than were previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed veterans was more than 20 times higher than were rates for the general VHA population. Also, the prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. (Blosnich, R., et al. 2013. Prevalence of Gender Identity Disorder and Suicide Risk Among Transgender Veterans Utilizing Veterans Health Administration Care. American Journal of Public Health,103: e27-e32.)

A 2001 study of 392 male-to-female and 123 female-to-male transgender persons Sixty-two percent of the male-to-female and 55% of the female-to-male transgender persons were depressed; 32% of each population had attempted suicide. They also found a high HIV prevalence. (Clements-Nolle, K., et al. 2001. HIV prevalence, risk behaviors, health care use and mental health status of transgender persons: implications for public health intervention. Am J Public Health, 91: 915 V 921).

An international review (Pfafflin & Junge 1998) of 2,000 persons receiving gender reassignment surgery identified 16 possible suicides, which equates to an “alarmingly high rate of 800 suicides for every 100,000 post surgery transsexuals” (p. 26). 

Kuhn and colleagues (2009) studied post-surgery quality of life in 52 MtF (male to female( and 3 FtM (female to male) transsexuals fifteen years after sex reassignment surgery.  This study found considerably lower general life satisfaction in post-op transsexuals as compared to controls (the control group consisted of females with at least one pelvic surgery); general health was also significantly lower for transsexuals, and physical and personal limitations were significantly greater.  In explaining their reasons for using subjectively reported rather than objective measures of quality of life, the authors (perhaps inadvertently) make an interesting point about the difficulties inherent in justifying sex reassignment surgery: “An evaluation of sex reassignment surgery can be made only on the basis of subjective data because SRS is intended to solve a problem that cannot be determined objectively." (Kuhn, A., et al. (2009) Quality of Life in Transsexuals. Fertility and Sterility, 9, 1685-89)

In our professional opinion the vast majority of children who express a wish to be of the opposite sex have gender dysphoria/GID and have the right to know of the highly effective treatment that is available for this disorder.

Important medical and psychological issues need to be considered before the educational, medical, political and judicial systems rush headlong into a process of affirming in youth and in their parents a fixed false belief that a person can be a sex that is not consistent with their biological and genetic identity and that such individuals have the right to transsexual surgery. Fixed false beliefs are identified in the mental health field as manifestations of a serious thinking disorder, specifically a delusion.  Health professionals are supporting this delusional belief in these youth and their parents.

Informed consent for youth requires an understanding of what motivates youth to identify with the opposite sex is essential, reasons why parents would encourage or support transsexual attraction.

Dale O’Leary, the author of the important book, The Gender Agenda, has coauthored an important a 2015 research paper, Understanding and Responding to the Transgender Movement.[5] Parents, youth and adults would benefit from reviewing this important research paper.

Gender Identity Disorder/Gender Dysphoria: The Most Common Precursor to Transsexual Conflicts

Many youth who identify as a person of the opposite sex meet the earlier DSM criteria for Gender Identity Disorder (GID).  GID is a childhood psychiatric disorder (DSM IV TR) in which there is a strong and persistent cross-gender identification with at least four of the following preferences:

•    repeated stated desire to be of the opposite sex

•    in boys, a preference for cross-dressing or simulating female attire and, in girls, wearing stereotypical masculine clothing and a rejection of feminine clothing such as skirts

•    a strong and persistent preferences for cross-sex role in play

•    a strong preference for playmates of the opposite sex, and

•    an intense desire to participate in games and pastimes of the opposite sex.


The DSM 5 has replaced the diagnosis Gender Identity Disorder with a new diagnosis, Gender Dysphoria.  It also describes the symptoms that arise from the failure to identify with one's biological sex.

Children who seek SRS should be evaluated for psychological conflicts but regularly are not.  Dutch researcher and clinician, who specializes treating such youth, Dr. Peggy T. Cohen-Kettenis has written in this regard:

“The percentage of children coming to our clinic with GID as adolescents wanting sex reassignment is much higher than the reported percentages in the literature. We believe treatment should be available for all children with GID, regardless of their eventual sexual orientation.”[6] 

Study of Youth from Gender Identify Center

A 2013 study from a gender identity service in Toronto that consisted of a sample of 577 children (ages 3-12) and 253 adolescents (ages 13-20) reported a number of findings and comments.

These included:

  • a sharp increase in adolescent referrals starting with the 2004–2007 block and this increased even more so in the last block, 2008–2011.

  • For the first six cohorts (1976–1999), the percentage of boys always exceeded 75%, with the sex ratio ranging from a low of 4.61:1 (1988–1991) to a high of 12:1 of boys to girls (1992–1995), but for the last three cohorts (2000–2011) hovered around 75%, with the sex ratio ranging from 2.77:1 (2000–2003) to 3.41:1 (2008–2011) of boys to girls.

  • The adolescent sex ratios were closer to parity. Of note, there were two cohorts (1988–1991 and 2008–2011) when the number of girls exceeded the number of boys.

  • The adolescent cases increased even more from the 2004–2007 cohort and and in the 2008-2011 cohort, the number of adolescent cases exceeded the number of child cases for the first time since the inception of their clinic in the mid-1970s.

  • For the adolescents, data on sexual orientation were available for 248 patients. The percentage of girls classified as homosexual was greater than the percentage of boys classified as homosexual (76.0% vs. 56.7%).

For the children, 66.4% were in two-parent families at the time of assessment compared with 45.8% of the adolescents.[7]

Another parameter that struck them as clinically important was that a number of youth commented that, in some ways, it was easier to be trans than to be gay or lesbian.

Along similar lines, they have also wondered whether, in some ways, identifying as trans has come to occupy a more valued social status than identifying as gay or lesbian in some youth subcultures. Perhaps, for example, this social force explains the particularly dramatic increase in female adolescent cases in the 2008–2011 cohort.

Another factor that impressed them in accounting for the increase in adolescent referrals pertained to youth with gender identify disorder who also had an autism spectrum disorder which has been reported from by others.[8]

A center in the Netherlands reported the co-occurence of gender identify disorder and autism spectrum disorders (ASD) in a study of children and adolescents (115 boys and 89 girls, mean age 10.8) The incidence of ASD was 7.8%.  The authors recommended a greater awareness finding and the challenges it generates in clinical management.[9]

Family Conflicts in Youth with Gender Identity Confusion/Gender Dysphoria

Drs. Zucker and Bradley in Toronto have been recognized as leaders in the study gender identity disorder.  They have identified a number of conflicts in the families of children with GID that included:

  • A composite measure of maternal psychopathology correlated quite strongly with Child Behavior Checklist indices of behavior problems in boys with GID.

  • The rate of maternal psychopathology is high by any standard and includes depression and bipolar disorder.

  • The boy, who is highly sensitive to maternal signals, perceives the mother's feelings of depression and anger.  Because of his own insecurity, he is all the more threatened by his mother's anger or hostility, which he perceives as directed at him. His worry about the loss of his mother intensifies his conflict over his own anger, resulting in high levels of arousal or anxiety. The father's own difficulty with affect regulation and inner sense of inadequacy usually produces withdrawal rather than approach.

  • The parents have difficulty resolving the conflicts they experience in their own marital relations, and fail to provide support to each other. This produces an intensified sense of conflict and hostility.

  • In this situation, the boy becomes increasingly unsure about his own self-value because of the mother's withdrawal or anger and the father's failure to intercede. This anxiety and insecurity intensify, as does his ange6.

  • These men (fathers) are often easily threatened and feel inadequate themselves. These qualities appear to make it very difficult for them to connect with sons who display non-masculine behavior." Withdrawing from their feminine sons, "they often deal with their conflicts by overwork or distancing themselves from their families. The fathers' difficulty expressing feelings, and their inner sense of inadequacy are the roots of this emotional withdrawal.

  • Fathers demonstrate depression and substance abuse disorder.

  • Parental psychopathology among the parents of children with GID deserves thoughtful consideration.[10]

Also, Dr. Bradley has described additional maternal conflicts in these youth,

…boys with GID appear to believe that they will be more valued by their families or that they will get in less trouble as girls than as boys. These beliefs are related to parents’ experiences within their families of origin especially tendencies on the part of mothers to be frightened by male aggression or to be in need of nurturing, which they perceive as a female characteristic.[11]  

They also found that gender identity disorder youth had high rates of general behavior problems and poor peer relations.[12]

It should be noted that these observations are not derived from controlled studies. As such, there is no comparison to the prevalence of such conflicts among control groups. Thus the specificity of these conflicts (or their prevalence in children with gender dysphoria) is not clear. There is no conclusive evidence of the role of such conflicts in the development of gender dysphoria or whether treatment aimed at correcting these leads to improvement. However, the comments of the Zucker and Bradley do seem relevant to understanding the development of GID.


Family Therapy

The psychological conflicts identified in the parents of youth with gender dysphoria/GID should encourage health professionals to first recommend family therapy before proceeding with puberty blocking drugs to youth or hormonal treatment. 

Most parents of youth with the belief that he or she is something they are not is, at best, a sign of confused thinking. When an otherwise healthy biological boy believes he is a girl, or an otherwise healthy biological girl believes she is a boy, an objective psychological problem exists that lies in the mind not the body, and it should be treated as such. 

The American College of Pediatricians' statement on transgender conflicts in youth states, " These children suffer from gender dysphoria. Gender dysphoria (GD), formerly listed as Gender Identity Disorder (GID), is a recognized mental disorder in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-V).5 The psychodynamic and social learning theories of GD/GID have never been disproved."

Conflicts that we have seen while engaging in the family therapy recommended by Dr. Paul McHugh include:


In females’ relationships with their fathers observed conflicts may include:

1. A father's unresolved intense anger and mistrust with his mother that was misdirected at his wife resulting in a daughter's fear of being hurt as a female by male anger as she saw her mother hurt.  This dynamic can lead to an unconscious belief that there would be safer feeling in life being a male.

2.  The father’s failure to affirm his daughter's feminine goodness and gifts, to critique and protect her from gender theory errors, and to communicate that fulfillment and happiness can be found in being a psychologically healthy female.

3.  The father's unresolved anger with his mother with whom he never had a secure, loving attachment coupled with the father's misdirecting this anger at his wife.  Unconsciously, the daughter, who wants to please her father, seeks to please him by identifying with masculinity.  Also, she comes to feel and think in the home that there is something wrong with femininity.

In males’ relationships with their mothers observed conflicts may include:

1. The mother's unresolved intense anger and mistrust with her father that was misdirected at her husband resulting in a son's fear of being hurt hurt by females as a male. 

2. Her desire that her son had been born a daughter, leading to a failure to support and affirm the goodness of his masculinity and later initiating or supporting cross dressing and cross sexual identification.

3. A boy’s fears that he does not please his mother as a male, together with his unconscious belief that he might receive more love and acceptance from his mother if he identified with femininity

4. A mother’s failure to support and encourage her son to have same sex friendships.

5. A failure to critique and protect him from gender theory errors.

6. A failure to communicate that fulfillment and happiness can be found in being a psychologically healthy male.

7. The Eve dynamic of not trusting in the goodness of God and subsequent grandiose thinking that one can be as God and determine the sex of one's child.

In males’ relationships with their fathers observed conflicts may include:

1. Failure to develop a secure father-son relationship because of a father’s emotionally distant behaviors or severe male insecurity

2. A father’s excessive anger or rejecting behaviors that undermine a son’s ability to model after his father or create a negative view of masculinity

3. A father’s failure to support a son's strong creative and artistic gifts

4. A failure to protect the son from abusive behaviors by siblings or by same sex peers that contribute to a son’s failure to identify with the goodness of masculinity

5. A failure to support same sex friendships in childhood and adolescence

6. A failure to critique and protect youth from gender theory errors

7. A failure to communicate that fulfillment and happiness can be found in being a psychologically healthy male.

In females’ relationships with their mothers observed conflicts may include:

1. An emotionally distant, angry, selfish, depressed or critical mother who failed to bond closely with her daughter for any number of reasons, including unresolved anger with the maternal grandmother that was misdirected at the daughter

2. The failure to affirm the daughter’s goodness and female gifts

3. A failure to support and encourage same sex friendships

4. A failure to critique and protect her daughter from gender theory errors

5. A failure to communicate that fulfillment and happiness can be found in being a psychologically healthy female.

Other factors and conflicts observed in males may include:

1. A keen appreciation and love for beauty that is often associated more with femininity than masculinity and a desire to be what one loves

2. A poor body image and the belief that one would be more attractive is he were of the opposite sex

3. Severe childhood rejection by same sex peers, creating a sense of not fitting in with them, which results in intense fears of rejection and an unconscious belief that one would feel safer if he/she were of the opposite sex

4. Repeated failures in relationships with women, associated with a severe loss of self-esteem

5. A sense of pleasure in rejecting the values and moral code of one’s parents

6. The belief that one’s sex is not as a gift, but a constraint that must be overcome

7. Pressure from a significant other to cross dress, take hormones and move toward SRS

8. Severe narcissism and acceptance of gender theory with a delusional belief that one can create oneself as one wants.


Other factors and conflicts observed in females may include:

1. The absence of close female friendships and a sense of not fitting in, along with a belief that one would be less lonely and happier if one were a male

2. In strong young females a love for what is perceived as male strength and preferential treatment for males, together with the desire to become what one loves

3. Poor body image and a belief that one would be more attractive if she were of the opposite sex

4. In very athletic and strong young females an intense bonding and identification with young males through athletic activities

5. A sense of failure as a female and a delusional belief one would feel more confident and happy being a member of the opposite sex

6. Repeated failures in relationships with males with severe loss of self-esteem

7. Pressure from a significant other to cross dress, take hormones and move toward SRS

8. A sense of pleasure in rejecting the values and moral code of one’s parents

9. The view that one’s sex is not a gift but as a constraint that must be overcome

10. Acceptance of gender theory, along with a delusional belief that one can create oneself as one wants.

The exposure of youth to gender theory in college can result in their embrace of post modern philosophies focused on freedom as an end in itself. Such ideas come from various sources, including the writings of Friedrich Nietzsche and Jean-Paul Sartre. If freedom (some would call it license) is the greatest good in the world, then why should anyone be constrained by biology? One’s sex as male and female is seen not as a gift but as a constraint that must be overcome, so if technology can alter one’s body, then so be it.

PC Medicine

Some medical centers fail or refuse to diagnose the psychological difficulties youth have in accepting and appreciating their biological sex. They neglect to provide information about treatment and the risks of sexual reassignment surgery. Instead, they support the beliefs of the youths and their parents and initiate hormone treatments in preparation for eventual body-mutilating surgery.

A pediatric specialist at Boston has a program for boys who feel like girls and girls who want to be boys. He offers his patients — some as young as 7 years old — counseling about the “naturalness” of their feelings and hormones to delay the onset of puberty. These drugs stop the natural process of sexual development that would make it more surgically difficult to have a sex alteration later in life.

This physician alleges that those whom he labels as transsexual children are deeply troubled by a lack of understanding of their feelings and have a high level of suicide attempts. While this physician is accurate in his interpretation of the literature — that children with GID and transsexual ideation are deeply troubled — his claims of a high level of suicide attempts in children with GID is not substantially supported by the medical literature. In fact, the literature demonstrates a shocking increase in suicide and in psychiatric illness after sexual reassignment surgery.

In his Wall Street Journal 2014 article, Dr. McHugh wrote that "misguided doctors at medical centers including Boston's Children's Hospital have begun trying to treat" transgenderism in youths "even though the drugs stunt the children's growth and risk causing sterility." He recommends "a better way to help these children: with devoted parenting."

Risks with Medications

The American College of Pedicatricians have stated in their position paper that, "Puberty is not a disease and puberty-blocking hormones can be dangerous. Reversible or not, puberty blocking hormones induce a state of disease, the absence of puberty, and inhibit growth and fertility in a previously biologically healthy child. Children who use puberty blockers to impersonate the opposite sex will require cross-sex hormones in late adolescence. Cross-sex hormones (testosterone and estrogen) are associated with dangerous health risks including but not limited to high blood pressure, blood clots, stroke and cancer (2016)."

The Treatment of Youth with Transsexual Confusion is Highly Effective

According to Dr. Zucker and Bradley:

  • The fantasy solution provides relief but at a cost.  They are unhappy children    who are using their cross gender behaviors to deal with their distress.          

  • Treatment goal is to develop same sex skills and friendships.

  • In general, we concur with those who believe that the earlier treatment begins, the better. ...It has been our experience that a sizable number of children and their families can achieve a great deal of change.

  • In these cases, the gender identity disorder resolves fully, and nothing in the children's behavior or fantasy suggest that gender identity issues remain problematic. ... All things considered, however, we take the position that in such cases clinicians should be optimistic, not nihilistic, about the possibility of helping the children to become more secure in their gender identity.[13]


Drs. Kenneth J. Zucker and Susan Bradley have been providing sensitive treatment to children with the precursor of transsexual conflicts. They have written that the goal of treatment is to develop skills associated with children of their own biological sex and friendships with such children.  We have found a similar treatment approach to be beneficial in treating such children.[14]

While data from controlled clinical studies are not available to measure the effectiveness of these therapies, it seems reasonable to follow the recommendations of those with extensive clinical experience until such time as controlled trials are performed.

Also, Dr. McHugh has written that transsexual attractions are often fluid and can change.  “When children who reported transsexual feelings were tracked without medical or surgical treatment at both Vanderbilt University and London's Portman Clinic, 70 to 80 percent of them spontaneously lost those feelings.”[15]

Dr. McHugh has described also his research experiences at Johns Hopkins:

As for the adults who came to us claiming to have discovered their true sexual identity and to have heard about sex-change operations, we psychiatrists have been distracted from studying the causes and natures of their mental misdirections by preparing them for surgery and for a life in the other sex. We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness rather than trying to study, cure, and ultimately prevent it.

One might expect that those who claim that sexual identity has no biological or physical basis would bring forth more evidence to persuade others.  But as I’ve learned, there is a prejudice in favor of the idea that nature is totally malleable.

A practice that appears to give people what they want turns out to be difficult to combat with ordinary professional experience and wisdom. Even controlled trials or careful follow-up studies to ensure that the practice itself is not damaging are often resisted and the results rejected.[16]


Sexual Reassignment Surgery

SRS violates basic medical and ethical principles and is therefore not ethically or medically appropriate.

  1. SRS mutilates a healthy, non-diseased body. To perform surgery on a healthy body involves unnecessary risks; therefore, SRS violates the principle primum non nocere, “first, do no harm.”

  2. Candidates for SRS may believe that they are trapped in the bodies of the wrong sex and therefore desire or, more accurately, demand SRS; however, this belief is generated by a disordered perception of self. Such a fixed, irrational belief is appropriately described as a delusion.

  3. SRS, therefore, is a “category mistake” — it offers a surgical solution for psychological problems such as a failure to accept the goodness of one’s masculinity or femininity, lack of secure attachment relationships in childhood with same-sex peers or a parent, self-rejection, untreated gender identity disorder, addiction to masturbation and fantasy, poor body image, excessive anger and rebelliousness and severe psychopathology in a parent.

  4. SRS does not accomplish what it claims to accomplish. It does not change a person’s sex; therefore, it provides no true benefit.

  5. SRS is a “permanent,” effectively unchangeable, and often unsatisfying surgical attempt to change what may be only a temporary (i.e., psychotherapeutically changeable) psychological/psychiatric condition.[17]

Regrets over SRS

Youth, their parents and adults who are considering SRS should be informed by their doctors and psychologists about the serious regrets many people have.

Dr. Renee Richards, a former professional tennis player, has written that her transition failed to meet even her own expectations. She wrote,

"I wish that there could have been an alternative way, but there wasn't in 1975. If there was a drug that I could have taken that would have reduced the pressure, I would have been better off staying the way I was -- a totally intact person. I know deep down that I'm a second-class woman. I get a lot of inquiries from would-be transsexuals, but I don't want anyone to hold me out as an example to follow. Today there are better choices, including medication, for dealing with the compulsion to cross-dress and the depression that comes from gender confusion. As far as being fulfilled as a woman, I'm not as fulfilled as I dreamed of being. I get a lot of letters from people who are considering having this operation...and I discourage them all."[18]

Walt Heyer, who went through SRS, exposes the origins of the practice and its often tragic results in his article.[19]

Youth, their parents and adults who are considering SRS should be provided informed consent by their doctors and psychologists about the serious regrets many people have who underwent SRS.  This information should also be communicated in schools where SRS is being taught as a healthy step to seek greater happiness and fulfillment in life.

Parental Responses to Youth with Transsexual Attractions (TSA)

As the protectors of their children, the first step parents can take is to understand possible reasons why their child is identifying with the opposite sex and has difficulty in embracing the goodness of his masculinity or her masculinity.  Then parents should learn about the serious health risks associated with SRS.  Next, it is essential to do what most health professionals, educators, and the media fail to do, which is to warn their children of the serious psychiatric dangers associated with SRS, especially the risk of suicide.

Many parents report the benefits of limiting time on the internet for their children with this conflict.  They believe that communication with those who are supporting and encouraging SRS reinforces the false belief that their thinking can determine their sex, that they have no emotional conflicts and that SRS is a path they should pursue.

The leading experts in GID Zucker and Bradley have written, "parental ambivalence is, in most cases part of the problem." Parents, particularly mothers, who might rationalize that it is "cute" to have a boy wear female clothing, often ignore or excuse obvious appearances of effeminacy in males. These psychologists encourage early intervention to prevent the suffering of isolation, unhappiness and low self-esteem in children who fail to appreciate their goodness as boys or girls.

"In general," they have written, "we concur with those who believe that the earlier treatment begins, the better. ...It has been our experience that a sizable number of children and their families can achieve a great deal of change." They also state, "In these cases, the gender identity disorder resolves fully, and nothing in the children's behavior or fantasy suggest that gender identity issues remain problematic. ... All things considered, however, we take the position that in such cases clinicians should be optimistic, not nihilistic, about the possibility of helping the children to become more secure in their gender identity."[20]

Children are born with a drive to seek love and acceptance from each parent, as well as siblings and peers. If this need is met, children develop a positive identification with their masculinity or femininity. When this developmental task is successfully completed, the child is free to choose gender atypical activities. Boys and girls with gender identity problems are not freely experimenting with gender atypical activities. They are constrained by deep insecurities and fears and are reacting against the reality of their own sexual identity, often as a result of failing to experience secure attachment relationships with the parents, siblings or same sex peers.

Mistakes Parents Make Whose Children Have TSA May Include:

  • failing to identify a child's weakness in embracing the goodness of his masculinity or her femininity

  • allowing a child unsupervised time on the internet in the evening during which the delusional belief that one can change one's sex is communicated and affirmed

  • failing to help failing understand the causes of their conflicts

  • failing to warn about the severe dangers of SR

  • enabling the delusional thinking that one can change one's sex

  • depending too much on the acceptance by a child

  • failing to monitor the internet

  • allowing the use of unsupervised time in the evenings on the internet during which youth can be encouraged to believe they can change their sex and during which they are not warned about the dangers of SRS

  • allowing a child to see a health professional who fails to provide informed consent and who fails to explore possible psychological origins of the failure to embrace the goodness of masculinity or femininity

  • failing to get a professional opinion about the origins of transsexual attractions and the serious risks associated with sexual reassignment surgery

  • supporting the controlling behavior of the child who insists upon being called by a name of the opposite sex at home and at school

  • enabling communication with peers and others who encourage SRS.

Children can also learn to correct their cognitive distortions in regard to their natural goodness and beauty as a male or female. The responses can be including thinking:

  • "I can grow to be appreciate the goodness of my body and masculinity and femininity,"

  • "I can be thankful for my special masculinity or femininity,"

  • "I can grow to feel more comfortable and confident in being who I am."

While there are no controlled clinical data to support specific interventions in treating children with transsexual conflicts, the following recommendations could be helpful if incorporated into a family therapy treatment program.

For boys with transsexual conflicts:

  • increasing quality time for bonding with the father

  • increasing affirmation of the son's masculine gifts by the father

  • bonding with the son in his artistic or creative activities

  • participating in and support for the son's creative efforts by the father

  • encouraging same sex friendships and diminishing time with opposite sex friends

  • slowly diminishing play with opposite sex toys

  • encouraging the boy to be thankful for his special male gifts

  • working at forgiving boys who may have hurt him

  • communicating with other parents whose children have been treated successfully for GID and who have come to appreciate and to embrace the goodness of their masculinity and femininity

  • addressing the emotional conflicts in a mother who wants her son to be a girl

  • in those with faith, encouraging thankfulness for one's special God-given masculine gifts.

For girls with transsexual conflicts 

  • encouraging the daughter to appreciate the goodness and beauty of her femininity, including her body

  • encouraging same sex friendships and activities

  • increasing the mother-child quality time

  • praising their daughter's special goodness and gifts

  • working with the daughter to forgive peers who have hurt her

  • encouraging pursuit of a balance in athletic activities

  • addressing conflicts in a parent who may want her to be a boy

  • forgiving peers who have inflicted severe hurts during adolescence or young adult life

  • in those with faith, encouraging thankfulness for one's special God-given femininity.

Transsexual Indoctrination in Schools

Some school districts have been attempting to incorporate transsexual education into the required health programs in junior and in senior high schools. In the Fairfax County School District parent’s groups strongly objected to this attempt and the program was left in the family life section which is not required for students.

In an important article, Gender Free Children – the newest fad in public education, the British Columbia Teachers Federation, Handbook on gender education was cited.  It stated that gender is a product of the mind…Being transgender or gender non-conforming is normal and healthy.

The author, Lee Duigon, wrote, “Coming soon, to a public school near you: the teaching that "gender is a spectrum," and "gender identity" a state of mind, a social construct-and it's all part of a top-down campaign to convince your children that they can be "whoever they want to be." Boys can be girls and girls can be boys.”[21]

The author noted that The Redwood Heights Elementary School in Oakland, California, has already installed a "gender coach" in the classroom to teach very young children that "you can be a boy or a girl, or both."  The "coach" was provided by an organization called Gender Spectrum ( which presumably would not exist if it did not perceive a demand for its services.

In addition, school principals are placing children at risk and are creating confusion in the minds of many children by giving into the requests of parents to allow young children to change their names to those of the opposite sex, cross dress and accepted as being of the sex opposite of their biological sex.  These school administrators either do not know or ignore medical and psychological science and research on transsexual issues and SRS.  They are participating in a false belief that the children are not of their biological sex.  Such a fixed false belief is identified in the mental health field as a delusion.

Faith and Transsexual Issues

While he has not specifically addressed the issue of transsexualism, Pope Francis has repeatedly criticized gender theory indoctrination of youth.  In January 2015 he described the forcing of gender ideology onto students in schools as a form of "ideological colonization" comparable to Hitler Youth indoctrination.

Pope Francis commented on April 15, 2015 at his weekly General Audience "if so-called gender theory is not an expression of frustration and resignation, that aims to cancel out sexual difference as it is no longer able to face it.  Yes, we run the risk of taking a step backwards.  Indeed, the removal of difference is the problem, not the solution."

On June 8, 2015 he stated that so-called gender ideology is challenging the complementarity between a man and a woman under the guise of seeking a more just society.  He related, "Let me draw your attention to the value and beauty of marriage.  The differences between men and women are not of the order of opposition or subordination, but rather communion and generation, always as the image and semblance of God."

Pope Benedict XVI also spoke on this issue in 2008:

It (the Church) has a responsibility for the created order and ought to make this responsibility prevail, even in public. And in so doing, it ought to safeguard not only the earth, water, and air as gifts of creation, belonging to everyone. It ought also to protect man against the destruction of himself. That which is often expressed and understood by the term Gender, results finally in the self-emancipation of man from creation and from the Creator. Man wishes to act alone and to dispose ever and exclusively of that alone which concerns him. But in this way he is living contrary to the truth, he is living contrary to the Spirit Creator. 

The tropical forests are deserving, yes, of our protection, but man merits no less than the creature, in which there is written a message which does not mean a contradiction of our liberty, but its condition (Pope Benedict XVI, December 22, 2008).

Youth have the right to be provided by physicians, mental health professionals, school nurses and the media accurate medical information about gender confusion, the serious medical and psychiatric associated with SRS and the excellent prognosis associated with an alternative proven treatment described in the literature.

Parents, family members, educators, politicians and clergy have a moral responsibility to be familiar with medical science and to provide prudent counsel to youth that will protect and not harm them.


[1] Paul McHugh, �Transgenderism: A pathogenic meme.� Retrieved from


[2] Reisner, S.L., Vetters, R., Leclerc, M., Zaslow, S., & Wolfrum, S. et al. (2015) Mental Health of Transgender Youth in Care at an Adolescent Urban Community Health Center: A Matched Retrospective Cohort Study.J. Adolesc Health, 56: 274-9. doi:10.1016/j.jadohealth.2014.10.264.


[3] Dhejne C, et al, (2011) Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLoS ONE 6(2): e16885.


[4] Transgenderism: A pathogenic meme.  Retrieved from




[6] Cohen-Kettenis, P. T. (2001)  Gender Identity Disorder in the DSM?” J Amer Acad. Child & Adolesc Psychiatry,.40:391.


[7] Zucker KJ, Bradley SJ, Ben-Dat DN, Ho C, Johnson L, Owen A. (2003) Psychopathology in the parents of boys with gender identity disorder. J Am Acad Child Adolesc Psychiatry, 42:2–4.


[8] Wood, H., et al. 2013. Patterns of Referral to a Gender Identity Service for Children and Adolescents (1976-2011) Age, Sex Ratio, and Sexual Orientation. J. Sex & Marital Ther, 39: 1-6.)


[9] de Vries, AL, et. al. 2010. Autism spectrum disorders in gender dysphoric children and adolescents.  J Autism Dev Disord, 40:930-6.


[10] Zucker KJ, Bradley SJ, Ben-Dat DN, Ho C, Johnson L, Owen A. (2003) Psychopathology in the parents of boys with gender identity disorder. J Am Acad Child Adolesc Psychiatry, 42:2–4.


[11] Bradley, S. (2003) Affect Regulation and the Development of Psychopathology, NY: Guilford Press., p. 201-202.


[12] Zucker, KJ, Bradley, SJ, et al. 2012. Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism. J Sex Marital Ther 38: 151-89).


[13] Zucker, K. & Bradley S. (1995) Gender Identity Disorder and Psychosexual Problems in Children and Adolescents. New York: Guilford Publications.p. 281-282.


[14] Retrieved from Fitzgibbons, R.


[15] McHugh, P. (2014) Transsexual Surgery isn’t the solution. Wall Street Journal.  June 12, 2014.


[16] McHugh, P. (2004). Surgical Sex, First Things. 147, 34-38.


[17] Fitzgibbons, R., Sutton, P. &  O’Leary, D. (2009). The Psychopathology of “Sex Reassignment” Surgery: Assessing Its Medical, Psychological, and Ethical Appropriateness. National Catholic Bioethics Quarterly 9.1 (Spring 2009): 109–137.


[18] Renee Richards, "The Liason Legacy", Tennis Magazine, March 1999.


[19] Sex Change Surgery: What Bruce Jenner, Diane Sawyer and You Should Know.

Retrieved from


[20] Zucker K, & Bradley S. 1995. Gender Identity Disorder and Psychosexual Problems in Children and Adolescents. New York: Guilford Publications, 1995, p.281 and p.282.


[21] Retrieved from

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