from Gender Identity Disorders

In two separate presentations sponsored by the Pediatric Academic Societies in San Francisco, a group of pediatricians traded their expertise in medicine for activism, which they presented as science. The meetings were held April 29-May 3, 2006.

Pediatricians As Advocates

In the first presentation titled "Pediatricians as Advocates," the speakers were Ellen Perrin, M.D. (Tufts-New England Medical Center), James G. Pawelski, M.S. (American Academy of Pediatrics ) and James E. Crawford, M. D. (Children's Hospital and Research Center at Oakland). They highlighted the American Academy of Pediatrics' support of "non-discriminating gender-neutral civil marriage," as well as the Academy's opposition to the Federal Marriage Amendment.

The Federal Marriage Amendment Is A Nuclear Bomb

Crawford, an openly gay pediatrician, provided an advocacy document where he described the Federal Marriage Amendment as a "nuclear bomb" for gay and lesbian families. Comparing the Marriage Amendment to the ban on interracial marriage, Crawford led a coalition exercise where he focused on soliciting local chapter members of AAP to mount public relations campaigns to stop the passage of the FMA. Included in the coalition exercise was the following: agreeing upon the goals of the coalition, determining who will be invited to the first meeting, determining/remedying problems associated with reluctant participants, as well as determining who not to invite and how to steer the coalition.

Activism, Not Data, Drives Advocacy Presentation

This session was primarily focused on advocacy on behalf of same-gender parents and their children, claiming that

• the comparative data reveals no difference in parents
• lesbian couples share household and child care tasks more equitably
• children in lesbian households may be less aggressive, more nurturing to peers, more tolerant of diversity, more androgynous and
• that children's adjustment is better when there is equal distribution of labor.

To the critics who question the small unrepresentative samples, biased investigators, lack of primary data, and statistical manipulations, the presenters respond, "Unanswered questions are far less dangerous than unquestioned answers."

Unfortunately, the presenters seemed to have little concern for advocacy of policy that is based on insufficient scientific data. The stark reality is that there is a dearth of data on gay parenting, and what data exists is incredibly poor--certainly not sufficient to propose child-centered policies.

In fact, what data exists is basically limited; it involves children who were conceived during heterosexual marriage where their mothers later claimed a lesbian identity. Even these children (who were highly visible in the Stacy and Biblarz meta-analysis) reflected issues that should have been of serious concern, particularly, gender confusion--the boys acted like girls and the girls acted like boys.

Stacy and Biblarz reported, "...the adolescent and young adult girls raised by lesbian mothers appear to have been more sexually adventurous and less chaste ... in other words, once again, children (especially girls) raised by lesbians appear to depart from traditional gender-based norms, while children raised by heterosexual mothers appear to conform to them."

The real (and unaddressed) question is, how healthy is the rejection of gender roles?

There is significant research that supports the vital role of opposite-sex (gender-complementary) parents in child-rearing. The plethora of such studies are really quite pronounced in their conclusion: all factors considered, children do better in a family with a married mother and father because mothers and fathers contribute in complementary ways to the healthy development of children.

None of the presenters referenced any of the research on gender complementarity and the best interests of children. Rather, they seemed focused on the rights of adults, with virtually no interest in the ethicality of exposing children to a veritable social laboratory where there is no evident concern for harm.

Gender-Variant Youth - The Role Of The Pediatrician

The second presentation was titled "Gender-Variant Youth - The Role of the Pediatrician." The co-presenters were Irene N. Sills, MD and Arlene Istar Lev, LCSW, CASAC. Ms. Lev was the primary presenter and identified herself as a "lesbian currently in a same-sex, opposite-gender relationship."

As one of the goals of her presentation, Lev proposed to "outline a non-pathology model for transgender expression and to identify the gender-variant child as one who simply marches to the beat of a different drummer."

Although she admits that gender is fluid, Lev strongly opposed any attempts to influence its expression externally (such as those by parents or therapists), insisting that it is perfectly acceptable for little boys to come to school dressed as little girls.

"Gender variance is an expression of gender diversity," she noted, and "it has potentiality in all children."

Treatment Models And Counseling Guidelines

Lev's basic treatment model for gender variance is:

• Was developed from the transgender liberation movement
• Challenges the idea that transgender people have a mental illness, a pathology
• Does not emphasize causality or treatment strategies to eliminate the behaviors
• Allows for greater fluidity of gender expression and identity, outside of a medical model
• Not a "sex-change" but a gender confirmation
• Respectful of various levels of transformation
• Allows for younger gender transitions

Her view includes the "normalization of the experiences involved in emerging transgender" with the basic goal of "supporting the transgender person's integration in the family system."

This support may include surgical "body modification." "Everyone," according to Lev, "has the right to their own gender expression.... Everyone has a right to make informed and educated decisions about their own bodied and gender expressions."

Lev emphasized that there are many ways to be boy or a girl. She noted that there are boy-girls and girl-boys. Young men can even put aside "sperm in sperm banks and when they become mothers, can use their sperm to have children."

For her, the issues for children to address include:

• How do they know they are not boys or girls?
• Are they confusing "sexism" with legitimate gender-identity issues?
• Parents often feel shame and guilt; fathers in particular struggle with these issues
• Parents [of gender variant children] wish their children would only be gay!

According to Lev, the issues particularly relevant to teens include:

• Understanding the authenticity of their identity; is this exploration or just rebellion?
• "Celebration" of diverse sexual and gender identities.
• Experimentation with diverse sexual and gender expressions.
• Gender-bending and gender-blending.
• Rejection of hetero-normative identities.

For counseling the child, Lev recommends the following:

• Explain that there is more than one way to be a boy or girl
• Explain that there is nothing wrong with the child
• Acknowledge how hard it is to be understood
• Support non-traditional gender toys and play

For counseling the adolescent, Lev recommends:

• Treat them with complete respect
• Let them know they can actualize themselves, even if they have to wait
• Support their families
• Educate them about the dangers of hormones, particularly street hormones
• Help them understand the realities of transitioning, and intervene to counteract "sexist" belief systems.

Medical Treatment Options Offered

She discussed medical treatment for transgender transition, including both hormonal therapy and surgery, with the following question posed: "Is letting puberty progress in the 'wrong' gender harmful enough to merit stopping puberty and the physiologic benefits of puberty?

The best hormonal therapies for transitioning from female to male (testosterone) as well as the best hormonal therapies for male to female therapies (estrogens, anti-androgens, progestins) were discussed.

The authors concluded with the following: "Transgender identity and the questioning of gender identity is here to stay, and like other liberation movements, will change how we all see and understand our own genders."

Lacks Scientific Perspective

The workshop format was significantly less academic, and focused more on activism, focusing little on research findings. In fact, mentioned only briefly was Richard Green's seminal work and his admonition that "the right of parents to oversee the development of children is a long-established principle. Who is to dictate that parents may not try to raise their children in a manner that maximizes the possibility of a heterosexual outcome?... parent have the legal right to seek treatment to modify their child's cross-gender behavior to standard boy or girl behavior, even if their only motivation is to prevent homosexuality. If that prerogative is denied, should parents also be denied the right to raise their children as atheists? Or as priests?"

That Sills and Lev would consider GID a fait accompli is not consistent with the findings of science. The peer-reviewed literature on GID clearly demonstrates that parents do play a role in influencing patterns of sex-dimorphic behavior.

More importantly, the exceptional work of research/clinicians like Zucker and Bradley yields an optimistic outlook. They conclude, "It has been our experience that a sizable number of children and their families achieve a great deal of change. In these cases, the GID resolves fully, and nothing in the children's behavior or fantasy suggest that gender identity issues remain problematic.... All things considered, we take the position that in such cases a clinician should be optimistic, not nihilistic, about the possibility of helping the children to become more secure in their gender identity."

Science, Not Activism, Should Be Center Stage

What is surprising about both presentations is not that they were given, but that they were given under the sponsorship of the Pediatric Academic Societies. Whether or not the presenters agree, GID is listed in the DSM as a psychiatric disorder. GID was ostensibly included in the DSM because of science. And science should determine its removal.

Recognizing that it is difficult to arrive at a consensus about what is normal and what is not, still, there are some objective indicators. Spitzer and Endicott's useful definition would lend support to the DSM classification: that is, a psychological condition characterized by "distress, disability and disadvantage." Clearly, GID fits.

Normal Is That Which Functions According To Its Design

An even more useful definition of "normal" comes from King in 1945: normality is "that which functions according to its design."

Helping children function according to their design would be a worthy goal of the Pediatric Academic Societies. Perhaps someone who reads this article might offer the suggestion to one of the Pediatric Academic Societies--like the American Academy of Pediatrics. Such a thought might introduce some measure of sanity into this discussion.

Updated: 8 February 2008

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