How to diagnose a child as transgender (according to the professionals)

The World Professional Association for Transgender Health (WPATH) recently released the 8th version of its Standards of Care (SOC). Health professionals around the world will use these guidelines when they make decisions on how to diagnose and treat transgender-identified people. As the parent of a trans-identified child as well as a public health professional, I read the chapter on adolescents with interest.

In my child’s school, there are already children who have started medical transition but then decided to detransition. While no one really knows how many detransitioners there are (only 24% of them inform their doctors that they have detransitioned) we can all see the r/detrans subreddit growing, more people on social media talking about their detransition, and of course, people around us detransitioning.

This tells us that there are some people who are incorrectly diagnosed as trans, and who then receive treatment that is unnecessary. The treatment WPATH recommends is (for boys) cross-sex hormones at age 14, breast augmentation and other cosmetic surgeries at age 16, and removal of the penis and testicles to create a neovagina at 17; and (for girls) cross-sex hormones starting at age 14, mastectomy at age 15, hysterectomy at age 17 and phalloplasty available at 18.

Yes, read that last sentence again, very slowly. The recommended treatment is a series of highly invasive medical and surgical procedures that remove fertility and sexual function, and happen before a child is old enough to get a tattoo, buy cigarettes, or drive a car in most countries.

It stands to reason that we should be very sure we’re not giving these treatments to the wrong kids. So, how do we do that? What are the diagnostic criteria?

WPATH recommends that “the adolescent should meet the diagnostic criteria of gender incongruence as per the ICD-11 (Statement 12A in the SOC).

ICD-11 is short for the International Classification of Diseases 11th revision, a global standard for diagnostic information used in health systems across the world. The ICD-11 says:

Gender Incongruence of Adolescence and Adulthood is characterized by a marked and persistent incongruence between an individual ́s experienced gender and the assigned sex, which often leads to a desire to ‘transition’, in order to live and be accepted as a person of the experienced gender, through hormonal treatment, surgery or other health care services to make the individual’s body align, as much as desired and to the extent possible, with the experienced gender. The diagnosis cannot be assigned prior the onset of puberty. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.

Note that last sentence: “Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.” In other words: don’t diagnose based on gender stereotypes.

Who should make the diagnosis?

According to WPATH, “Healthcare professionals should realize they do not diagnose a gender identity per se, as one’s gender identity is the subjective experience of being male or female or another gender.”

So, because gender identity is a subjective experience, the only people who can make the diagnosis are the children themselves.

So, in other words, where are no objective diagnostic criteria. It is a self-diagnosed condition.

How good are the children at following ICD-11?

If the children are trusted to diagnose themselves before embarking on these invasive medical and surgical procedures, surely they must be aware of the ICD-11 statement that “Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.” Let’s see, shall we?

We’ll take one of many examples on social media, in which a teen boy at boarding school posted on both r/asktransgender and r/detrans, to “get different perspectives” on whether he is trans. His evidence for being a girl includes loving wearing a girl’s hoodie, making hot chocolate for people, being submissive and kind, wanting long hair, and having fancy handwriting.

Where could a child possibly get outdated ideas like these? Well, the gender organisations are in on the stereotype action. In a training session delivered by the British organisation Mermaids in 2019, participants were shown an image with Barbie on the left, next to an icon that indicates a women’s loo, and GI Joe in the right, next to an icon of a men’s loo. In between the two were 10 icons that gradually morphed from the female to the male, with the question “where on a spectrum might your gender identity be?”

So if you like Barbie you’re a girl, if you like GI Joe you’re a boy, and if you like both you’re somewhere in the middle. Even parents are using such stereotypes to diagnose their children as trans.

Also in the UK, materials from the Proud Trust are used in primary schools to teach kids about gender. A booklet called Alien Nation represents children as aliens on a blue planet and a pink planet. The boys on the blue planet get cross because they want to do things that are only allowed on the pink planet. So far so good. If boys want to wear pink dresses, let them! Bust those stereotypes!

But oh wait. That’s not how it works on Alien Nation. Another image shows that if a boy wants pink planet things, he must cross over the pink-and-blue trans bridge to live on the pink planet. (The fact that this entails removal of the penis is not mentioned in the booklet.)

When I look at the large number of children in my child's school identifying as trans or nonbinary, it is clear that for many of them it is a fashion statement. I celebrate their style. I encourage their exploration of stereotypes and socially constructed gender boundaries. I say YES! to the boys wearing nail varnish and the girls being leaders. But I absolutely do not think this needs medication and surgery.

WPATH is allowing children to self-diagnose based on gender stereotypes, while at the same time supporting the ICD-11 statement that diagnosis should not be on the basis of stereotypes. It’s also notable that this changes when a child enters their teens, because the ICD-11 category “gender incongruence of childhood” includes in its diagnostic criteria “...make-believe or fantasy play, toys, games, or activities and playmates that are typical of the experienced gender rather than the assigned sex.” So when you’re a child, liking Barbie makes you a girl, but according to ICD-11 this is no longer the basis for diagnosis when you become a teen.

The end result of this weird logic is the amputation of breasts aged 15, and penises aged 17. This is total madness. Children are being asked to diagnose themselves, they are not being equipped with the skills to make that diagnosis, and they are then having their fertility removed and sexual function impaired based on a self-diagnosis they make while still immature.

I cannot believe that any sane person can support this, and yet here we are: I write this anonymously because what I have said here is considered a thoughtcrime. These truly are Orwellian times.