When Two Worlds Collide: Part 2 - A World of Live Daughters and Sons

This is the second part of a three series essay, you can find the first segment at: Part 1: A World Turned Upside Down

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If PITT readers each had a dollar for every time we’ve heard the much debunked, emotionally manipulative “live son or dead daughter” myth we’d all be very rich. We hear the “transition or die” trope from the media, schools, the government, misinformed family and friends, and from our own trans identified kids, who hear it themselves from the same sources as us and from fellow trans-identified peers in real life and on social media. I’ve heard it from Governor Spencer Cox of Utah. In February 2021 Governor Cox vetoed a bill that proposed to ban ‘transgender girls’ from participating in girls’ K-12 sports stating, “I don’t understand what they are going through or why they feel the way they do. But I want them to live… These kids are… they’re just trying to stay alive.”

A well-known purveyor of this harmful narrative is Diane Ehrensaft who is the chief psychologist at the UCSF Benioff Hospital Child and Adolescent Gender Clinic. In a widely circulated video of Dr. Ehrensaft giving a conference presentation she acknowledges that when children are given puberty blockers and cross-sex hormones as part of ‘gender affirming’ medical intervention, one side effect is infertility, and she wonders if children can really consent to this. She says, “The other issue that’s a showstopper now for many parents around giving consent to puberty blockers is the fertility issue. That if a child goes straight from puberty blockers directly to cross sex hormones they, at this point in history, they are pretty much forfeiting their fertility and so they will not have a genetically related child… The question is, can an 11-year-old, 12-year-old at that level of development, be really thinking and know what they want at age 30 around infertility?” Dr. Ehrensaft answers her own question by likening ‘gender affirming’ medical care to oncological care for children with cancer. “The answer to that is we don’t think twice about instituting treatments for cancers for children that will compromise their fertility. We don’t say, ‘We’re not going to give them the treatment for cancer because it’s going to compromise their fertility.’ For some youth, having the gender affirmation interventions is as life-saving as the oncology services for children who have cancer.”

Dr. Ehrensaft is, of course, insinuating that ‘gender affirming care’ is “life-saving” for children who identify as transgender because, if not affirmed, they might commit suicide. Her colleague, Joel Baum, states this more explicitly. “I’ll just add one thing here. When we’re working with families, what is the leverage point for that family?…The fact of the matter is at the end of the day, it is their decision and we just hope they’re going to make an informed decision. Just make sure you have all the information you need. Which includes, you can either have grandchildren or not have a kid anymore, because they’ve ended the relationship with you or in some cases because they’ve chosen a more dangerous path for themselves.”

Activists like Diane Ehrensaft peddle, and stooges like Governor Cox buy, the claim that ‘gender affirming care’ is like chemotherapy for cancer—life-saving and medically necessary. This is infuriating and deeply offensive to me because I am the mother of a trans-identified young adult daughter who thankfully seems to be desisting, and an older teenage son in active treatment for leukemia. Based on my son’s risk factors, his oncologist has given him an 85% chance of survival. His treatment is life-saving and medically necessary. Without it he would already be dead. The hard truth is that even with it he might still die. It is hyperbolic and shameful for anyone to conflate chemotherapy with ‘gender affirming care’, or to hold parents emotionally hostage with the words “transition or die”, “live son or dead daughter.”

It’s true that my daughter has been in great distress. She is a bright, socially awkward, mildly autistic girl with depression and generalized anxiety. But she is not going to die. In fact, how can she not be distressed when she has internalized what she’s heard repeatedly—that she one of the most marginalized, most oppressed, and most hated people on the face of the earth? That people are literally trying to erase her existence? That she must undergo extreme medical and surgical procedures and become a lifelong medical patient or she might kill herself? As she walks the road to desistance she told me recently that she believes she can relearn to love her body, but she is going to have to “unlearn a lot of stuff.”

Advocates of ‘gender affirming’ healthcare cite high suicide rates as evidence that medical and surgical intervention is “life-saving and medically necessary.” It goes without saying that every suicide is tragic, but there is no high-quality evidence to suggest that the often quoted overall attempted suicide rate of youth who identify as transgender is 41%. Dr. Laura Edwards-Leeper who is the Chair of the Child and Adolescent Committee for the World Professional Association for Transgender Health has stated, “As far as I know there are no studies that say that if we don’t start these kids immediately on hormones when they say they want them that they are going to commit suicide.. So that is misguided… in terms of needing to intervene medically to prevent suicide and doing it quickly. I know of no studies that have shown that.” There is also no evidence that medical transition decreases suicidality. In fact, one study showed that post transition adults were 4.9 times more likely to have made a suicide attempt and 19.1 times more likely to have died from suicide than the general population. No one is born in the wrong body. Our sex is written into the DNA of every cell of our body. People cannot change sex. It’s a serious thing to insinuate to someone that their healthy body is somehow wrong and might require extreme, irreversible cosmetic interventions to relieve mental distress. There is no right or wrong way to be a boy or a girl, a man or a woman.

Let me spell out for Diane Ehrensaft a few of the many reasons why it’s inaccurate to conflate cancer treatment and ‘gender affirming care.’ First, chemotherapy is given only after a confirmed diagnosis of cancer. We could not have brought our son to the hospital, declared he had cancer, and demanded chemotherapy. Demanding medication based on a self-diagnosis is something only my trans identified daughter could have done—because that only happens in gender clinics.

Second, pediatric cancer treatment is evidence-based. My son’s treatment plan was mapped out from the moment of his diagnosis based on exact protocols obtained over decades of research. It’s literally on a spreadsheet his medical team calls “the road map”. His hospital is part of a consortium of children’s hospitals that share data to further improve treatment and outcomes. ‘Gender affirming care’ is called the Wild West of healthcare for a reason. After a systematic review of the literature the countries of Finland, Sweden, the UK, and France, and the state of Florida have found the evidence for ‘gender affirming’ care to be of such low quality that they have abandoned the affirmative model of care. Even the much touted “gold standard” Dutch Protocol is now being discredited due to serious methodological flaws.

Third, outcomes for childhood cancers are well known, published, and updated. Post treatment my son will be followed for many years to assess his outcome. Outcomes for patients of ‘gender affirming care’ are mostly unknown. Clinics and providers rarely keep data and patients aren’t followed long enough to get reliable outcome information. Studies show that the average time to regret a gender transition is 8-10 years, but most patients are given follow up for much shorter times, if at all.

Finally, kids with cancer are given harsh, life-altering treatments because there is no other choice. Cancer treatment is truly life or death. ‘Gender affirming care’ however is iatrogenic, meaning that the treatment actually contributes to the condition. Eleven longitudinal studies have shown that, if just left alone, approximately 80% of dysphoric kids will simply outgrow the distress they feel and become comfortable with their bodies.

My family is very fortunate that childhood leukemia has a good prognosis, but the treatment is a grind. My son has faced his treatment with grace, good humor, and as much optimism as he can muster. One clinic day though my son just wasn’t having it. He was exhausted, nauseated, and facing a long day of treatment. When his nurse came in to get him ready for chemo he was sitting hunched over on the bed, hoodie pulled over his head, eyes closed, earbuds in. She asked him if he had done anything fun that week and he just rolled his eyes. Nurses work with these kids every day for their job but they don’t live the reality. It’s hard to do anything fun when you feel like crap.

After a few one-word responses from my son to her questions she asked him point blank “Are you having suicidal thoughts?” We felt ambushed by the question and I immediately  jumped into the conversation. “Are you kidding me? Why would you ask him that?” She explained that per hospital protocol she has to ask that question monthly. “ Fine,” I said. “We get it. But please put the question in context.” My daughter announced her ‘transgender’ identity to us with the help of an adult my daughter felt she could trust. We all sat on the couch in our living room while this man called our daughter by the new name she had chosen and warned us of her “high suicide risk.” As shocked as I was I still remember thinking, “Why are you talking about suicide in front of her? She’s sitting right here!?!” I understand that one way to prevent suicide is to ask about it directly. I’m not discounting that. But why didn’t my son’s nurse say, “Look, I know things are really hard right now but it will get better. We’re here for you and are going to take very good care of you.” Why hasn’t anyone except PITT parents and allies thought to say these same words to trans identified kids? “Life is hard sometimes but you can get through this.” There are many detransitioners who have expressed that they wish someone had said these words to them.

Experts agree that suicide contagion is a risk. That’s why the media has strict guidelines in how they report suicide. It’s incomprehensible why all that goes out the window with ‘trans kids.’ Sociologist Michael Biggs highlighted this in a recent podcast interview. He stated that the “live daughter better than a dead son” rhetoric has been around for a long time, and that it is true that a large number of young people who identify as transgender claim that they’ve thought about or attempted suicide. Suicide and self-harm can be a real concern but, he explains, “…when you make suicidality a central part of the [trans] identity, that actually that sort of enhances the likelihood of making claims about suicide. Because ‘to be trans’ in some ways means ‘to be suicidal’ because ‘society is rejecting you’ or ‘your parents are rejecting you’. So it’s very important to actually know how many deaths result.” Data he obtained with a freedom of information request from the NHS in the UK showed 4 suicides out of 15,000 transgender identified individuals. That’s not 41%. I wonder if Utah Governor Cox would still think boys should be allowed to play in girls’ sports if he understood it’s really not a life-or-death situation.

PITT readers, we have to get this suicide myth stopped in its tracks. We must take back control of the narrative. Speak up and speak out whenever and wherever you can. Call out this emotional blackmail for what it is. Challenge your kid, your medical providers, your legislators, your schools, your friends, and your family. Debunk this untrue, harmful myth wherever it’s being perpetuated. “Transition or die” is one of the flimsiest reasons among a host of incredibly flimsy reasons for the chemical castration and genital mutilation of kids. Calling the suicide myth out for the harmful nonsense it is will help to bring an end to this horrible era of medical experimentation on kids. Proclaim the truth! We have live daughters and sons!!