Gender Identity Problems in the Closet

Dr Jason Rafferty, a Paediatrics Specialist at the disconcertingly named Thundermist Health Centres in Woonsocket, Rhode Island in the US, has attracted a single review – one-star at that. Here it is:

My child described him as ‘weird’ and ‘creepy’ after he repeatedly grilled her about her gender identity. She said she didn’t identify as anything, so they put ‘genderqueer’  on her medical records even though she identifies as a lesbian female. I didn’t even authorize this doctor to talk to my doctor; he just appeared at her regularly scheduled med check. (October 2020, by ‘Laura’.)

Dr Rafferty is the Lead Author of a Policy Statement put out by the American Academy of Paediatrics (AAP) in 2018, modestly titled Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents.

Now to some definitions as set out in this document (paraphrased):

Sex’ or ‘natal gender’ is a label, generally ‘male’ or ‘female’, that is typically assigned at birth on the basis of genetic and anatomic characteristics.

‘Gender identity’ is a person’s deep internal sense of being male, female, a combination of both, somewhere in between, or neither, which result from a multifaceted interaction of biological traits, developmental influences, and environmental conditions.‍

Biological traits, developmental influences, and environmental conditions cover just about everything, so they’re stating the obvious, but this means that the ‘cause’ of gender identity, and by extension, the cause of gender diversity or transgenderism or whatever you like to call it, is unknown. Incidentally, I wonder what biological traits they are referring to.

Ideology or scientific hypothesis?

People who need a simple, not to say dumbed-down, approach to the concepts of sex and gender are referred to a comic book-style creation, The Gender Book, of which one reviewer on Amazon says: ‘The premise that everyone has a gender identity is a belief as part of an ideology, not a scientific hypothesis.’

Nonetheless, the Policy Statement seems to be based on the assumption that transgenderism and gender diversity are entities that exist in nature rather than being abstractions thought up by the writers of scholarly papers. This is in spite or their definition that ‘Gender identity is one’s deep internal sense (the words ‘deep’ and ‘internal’ are redundant) of who one is.’ In other words, it’s a feeling.

Further on they discuss the ‘Gender-affirmative care model’. This amounts to agreeing that a young person’s gender is whatever he or she says it is. People may have opinions and feelings about all kinds of things, but I can see no justification why a doctor should accept someone’s subjective view of themselves as a medical diagnosis in the absence of any objective criteria.

The annual check-up industry

America is a country that seems obsessed with annual check-ups. For example, in the 2017 edition of the AAP’s Guidelines for Health Supervision of Infants, Children, and Adolescents, there is a section on ‘Early Adolescence Visits (11 through 14 years)’ where they recommend for females: ‘Assess breast (sic) by inspection or palpation.’ The female, being expected to expose her breast or breasts to a doctor’s gaze or touch, is unlikely to perceive this as anything other than embarrassing or even humiliating.

As a further example of how intrusive the recommendations are, here is a quote from another AAP publication. It’s from 2010 but does not seem to have been updated:

The AAP promotes the inclusion of the gynaecologic examination in the primary care setting…At a minimum, examination of the external genitalia should be included as part of the annual comprehensive physical examination of children and adolescents of all ages.

In my unhumble opinion, in the absence of symptoms or concerns related to the genitals, this is utterly without justification.

Thus, apart from the question of whether a healthy child needs a regular medical check at all, seeking out gender identity problems is reminiscent of searching for reds under the bed or instances of racism by the race-relations industry in Britain. However, as far as gender identity problems are concerned, we are informed that:

The best way to approach gender with patients is to inquire directly and nonjudgmentally about their experience and feelings.

As indicated above, this approach was not appreciated by at least one parent and her child.

Furthermore, the Policy Statement shows confusion about transgenderism because on the one hand it says:

Transgender identities and diverse gender expressions do not constitute a mental disorder…variations in gender identity and expression are normal aspects of human diversity.

And on the other hand:

Paediatric providers have an essential role in assessing gender concerns and providing evidence-based information to assist youth and families in medical decision making.‍..Many medical interventions can be offered to youth who identify as transgender and their families.‍

If medical decision making is needed and medical interventions can be offered to youth in this situation then presumably we are dealing with a mental disorder or diagnosis of some sort.       

Reality or fantasy?

Let’s take a short section from the middle of the paper about parents’ concerns when their child ‘comes out’ as transgender:

One model suggests that the process resembles grieving, wherein the family separates from their expectations for their child to embrace a new reality. (Emphasis added.)

Earlier they define gender as a feeling; now they say it’s a reality. If they were to say something like ‘the reality of their child’s new perception of himself (or herself)’ this might make sense, and then they could merely say ‘The child’s new perception of himself (or herself).’ But clarity of expression is not something about which the authors of the Policy Statement are overly concerned. For example, we are also told:

The need for more formal training…often leaves providers feeling ill-equipped.

Does this mean that providers feel ill-equipped because there is insufficient formal training, so more of it is required, or that the training they do receive is too informal and it should be presented in a more formal way?

More contradictions

We are also told that one problem with transgenderism is that:

Adolescents and adults who identify as transgender have high rates of depression, anxiety, eating disorders, self-harm, and suicide.‍

However, we are reassured:

There is no evidence that risk for mental illness is inherently attributable to one’s identity as transgender or gender diverse.

Now we get to the bit, as noted by the Amazon reviewer, indicating that gender identity is part of an ideology:

Rather, the risk for mental illness is believed to be multifactorial, stemming from an internal conflict between one’s appearance and identity, limited availability of mental health services, low access to health care providers with expertise in caring for youth who identify as transgender, discrimination, stigma, and social rejection.‍

So the risk for mental illness is, after all, due to the conflict (again, the word ‘internal’ is redundant) of gender confusion which should be taken at its face value and regarded as a newly discovered disease to which society needs to adapt and for which the emotional and physical health needs should be provided.

Not everyone, however, is carried away by this idea. The Attorney General of Texas has declared that so-called sex change procedures and the use of puberty blockers are child abuse.

Text © Gabriel Symonds

Gabriel Symonds

Dr Gabriel Symonds is a British doctor living in Japan who is interested in helping smokers quit. He has developed a unique simple method without nicotine, drugs, hypnosis or gimmicks that he has used successfully with hundreds of smokers. Further information can be found at

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