(The letter that follows was shared by a mother concerned about her daughter. You can hear the letter read aloud on this episode of The Witness: True Stories of Children and Gender Identity.)
This letter was sent to my ex-husband after he filed with the court to remove my medical decision-making for our 13 year old daughter.
If you wish to make all medical and therapeutic decisions regarding our child, then I request that you consider how you would answer some questions that other parents of daughters have been faced with as their adolescent girls quite suddenly become enamored with living as boys thus attempting to escape the physically and mentally painful period of puberty in a society that values girls differently than boys. I have thought deeply about my answers to all of the questions that I am posing to you, since as part of my parent support group for transgender teens, I have talked to many, many parents who have had to make these difficult decisions.
Before I begin, I want to review some of the physical and mental health information for the past years of our daughter, our daughter. (Since this new identity is a recent creation and I’m speaking historically of the experiences of our daughter as a female girl in this letter, I have chosen to use the most logical nomenclature, which is supported and encouraged by other parents in my support groups.)
Do you feel that our daughter is physically and mentally healthy? What indicators of her health are notable to you currently and over the past year(s)?
Do you remember where you were when our daughter’s therapist called you to inform you that our daughter had expressed thoughts of suicide at age 8?
Do you remember how scared you were?
Do you remember when our daughter's therapist suggested that we consider antidepressants/antianxiety medication for our daughter when she was 9?
Do you want to reconsider our decision to not explore that therapeutic intervention that was recommended?
Do you feel that her anxiety has increased or decreased since age 8? Do you feel that her anxiety impacts her life in significant ways and does not allow her to maintain healthy relationships or participate in every day activities with expressing thoughts of overwhelming worry or panic?
What have you observed over the past year?
Have you joined any parent support groups to discuss your observations?
Are you meeting with your own individual therapist and/or parent support group to identify whether your observations are part of a period of normal “teenage angst” or are indicative of more significant mental health challenges?
What supports have you provided for our daughter’s physical and mental health?
Do you feel that additional resources are needed to evaluate and address her anxiety and depression?
What do you suggest?
The onset of puberty and the beginning of the menstrual cycle and its accompanying symptoms and impacts on a girl’s daily life are something that you have never experienced. It is a significant, though universal, experience, and many, many research studies have been done regarding its impact on the lives of girls.
Have you read about this physical and emotional experience in order to be able to parent our daughter, given that you don’t have your own personal experience to reference?
What have your discussions centered on regarding puberty and her experiences with her body?
Have you spoken with our daughter about her periods and how they impact her life?
Do you know that our daughter has had significant cramps that accompany her period, causing her debilitating pain to the point of vomiting?
Do you know what the cause of that is?
Have you spoken with her doctor about that?
Has she expressed that she doesn’t want to feel those awful cramps?
Are you aware that cramping and abdominal pain of that type could be a sign of a more serious, though possibly treatable, reproductive issue?
Has the cramping increased or decreased as she’s gotten older?
Are you aware that a doctor discussing monthly menstrual cycles are a way to catch significant physical development issues early in puberty?
Has our daughter expressed hatred for her period and a desire for it to end?
Are you aware that most if not all adolescent girls express a dislike of their menstrual periods?
What treatments have you explored with our daughter to address the significant painful cramping (physical) and monthly annoyance (mental) with the universal female experience of puberty and periods?
Have you spoken with her doctor (or will you) about the possibility of using hormonal birth control to alleviate some of the symptoms of painful cramping that accompany her period?
Have you asked whether an ultrasound might yield more information about why she has such painful cramping?
If you are not addressing these concerns, who is?
Who is speaking with our daughter and her doctors about these issues?
Have you started taking her to a gynecologist to address these common issues so that problems can be addressed early and that it doesn’t contribute to her body hatred?
Are you aware that this could be contributing to her desire to “not be a girl”?
Do you observe that she is attempting to disassociate from her identity as a girl in order to find a way out of the physical discomfort that accompanies this period of physical development?
Regarding our daughter’s recent demand for affirmation as a boy, I’d like to start with the most basic question that needs to be answered before any discussion can begin regarding medical decisions.
What do you think a boy is?
How do you define male and female?
What are the characteristics?
If a boy wears a dress (or wants to), does that make him a girl?
If a girl wears pants (or wants to), does that make her a boy?
Does a desire for short hair mean that a girl is actually a boy?
Who decides what a boy is and what a girl is?
Does the definition change?
What are the physical markers of male and female?
If a girl feels like a boy, does that mean that she will always feel that way (or has always felt that way)?
Does that feeling change?
Do feelings change?
If you are “affirming” that our daughter is a boy,
Does that mean that she has always been a boy?
When was she a boy?
Did she become a boy in the past year?
Is she a boy now?
What does it mean to be a boy?
Do you need to have a “boy” name to be a boy?
Maybe our daughter is saying that she’s “nonbinary.”
What does that mean?
What are the physical characteristics of children who are nonbinary?
Do they have short hair?
Do they wear pants?
Do they wear dresses?
Is that socially acceptable for a nonbinary person?
Does that make them look like a girl?
Are girls the only people who can wear clothing such as dresses and items such as makeup and earrings?
What is the physical structure of a nonbinary person’s body?
If our daughter wants to be referred to as “he,”
Does that mean that she believes that she is a boy or that she wishes that she was a boy?
Is that a desire or wish or is it a reality?
How can you “affirm” that chosen identity?
Was the identity “chosen” or has it always been true?
When did it change?
What happened for it to change?
What role do medical professionals, such as obstetricians play in the identification of boys and girls at birth?
What information do they use to determine whether a baby is a boy or girl?
What decisions do children have in deciding their own identities?
How can you “affirm” their decisions?
Again, is our daughter’s identity a decision or is it something that has always been true and has only recently been discovered/uncovered by her?
What led to that “discovery”?
If you are “affirming” that our daughter is a boy and that boy is named a very popular chosen name for transgender adolescent females, is that all you need to do?
What about her physical body?
Does her physical body need to change in order for her to become a boy or is she already a boy now?
Is she a boy in her mind and her body needs to change to match her feeling of being a boy?
How does she describe feeling like a boy, or not feeling like a girl?
What do you think she is?
Do you think that it’s necessary to agree?
What are the necessary changes that you feel or she feels need to take place in order for her to become a boy, if she isn’t one now?
Do you feel comfortable with her sharing private spaces with other boys and men, such as locker rooms, restrooms, and hotel rooms during school trips?
Does she want to do that?
Why or why not?
Does she want her own private space for changing or using the restroom?
If so, why do you think she feels that way?
What if there is no private individual space for using the restroom or changing clothes, such as at a baseball game or music concert?
If she is expressing a desire to change her body or expressing body self-hatred,
Do you think that she is at risk for self-harm?
Is our daughter wearing a device that has the intent to restrict the development of her breasts?
Have you discussed with her the possible physical impacts of wearing a “binder,” including damage to her muscle and bone development as well as her respiratory health?
Have you researched these impacts and discussed them with her doctor?
Have you been monitoring that, and what observations have you noted?
Is she communicating with you about how she is feeling physically?
Do you have a system of recording your observations with dates?
Will you communicate these to her new doctor?
When you go to the new doctor, what if he suggests that our daughter start puberty blockers in order to stop the development of her female body and reproductive organ development?
Are you going to accept that advice and prescription?
How long will you take to make a decision?
Have you discussed any waiting period with our daughter?
Are you aware that puberty blockers may or may not cause permanent sterility?
Are you aware that early research indicates a negative impact on the bone density of females who begin to take puberty blockers, even after only a short time?
Have you been told that puberty blockers are “reversible,” and have you verified that claim against scientific studies?
What long term studies have been done regarding these drugs on pre-pubescent and pubescent girls?
Where are you getting your information, and if our daughter is learning about these “interventions” on her own, where is she getting her information?
Are those trusted resources that are subject to scientific scrutiny in which critical thinking and questions are encouraged and welcomed as a matter of education and information dissemination to parents and children? What have you found to be your best resources of information regarding these medical interventions/treatments?
If you are prepared to allow puberty blockers to be injected into our daughter in order to halt her physical development,
Are you also going to consent to weekly testosterone injections in order to “affirm” our daughter is a boy?
Will you administer these injections or will our daughter be responsible for doing it herself?
Are administering injections considered medical treatment?
Are you aware that testosterone will likely cause permanent changes to our daughter’s body, including deepening her voice, broadening her shoulders, breast pain, creating a more pronounced and wider jaw line, and significant and permanent enlargement of her clitoris (resembling a micro-penis)?
Are you aware that these changes are not reversible?
Is our daughter aware of that?
Maybe you have already considered all of the above.
Have you already decided that you are unwilling to provide consent for such treatment of her “dysphoria”?
Have you communicated your decision to our daughter?
Has she accepted it?
Have you discussed the limits of how much you are willing to “affirm” her identity as a boy?
If you haven’t decided the above and if she asks you, will you tell her no?
What if she threatens to kill herself if she doesn’t receive medication treatments that affirm her identity, such as puberty blockers and testosterone?
Will you change your decision?
Will you tell her therapist and medical doctor about her threat of suicide?
What interventions will you take to assure her safety if you choose not to consent to treatments that she is demanding to affirm her identity as a boy and/or reject her identity as a girl (i.e. nonbinary)?
Since the prevalence of gender dysphoria has recently increased for adolescent girls,
Have you looked into research regarding the underlying causes of gender dysphoria and its relationship to previous diagnoses of depression, anxiety, and autism?
Have you talked to her doctor (or do you plan to) about her early diagnoses of severe anxiety and depression?
Have you talked to the family therapist, your own therapist, or our daughter’s therapist about the intersection of these diagnoses?
Are you aware of studies that examine the impact of “gender reassignment” on a patient’s depression and anxiety and whether it was alleviated by the medical intervention of hormone suppressants, hormone replacements, and surgeries?
Have you spoken with our daughter about why she feels that she cannot be a girl?
Are you concerned about the disassociation (self-hatred) with her body and her identity?
Have you considered that she is attempting to disassociate from the experiences of her past by stating that they do not exist for this new identity, though the effects of those traumas are part of her physical, mental, and emotional reality, specifically her brain chemistry?
Do you believe that by creating a new “identity” that she will be able to be “born again” as a new person, carrying nothing of her past into her future life?
Do you believe that is her wish, to become a wholly new person, different and separate from the child who has divorced parents?
Do you feel that the creation of this new identity has a relationship to her identity as a child of divorce, one of eight adverse childhood experiences (ACES) that impact health over the lifespan?
Are you comfortable with never discussing events, positive or negative, that occurred in the past, when she was our daughter?
Do you refer to her as our daughter when you’re talking about events in the past because at the time she was our daughter, not this boy?
Do you feel content with not displaying any photos of her childhood previous to July 2019?
Is she requesting that of you?
If you consent to puberty blockers and weekly testosterone injections,
Are you aware of all the side effects of such treatments and are you prepared to communicate with our daughter about how the drugs are impacting her physical body?
What research have you done regarding the impact of testosterone on the uterus and how atrophy of it can cause significant pain during urination, likelihood of uterine infections, and pain during sexual intercourse, which could continue for the rest of her life, even if she stopped weekly testosterone injections?
Are you prepared to consent to a hysterectomy when the uterus has atrophied to the point that it must be removed?
What is that happens after three years of testosterone?
What about two, or just one year?
Do you think that a 13 year old is able to make decisions that could impact her sexual and reproductive health for the rest of her life?
Are you aware that your adult parental consent to such treatments means that you are making those decisions on her behalf as her parent?
Are you prepared to be held accountable for those decisions?
If she wants puberty blockers to halt the natural development of her body and weekly testosterone injections to change her secondary sex characteristics from female to male,
Is that all that is necessary to have her body match her feeling of being a boy (or not being a girl)?
Is there anything else that needs to be changed about her body?
In her opinion, who didn’t accept her body the way that it was?
Was it her, you, or someone else?
Do you think that she needs to change her body in order to become a boy, or is it unnecessary?
Do you think that she needs to change anything about herself, and if so, what?
Is it possible to just “identify” as a boy and not change anything about her body?
Is being a boy about feeling like a boy or is it about looking like a boy?
Is boyness and girlness about how people look and dress and style their hair?
What has our daughter changed since declaring a new identity?
What is it that makes someone a boy or a girl?
Do you believe that we can change that, and what parts of it can we never change?
Do you believe that puberty blockers and testosterone will decrease or eliminate our daughter’s anxiety and depression?
Do you believe that this is the secret to her finally being happy and “not so negative,” as she quoted you in her journals?
What if she isn’t happy…
With the puberty blockers and weekly testosterone injections, even after her voice is deep, her body looks more like a man, and she begins to grow facial hair and a micro penis in the form of an enlarged clitoris...
Will you consent to a double mastectomy, or “top surgery” in order to “affirm” her identity?
Are you prepared to bring your teenager to a surgical appointment to have her healthy breast tissue permanently removed because she “feels like a boy”?
Is the desire or attempt to remove healthy body parts a form of self-harm?
Do you think that your consent as a parent to such treatments is considered harm?
Are you also prepared to consent to phalloplasty, or “bottom surgery”?
If the “micro penis” that has grown during the weekly testosterone injections does not make her feel like her body matches her feeling, then maybe using the tissue from her forearm to form a normal sized penis will allow her body to match what she has in her mind, but will it?
Are you aware that the form and function of such cosmetic phalli do not replicate the urinary and sexual function of a normal, healthy phallus of a male?
Have you looked into the impact of puberty blockers, testosterone, and surgeries on primary and secondary sex characteristics on the ability of people to experience sexual pleasure or orgasm?
Are you aware that people have scar tissue at surgery sites that causes significant pain?
Let’s say that you decide that you will not consent to any of the above treatments for our daughter.
Will you change your mind if she threatens to kill herself if she doesn’t receive the prescriptions and medical treatments that she demands?
Will you leave her alone at home or allow her to travel out alone with the fear that she may follow through on her suicidal threat?
In four short years, she will be 18, and I assume you will keep her on your health insurance.
Have you considered that she will be able to obtain medical treatment without your consent using your insurance coverage?
If you did not consent to puberty blockers or testosterone or a double mastectomy for her, will you remove her from your insurance in order to make it less likely that she will proceed with medical treatments to which you do not consent
Or will you keep her on your insurance to give her coverage to address the possible negative side effects of the treatments and/or any catastrophic event that may occur?
Have you talked to your insurance carrier about the costs of any of the above treatments and how they could impact your premiums and whether any or all of them are covered?
If you decide to drop her from your health insurance in order to dissuade her from medical treatments of which you do not approve, could you please inform me so that I can make a decision about whether or not I choose to bring her onto my health insurance policy after she is 18?
If our daughter decides that she doesn’t want to be this new person that she's created and doesn’t want to identify as a boy or nonbinary or use male or non-female pronouns,
Who do you think would be the first person she would tell?
Have you talked with trusted adults in her life and have a communication plan with them regarding this?
Do you think that she might feel trapped in the identity that she’s created and feel anxiety about how to form a new one, after this experiment with being a boy has not gone as planned?
Have you talked to her about this?
During this adolescent period of risk taking and identity formation, what relationship do risks and consequences play in this stage of development?
Have you researched the process of “detransition” and how young adults describe their experiences from identification as transgender to and through the process of detransition?
Have you talked to your insurance carrier to ask if they will cover reconstructive surgery for our daughter (to reconstruct her breasts, for example) if she changes her mind when she’s 18 or even 24?
If insurance does not cover detransition, are you willing to pay out of pocket for those treatments and surgeries?
Are you willing to pay for a uterus transplant if our daughter decides that she wants to have children but the testosterone that was injected has made her uterus unviable for pregnancy?
At what age do you expect our daughter to pay for her own healthcare costs related to medical decisions that were made by you when she was a minor child?
In my parent support groups, we discuss acceptable levels of allowing children to have to accept the consequences of their actions, versus having a parent veto decisions in order to prevent consequences that would be long lasting, if not permanently damaging.
Is it an acceptable consequence to our daughter’s risk to have her body permanently change due to medical interventions that she demanded after just becoming a teenager?
Is that simply a consequence that she will have to deal with because of her actions?
What responsibility do you have as a parent who has medical decision making authority and are responsible for consenting to such demands?
Is it responsible or irresponsible as a parent to allow a 13 year old to determine what happens to her body in the medical setting, and if it is responsible, why doesn’t the law allow for minor teenagers to make those decisions?
Does the law need to catch up to how smart teenagers are nowadays?
Is our daughter a typical teenager?
Is she atypical?
In what ways?
Since we all grow and change as we go through life, just like you and I did from the time we married to the time we divorced,
Have you considered regrets?
Have you considered that our daughter may regret the decisions that she’s made (or will make) regarding her identity and her body?
Do you feel that the responsibility for her choices falls solely on her or what role do the adults in her life play?
Do you think that she will go on to live happily as a man?
Is she aware that testosterone injections will be required in order to maintain some physical characteristics of being a man?
What social and physical impacts might her decisions now have on her adult life?
If she decides that she wants to be a girl/woman again, will she be frustrated by being misidentified as a man on the telephone and in person because of the changes to her body that cannot be reversed, such as her deepened voice, hard jaw line, and facial hair?
Are her wishes like a Pandora’s box, seemingly remedying a problem but, in reality, creating a whole new set of unexpected and serious troubles?
Can a 13 year old make long term decisions with permanent consequences?
What role do parents play in the decision-making process, and what responsibility do they hold as adults as stewards of children with a history of anxiety and depression?
These are questions that I have been asked and have discussed with other parents in the same situation. I hope that you will consider them, since you have petitioned to take full control of medical decision making for our child. With that power comes responsibility, and as our child is a minor, you would become wholly and completely responsible for medical decisions. I trust that you have thoroughly considered that before you filed that petition with the court.
Thank you for taking the necessary time to think about all these important questions.
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