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Culture & the Family

Ray Carter | August 10, 2023

Transgender ‘affirmation’ has long-term consequences, Oklahoma City psychiatrist says

Ray Carter

“Affirming” a child’s belief that he or she is actually the opposite gender puts those children on a fast-track to medical interventions that have severe, negative side effects that cause that child to be a patient for the rest of their lives, according to a local expert.

And in most cases the gender distress expressed by children is often resolved within a few years when the child is not subjected to puberty blockers or cross-sex hormones.

“Every single patient deserves to be treated with respect, with dignity, with empathy, with compassion, and they deserve excellent medical care,” said Lauren Schwartz, a board-certified psychiatrist and psychotherapist in Oklahoma City. “That’s not what’s going on here.”

Like many medical professionals in recent years, Schwartz has encountered a growing number of families whose children are convinced they are transgender, and has begun speaking publicly about the issue, including at a recent OCPAC Foundation luncheon. How parents respond to a child’s declaration of gender distress can have lifelong consequences for that child’s quality of life for the rest of that child’s life, she said.

Contrary to common perception, Schwartz said “social affirmation,” the practice of calling a child by opposite-sex pronouns or allowing the child to dress as a member of the opposite sex, “is not harmless.”

“Parents think that affirming their child is kind and loving. That’s what they’re told. Their doctors tell them that. Their teachers tell them that. Your child may tell you that. Instead of distress, it feels comfortable and she’s happy. But it’s not kind of loving to validate an untruth. Adults have a responsibility to represent reality,” Schwartz said, quoting Miriam Grossman, a child and adolescent psychiatrist who authored the book “Lost in Trans Nation.”

Similarly, Schwartz said surveys that allow kids to choose from a range of alleged genders other than male or female “is doing something psychologically” to those children by signaling that they have reason to question their gender. Such surveys have become more common in public schools and other venues in recent years.

“Social transitioning is affirmation. It means you affirm a child’s current concept that he or she was born in the wrong body,” Schwartz said.

And once adults “affirm” a transgender identity for a child by changing the child’s name and pronouns, it creates psychological pressure for the child to continue down that path even if the child has subsequent doubts.

That psychological pressure leads to further actions with permanent physical and mental consequences.

Schwartz said allowing a child to receive “puberty blockers” in response to gender dysphoria can fuel an iatrogenic effect in which an alleged response to a condition is actually responsible for creating or worsening the condition. Children who feel they don’t fit in truly don’t fit in with their peers after use of puberty blockers, she noted.

“You get a child and their peers have moved further on than they have, now they feel even more left out, more isolated,” Schwartz said.

That’s one reason that 98 percent of kids who take puberty blockers go on to take cross-sex hormones, she said.

Many children experiencing gender dysphoria begin use of puberty blockers and cross-sex hormones without truly understanding the consequences, and neither do their parents.

“It’s not kind or loving to validate an untruth. Adults have a responsibility to represent reality.”

Schwartz noted that some medical websites claim that puberty blockers simply “pause puberty to give children time to think,” are fully reversible, harmless, safe, effective, and lifesaving.

“None of these things are accurate,” Schwartz said.

Science has shown puberty blockers have significant side effects that are not fully reversible. Those side effects include damage to the hypothalamus, which regulates body and brain development, communication between hormones and the nervous system, sleep-wake cycles, temperature regulation, fluid balance, heart rate, hunger, and reproduction.

“These are not small things that we are impacting,” Schwartz said.

The drugs used as puberty blockers have never received U.S. Food and Drug Administration (FDA) approval as treatments for gender dysphoria. While off-label use of drugs is common, Schwartz noted most off-label use targets conditions similar to those for which a drug has received FDA approval.

That’s not the case with puberty blockers.

“This is the wild west,” Schwartz said.

The side effects caused by puberty blockers also include diminished bone density, early-onset osteoporosis, chronic bone pain and fractures (which does not cease even when the use of puberty blockers is halted), increased risk of infertility, permanent negative impacts on adult sexual function, and cognitive impairment.

“It does impact IQ,” Schwartz said, adding that the full cognitive impact of puberty blockers remains unknown.

Male patients who are given female hormones have increased risk of blood clots, tumors of the pituitary gland, strokes, high cholesterol, and irreversible infertility. Female patients who take male hormones experience increased red-blood cells (which negatively impacts the heart and cardiovascular system); severe liver dysfunction; heart attacks; depression; hypertension; breast, cervical, and uterine cancers; and irreversible infertility.

“They are going to be a patient for life,” Schwartz said. “If you arrest puberty and you put someone on cross-sex hormones and you remove their organs that produce their own biological hormones, they’re going to have to take hormones for the rest of their life.”

Schwartz noted the websites of various children’s hospitals across the country list transgender procedures they will perform on child patients. Those descriptions often glance over the procedures with only slight detail and provide youth with a misleading perception of what they will face.

Schwartz referenced one hospital website that states the facility will provide phalloplasty, which the hospital describes as the creation of a penis using other parts of the body. That description does not reflect reality, she said.

“This is not a functional penis,” Schwartz said, and noted there are numerous risks associated with the procedure.

Radical double-mastectomies and the removal of the uterus and ovaries are similarly described as minor procedures for transgender-identifying youth.

Schwartz noted one hospital site nonchalantly describes vaginoplasty as the removal of the penis and testicles, followed by the creation of a vagina, clitoris, and labia from penile tissue. Once again, Schwartz said the description does not reflect the reality facing male patients who undergo that surgery.

“This isn’t a functional vagina, and most of the time your body treats it as an open wound. It will try to heal it,” Schwartz said. “So what they don’t typically discuss with the patients is several months after surgery they have to dilate it, very painfully, every six hours. And then they have to dilate it for life.”

The pressure to push children into taking puberty blockers and cross-sex hormones comes not only from medical facilities that profit off those procedures, but from groups that view promotion of transgenderism as an ideological goal.

Until recently, the website of the Oklahoma Education Association (OEA) provided its members with “Schools In Transition: A Guide for Supporting Transgender Students in K-12 Schools,” a document produced by the National Education Association and likeminded groups.

That guide tells Oklahoma teachers that children begin expressing gender identity “between the ages of two and four years old” and instructs teachers they should never encourage a student to express their gender based on the student’s sex even if there is concern that a student “lacks capacity or ability to assert their gender identity or expression (e.g., due to age, developmental disability or intellectual disability).”

The guide also recommends that teachers affirm a child who says he or she identifies as a member of the opposite sex, and also tells teachers they should “educate the student’s family members about the serious consequences of refusing to affirm their child’s gender identity.”

The OEA took the report off its website after the Oklahoma Council of Public Affairs publicized the union’s activity.

Notably, the U.S. is also an outlier in promoting the use of puberty blockers and cross-sex hormones on transgender-identifying youth.

“Seven of the most prominent nations in gender-affirming care have completely changed course,” Schwartz noted. “They have been doing this at the biggest clinics out there in the world for the past 30 years, and they’ve said, ‘We’ve got to stop.’”

Rather than push children into taking puberty blockers and cross-sex hormones, let alone undergoing surgeries to remove healthy tissue and organs in pursuit of cosmetic change, Schwartz said kids should be given time to grapple with the issues that are causing them to feel discomfort about their sex—issues that are often short-term and treatable with standard mental-health care.

“The majority of gender distress will develop a better, more flexible concept of themselves if not treated medically or surgically,” Schwartz said. “This is where Europe is.”


NOTE: The sixth paragraph of this story has been revised since publication to clarify attribution.

Ray Carter Director, Center for Independent Journalism

Ray Carter

Director, Center for Independent Journalism

Ray Carter is the director of OCPA’s Center for Independent Journalism. He has two decades of experience in journalism and communications. He previously served as senior Capitol reporter for The Journal Record, media director for the Oklahoma House of Representatives, and chief editorial writer at The Oklahoman. As a reporter for The Journal Record, Carter received 12 Carl Rogan Awards in four years—including awards for investigative reporting, general news reporting, feature writing, spot news reporting, business reporting, and sports reporting. While at The Oklahoman, he was the recipient of several awards, including first place in the editorial writing category of the Associated Press/Oklahoma News Executives Carl Rogan Memorial News Excellence Competition for an editorial on the history of racism in the Oklahoma legislature.

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