Several months ago, while covering for a fellow pediatric psychiatrist on leave, I met a new patient. She was 12 years old, and I noticed that many of her chart notes referred to her by a “male” first name that was not her name of record. As we began our appointment, I asked her and her mother about this.
They gave each other an odd look, and then the mother explained that her daughter used to think she was transgender but not anymore. The girl told me that because she liked playing sports and wearing boys’ clothes, she was led to believe that made her transgender. She cut her hair, changed her name, and started living as a boy.
After a few months, she realized that she had made a mistake and went back to living as a girl. I told them that there was nothing wrong with being a girl who liked to play sports and didn’t want to wear dresses. Her mother immediately agreed, as she had told the patient that lots of girls are “tomboys,” but it doesn’t mean that they will grow up to be men. The girl seemed relieved, and we moved on to discuss other issues.
This happens to children these days more often than people may realize. The messages they get from peers and social media are quite odd. They define “male” and “female” according to outdated, sexist assumptions of what is “masculine” and what is “feminine.” The feminist movement of the 1970s did a great job of blasting through those stereotypes for women. Girls in those days dressed however we wanted, skinned our knees, played in the dirt, and roughhoused with the boys as equals.
It has been harder for boys to “act like girls” without being called “sissies” and, even worse, homophobic slurs, but the answer is not to turn little boys who want to wear dresses into little girls. It would be healthier for them, and for us, if we could learn to accept them as feminine boys, the way that “tomboy” girls started to be accepted in the 1970s.
The alternative, immediately classifying these children as “transgender,” only plays into sexist stereotypes and makes children uncomfortable with their own “masculine” and “feminine” qualities. Children have a hard enough time being accepted for whom they are without someone telling them that they have to change their name, physical appearance, and biological anatomy to conform with society’s expectations for being “male” or “female.” It’s ironic that woke conspiracy theorists complaining about “transphobia” and discrimination fail to see their own inability to accept children whose feelings and behavior do not conform to traditional gender norms.
Gender dysphoria is a complex phenomenon that psychiatrists have helped patients deal with for many decades. Traditionally, a lengthy and comprehensive psychiatric assessment would be required to determine whether gender reassignment would be the healthiest way for a patient to resolve their dysphoria. This is because medical treatments such as hormone therapy and surgery have serious and often irreversible side effects, especially in children who are still developing physically and emotionally. Yet somehow, social activists have pressured children, parents, and even doctors into skipping this important step in recent years.
When children can pick and choose their gender at will and go back and forth about their preferred pronouns, of course critics will start taking this issue less than seriously. The result is heated arguments about school bathrooms, locker rooms, and girls’ sports. These do nothing to help children with gender dysphoria, though they might help politicians get votes and social influencers gain followers. It would help a lot of children, including my patient who mistakenly thought she was transgender, if we “followed the science” on this issue and put it back into the hands of mental health professionals.
Sujatha Ramakrishna is a pediatric psychiatrist in Fort Worth, Texas.
