It’s apparently trans awareness week but, based on the reactions I’m seeing on Twitter, this isn’t the kind of awareness most trans activists were hoping for. Reuters has published a lengthy article about concerns among some experts that the gender imbalance among trans teens is a cause for concern.

Thousands of children who…were assigned female at birth have sought gender-affirming care in recent years. And for reasons not well-understood, they significantly outnumber those assigned male at birth who seek treatment…

Professionals in the gender-care community agree that treatment of all transgender children should be supportive and affirming. The question, for some, is whether peer groups and online media may be influencing some of these patients to pursue medical transition, with potentially irreversible side effects, at a time in their lives when their identities are often in flux.

Corey Basch, a professor of public health at William Paterson University in New Jersey who researches health communication and teens’ use of social media, said she fears that some adolescents are susceptible to making faulty self-diagnoses without adequate input from medical professionals. “Teens are so incredibly vulnerable to information overload and being pushed in one direction,” Basch said. “They could be lacking the analytical skills to question who is giving this advice and if their advice is valid.”

Adolescents assigned female at birth initiate transgender care 2.5 to 7.1 times more frequently than those assigned male at birth, according to the World Professional Association for Transgender Health (WPATH), a 4,000-member organization of medical, legal, academic and other professionals. Several clinics in the United States told Reuters that among their patients, the ratio was nearly 2-to-1, and similar phenomena have been documented in Europe, Canada and Australia.

There are basically two camps about how to interpret these facts. One camp suggests that the rise in the number of trans teens just signals greater acceptance and social awareness of the options. The other camp sees the gender imbalance as an indication that there may be more going on than just some people’s internal feelings of discomfort with their bodies.

In its new Standards of Care, published in September, WPATH acknowledged for the first time that “social influence” may impact an adolescent’s gender identity. The organization recommends that youths undergo an in-depth evaluation in part so that clinicians “can discern between a person’s gender identity that is marked and sustained and an identity that might be socially influenced,” according to Dr Eli Coleman, director of the University of Minnesota Medical School’s Institute for Sexual and Gender Health who oversaw the update of WPATH’s guidelines.

Some patients may see others touting huge improvements in their quality of life after transitioning, and so they think, “‘I’m having these same problems, and transitioning to a different gender will help me feel better,’” said Dr Laura Edwards-Leeper, a clinical psychologist in Oregon who specializes in treating transgender children. She was a co-author of WPATH’s new Standards of Care for adolescents.

The story includes one example of a mother who refused to give in to pressure for medical intervention for her daughter prior to 18. And in her case, she, and her daughter, are glad she did.

Kelly, a 43-year-old parent who asked that her full name not be used to protect her family’s privacy, told Reuters that her child was heavily into highly sexualized anime and transgender online forums when the 12-year-old started experimenting, seemingly overnight, with being a transgender boy. The child’s therapist encouraged medical intervention, Kelly said, but while Kelly supported social transition outside the home, she made it clear that her child would have to wait until she was 18 for hormones and top surgery.

After several years of living as a boy and using “he” and “him” pronouns, Kelly’s child, now 18, is back to using her female name, dressing in feminine clothing and using “she” and “her” pronouns. “We would have lost our daughter if we had followed what the therapist was telling us to do,” the mother said.

The story quotes a psychiatrist from Finland who says the fact that some teens may be emulating their peers doesn’t bother her. What bothers her is seeing them quickly settle on a fixed identity.

That these teens were possibly emulating each other didn’t bother [Dr] Kaltiala. “That is perfectly normal” in adolescence, she told Reuters. What did bother her was that many of the teens had concluded quickly that they were transgender and viewed their identity as fixed, attempting to cut short the process of identity formation that typically lasts years.

She also encountered a handful of young patients who regretted medically transitioning. “They have said, ‘I was so sure that you could not have changed my mind. I was so confident that this is the way, but nevertheless I think it was a mistake,’ ” Kaltiala said. “I take that really seriously. It’s a horrible situation for everybody.”

Reuters quotes a doctor who helped write the current WPATH guidelines dismissing the “false narrative” that some teens are being lured into becoming transgender. But they follow his objections with the story of Prisha Mosley a girl who became convinced she wanted to transition and who had top surgery only to later regret it.

Mosley said the physical transition did not alleviate her depression; she continued to cut herself. Her mental health began to improve only after several years of behavioral therapy. At 22, she stopped taking testosterone and determined that she regretted transitioning.

“I decided that I didn’t want to be a woman before I had ever even experienced being a woman,” said Mosley, who is now studying psychology at a community college in Michigan. “Now I feel like I will never entirely know.”

Now she is hoping to get breast reconstruction surgery. There’s a lot more to the story which seems like an effort to be even-handed even as it raises some concerns. But scrolling through some reactions on Twitter, trans activists are not pleased that this was published at all.

Update: I’m not including the reaction tweets because most of them are from accounts with very few followers. But this one involves two people who are relatively well known.

Why not address the actual issue? Why so many girls rather than boys? Have you ever given an answer to that question? https://t.co/aC9nznlT59

— Andrew Sullivan (@sullydish) November 18, 2022