Affirming Anorexia

Three years ago, Katherine’s world turned upside-down when her teenage daughter—we’ll call her Lauren—came out as transgender in a Google Doc. She knew that her daughter—and her daughter’s friends—had been trying on new identities and struggling to adjust to the changes puberty brings. Just a few months earlier, Lauren had come out as gay—an announcement her parents took lightly, given Lauren’s year-long crush on a boy in her class. “I knew sexual orientation can take awhile to figure out,” Katherine said. But trans came out of nowhere. 

The Google Doc declaration had Katherine confused and concerned. “My kid is a writer, so I’ve read hundreds and hundreds of pages of her writing over the years. It was obviously not written by her. And it was so hard to follow. At one point, she said she was a gay boy and then, at the end, said she was nonbinary.” When Katherine and her husband tried to talk to their daughter,  Lauren broke down: “She was hysterical and crying. She was so sure we were going to kick her out.” The time Lauren had spent immersed in online trans communities had convinced her that her family would reject her and that she would end up on the street. These communities “made her believe we were the enemy.” Her parents did everything they could to reassure Lauren and help her feel safe and loved. 

Katherine paused. “We made a critical error at that point.” Katherine and her husband took Lauren to see the pediatrician who they had known and trusted for years. “It didn’t occur to me to talk to the doctor ahead of time. In every other case where we’ve had some fear, she’d calmly say, ‘this is what the science says.’ So I had no reservations about telling her this. I expected her to be logical. I expected her to ask more questions that would get to the root of my daughter’s concerns.” 

But that’s not what happened. Instead, the pediatrician said: “‘Oh, how wonderful! Where are you in your gender journey? Have you chosen a new name and pronouns?’” and immediately offered a referral to a gender clinic. 

“It was one of the worst moments of my life,” Katherine reflected. “We begged our daughter to delay coming out to give us time to research and understand her point of view. She wanted us to do all the announcements with our family and friends and we weren’t willing to do that without understanding it ourselves. She reluctantly agreed and I started researching.” 

At first, Katherine found only pro-trans materials, resources that echoed the pediatrician’s line: “Oh, that’s wonderful, you have a son now.” But she kept digging. “My degree was in pre-med. I know you can’t change your chromosomes. I took clinical anatomy. I’ve held reproductive organs in my hands. I know you can’t ignore reality.” 

Finally, Katherine couldn’t postpone the visit to the gender clinic any longer. Her daughter insisted. 

“I think I’m the only parent I’ve ever heard of where they took their child to the gender clinic and they were sent away.” The intake coordinator was a “lovely woman” who spent a lot of time speaking with Lauren and her parents. At the end of the appointment, she said she didn’t think Lauren was a good fit for the gender clinic. Katherine felt a rush of relief: She’s not trans. 

After Jamie Reed blew the whistle on the Transgender Center at St. Louis Children’s Hospital, Katherine thought she finally understood why. “I think this article solves the mystery of why my daughter is the only child I’ve ever heard of being turned away from a gender clinic. I now suspect it’s because the intake coordinator there was seeing the same trends as Reed and turned us away because of my daughter’s anorexia, ADHD, and anxiety diagnoses. I was so grateful at the time that I didn’t ask questions. But I’ve always wondered.” 

Meanwhile, Lauren’s struggles with anorexia had come roaring back. “Right after that, we had to put her in the hospital. And since then she’s been in the hospital twice and she spent months in a residential clinic, where she came in contact with other trans-identified girls and learned new tricks—like cutting, she had never done that. She was exposed to things she had never thought of herself. And I think that was traumatic. It made getting better harder.” 

Katherine and Lauren didn’t know it, but they weren’t alone in their experiences. Over the past few years, I’ve spoken to several former staff members of residential eating disorder clinics. The women I spoke to said social contagion is a huge problem in residential facilities. “We have to be constantly on hyper-alert to prevent clients from cross-contaminating their disordered behaviors… negative body talk was redirected every time, in the moment, if possible.” But when a patient came out as trans, strict rules bent and broke. Negative body talk was suddenly allowed—even encouraged—if patients who identified as trans voiced hatred for their breasts and hips or expressed the desire for breast amputation. Consequently, trans ideation—like other maladaptive and self-harming behaviors—spread like “wildfire” in residential settings. 

“The most frustrating thing has been trying to get help for her eating disorder,” Katherine said. “Clinicians only wanted to talk about her gender identity. They see trans identity as a causative thing: the trans identity is trying to come out and the anorexia is the result of that.” But Katherine saw things differently: “I view trans identity as a magical cloak that protects the eating disorder.”

“These medical professionals should know better. Especially the first time Lauren was in the hospital, not a day went by without one of the doctors pulling me aside and asking why I didn’t have her on hormones or puberty blockers. I felt so bullied by the end of it.” 

Katherine looked for help. “I begged her pediatrician: ‘Just get us out of here. This isn’t helping.’ And it was frustrating because Lauren didn’t even want any of those interventions and these medical providers were bullying me about putting her on blockers or hormones against her will, while ignoring her anorexia.” 

“By the second time she was in the hospital, I was ready to deal with the doctors, especially the one who was the most insistent. I finally asked her: ‘why are you pushing this?’ And she said her best friend had a child who was trans, a boy who identified as a girl, and she said ‘but this child is so happy.’ And I said: ‘That’s great for your friend’s child, but that doesn’t have anything to do with my child. Are you going to affirm her anorexia, too, or are you going to help us?’” What Katherine learned the hard way was that activist-doctors were prepared to bully any parent who wasn’t prepared to fight back. “I was ready to fight. By then, I had way more resources. I’d been talking to Sasha Ayad and Stella O’Malley. I’d binged on podcasts and read books on the topic like Helen Joyce’s Trans. I knew what I was talking about. I don’t give those people any leeway anymore. I’m strong about it.” 

Once Lauren was out of the hospital, finding a good therapist proved to be another battle. “I spent months and months trying to get her a therapist to focus on her anorexia. But as soon as she said something about gender, the therapists would focus on that. Even therapists who claimed they were Christian or non-affirming, even Jungian analysts, who really should know better. They were all just totally on board.” 

“It wasn’t until recently that I found a therapist who was willing to talk more openly.” But the therapist had her own frustrations, confiding in Katherine that even if she were able to get through to her young patients, who tended to “clam up” as soon as therapists started probing, a new Oregon law banning “conversion therapy”—including talk therapy for patients struggling with gender identity issues—tied her hands. 

Over the years, Katherine has gotten to know many other parents who are desperate to find help for their kids—many of whom struggle with eating disorders or other self-harming behaviors—and meet with blind affirmation instead. “Once a kid talks about gender, it’s like doctors and therapists all lose their brains and forget everything they know about child psychology, puberty, and child development… They just don’t see the connection between self-harm and transgender identity… how does a doctor not look at those self-harm scars and see the hatred of the body expressed by trans identity and not see that it’s the same thing?” 

“Doctors shouldn’t rush to confirm a child’s self-diagnosis. They should get curious about what might be driving this.” 

Katherine also went back and confronted her daughter’s pediatrician, asking her why she had jumped to affirm Lauren’s new transgender identity without asking any questions. The pediatrician—caught off-guard—confessed that she knew it was a fad but she was just following the American Academy of Pediatrics guidelines. Affirmation was essential “because of the suicide risk.” Katherine pressed on: “‘If you were worried about my child, why didn’t you ask any questions about that? Why didn’t you refer her to anybody who could assess her risk? Why did you just affirm her and assume the gender clinic would assess that risk?” 

“I wish doctors would be willing to—I don’t want to say they should distrust their professional organizations—but I wish they were willing to be curious and treat each kid as an individual… These feelings could be transitory. It seems like doctors forget what it’s like to be a kid and I want them to remember that kids aren’t mini-adults. They’re not fully formed yet. They can change their minds. And it’s so frustrating that so many doctors seem to have forgotten their training in favor of blindly adhering to activist guidelines that are backed by so little evidence… they have to know that cutting off healthy body parts and filling the body with opposite-sex hormones isn’t going to lead to a healthy life.” 

I asked Katherine what advice she would give to other parents who find themselves in her situation. “This comes up all the time, actually, because so many people are always joining the various parent groups I’m in. And it’s always the same pattern. We let them vent for a while. They need to talk. But it’s the same story every time, almost word for word… We empathize with their pain and fear and then we share the resources we have like the podcast,  Gender: A Wider Lens or books like Irreversible Damage by Abigail Shrier and Hold Onto Your Kids by Gordon Neufeld and Gabor Mate. And we always tell them: you’re not alone. You’re not crazy. You have to try to take a step back and work on the relationship with your child and ignore the gender thing if you can. It helps.” 

Looking back on the days after Lauren first came out as transgender, Katherine remembered that, “for a while, I really tried to talk about it openly. But that just triggered her more. She said she didn’t want to talk about this with me. So I’ve gotten more covert. We talk about it but tangentially. We talk about critical theory. We talk about how other people perceive you and how you can’t control what other people think. I think it’s helping.” 

“Before she came out to us, she had thrown out all her Harry Potter stuff. She had been such a huge fan. She told me after she came out that she thought JK Rowling was a transphobe, which I had never heard of. And right after that, she called me a ‘TERF’ because I said that people couldn’t change sex. I didn’t know what it meant at that point. But I kept pressing. I asked her why she hated JK Rowling, and she said, ‘because of what she said.’ So what did she say, exactly? She sent me a YouTube video that broke down every supposedly ‘transphobic’ thing Rowling had ever said. So we watched that and talked about that for awhile. I said that this is about cancel culture and that if you cancel somebody for a view you think they hold that precludes them from ever changing their mind. She no longer hates JK Rowling. When the Hogwarts Legacy game came out a few weeks ago, she said, ‘Oh, are they trying to cancel her again?’” 

“Lately, I feel like there’s a little openness that wasn’t there before. I just keep at it. I look for opportunities to point out differences between men and women that aren’t going to upset her. Her brother is growing up and I’ll say, ‘yeah, that’s what testosterone does.’ She rolls her eyes. I can tell she doesn’t want anything to do with that sort of thing, or boys in general. I think she’s seeing herself more aligned with being female, after being in this for three years. At the beginning, she was holding herself away from me and everybody else. Now she’s talking.”