Edwards-Leeper: Support doesn’t always mean medical interventions

This summary was written by a Genspect parent.

Many thanks to independent journalist Meghan Daum of the Unspeakable podcast for giving the complex issue of best care for gender-questioning children and youth the attention it deserves by hosting a three-part series this week with Dr. Laura Edwards-Leeper, journalist Lisa Selin Davis, and affected parents. Many thanks to independent journalist Meghan Daum of the Unspeakable podcast for giving the complex issue of best care for gender-questioning children and youth the attention it deserves by hosting a three-part series this week with Dr. Laura Edwards-Leeper, journalist Lisa Selin Davis, and affected parents. Listen to the first episode (interview with Dr. Laura Edwards-Leeper) here and the third episode (Lisa Selin Davis) here.

“As far as I know, there are no studies that say that if we don’t start these kids immediately on hormones when they say they want them that they are going to commit suicide. So that is misguided. “

Dr. Laura Edwards-Leeper

With this stunning admission from Dr. Laura Edwards-Leeper, part two of this week’s three-part “Gender Nuance” series, “We Feel Like We’re In The Wild West:” Parents of Gender-Questioning Kids Ask Their Own Questions, opens up a lively discussion. Dr. Edwards Leeper returns to answer questions from “Jolene” and “Marie,” two moms of gender-confused kids who were originally interviewed by Meghan on the Unspeakable last July.

Dr. Edwards-Leeper starts by defining the terms gender dysphoria and transgender, saying there are people who may experience gender dysphoria but who are not transgender and would not benefit from transitioning. Often providers see gender dysphoria as a diagnostic label if someone meets the diagnostic criteria simply per their self-report. Unfortunately, these providers then jump to medical treatment, which is problematic because it is not always the best treatment.

Both Moms believe their sons had rapid-onset gender dysphoria, so this controversial topic inevitably came up. Dr. Edwards-Leeper noted the high correlation between gender dysphoria and autism and that these and other kids, who had no evidence of gender dysphoria growing up, learn about gender ideology from the internet or peers at school at or after puberty.

She has mixed feelings about ROGD and how it is used by some parents. She also addressed some of the criticism around the methodology used by Dr. Lisa Littman. However, she added that interviewing parents of children is commonly used in child studies generally because parents’ perspectives are crucial to understanding. She pointed out similarly designed studies on the pro-trans side, and no one is all up in arms over those. She said the Littman study has given us some language to talk about what’s going on; thus, the study shouldn’t be thrown away.

She went into great detail about the types of assessments she does with her clients – and which she believes every child should have. Critical elements of the assessment include general development as well as gender identity development; she also looks for conditions such as autism and other mental health issues that could be causing the gender dysphoria. She talked about the importance of including parents and the family in this process and is surprised that many providers completely omit the family. She admitted there is no certification program for transgender health and that current trans courses are not teaching providers how to do in-depth assessments or exploratory therapy. Instead, the model is to affirm as quickly as possible because of the belief that the mental health of such gender-questioning kids is going to deteriorate and they will become suicidal. A big problem is that many of these mental health and medical providers have not been trained in child and adolescent psychology and therefore don’t understand normal development for people under the age of 25.

When asked to discuss the actual suicide risk and to cite the evidence and studies we keep hearing about but can’t find, she admitted there are none as far as she knows. She said these youths are misunderstood and need support from their parents. However, she clarified that support does not always mean providing medical interventions; she has a real problem with those who feel the need to intervene medically to prevent suicide and doing it quickly without proper or even any real assessment.  

She addressed the fact that transgender care has moved away from a partnership between mental health and medical care to primarily a medical-only treatment model. Furthermore, some medical providers disagree with the WPATH Standards of Care and do not follow them because they see them as transphobic and not affirming. She hopes the new version of the Standards of Care will provide clearer guidance. Providers also fear that if they don’t act quickly to affirm and medicalize, they will be labeled transphobic and non-affirming. She said unfortunately some providers view her in that light. However, the danger of moving kids so quickly down the medicalizing path is that they may be facing irreversible medical treatment, via cross-sex hormones, while still very young. She said children and young people before 25 can’t make a decision like someone who is 25 or 35.

There was some discussion of gender and sexuality being intertwined as well as internalized homophobia as a factor in a trans identity. We know from many detransitioners that internalized homophobia played a big part in their former transgender identification. Jolene asked: “Wouldn’t transitioning a gay person to turn them straight be the ultimate form of conversion therapy?” Dr. Edwards-Leeper replied that sexuality and sexual orientation needed to be discussed as part of assessment and therapy. In therapy, some young adults indeed recognize they have a sexual orientation rather than a transgender issue.

The interview ended with a poignant plea from one of the parents: Why isn’t the ultimate goal to be at peace with the body you were born with?

Unfortunately, that question remains unanswered.

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