Transgenderism and Adolescent Identity Formation
Reasons for pause
12th May 2022
Bonnie Kerrigan Snyder
Adolescence is often experienced as an emotionally turbulent period of identity formation. For this reason, it is imperative that adults prevent children from making life-changing decisions about their gender identity and protect them from an array of potential harms, argues Bonnie Kerrigan Snyder.
If anecdotal and documented accounts are accurate, the number of young people identifying as transgender is skyrocketing. I won’t pretend to know all of the reasons why this is so, because I certainly do not. This is uncharted territory. But as a trained secondary school counselor who taught developmental psychology classes to undergraduate and graduate students for more than a decade, I would like to share a few well-founded, grounded concerns about this trend that should make thoughtful and observant adults pause.
Adolescence is a time for experimenting with different identities. Before adulthood, teens try on various possible selves en route to forming a stable adult identity. The developmental psychologist Erik Erikson characterised this as the identity versus role confusion stage of psychosocial development. It can include temporarily trying out a negative self in direct opposition to the expectations and norms of the prevailing culture. (Some teens, for instance, go through a period of juvenile lawbreaking without becoming habitual or adult offenders. This is why we have a separate system of justice to handle offenders who are minors.) Adolescents may ‘try on’ various identities, often in rapid succession, before discarding them.
During this ‘identity crisis’ stage, adolescents may go through a period of intense questioning before achieving identity ‘commitment’. According to psychologist James Marcia, who elaborated on Erikson’s identity stage, this temporary exploratory status is known as a moratorium, during which society allows the emerging adult to be undecided about their identity, while investigating various options. (Moratoria can take different forms in different cultures, but some examples include a ‘gap year’, rumspringa, foreign travel or backpacking, internships, and enrolling in college as an ‘undecided’ student.) Premature resolution of this phase, with commitment before or without exploration, can result in identity foreclosure, which is an unsatisfactory outcome laying the groundwork for future irresolution and disruption of succeeding developmental milestones. Wise adults typically loosen their grip over adolescents’ lives during these years, allowing the experimentation to proceed while remaining watchful for potentially dangerous choices, given teenagers’ natural and hormonally-driven proclivity towards emotional reasoning.
The immature brain
Teens do not reason like adults. They can’t. This is why they still merit the protection of legal guardians. Scientists now believe that human brains are not fully developed until their mid- to late-twenties – particularly the prefrontal cortex which governs abstractions like planning, thinking ahead, predicting outcomes, and controlling impulses. This may explain why societies continue to supervise young people, and why parents often have to redouble their efforts during adolescence, as risk-taking behavior often increases while poor judgment intensifies.
Adolescent brains finish developing from the inside out and from back to front; in other words, the primitive parts mature first. This process can lead to an overactive amygdala, which can increase emotional responses and result in greater impulsivity. Young people also have fragile egos and can be extremely insecure, with unstable self-esteem. They are highly suggestible, impressionable, and susceptible to peer and media influence.
Adolescents are naturally prone to particular kinds of distorted, egocentric thinking. Child psychologist David Elkind defined common types of egocentric thinking, including: the personal fable, the imaginary audience and the foundling story. The personal fable involves the feeling that you are extraordinarily special and unique and that others can not possibly understand you. This incorporates the implicit belief that your specialness somehow renders you invulnerable to harm, which is why teens can be so prone to risk-taking behaviors. The imaginary audience is a heightened sense that others are always watching you and obsessing over your appearance as much as you, yourself, are. The foundling fable is an internal myth that builds on the specialness of the adolescent fable. Because you are so unique and special, you people may imagine that you are not the offspring of your actual parents but of wiser, richer, and more beautiful ones who were somehow forced to give you up. This may sound preposterous until you realize how many enduring children’s stories are built upon this very premise, including Harry Potter, the best-selling children’s book series of all time, which not coincidentally highlights special hidden magical powers. Aspects of the current gender trend are consistent with these adolescent-unique cognitive distortions.
Those who have lived and worked with them (or who accurately remember being one) understand that teenagers frequently engage in dramatic emotional displays, but this tendency usually settles down with maturity. This is why therapists have traditionally refrained from diagnosing those under the age of 18 with personality disorders; such behavior can be a transient feature of normal development and apt to self-resolve with time.
We know a great deal about the complex processes of identity formation during adolescence. Yet increasing numbers of teenagers are assumed to be capable of making decisions about their gender identity that may have life-long social, psychological or biological ramifications. Here is what I would like to know:
How many trans-identifying youth have comorbid mental health conditions (diagnosed or undiagnosed)? This might include anxiety, depression, obsessive-compulsive disorder, borderline personality disorder, histrionic or other ‘cluster B’ disorders, or attention-deficit hyperactivity disorder. How many were victims of prior sexual assaults? It stands to reason that identifying and responding to these issues first would be a cautious first step before proceeding to experimental and possibly irreversible interventions involving young people who may lack the capacity to anticipate or comprehend the full consequences of such treatment interventions.
How great is the overlap and what is the connection between rising transgender rates and rising autism rates? Autism comes with heightened social anxiety and perceived social awkwardness. What are the chances that part of the rush to attribute a young person’s social discomfort to transgenderism might instead be a failure to understand and appreciate increasing neurodiversity? Shouldn’t we investigate this possibility, while perhaps increasing awareness and training in how to help young people on the autism spectrum cope with life’s challenges? You don’t treat the challenges of autism with hormones or surgery, but rather by building a young person’s social skills and introducing other ameliorating tools or therapies for hypersensitive, overly reactive individuals. Why not start here, and help troubled adolescents build coping capacity and relieve stress, rather than rushing to confirm a new gender identity?
How many hours a day are trans-identified youth spending on social media? My hunch is that transgender young people, who can lean towards social anxiety, may compensate by spending much more time online than their peers. Does this time spent online simply correlate with gender dysphoria or does it actually increase its likelihood? In at least one study, researchers found a positive correlation between an increase in media coverage of transgender issues and referrals to paediatric gender clinics. Is it possible that distressed teens would benefit from limiting or suspending social media access to give them a break the ongoing reinforcement being online can give to their existing anxieties? Speaking of addictions, how many trans-identified youth abuse drugs? Might this play a role in altering their perceptions of themselves?
Has anyone investigated similarities between adolescent transgenderism and anorexia nervosa? A wave of anorexia nervosa struck mainly among young females in the 1970s and 1980s. I and several of my peers became swept up in this different (but perhaps related) form of adolescent body image dysmorphia/cultural enthusiasm for several years during that era, despite the lack of internet connectivity. It spread via social contagion, media, peer pressure, and distorted thinking.
But there is a notable difference: anorexia was never affirmed by carers, educators or health professionals. It was considered a concerning, perplexing, alarming development. For the most part and for most of us, its course was time-limited and resolved, although tragically some individuals died of this affliction. Was anything learned from this era that can inform our approach today? The consensus now points to a strong anxiety component behind anorexia nervosa; others suggest female pubertal anorexia stems from a fear of growing up and specifically the (subconscious?) fear of developing into a woman, with curves that might attract unwanted male sexual attention.
Speaking of the 1970s, has anyone investigated whether the increase in young people identifying as transgender bears hallmarks of cultish practices? The sometimes overeager desire to cut off the gender-transition-seeker from family involvement and the ready provision of a surrogate family substitute raises this obvious question in at least some cases.
Why are we seeing a sudden spike in females seeking to transition to male? Known as rapid-onset gender dysphoria, this manifestation appears to be peer-driven, since it often occurs in social clusters. Would adolescents in the aggregate be better served if these self-reinforcing clusters were broken up by astute, alert teachers, parents, and counselors? We already know that females are more susceptible to emotional contagion. Are there other factors that could be driving this increase among young girls? Could it be driven by internalized sexism—self-loathing turned inward? Is it possible that prevalent media coverage of issues such as rape culture, the Me Too movement, omnipresent sexism, and workplace discrimination might be stoking pre-existing female anxieties and driving a desire to seek escape from their apparently stricken, targeted gender? Could it be a way of claiming power and self-determination in a culture perceived as threatening and overwhelming?
Is there a connection between the declining age of menarche and rising transition rates? With some girls now starting puberty as early as elementary school, is it any wonder that they may seek refuge through so-called ‘puberty blockers’? What are we doing to help young girls cope with this new biological reality and the accompanying attention and social pressure it brings? Menstruation certainly restricts personal freedom and imposes new, often unwanted limitations on a growing girl. Is it possible that what some of these kids need most is more time just to be kids? Perhaps our cultural traditions and assumptions need to change to adapt to these developments, rather than changing our children.
And finally, an ugly but unavoidable question: cui bono? Who is benefiting from rising rates of gender dysphoria? Is it really our teenagers? Or is it groups with financial interests in the increase, like pharmaceutical companies, the medical community, political activists, and/or the media? We must remember that none of these should take precedence over the moral imperative to exercise extreme caution to protect vulnerable youth from avoidable harm.
A duty to care
Until we have answers to these questions, let’s exercise copious caution and restraint in responding to adolescent urgency to change genders medically. We are now hearing about detransitioners, transition regret, and lawsuits by former gender clinic patients. With everything we do know about adolescent identity development, and so much unknown about what is driving increasing rates of gender dysphoria, we should be taking a collective breath and hit the brakes on the headlong rush to medicalize and pharmaceutalize a young person’s legitimate distress and valid concerns. Considering what is at stake, namely the health and wellbeing of minors, asking questions such as the ones that I have put forward is not just reasonable but absolutely necessary.
This does not mean neglecting young people who are struggling with their identity. We can hesitate without neglecting the immediate emotional needs of distressed teens experiencing gender discomfort. We can demonstrate copious care, empathy, and compassion for the excruciating challenges of adolescence – all heightened and exacerbated in today’s fraught cultural climate. We can build healthy self-esteem and provide support and appreciation for youth with body image issues. We can focus on the development of effective interpersonal social skills, encourage qualified talk therapy, and provide plenty of healthy distractions while their brain development proceeds. We can enrich their spiritual lives. We can pull the plug on unhealthy social media addictions, turn off our own digital devices, and head outdoors together to clear our collective heads and disrupt the nonstop, reinforcing narrative.
Medical transition options aren’t going anywhere. They will be there when we get back.
The primary counterargument — that not offering those seeking to transition unquestioning affirmation of their new gender identity increases suicidality — is frightening for obvious reasons. Yet new research indicates that the administration of puberty blockers does not alleviate negative thoughts in children but does interfere with height attainment and bone growth. Evidence about the long-term outcomes of sex reassignment remains scanty and unresounding; more research is needed to bolster our understanding. Whatever comes of such research, the potential competing harms must be weighed against one another. Certainly, anyone expressing suicidal ideation or intent to self-harm should be referred immediately for competent mental health evaluation and treatment.
While it will be difficult in today’s turbocharged political atmosphere, it is time for calmer, more mature heads to prevail. In an environment in which such profound disagreement persists among adults, guarded circumspection is the prudent approach. Adolescents are often in an impatient rush, despite having so much lifetime in front of them; their impulses frequently outrun and override their judgment and foresight capacities. Pleading for patience has always been the job of the adults in their lives.
We must hope that wisdom prevails and sober heads predominate to guide us and our precious children.