Theology in the Raw - 870: Another Take on the Pronoun Debate: Dr. Julie Maxwell

Episode Date: May 27, 2021

Should Christians use a trans* identified person’s chosen pronouns (i.e. ones that don’t align with their biological sex)? I (Preston) have argued for “pronoun hospitality,” that Christians should use a person’s pronouns. And Julie generally agrees with this perspective, but she believes that it’s sometimes better for the long term well-being for trans* identified children and adolescents when their parents don’t use their chosen pronouns. In case you didn’t know, this is super controversial! Which is why we need to have this conversation.  In this episode, I talk with Julie about her perspective, evidence for and against it, and various other things related to the discussion about how to best treat trans*-identified children and teens. Julie is a licensed pediatrician in the U.K. and has written extensively about Gender Dysphoria and trans* identities.  Support Preston Support Preston by going to patreon.com Venmo: @Preston-Sprinkle-1 Connect with Preston Twitter | @PrestonSprinkle Instagram | @preston.sprinkle Youtube | Preston Sprinkle Check out his website prestonsprinkle.com If you enjoy the podcast, be sure to leave a review.

Hey, friends. Welcome to another episode of Theology in the Raw. Okay, this episode is going to be, well, it's going to be controversial. I mean, this is Theology in the Raw, and almost every episode is controversial, I think. But this one is particularly sensitive. Let me just give you a brief backstory on how I got in touch with Julie Maxwell, Dr. Julie Maxwell. Maxwell, Dr. Julie Maxwell. First of all, she's a pediatrician in the United Kingdom and has been, in the last several years, has been fairly involved with the gender conversation, specifically as a pediatrician, how to best treat or think through teens and children with gender dysphoria. And she has written articles on this topic and has kind of just entered into a very controversial area. So Julie read my book and really loved it. She reached out with emails saying, hey, I loved your book, Embodied. I do have a slightly different perspective on your position on pronouns, like using someone's pronouns, or as some people say, using someone's preferred pronouns. Okay. So let me just, first of all, share just as concisely

as I can, kind of my perspective on pronouns. I often get asked, should a Christian use a person's preferred pronouns? And now I just want to acknowledge some people don't like the term preferred pronouns. Some people say, just call them your pronouns or their pronouns. And so I've thought through this question for quite a bit of time, and I have a whole good chunk of my chapter in my book, Embodied, deals with whether Christians should use someone's pronouns if they don't match their biological sex, okay? So if a male wants you to call them she or her, or maybe they them, you know, is another part of this conversation, you know, should a Christian comply to that? Now, some people would

say that it's lying to use the pronouns of a person that doesn't match their biological sex. Other people would say, like, I don't want to, and this is, I'm going to quote somebody here, you know, I don't want to feed their delusion. I think that language is a bit strong and can be pretty dehumanizing, but that would be an argument too. Like if somebody thinks they are, or if somebody is a male and thinks they're female or a female and thinks they're male or identifies as a sex different than who they actually are, that they are deluding themselves. And if I use their pronouns, then I'm only furthering that delusion. Okay, so that would be one perspective that we need to be truth tellers, that we need to not encourage somebody's wrong view of themselves. Another perspective is what I call, or what Greg Coles calls, pronoun hospitality. And this is the view that I do take.

And I've talked about this in the podcast before, so I know this is probably a bit old news to some of you who have been listening for a while. But pronoun hospitality says that you don't necessarily need to agree with a person's use of their pronouns. But as people who want to meet someone where they're at, we should exercise hospitality and use the pronouns that they desire that you would use of them. Okay. And the way I've explained it is that language is shared social space, right? Shared social space. So if you're watching on the video version of this podcast, which you can go to YouTube, and usually the video version is released after the audio version. But for those of you watching, so language is shared social space. I'm doing

some arm signals here. Over here, you have person A, and person A has a certain worldview. And over here, you have person B, and person B has another certain worldview. And the way they relate to each other is through this common ground of language. Language is shared social space. Now, sometimes as person A and person B are trying to talk, there's worldview differences that affect how they use certain words. And so person A might believe that pronouns are supposed to match a person's biological sex, whereas person B might think, no, pronouns match my gender identity, not my biological sex. Person A can say, well, I don't even agree with that whole perspective. I don't even think gender identity is a thing. Person A might have that worldview, but for person B, it is a thing. It's a huge part of their life and pronouns can be a big part of that, of their journey.

And so somebody kind of has to give in. And this is where I'm going to say as a Christian, I think that Christians should use the person's pronouns as a way of meeting them where they're at, as a way of using this. Because if we demand that person B lines up with our worldview commitments and uses language in the same exact way that we understand language, because again, language is connected to someone's worldview, then we're going to have a hard time relating with people. And specifically within the trans conversation, pronouns oftentimes are a huge deal to trans identified people. When I say trans identified, I'm including non-binary people who identify as gender fluid, genderqueer, and so on. Even if you don't understand that, even if you get frustrated at the whole pronoun thing, for other people, this is a huge deal. And for some people, hearing pronouns that match their biological sex can exacerbate their dysphoria. And it could possibly even lead to thoughts

of self-harm, maybe even suicidal ideation, and so on. So as a way of meeting someone where they're at, I think in the chapter in my book and in other places, I encourage people to use a trans-identified person's pronouns, okay? Even if you don't necessarily agree that pronouns should match gender identity and not biological sex. So that's my general position. Now, over the last couple of years, I have talked to several counselors, psychologists. I'm thinking right now of one medical doctor, one counselor, another medical doctor, a parent, a couple detransitioners, people who used to identify as trans and now no longer do. All of these people, I'm not going to name names, but I've got their names in my head, have said to me, basically, Preston, I see your general point and I might even agree with it.

But when it comes to parents and children, we would recommend not using your child's pronouns. So I've tried to think through this perspective because these are people that are very gracious and wise and are working a lot with young trans-identified kids, so like pre-adolescent or even adolescent kids. And they have said there are certain cases where we don't think it's helpful or good for the kid, for the parent, especially to use the person's pronouns. Obviously, the parent should be loving and listening and create a nurturing environment and should walk with the child and listen to the child and cry with the child and rejoice with the child and be there for them, provide for them, provide a loving,

safe context. But in certain situations, that doesn't necessarily, this is their perspective, that doesn't necessarily mean that we agree with every demand of the child. And this might be a case where it's more helpful for the long-term well-being of the child to not, as they would say, give in to pronoun usage, which might reflect some degree of social transitioning. So Julie is of that persuasion as well. So she reached out to me recently and said, I loved your book, agree with so much of it. I like your general take on pronouns, but I think there's cases, especially with younger teens that might be wrestling with lots of other mental health issues. Maybe they fall within the rapid onset gender dysphoria kind of category. Maybe they're really young, like seven, eight, nine, 10 years old.

they're really young, like seven, eight, nine, 10 years old. And she says, I got several scenarios where it was actually unhelpful for the parent to use a child's pronoun. So I said, you know what, Julie, thank you for reaching out. Can we talk about this in the podcast? And so we were going to have a phone conversation, but I'm like, let's just have a live podcast conversation because this is theology in the raw and this is extra raw. So in a sense, we just had a conversation. I said, I want to hear your perspective because I keep hearing people I respect share this as kind of one caveat, one scenario where not using a young person's pronouns might be the most helpful for that person. And so again, this isn't kind of the stubborn resistance of this anti-trans, you know, I don't like trans people, so I'm not going to use their pronouns,

or this is a Marxist agenda of trying to take over the country. And so I'm just going to resist it, or it's not, it's not coming from that kind of spirit. And that's why I wanted to have Julie, and maybe not some other people on to talk about, um, a kind of slightly different perspective. And so we had a conversation about it. And for some of you, I think you'll probably just full on agree with her. Some of you are parents who are like, man, this is exactly my situation. And I'd agree with Julie. Some of you might say, I totally disagree with Julie. And some of you might even say, I can't believe you're even having her on, you know, the whole like you're platforming this, you know, harmful, dangerous perspective or whatever. Um, I don't like,

I don't take that approach. Like I think if somebody has good, thoughtful things to say, we should consider it. We should wrestle with it. And I thought flat out, Dr. Julie Maxwell had good, thoughtful, convincing things to say. And so I'm still wrestling with it personally. Um, I think she brought up some really good points and I'm going to let her share those points with us. So we focus on the pronoun discussion for the first part, and then we do get into some broader conversations about where is the medical community at, especially in the UK and continental Europe, where is the medical community at in terms of addressing teens

who identify as trans who might be experiencing gender dysphoria? It's a huge debate today. Lots of kind of upheaval going on in the UK and in Europe. United States, not so much. We're still kind of behind the times a little bit in terms of some apparent kind of like on the surface medical consensus, which isn't really accurate. But yeah, so I think it's helpful for us to kind of look at the UK and other countries that are kind of further along than we are in this conversation to kind of learn from maybe some mistakes that they've made. And we talk about that quite a bit in this podcast. So that's a long intro, I know, but I want to kind of set it up with kind of my approach to how I've wrestled with the pronoun debate and also why I wanted to wrestle with Julie's really thoughtful perspective. So if you want to support the

show, you can go to patreon.com forward slash theology in the raw support show for as little as five bucks a month and become part of the theology in the raw community. All of the info is in the show notes. Really appreciate your support of this show. Without further ado, let's get to know the one and only Dr. Julie Maxwell. All right. Hey, friends. I'm here with somebody who I've known from a distance. I've seen your name pop up in some articles and stuff that I've come across. And I was so excited, Julie, when you reached out to me. So thanks so much for being on Theology in Iran. I know this is kind of a last minute setup. We've had some email exchanges and I was like, man, well, let's just get on the podcast and talk about this. And as I said in the intro, I mean, everything we're going to be talking about

now is going to be debated, controversial. Some of our listeners might applaud some things we say at one point and then be curs you know, cursing and screaming the next point. So, uh, this is Theology in a Raw. We're, we're, we want to have open, honest conversations and, uh, even especially with sensitive topics like the one we're going to talk about. So, um, Julie, yeah, I want to, um, I already shared my perspective on the pronoun, uh, conversation. Um, and, um, yeah, why don't we jump in? Yeah, let's just back up. Why don't you tell people who you are, what you do, and then we'll love to dive into the pronoun conversation. Yeah, hi. So I'm Julie and I'm in the UK. I'm a community pediatrician, which means that I work with children with learning difficulties, autism, ADHD, language disorders.

I also work for an organization called Lovewise, which teaches Christian sex education. So that's partly how I kind of got interested in the whole gender area. But through my own children, I was going to say three teenagers, but one's 20. So she's not a teenager anymore. And I also head up the 11 to 14 youth work in my local church as well. And you're in South East London, you said, or Southwest? Southwest of London. Yeah. Okay. By the airport or one of the many airports? About an hour from London.

Okay. Okay. London was one of my favorite cities. I've only been there a couple of times, but, uh, yeah, just, uh, yeah. Driving in London was, I don't recommend that for Americans. No, nor UK people either. I only ever go by train, but I'm missing it. I haven't been to London in about a year now. So I'm going on Friday, actually. Okay. Why don't you start? Can you summarize your general perspective on the pronoun kind of discussion, where you've come from? And then I want to dive down specifically into your specific field as a pediatrician and using pronouns with younger children? Because I know that that is kind of a unique situation. Yeah.

So, I mean, I think as I've got interested in the whole gender issue and kind of started off just, I suppose it was a bit of an academic interest to start with. I started reading about it. I then discovered I had a friend who had a teenage son who was identifying as a girl. And then I've increasingly read lots of things, but also gradually got to know families who've got children identifying as the opposite sex, both informally and through work. So I suppose I've I started off with a very clear kind of, well, I would never use the incorrect, biologically incorrect pronouns in any circumstance because it would be dishonest. However, you know, I sort of think, you know, when I'm faced with a, for example,

a 16 year old who turns up in my clinic, I'm, you know, to that 16 year old who is a already very troubled young person, you know, I'm not going to do anything that is going to upset them or make them, you know, make them feel uncomfortable. However, I'm going to be honest with them. So I think it's one of those things that is a little bit dependent on each individual situation. And you might be in a situation where you don't know. So if somebody appears to you and says that they're a boy, it might only be later that you find out

that actually biologically they're a girl or vice versa. But I think what really concerns me is is this whole area of sort of social transition. So when you're talking about children and I mean, I've I've come across children as young as five or six who who are socially transitioned. And the whole name and pronoun thing is a really big issue for them. So that for them is the sort of big thing that is then often, I don't know how it works in the US, but in the UK, schools will have celebration assemblies where they'll kind of reintroduce this child with this new name and this new pronoun. And everybody has to call the child by the new name and the new pronoun.

And this child then is then led into a situation where they believe that everybody really believes that they're the opposite sex. So particularly for a young child, which, of course, those people don't really believe that they're just doing it to kind of make that child feel more comfortable. And it also kind of solidifies or can solidify that gender identity in the mind of that young person. in the mind of that young person, you know, and we know from studies that actually the vast majority of children with gender dysphoria will, of course, grow out of it. And so we shouldn't be doing anything that might prevent them from growing out of it. And actually, it could very clearly be argued that using names and pronouns in some situations situations could go you know could could be one of the things that actually pushes them one way or the other um or encourages them one way or the other you said something interesting you said the other kids don't really believe it have you said

that kind of a passing is that what's that based on is it based on do you have like lots of experience where that's true or how like if someone's a pushback like how do you know they don't believe they don't actually agree with so i mean so i can think of a couple of scenarios so one is is a scenario which i i was told about um so it and i imagine it's a probably a fairly common scenario so a biological female who um has had the sort of the the celebration assembly where they've you know come out as a boy they've been given a you know they've chosen a boy's name boys pronouns all the children at school are using this is kind of secondary age so probably 13 14 something like that so everybody is is is referring to this girl as a boy um and everything all seems to be going well until this uh girl biological girl asks another girl out on a date

and this other girl who has been calling this child by a boy's name, the reaction is, well, of course, I'm not going to go out on a date with you. I'm not a lesbian. And the girl is then absolutely devastated because she honestly thought that everyone believed she was a boy. But of course, if they really believed she was a boy, they wouldn't be thinking that her asking them out was making them a lesbian. The other scenario is, I think, particularly becomes really obvious, I think perhaps more in primary schools, where often the children will accept, actually, and believe that the child is the gender they they say they are unless you have a child with autism and I I've come across a situation where if you've got a child who is on the autistic

spectrum another child in the class um decides that you know to identify as the opposite sex and this autistic child cannot handle it at all because they, you know, they deal with facts and they know that this child was a boy and is not a girl. And no amount of anyone telling them any different, you know, and so they end up then getting into trouble because they can't, you know, change it. So, yeah, those are two kind of scenarios. it. So yeah, those are two kind of scenarios. I'm curious, because I've got a little echo here. Turn this down. If a parent comes to you and their kid is wants to transition or is, you know, acting in ways that are stereotypical of the opposite sex. Maybe they're wrestling with gender dysphoria and they want to be called, the child wants to be called by the pronouns that match their gender identity, for lack of better terms, even if they wouldn't frame it that way. How would you counsel the parent then? Is it just case by case? I mean, it depends on

what the... Well, let me, let me stop. I got all these questions that follow questions, but I'll just would love to hear your thoughts on that. I mean, I think it was interesting actually, because I was talking to somebody just yesterday who is involved in a parent support group. And they, they were saying that a lot of the parents that when they first come to that group they have started using the child's chosen name and pronouns but actually were feeling very uncomfortable about it weren't really that happy about it but thought it was

thought it kind of they had no choice and actually once they talk to other people and kind of realize the potential implications of using of doing that actually a lot of them then switch back um to using the that you know the biological pronouns and their and their birth name i think you know i think i i would i would definitely counsel parents against using a child's chosen pronouns. I think names are a bit different. I think particularly if a child, I mean, in my experience, often they go for kind of more gender neutral names, particularly the teenagers seem to go with gender neutral names rather than clearly boys' names or girls' names. So they might go from, I don't know, Luke to Luca or some kind of nickname, I suppose, because children often have nicknames, don't they?

So I think that it might be that you can have some kind of compromise and have a kind of a nickname, but, but I think, I think it's just this issue of to, to go along with the name and pronouns, which are clearly belonging to the opposite sex is, is encouraging a child to take on that gender identity um and and i think particularly with the the issues around um you know restrictions now and people turning around of using things like puberty blockers and you know and hormonal treatment you know to to allow a child to

socially transition and then to say but actually you're going to allow a child to socially transition, and then to say, but actually, you're going to go through the puberty of your biological sex. You know, potentially, you are setting your child up for it hugely increased distress, because they started living as the opposite sex, and then they've got to go through puberty. Because they've started living as the opposite sex, and then they've got to go through puberty. What happens in those situations where the parent began using the child's pronouns but then changed? Does that cause a lot of stress and maybe even trauma on the child? Does it sever the relationship?

And again, I'm sure every case is different and unique, but what's your overall perspective on how that has gone? I mean, I think the reality is that every single one of these situations is slightly different, although, you know, there are lots of similarities. And, you know, when you hear people like Stella O'Malley and Sasha Raya talking about their vast experience, you know, there are lots of similarities. But there are, you know, every individual situation is an individual situation but I think you know I think this whole thing is so wrapped up in um you know distress and some of it's around you know normal teenage yeah you know teenagers you know they they like to disagree with their parents. You know, you know, my you know, my my 18 year old son, you know, he currently refuses to call me mom. You know, I'm Julie, you know, and they just like to argue. They like to disagree with you. And actually, conflict is kind of part of being a parent of a teenager. And we can't avoid conflict and I think actually if

we're honest with with children and I think you know you asked about kind of changing your mind about the pronouns actually if a parent is honest and say you know actually we feel we've done the wrong thing here and give reasons why the child may not agree as it, as they may not agree with lots of things that we tell teenagers that they can and can't do. But it's, as a parent, it's about doing what's best in the longterm, isn't it? And as a medic as well, and that's where this whole controversy around puberty blockers and hormones and all the rest of it is because it's about what's best for the child longterm,

not about what's going to immediately alleviate distress because while using their preferred pronoun name might immediately alleviate some distress what is it going to do in the long term for that child that is the question isn't it so what okay so i've got friends that work with trans teens, especially trans teens that come from pretty, not identified teenagers pronouns, you are like pretty massively increasing risk at suicidality, self-harm, anxiety, because, well, yeah, just because this is just adding to the tremendous amount of stress that they're going through. Like, would you say that not using someone's pronouns puts the kid at higher risk of suicide i i mean my understanding of of evidence would be that that that is not supported um i think i think that the risk of suicide is is kind of is often used as a um to push push parents into agreeing with things.

And I think, you know, I mean, we're talking about troubled, you know, troubled children and teenagers and difficult family situations. And I think, you know, the important thing is showing that the child is loved and understood. And I think you can show that a child is loved and understood and I think I think you can show that a child is loved and understood without agreeing with them and I think that's the key thing is it's hearing their distress it's showing them that you that you love them and you care about them and I think you know I think that can be done without affirming that gender identity. And, you know, I suppose like everything with teenagers and children, it's about picking your battles, isn't it?

And I think that, you know, there may well be things that you can other things you can compromise on. But I think as a parent, you have to kind of draw a line, don't you as to where you are willing to um concede or not and i think you know as a parent the things you draw the line on are the things you know are going to be harmful for your child so for example you know i'm not going to let my child live on chocolate or every day all day every day because i know it'll be harmful for them even though they might want to um and you know and and you know there are all sorts of things that we as parents decide are in the best interest of our children but we do that within a loving relationship and i guess that's the key isn't it if you if you've already got a relationship where there's

lots of conflict then then the whole pronoun thing might be an added source of conflict along with whatever else is going on so so if there is a case where refusing to use someone's product your kid's pronoun is kind of is increasing say yeah anxiety depression suicidality you're saying that like that might be due not to simply refusing to use their pronouns, it might be due to many other things going on in their life that you could maybe address and, and alleviate. But if it was a very other, say, otherwise, you know, loving, accepting, affirming, whatever household that if the parent doesn't use that pronoun, then that's going to be a very different case than if it is

an actual very toxic kind of environment. Yeah, yeah, absolutely. You know, I think, you know, because it's, yeah, it's about, it's about the environment, isn't it? You know, and, you know, I think it, and, you know, some of these children, you know, come, come from, you know, very loving, loving family. Some of them come from very disturbed families, but some of them will come from very loving families, you know, and, you know, and, you know, and will often then, you know, they might distance themselves from their families, you know, in a way that, well, I guess teenagers do sometimes anyway, don't they? But I think, you know, this, the trouble with this scenario is it has such huge long-term consequences.

If a child ends up embarking down the medical, surgical route, that has such life-changing long-term consequences that sets it as something quite different to other kinds of scenarios. Does that make sense? Yeah, yeah, totally. What would happen like legally or even socially if, for instance, the child comes out, let's just say they're 10 years old, they change their name, their pronouns, everybody has to have a celebration party at school.

And what if word gets back that their parent is basically the only one who's not accepting this new name change and pronoun or let's just say the pronoun change um could the parent lose custody of the child um or what would happen even just socially if people were aware that the parent refuses to do what everybody else is doing and celebrating i mean i i think i mean i think that i think that's what everyone worries about isn't it you know that kind of and i think there have been kind of reports of scenarios where parents have lost custody of their children i mean i think you know i think it would be

probably as part of a bigger scenario i i would have i would have thought I mean you know in the in my professional kind of capacity um you know I I come across more people who are concerned that parents are going along with their child's gender identity than than concerned that parents aren't going along with it that that's what I've encountered professionally um I mean, I guess it depends where you work and, you know, what country you're in even. But I think, and I think, I think because there is increasing concern now about the use of puberty blockers and hormones, and then I think it is changing people's opinion as well um because I think people are realizing that it's not as simple as this child is trans they need to socially transition they need to go on puberty blockers they need cross-sex hormones you know everything sorted job done

um because it's not it's not that simple and actually you know there is increasing evidence that you know it's not the best way to treat children. And so I think that does, therefore, change the perspective, I think, on social transition. Okay. Can we back up? And I want to talk very, very much like the gender affirmative only approach to treating trans identified kids and teenagers is, you know, almost every professional organization embraces that any other approach is viewed as conversion therapy. And some people are even trying to outlaw it, you know? it. In fact, we have this SOGI laws, sexual orientation and gender identity change efforts are viewed as dehumanizing,

if not destructive. But it seems like, from my vantage point, in the UK and in Europe, Sweden and other countries that have already kind of gone down the gender affirmative only route have kind of, in the last year or two, began to rethink that. And from a secular perspective, this isn't just Christian, you know, this is people saying, I don't think, like you just said, it seems like it's more complicated than this for the long term health of this child. Maybe the gender affirmative only approach isn't the best. Is that an accurate, I mean, you're in the UK, so I mean, is that an accurate read on the situation or what's been the last five years of medical discussion regarding gender identity among kids in the UK? Yeah, so I mean, I think, yeah, you're absolutely right. You know, the scene is kind of changing.

You know, when I when I first started kind of looking into this and sort of writing a few bits about it, that, you know, we were there were a few of us raising concerns and kind of people were a bit kind of, you know. And interestingly, in my workplace, I did a teaching session about three years ago now on treatment of children with gender dysphoria. And my colleagues were horrified that children were receiving puberty blockers and cross-sex hormones. People didn't even know it was happening, which is really interesting. And as people have realized what's happening, they're kind of people are becoming more uncomfortable about it. But I mean, I think the Kiribati case obviously was a key kind of issue, where, you know, the UK courts ruled that the children were not able to give informed consent for this kind of experimental treatment that has such long-term consequences, particularly on fertility and sexual function,

which of course a pre-pubertal child can't give consent about something that they have no experience of and no knowledge of. Real quick, for the audience that doesn't know, can you explain just briefly the Kirabel case? So, yeah, so Kirabel was is a uh young lady who went through um transition um and i'm not i'm not exactly sure how how much of a transition she went through but she basically transitioned was living as a man um she'd had hormones certainly um and i think probably a mastectomy but i'm not absolutely sure about that that. And she then she's now what we call a detransitioner.

So she's now living as as a woman again and is very clear that she shouldn't have been put down that route of medical treatment and that her underlying issues should have been dealt with rather than people just kind of going along with this idea that transitioning was the answer to all her problems. Because that's what you see in these these children and these teenagers. They think that transitioning is going to miraculously sort out all their problems. And, you know, and instead of the, you know, the psychiatrists and psychologists and therapists actually dealing with whatever issues they might have, as well as the gender issues, they just, you know, push them straight down the, you know, like you a result of the Kira Bell case and also as a result of a number of clinicians at the gender identity clinic raising concerns, which was all around the same kind of time. So there is underway a review. The NHS England are reviewing the treatment of children and reviewing the use of puberty blockers. There was recently a NICE, which is National Institute for Clinical Excellence, who kind of deal with all the treatments and things in the NHS. They did a review of the evidence of puberty blockers and cross-sex hormones and concluded the evidence is really,

really poor. And that, you know, the evidence just is not there to use these treatments on children at all. I'm curious about, you've mentioned several times now, you know, these are troubled teens. Maybe can you explain that a little more? I mean, a trans-identified teenager, are they troubled because they are trans and society doesn't accept them or they're being, you know,

there's social kind of pressure on them or whatever, or is there, are there other mental health issues going on or what do you mean by troubled teens? Um, Oh, that's a, that's a trick. That's a tricky question. You know, and obviously I'm, I'm not a therapist, um, and I, you know, or a psychologist, uh, I'm, I'm just a humble pediatrician. Um but i think i mean i suppose you know growing up is is tricky for lots of children um puberty is a difficult time for for everybody and and we're we're in a kind of generation as well where mental health is a big issue amongst teenagers generally um and you know we're all very aware that you know teenagers have kind of poor mental health you know um and there's lots

of concerns about it and and and i think you know i mean my my experience that, you know, the children that I've seen, you know, have all had other issues going on now, which came first or which, you know, is is might have a child, for example, who who has been abused. So that might be one of the issues. You might have a child who's had a difficult relationship with, you know, with a parent or with a sibling. You might have a child who, you know, just just finds puberty difficult, went through puberty early and has found that really difficult transition. went through puberty early and has found that really difficult transition because a lot of there is also a big association with autism so you know a big number of the these children who or teenagers who identifies as transgender actually are on the autistic spectrum now you know I don't think anybody totally understands what the relationship is but there might be any number of reasons why that's the case. Yeah, I've heard that in several places.

And I mean, you're more of an expert in autism. So when you said that, I was like, oh, I wrote down on my notepad here. I'm like, I want to ask about that because I've seen percentages anywhere. anyway, I mean, I don't know. Um, it probably a general one is, you know, 25% of, um, of teenagers who identify as trans or on the autism spectrum. I've seen 10%. I've seen, so somewhere in that range, whereas 2% of the general population, according to Google, I mean, I Googled around a couple of places, about 2% might be on the, on the spectrum. So that's, you know, five, 10 times I did my math, right, five or 10 times higher. What, yeah, do you have any thoughts on why,

why a fairly high percentage of trans teens, trans identified teens are on the spectrum? I mean, is there a organic connection there or is it just, I don't know? Yeah, I mean, I think, I mean, you equated some statistics there and I'm pretty sure that the Tavistock, the General Identity Clinic in London, has actually said I think it's somewhere near 40% of their referrals

have got autistic features. So they may not have a diagnosis of autism, but they have autistic features. Well, I think, I mean, my understanding from, you know, some of the amazingly, you know, experienced therapists that, you know, that I've spoken to is that I think there's all sorts of reasons. So when children are on the autistic spectrum, they struggle with social relationships, they struggle, you know, struggle with friendships, which can make them feel like a bit of a misfit, a bit of an odd one out. And if they then kind of get, you know, in with a group that kind of tells them that they're trans, the reason they don't fit in is because they're transgender, they could easily accept that.

I think the other thing is that children on the autistic spectrum often get very fixated by things and they're very black and white about things so once they fixate onto an idea then it's very difficult to get them off it so if they for whatever reason begin to to believe that they're the opposite sex then it's it's very hard to for them to change that change that view again. And I think this also can be sensory issues. So children on the autistic spectrum often have lots of sensory issues. So they might really like sparkly things or soft things or they might not like certain types of clothes. So the kind of thing about boy-girl clothes might be partly a sensory-driven thing. So I think there's all sorts of potential reasons or contributing factors as to why they kind, head down this line, you know, or they're just, you know, sometimes I think they also are very prone to being influenced online as well.

Because, you know, when you're on the autistic spectrum, they often struggle with face to face social relationships. So they might conduct a community of kind of, you know, gender variant people online, then they can easily get, you know, join that community and identify with them. If you were approaching a trans identified teen on the autism spectrum and another one that's not on the autism spectrum would you approach those differently in this sense like is there a if you're trying to like work through the dysphoria how can we address the dysphoria you know from a maybe psychological perspective does that look categorically different between an autistic kid and a non-autistic kid or i mean well as i say i'm i'm not a therapist so i'm not particularly kind of but i mean it my my experience is is often it's it's the other it's kind of the flip the other way around is that the children present with gender dysphoria and the off the question then is often actually are

they on the autistic spectrum okay or do they have adhd or um so so rather than necessarily they come to you with autism and then your gender it's often it's it's it's the other way around because i think if you already know they've got autism that is probably easier to easier to kind of manage because you know what you're dealing with with and there are very specific so things like CBT and that kind of thing have to be done in a very specific way I understand when you've got children on the autistic spectrum but more often it's undiagnosed so particularly with the girls because autism is often undiagnosed or diagnosed much later in girls so it can be that the gender issues are the things that and the mental health problems around that are the first thing that pop up and

then you discover actually they're on the autistic spectrum i'm curious so as a pediatrician i'll stop asking you uh therapy questions let's stick to your actual field. I mean, as a pediatrician, are you seeing a, I don't want to say a percentage cause I don't know, but like a, a, a percentage of, uh, teenagers or kids that used that did identify as trans and now no longer are. Um, even if it was just kind of a social transition, maybe they went through a certain phase or whatever. I know people don't like that phrase, but I mean, are you seeing that more and more or are you seeing kids that once they identify as trans, that they keep identifying as trans?

That's a difficult one to answer because they, as a pediatrician, we don't actually see that many of them because they would normally be referred to the Child and Adolescent Mental Health Services rather than to us. So we wouldn't necessarily see them unless we were seeing them probably for another reason. But I think, and also, of course, as as a pediatrician i would only be seeing children up to the age of kind of 16 or 17 um and often it seems that that that because of the way things are at the moment that they socially transition and you know up until recently have been able to then go on puberty blockers and then cross-sex hormones it's often the kind of young adults that are the ones that seem to be detransitioning. So they would be out of our remit, as it were.

And I think that's one of the issues as well, is the whole follow-up issue, is that nobody really knows what happens to these kids because they might be afraid to tell people that they've detransitioned, they might not come back for help, they might be afraid to tell people that they've detransitioned. They might not come back for help. They might be ashamed to. So I don't think anybody really knows what happens to these children. It seems like, again, anecdotally,

that there's a growing number of detransitioners. And I know that, like you said, getting an actual percentage is complicated for various reasons. Kids not returning back or, you know, studies being skewed or having bad methodology. But are you just anecdotally, just as a person in the gender conversation in the UK, does it seem like there's a growing number of detransitioners? Or how do you think through that? There's certainly a growing number of detransitioners coming forward. There's a growing community of detransitioners.

And I guess if you look at, for example, the numbers of referrals to the gender identity claim in the UK kind of had this massive spike over the last kind of few. I mean, it's kind of leveled out now but there was there was a massive spike so I guess the detransitioners from that will be in the next few years so we probably haven't probably haven't necessarily seen that that those coming through you know and the sort of you know the the numbers that I'm you know hearing about sort of kids transitioning in schools and things like that you know a lot of those kids haven't even been seen in a gender clinic yet you know they're still on a waiting list you know they they but they socially transition often before they've even seen a medical professional which is which goes back to the whole pronoun thing is that people are embarking on this social transition thing and these kids haven't even seen a health professional

a lot of the time um this is just being done on on kind of on their say-so um which you know which is it which is a concern how do you explain somebody asked me this actually a couple people asked me this question and and it's always a tough one to answer could be people say okay like it seems like within the medical community, there's a growing diversity of medical professionals thinking through how to address a child or a teen with gender dysphoria or identifying as trans. And yet in the school system, it just seems like there's no diversity. It seems to be, for lack of better terms, a very just radical, progressive view that's not even liberal. I mean, maybe I shouldn't use that term. I know UK liberal is different than American liberal.

But I know a lot of very liberal people who would be concerned about some of the just radicalness of the teaching on gender in public schools. And it sounds like you, like you said, they have celebration parties and everything. But then in the medical community, there's a lot of more diverse opinions on this. And I don't have the answer. Like, how do you explain that dichotomy? Is it just like, how did a certain viewpoint become so pervasive in the school system? I don't know if that makes sense. Yeah, no, no, absolutely.

And I think it's one of the biggest issues been a very active um sort of groups of of people who've gone into schools and trained and trained schools and trained other professions as well in this whole gender ideology thing um and and you know a lot of you know education professionals for example you know they they don't know any different you know and if they they have been told by the experts that you've got to affirm this child you've got to use their pronouns you've got to do all of this otherwise they're going to commit suicide which you know as I said that you know that is not strictly that is not true the statistics don't bear that out um and and so they've been told that that's what they have to do and you know and and you know I've spoken to a number of education professionals actually who have been very

uncomfortable about doing this but have done it because they felt that that was what they had to do and that that was the you know the what they were being told and that's you know and it's you know there's this sort of huge capture of kind of well all the institutions and by these kind of you know activist um organizations that you know are sort of pushing one agenda um rather than making sure that everyone's got all of the information and the right information and and facts and and evidence and and that's what's really lacking i think in this in this whole argument um and i think that's probably where the medical professionals perhaps are a bit different is that you know perhaps we have a bit more access to the

you know to the evidence and the arguments um and you know and certainly in the uk it's it's the secular medical professionals and um and therapists etc who are who are making the biggest noise about this um not the christians sadly i i i think I remember reading somewhere I think it was about a year ago maybe that there was some statement signed by the is it the Royal College of General Practitioners in the UK about signing something maybe was

that about concern over puberty blockers or I'm not recalling it does that ring a bell at all or I mean there's the memorandum of understanding yeah um that which is about conversion therapy which which kind of lots of organizations signed up to but i think the royal college of general practice didn't sign up to it maybe that's not what i'm thinking of i i know there's some medical professors at Oxford. Michael Biggs, I think, is one of them. Yeah. And Carl Hennigan. These are like top of

the top, right? And they've raised concerns. What is their concerns? They're not like ethically against transitioning on an absolute level, I don't think, but just are they concerned over like teenagers being rushed to transition or? Yeah. So, I mean, you know, it is this whole concern about the, you know, the impact of puberty block. So, I think, you know, when puberty blockers were first kind of started to be used in this scenario, they were used under the kind of understanding that what it would do would be alleviate the distress of the child of going through puberty in order for them to undergo therapy and to be able to kind of work out what was going on. And then the puberty blockers could be reversed and then they could go through puberty and you know if they change their mind and unfortunately and I suppose it doesn't

doesn't take much to kind of work out why but what they actually found out was that once these children went onto puberty blockers almost all of them I think it's 99% of them or something like that go on to have cross-sex hormones and you know and and of course logically if you if you kind of think about it you realize that for a lot of children with gender dysphoria it's kind of the the process of puberty that matures their body and their mind and and enables them to then come to terms with their body they might you know feel quite uncomfortable with it while it's going on. And being a teenager is time of trying to understand who you are.

But of course, if you pause that, if you halt puberty, you stop them doing all that stuff. So it's not just the physical changes you stop. It's the brain changes. It's the physical changes you stop it's the brain changes it's the emotional changes all of those things that would help them come to terms with with their biological sex or potentially in the majority of cases you've stopped it so they then get stuck in that kind of immature um you know childlike phase um and and then the next logical thing is the cross-sex hormone. So,

yeah, so, you know, Michael Brigg and Carl Hennigan, you know, they raised all the concerns about this and about the poor evidence and also the evidence of the, you know, the long-term effects of puberty blockers. Because obviously, when you go through puberty, you have a growth spurt, your bone density changes, all of those things. If you stop that, you, you know, you stop all of those normal physical changes as well as all the brain changes and emotional changes. Um, yeah, I've had two endocrinologists on in the last several months. Um, uh, Paul Ruse, on in the last several months um uh paul ruse do you know paul ruse he's an american um endocrinologist um and oh michael laidlaw do you know michael i i've heard of him i've not met him he's friends with will malone i know you've you've you're you know will and they both said almost the

exact same things and not even like well here's here's my thoughts, but there's other perspectives. It's kind of like, there's some basic endocrinologist perspective. Here's what the risks you run if you do either puberty blockers or cross-sex hormones. And my understanding, again, I don't like getting over my skis, as we say, and speaking beyond what I know, from what I understand, we just don't know the long-term effects of puberty blockers. We know that there are risks, all the things that you mentioned, but then in terms like 10, 20, 30 years, we just don't know because this has been such a new, quote unquote, experimental way of treating gender dysphoria. But we do know some of the side effects and concerns with cross-sex hormones, right?

We do have a lot more knowledge and studies of the risks that people run taking cross-sex hormones. Would that be correct? Yeah. I mean, obviously, someone like Will or Michael Adler would be would be much better place to answer this. But yes, I mean, so we do have. But what we what we know is the effects of those mostly in older people. So obviously that, you know, there have been adults who've taken cross sex hormones and had sex, you know, sex change surgery and all that kind of thing. So we do know some of the long-term effects of that. But younger people and teenagers being given cross-sex hormones is still a very new phenomenon. So we don't, still don't really know

because that is a very new, you know, much newer phenomenon. So, you know, so that is still, I would guess, quite an unknown thing. But yes, we do know a lot of the effects. Do you think going back to the kind of public school uh view of things and then the medical professional having more diversity of thought and rethinking some things do you see if you can make a prediction i don't know if you have the prophetic gift or not that that they're that the school system will end up catching up to some of the current medical perspective um or yeah i mean

in two or three or four years do you think there will be more diversity of thought within the schools or does it not look too hopeful well there there are certainly a lot of people in the uk working very hard to um to try and um kind of change what's happening in schools. So, I mean, in the UK, there was a new guidance around relationships and sex education came out last year. And as part of that, there was a kind of a bit in it which talked about, actually about gender ideology and making sure that facts are taught and that children aren't taught that just because you like girl things that you're a girl or just because you like boy things that you're a boy kind of thing and so there are a

number of secular organizations who are working very hard to kind of try and counter and argue and make sure that, you know, that actually what children are being taught in school is accurate, scientific, and also complies with the Equality Act as well. So, you know, so there is a lot going on, a lot going on. Can you talk to us just briefly about what's going on in, I think, Sweden? I think I got it from your Twitter feed, that they did they outlaw did they outlaw puberty blockers for kids under 18 is that did i read that right or yeah yeah so i mean i haven't i haven't read it in in masses of detail

today being i've been too too busy but um so it seems that yeah in sweden the um the clinic there which i think is this sort of the main clinic which treats children there, has made a ruling that because of the concerns around use of puberty blockers and cross-sex hormones, that they are not going to use them in under 16-year-olds at all. And in 16 to 18-year-olds, only as part of a clinical trial. So that's what they, you know, come up with in Sweden. So which is, you know, which is really encouraging together with the sort of developments that have happened in the UK over the last year. It looks like, you know, things might be turning.

And of course, the key thing then is making sure that these children get the help that they need. It's no use just saying we can't have that. We need to then make sure that they are getting the therapeutic help, the psychological help that they actually need. And that is the key. That's the key thing that we need to be making sure now. And I know that, again, this isn't your primary area, but when kids do get the proper help or, I mean, when certain possible psychological issues are addressed first rather than, you know, transitioning to them, have you seen, from your perspective, success in that? Because I have heard people say, like, how else the only way, I've heard people tell me, you know, the only way we know that is effective in treating gender dysphoria is medical transitioning. Um, I, I, yeah. Uh, and there's obviously different, you know, different opinions on that. Um, have you seen when people do approach it from a more psychological perspective that there is success in reducing dysphoria? Cause I, yeah, I've got friends that they were like, I just,

that there is success in reducing dysphoria? Because, yeah, I've got friends that they were like, I've got one friend in particular who, after several years of trying to address the dysphoria through other ways, two suicide attempts and just nothing, nothing was working. And I don't really have a – it's not my area, but I'm like, I don't know what I would say. What do you do when a psychological approach just isn't working, for lack of better terms?

I mean, you just keep going or how do you – I mean, I think – I mean, it's really difficult, isn't it? And I think it is one of those things where there are no easy answers is and i suppose i suppose it's the same with you know mental health generally isn't it you know there are people who suffer with depression for their entire lives there are people who suffer with anxiety for their entire lives and and doesn't matter what treatment you give them sometimes it they will always struggle with it you know and i think there are people who will struggle with gender dysphoria their entire lives, but there are equally. I mean, I think I suppose probably the most helpful thing is hearing stories

of adults who now look back at their childhood and say, goodness, if I'd grown up in this kind of scenario now, I think I would have identified as transgender. So I think Stella O'Malley says says that um you know and I've heard you know a number of others kind of saying that you know they're when they were a child they really wanted to be a boy they thought they were a boy um but actually you know back in those days you know you know you were you know a tomboy or you know a sort of girl who just liked climbing trees and whatever it was but then but then they've gone through puberty and got married and had children and you know been perfectly happy to be a woman um so you know so I guess perhaps

that is you know perhaps that's where we kind of need to look at those ones, because those are the ones who their gender dysphoria was there. It was real, but it resolved. But actually, you know, those people are quite clear that they think that if they were growing up in today's society, they would probably have identified as transgender. they would probably have identified as transgender and maybe it may have gone down the you know medical and surgical route and been infertile and yeah had to have medical treatment for the rest of their lives which is that is so sad you know like you said you know that that's where a big concern of mine is is specifically with teens and children being raised in the environment we have today. Yeah, you know, maybe their dysphoria is wrapped up with other things that need to be addressed, you know. I mean, the whole rapid onset gender dysphoria discussion. And it's troubling when, particular in, in schools, you know, I talked to a lot of friends that are in the public school system and, and how there's, there's just, there's no diversity of thought. There's nothing. It's like, there's the gender affirmative only approach and then everything else is transphobic or conversion therapy. And it's like, man, there's, it's, it's still a shocking because there's, there's, from my perspective, there's a good number of very secular, very liberal voices who are saying, no, there's several different ways in which we're still learning, you know, to approach someone who identifies as trans.

There just simply is no one size fits all. Yeah. Well, Julie, I've taken enough of your time and I really appreciate you reaching out. Um, and, uh, yeah, I go, I mean the, the pronoun thing, I know it's really sensitive, really touchy, especially when it involves parents and kids. And so I really hope that, um, parents may be listening can, can take away just, man, this is, uh, this is, this can be really complicated, you know? Um, but I, I hope that your perspective will give them something to think about. Do you have any final words for specifically a parent with a child or

teenager who's identifying as trans? And it's, you know, my audience is primarily going to be Christian parents. Any last words of advice for that parent? I guess I would say, you know, walk with them, love them, pray for them. And, you know, whatever the sort of outcome, kind of keep your line and know that you've done what you can in the most loving way that you can, I suppose, because you don't want to kind of in the future regret saying things or doing things. And, you know, but loving them sometimes is about being truthful and biblical, not just going with what they say. That's a good word. Julie, thank you so much. Really appreciate you. Thanks for coming on Theology in a Row. you