The first challenge we face is terminology. The language around gender, sex, gender identity, transgender, gender dysphoria and gender incongruence is confusing. It is important to know the facts and to distinguish the concepts.

Biological sex is an objective, clearly-defined binary trait: male and female. There are only two sexes, there is no third sex.1 In the physical, objective reality an organism is male or female because its structures point to their specific role in reproduction. This is true, even when reproduction is not wanted or not possible. It has nothing to do with typical or untypical personality traits or behaviours. A girl does not become a boy because she likes to jump over fences. Regarding behaviours and preferences, there is a huge overlap between girls and boys, men and women.

Gender identity refers to an internal sense, a subjective feeling, to be a male or a female person. For most people this is not a big question. Most biological males identify as a boy or a man. Most biological females identify as a girl or a woman.

Some individuals however experience an incongruence between their biological sex and their felt gender identity. This is commonly called "transgenderism". Transgenderism is a general term used to describe an incongruence between a child's feeling of who he or she is -- boy or girl -- and the material reality of their biological sex. The feelings and thoughts of these children do not match the reality of their bodies. The feelings may be strong and a child may adopt a transgender identity on the basis of these feelings. If a person experiences significant distress because of this incongruence, the diagnosis of "gender dysphoria" can be made. An even newer diagnosis is "gender incongruence" (ICD 11) for which no inner distress is required.

Children with transgender feelings either wish to be of the other sex or are convinced that "inside" they "really" are of the other sex. A boy may claim that he has a boy's body, but a girl's brain, and therefore he "really" is a girl and wants to be seen as a girl. In many cases children and adolescents with transgender feelings express a hatred towards their body, especially towards the sexual characteristics of their body. A significant rejection of their own body is always present.

Transgenderism may start early in childhood or in puberty or later. It used to be a rare condition. Today, 3% of school children in the United States identify as transgender.2 Transgender clinics like the Tavistock Gender Clinic in London have seen a huge rise in referrals.3 It used to be mainly boys; now it is overwhelmingly girls who struggle with their gender identity.

Are transgender feelings inborn and biologically fixed? No.

Transgender feelings are neither inborn nor biologically fixed and they can change throughout one's lifespan. Attempts have been made to find a biological basis for transgenderism, but there is none. There is no laboratory test, no gene test, hormone test nor neuroimaging test that can tell which child is a "transgender child" and which child is not.4 In other words: there is no objective diagnosis. Transgenderism is a psychological condition, a feeling, not an objective, physical condition.

Are some people "born in the wrong body"? No.

Children with transgender feelings are biologically healthy children with healthy sex organs and normal physical development. They have two sex chromosomes in each cell of their body, including in each of their brain cells. The sex chromosomes are XX for girls and XY for boys. They are the biological foundation for being a female or male person. The sex chromosomes remain in each cell, also in each brain cell, from conception until death; they cannot change.

In addition, in boys at about 8 week's gestation in the womb, their body starts to produce testosterone, the male sex hormone. Testosterone does not only flow with the bloodstream into the pelvis where male genitalia develop, it also flows into the brain. The concept that a boy can have a girl's brain and vice versa is not grounded in objective reality. Independent of individuals' behaviours, a boy has a boy's brain. A girl has a girl's brain. A girl does not become a boy because she loves to climb over fences. She remains a girl. A boy does not become a girl because he exhibits behaviours that are not typical for many boys or are stereotypically associated with girls. He remains a boy.
There is also no evidence that some children are born with a "transgender brain". The few studies on possible differences between brains of transgender and non-transgender adults show inconclusive, inconsistent and contradictory results.5

One difficulty such research faces is neuroplasticity. Human brain structures change throughout one's life -- depending on experience, thinking, habitual behaviours. Addictive behaviours significantly change brain microstructures. A child with unresolved trauma has a
2 Laidlaw, M., The Pediatric Endocrine Society's Statement on Puberty Blockers Isn't Just Deceptive. It's Dangerous. 2020. https://www.thepublicdiscourse.com/2020/01/59422/
3 https://www.transgendertrend.com/surge-referral-rates-girls-tavistock-continues-rise/
4 Laidlaw, M., Letter to the Editor. J Clin Endocrinol Metab, March 2019, 104 (3), 686--687.
5 See for example: Mayer, L., McHugh, P., Sexuality and Gender. The New Atlantis, 2016, Part III. https://www.thenewatlantis.com/collections/sexuality-and-gender

different brain than a child with no history of trauma. Violinists have a different brain compared to people who do not play the violin. Differences that might be found in brain microstructures of transgender adults or adolescents would most likely be the result of certain behaviours and intense preoccupation with certain thoughts, not their cause.

Transgender feelings, gender dysphoria and gender incongruence are psychological conditions. From a scientific point of view, transgenderism is a vague phenomenon and gender dysphoria and gender incongruence are unreliable diagnoses. In adolescents, it mostly comes down to a self-diagnosis. However, these conditions are now treated as if they were severe biological-physical conditions.

The new treatment that is currently pushed on children -- and parents are pushed to agree -- is called "gender-affirmative therapy". It is a confusing term. Instead of helping children as far as possible to align their thoughts with the reality of their body, it affirms the child's misguided belief that on the "inside" it is of the other sex. The treatment affirms, rather than heals, the split between mind and body. In an immature child it cements the child's fantasy that it can change its sex -- rather than helping a child to find peace with the objective reality of its body.

2. "Gender-affirmative Therapy"

"Gender-affirmative therapy" means social and medical transition in order to live to some extent in the role of the other sex and to change the outer appearance of a person. We live in liberal societies. Adults have the liberty to do this. But we should do everything we can to protect children and minors from the destructive path of social and medical transition.

Medical transition in children and adolescents includes puberty blockers, cross-sex hormones and often surgical operations.

Puberty blockers

Puberty blockers are usually given when the child is about 11 years old, sometimes already when he or she is only 8 or 9 years old. Puberty blockers are hormone-like substances, they stop puberty, stunt growth and block the production of oestrogen in the girl and testosterone in the boy. Normally, puberty is the time for genital maturation, for sperm and egg cells to mature and become capable of fertilizing or being fertilized. Puberty blockers block this process. Sperm cells and egg cells cannot mature and the child remains infertile.

Puberty is also immensely important for growth in bone density. Puberty blockers lead to reduced bone mineral density with a high risk of osteoporosis and fractures.6
6 Biggs, M., Revisiting the effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria. J Pediatr Endocrinol Metab 2021, 34, 7: 937--939.

There is a further risk for girls, in whom, in normal puberty, under the influence of oestrogen, the female pelvis considerably changes its shape in order to allow room for a baby to pass through. In girls who take puberty blockers, the pelvis remains in a childlike configuration. Should a girl later decide to live in her natural sex again and becomes pregnant, her pelvis may not be suitable as a birth canal. Pregnancy may end in obstructed labor -- a possible grave danger for mother and child. The endocrinologist Michael Laidlaw remarks that it is completely unknown if -- after stopping puberty blockers -- there is still a developmental window for the pelvis to reach its optimal female shape.7

Puberty is also crucial for brain development. In puberty the human brain undergoes major changes. Puberty blockers may lead to an impairment of brain maturation and of cognitive skill development;8 they may lead to a potential drop in IQ and also to depressive symptoms.9

Unpublished data from the Tavistock Gender Clinic in London10 reveal that after a year on puberty blockers, children reported greater self-harm and greater suicidality. Girls reported more emotional problems and developed an even greater dissatisfaction with their body.11 Then, why are puberty blockers given? Proponents of puberty blockers say that they give a child time to consider if it wants to continue with cross-sex hormones. They say that all adverse effects will be reversible once puberty blockers are stopped. However, there is no evidence for this.12

Some countries recently reversed their policies. Sweden for example reversed its health policy and now prohibits puberty blockers and cross sex-hormones in children under the age of 18.13

Puberty blockers dramatically rise the rate of gender dysphoria persistence

If children with a transgender condition are allowed to go through normal puberty, the majority of them (61%-98%) will eventually lose their transgender thoughts and accept their
7 Laidlaw, M., 2020.
8 Hayes, P., Commentary: Cognitive, motional, and psychological functioning of girls treated with pharmaceutical puberty blockers for idiopathic central precocious puberty, Frontiers in Psychology, 2017. 9 Schneider, M., Brain Maturation, Cognition and voice pattern in a gender dysphoria case under pubertal suppression, 2017.
10 The Tavistock Gender Clinic had to close. "An independent review condemned the clinic as 'not a safe or viable long-term option' because its interventions [gender-affirmative therapy] are based on poor evidence and its model of care leaves young people 'at considerable risk' of poor mental health." See: World's Largest Paediatric Gender Clinic Shut Down Due to Poor Evidence, Risk of Harm and Operational Failures. https://segm.org/UK_shuts-down-worlds-biggest-gender-clinic-for-kids
https://segm.org/new
11Biggs, Tavistock's Experimentation with Puberty Blockers: Scrutinizing the Evidence. https://www.transgendertrend.com/tavistock-experiment-puberty-blockers/
12 Laidlaw, M., 2019.
13 https://www.imabe.org/bioethikaktuell/einzelansicht/transgender-schweden-stoppt-pubertaetsblocker-bei- minderjaehrigen The only exception are strictly controlled clinical trials.

biological sex.14 By late adolescence most of them will align their thoughts and feelings with their body. However, this changes fundamentally when children are put on puberty blockers. A groundbreaking study from Amsterdam shows15 that all children (100%) on puberty blockers decided to continue with cross-sex hormones and the vast majority then also had "sex reassignment surgeries". None of them decided to reverse course and live in their natural sex. Not a single one opted for the possibility to align his or her thoughts with their body. All children on puberty blockers opted for a lifelong dependency on harmful medications, indeed, opted for a lifelong war against their body. Puberty blockers together with social transition reinforce a child's misguided belief that "inside" he or she is of the other sex and that the rift between body and mind cannot heal.

Cross-sex hormones

Usually at age 16, sometimes already at age 13, cross-sex hormones are given.16 Cross-sex hormones are high doses of testosterone for the girl and high doses of oestrogen for the boy. Do not forget that these medicines are given to children with completely healthy bodies. Cross-sex hormones increase the risk for heart diseases, cancer and thromboembolic diseases.17

Children who start on puberty blockers and then continue with cross-sex hormones remain infertile and this may not be reversible.18 Once a child has undergone sex reassignment surgery, the sterility will always be permanent and irreversible. Can a child, put on puberty blockers at age 11, grasp the long-term consequences of such a treatment? Medical sterilization for any other reason is usually prohibited for individuals under the age of 25.

Children whose brains are still undergoing major developmental changes are not able to give valid consent to treatments that produce (permanent) sterility and subjects them to a life- long dependency on harmful medications.

Sex reassignment surgery

Surgical procedures are often done at age 18, sometimes earlier.19 They involve removal of breasts, ovaries and uterus in the girl and removal of male genitals in the boy -- all of this done on biologically healthy organs. Once individuals have had their surgical operations with removal of ovaries and testicles, the sterility will always be irreversible. Breast removals have already been performed on children as young as 13 or 14 years old. Endocrinologist
14 Ristori J., et al., Gender dysphoria in childhood. Int. Rev. Psychiatry. 2016, 28, 1, 13--20. Cited in: SEGM, Early Social Gender Transition in Children is Associated with High Rates of Transgender Identity in Early Adolescence, 2022. https://segm.org/early-social-gender-transition-persistence
15 De Vries A., et al., Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2011, 8, 8, 2276--2283. De Vries, A., et al., Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment. Pediatrics, Sept 2014.
16 For example: Hembree, W., Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline, 2017. -- In the new WPATH guidelines 8th edition (Sept. 2022) all sections related to minimal ages for offering cross-sex hormones or surgical operations are removed.
17 https://www.aerzteblatt.de/archiv/216299/Geschlechtsangleichende-Hormontherapie-bei- Geschlechtsinkongruenz See also: Laidlaw, L., Gender Dysphoria and Children: An Endocrinologist's Evaluation of I am Jazz https://www.thepublicdiscourse.com/2018/04/21220/
18 Hembree, W., 2017.
19 https://thebridgehead.ca/2019/04/22/doctor-says-teen-trans-girls-getting-mastectomies-can-go-and-get- new-breasts-later-in-life-if-they-change-their-mind/

Michael Laidlaw comments: "We are giving very harmful medicines on the basis of no objective diagnosis."20

Medical transition cannot reduce the high rates of mental health disorders including depression and suicidality

If parents hesitate to agree with such drastic and destructive medical procedures, child protection services may threaten to remove the child from home. Their argument is that children with transgender issues have a higher risk for suicidal ideation and suicide attempts. This is true, but can cross-sex hormones and sex reassignment surgeries reduce the risk? No. The world's largest and most comprehensive dataset, from Sweden, shows that neither hormones nor sex-reassignment surgeries can reduce the high rates of depression, anxiety disorders and suicide attempts from which transgender people suffer.21 Neither cross-sex hormones nor surgeries can bring the desired happiness and peace. Another large study from Sweden shows that the rate of completed suicides 10 years after the sex reassignment surgeries was 19 times higher than in the general population.22 Suicidality always needs to be taken seriously. But the treatment is psychotherapeutic care, not dangerous cross-sex hormones or surgery.

Social transition

Social transition is mandatory before medical transition. Social transition means compulsory treatment of a child as if he or she were of the other sex. For girls it includes (and vice versa for boys): constantly addressing a girl by a boy's name, using only male pronouns and referring to her as "he" and "his". It involves parents, teachers, counsellors and others in positions of authority. Social transition requires rigid use of male clothing and hairstyle. In reality, it reinforces sex stereotypes. It is not a neutral approach, but an active psychosocial intervention. It reinforces -- on a daily basis -- the child's delusionary belief that "inside" he or she is of the other sex. It leaves the child in its fantasy world. It alienates the child even further from the reality of its body. It manipulates an immature mind and prepares children mentally for harmful medical transition. Similar to puberty blockers, social transition dramatically rises the rate of persistence in gender dysphoria. It makes permanent what otherwise in most cases would be temporary.23 We, adults, are responsible, but the children have to pay the price of medications and surgeries that seriously harm their body and psyche.
20 See footnote 19.
21 Correction for the study by Bränström and Pachankis, originally published in 2019. Correction: https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.1778correction
See also: Van Mol, A., Correction: Transgender Surgery Provides No Mental Health Benefit. Sept. 2020. https://www.thepublicdiscourse.com/2020/09/71296/ "The American Journal of Psychiatry has issued a major correction to a recent study. The Bränström study reanalysis demonstrated that neither 'gender-affirming hormone treatment' nor 'gender-affirming surgery' reduced the need of transgender-identifying people for mental health services." The study looked at anxiety disorders, depression and suicide attempts.
22 Dhejne, C., Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLoS One Feb. 2011. https://pubmed.ncbi.nlm.nih.gov/21364939/
23 See: Zucker, K., Different strokes for different folks. Child and Adolescent Mental Health 2019. https://www.researchgate.net/publication/333516085_Debate_Different_strokes_for_different_folks
SEGM, Early Social Gender Transition in Children is Associated with High Rates of Transgender Identity in Early Adolescence. May 2022. https://segm.org/early-social-gender-transition-persistence

3. Mental health disorders, autism, trauma

Many children and adolescents with gender incongruence suffer from underlying mental health disorders. In a representative study from Finland, 75% of transgender adolescents were currently or had previously been in treatment for psychiatric disorders, usually depression, anxiety, suicidality and non-suicidal self-harm behaviours. The researchers note: "The recorded comorbid disorders were severe and could seldom be considered secondary to gender dysphoria."24 68% of the children had their first contact with psychiatric services due to reasons other than gender dysphoria. The majority of the children were girls.
A comprehensive study from the United States (2018)25 comes to similar results. Children with transgender conditions have a high prevalence of underlying psychiatric disorders, especially anxiety and depression. 75% of all girls and 71% of all boys with gender incongruence (age 10-17) had a psychiatric condition or neurodevelopmental disorder before they developed a gender incongruence. In the control group, i.e. children who did not develop a gender incongruence, only 4% of the girls and 3% of the boys ever had a psychiatric diagnosis. In the majority of gender incongruent children, it seems, psychiatric disorders come first, gender incongruence comes later. The claim that children are only depressed or suicidal because parents do not comply with their child's wish to "change sex" is not supported by science.
A high number of children with transgender issues suffer from neurodevelopmental problems like autism spectrum disorders, ADHD or other learning disabilities.26 They often feel marginalized and isolated. By adopting a transgender identity they may attempt to make sense of their feelings.

Adverse Childhood Experiences

"Adverse childhood experiences" (ACEs) is the umbrella term for a number of different types of childhood trauma or potential trauma. ACE includes sexual, physical or emotional abuse, physical or emotional neglect, "troubled family dynamics" (problem drinker or drug abuser at home, exposure to domestic violence, loss of parent or grandparent through death or separation, mother or father with mental illness, and chronic financial stress) and other, usually chronic traumatic experiences.27
24 Kaltiala, R., Two years of gender identity service for minors: Overrepresentation of natal girls with severe problems in adolescent development, in Child and Adolescent Psychiatry and Mental Health, April 2015. The researchers note: "More than three quarters of the adolescent sex reassignment applicants had needed and/or currently needed specialist level child and adolescent psychiatric services due to psychiatric problems other than gender dysphoria. Specialist level child and adolescent psychiatric services are provided exclusively for severe disorders in Finland. The recorded comorbid disorders were thus severe and could seldom be considered secondary to gender dysphoria." p.6
25 Becerra-Culqui, T., et al., Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics. 2018, 141, 5. The study looked at "588 trans-feminine and 745 trans-masculine children and adolescents". Children were 3--9 years old, adolescents were 10--17 years old.
26 Kaltiala, R., 2015: 26% of the children were suffering from an autism spectrum disorder, 11% from ADHD. See also: https://www.transgendertrend.com/autism-gender-identity-introduction/
27 See for example: https://www.ncsl.org/research/health/adverse-childhood-experiences-aces.aspx
A large study survey by Laura Baams with more than 80.000 participants (2018)28 reveals that adverse childhood experiences were much more common in children struggling with transgender issues than in children in general. Even worse, children with transgender issues often had a history of multiple types of adverse childhood experiences, and suffered from "polyvictimization". Polyvictimization was much more common in children with transgender issues than in children in general. Might children who struggle with gender identity issues be punished by their parents for gender non-conforming behaviours? Sadly, this may happen. However, the study reveals that even after controlling for adolescent gender identity expression and gender presentation, adverse childhood experiences were much more common in children with transgender issues than in children in general.29

ACEs may very well be one of the many causes that can lead vulnerable children to develop transgender thoughts. Traumatized children may come to reject themselves deeply, including their body, hoping that when living in a completely "new identity" -- a transgender identity -- they will be able to leave all their emotional struggles behind. Adopting a transgender identity may be for them a defence mechanism against emotional pain.

A new Australian study (2021) of 79 children with the diagnosis of gender dysphoria shows30 that not only did the majority suffer from mental health disorders or ADHD, but nearly all the children (97.5%) suffered from at least one type of adverse childhood experiences. On average, the children suffered from five different types of ACEs. In most cases, the traumatic experiences pertained to chronic relational stressors in the family, including family conflict, loss of a parent or grandparent by separation, bullying, mental illness of mother or father or exposure to domestic violence. It also included sexual, physical or emotional abuse.31 The adverse childhood experiences reflected "a long-standing history of relational stress and a chronic disruption of what are normally comfortable and nurturing attachments".32

Attachment trauma

Brain researcher, psychiatrist, and world-wide expert in attachment theory, Allan Schore, remarks: "We understand failure at gender acquisition to be rooted in the attachment dynamic between the mother and the baby."33 Schore is of the opinion that for some vulnerable children attachment trauma can play an important role in the development of a transgender condition.
28 Baams, L., Disparities for LGBTQ and gender nonconforming adolescents. Pediatrics 2018, 141, 5. Participants: 81.885 pupils, grade 9-11.
29 Baams. L., 2018.
30 Kozlowska, K., et al., Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service. In: Human Systems: Therapy, Culture and Attachments 2021,1, 1, 70-95. Prospective study. 79 children, age 8-15. Some of the results: Many suffered from mental health problems: 63.3% anxiety; 62,9% depression; 49.4% history of self-harm. 16.5% suffered from ADHD. Only 11.4% did not suffer from a mental health problem including ADHD. -- 97.5% suffered from adverse childhood experience: 65.8% family conflict, 59.5% loss of parent or grandparent through separation, 49,4% mental illness of mother; 38.0% mental illness of father, 26.6% financial stress.
31 Sexual abuse: 19.0%; physical abuse: 15.2%; emotional abuse: 13.9%. Kozlowska, p. 81.
32 Kozlowska, K., p. 91.
33 Schore, A., cited in: Nicolosi, J., Shame & Attachment Loss, 2008, p. 6.

Attachment trauma is an early relational trauma and happens in the first two years of life, usually in the relationship with the primary care-giver. In most cases, it is cumulative, chronic and without experiences of attachment repair. A small child who does not feel seen, does not feel heard, or does not feel understood in its most basic needs may experience this as deeply traumatic.34 For whatever reason, attachment trauma leaves a child "in an intensely disruptive psycho-biological state that is beyond the infant's immature stress coping strategies."35 The child's immature stress coping system is constantly overwhelmed and this may negatively impact right brain development. A brain under constant stress has little energy left for anything else than survival. It has little energy left for developing a sense of self, including a sense of the corporeal self. "Traumatic attachment experiences negatively impact the early organization of the right brain, and thereby produce deficits in... identifying a corporeal image of self."36

An Italian study (2018)37 with 95 adults with gender dysphoria reveals that 56% of them had experienced 4 or more forms of attachment trauma -- usually in their relationship with both parents, mother and father. Only 10% did not experience any form of early relational trauma. Compared with the control group, the "gender dysphoric adults showed significantly higher levels of attachment disorganization and polyvictimization." The researchers came to the conclusion that in many cases there is a relation between attachment trauma and the development of gender dysphoria and that this relation might be causal. Gender dysphoria, the researchers note, might be an "an extreme dissociative defense against trauma experienced in early relationships."38

4. Social contagion

A recent survey (parents' reports) by Lisa Littman39 suggests that for some vulnerable adolescents, social influences, "social contagion" and "peer contagion" can play a role in the development of a transgender condition. The survey collected information from parents of 256 adolescents, of whom more than 80% were girls. A high percentage of the adolescents had at least one mental health disorder or neurodevelopmental disability. Many were
34 Schore, A., For further information about the psycho-biological dynamics of attachment trauma see: Schore, A., Dysregulation of the right brain: a fundamental mechanism of traumatic attachment and the psycho- pathogenesis of posttraumatic stress disorder. Australia and New Zealand Journal of Psychiatry, 2002, 36, p. 9- 30.
35 Schore, A., Affect Dysregulation and Disorders of the Self, 2003, p. 247.
36 "Traumatic attachment experiences negatively impact the early organization of the right brain, and thereby produce deficits in... identifying a corporeal image of self and its relation to the environment, and [in] generating self-awareness." Schore, A., Affect Dysregulation and Disorders of the Self, p. 261.
37 Giovanardi, G., Attachment patterns and complex trauma in a sample of adults diagnosed with gender dysphoria. Frontiers in Psychology, Feb. 2018. Study participants: 74 trans-women (biological males), 21 trans- men (biological females), mean age 29 years. One of the study tools was the AAI which explores adults' mental representations of early childhood attachment patterns. Most common patterns of relational traumata: neglect, rejection, psychological abuse.
38Giovanardi, 2018: 56% of study participants experienced 4 or more forms of early attachment trauma in the relationship with their parents (control group: 7%). 46% had a history of disorganized attachment pattern. -- General population data (Germany): Secure attachment: 60--70 %. Insecure attachment (2 forms) 20-30%.
Disorganized-disoriented attachment (attachment disorder) 10--15 %.
39 Littman, L., Parent reports of adolescent and young adults perceived to show signs of a rapid onset of Gender Dysphoria. PLoS ONE Aug. 2018. Littman, L., Correction: Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS ONE March 2019. The study formulates important hypotheses that urgently deserve further research.

traumatized. Strikingly, their transgender identification process occurred in clusters within friendship groups. In one third of the groups, the majority became transgender-identified within a short time frame. More than 60% had a popularity boost after announcing that they were transgender. According to their parents, 47% of the children experienced a worsening of their mental health after adopting a transgender identity. The children had high expectations that transition would solve all their emotional problems, distress and psychological pain.

5.

Children struggling with gender identity issues are vulnerable children. They deserve our compassion and respect, but they also deserve to know the truth. Gender dysphoria is a psychological condition and should be treated with psychological therapy. Social-medical transitions to "change sex" are extremely destructive interventions leading to sterility and life-long dependency on harmful medications. Transition can never heal the split between mind and body. We need to think anew and find better and more humane ways to help the suffering children.

Christl Ruth Vonholdt (born 1954) is a German physician for Child and Adolescent Medicine, former Director of the German Institute for Youth and Society (Deutsches Institut für Jugend und Gesellschaft), Christian author and is member of the Reichenberg Fellowship.