Sasha Ayad is a therapist who has been working with gender dysphoric youth and families since 2016, using a groundbreaking approach, which combines compassion with deep, insightful exploration.

485: When Your Kid Says They’re Trans

Sasha Ayad

Being the parent of a gender-questioning child is confusing. How can we parents best support our children who are gender non-conforming when they are little kids?

When they are adolescents?

Hunter has a compassionate conversation with therapist Sasha Ayad about parenting gender non-conforming kids. 

When Your Kid Says They’re Trans - Sasha Ayad [485]

Read the Transcript 🡮

*This is an auto-generated transcript*

[00:00:00] Sasha Ayad: Gender nonconformity in childhood is a phenomenon that we've observed all over the world and all different parts of the planet and at different points in time. So it's not new that some children are really, really gender nonconforming and sometimes even kind of describing that they have a cross sex identity or something along those lines.

[00:00:22] Hunter: You're listening to the Mindful Parenting Podcast, episode number 485. Today we're talking about when your kid says they're trans with Sasha Ayyad.

Welcome to the Mindful Parenting Podcast. Here it's about becoming a less irritable, more joyful parent. At Mindful Parenting, we know that you cannot give what you do not have, and when you have calm and peace within, then you can give it to your children. I'm your host, Hunter Clark Fields. I help smart, thoughtful parents stay calm so they can have strong, connected relationships with their children.

I've been practicing mindfulness for over 25 years, I'm the creator of the Mindful Parenting course, and I'm the author of the international bestseller, Raising Good Humans, and now, Raising Good Humans Every Day, 50 Simple Ways to Press Pause, Stay Present, and Connect with Your Kids. Hello and welcome to the Mindful Parenting Podcast again.

I'm so glad you're here if you're a frequent listener, and if you are, of course, welcome. I would love it if you could grow the show by just telling one friend about it, and it makes such a big difference. And if you are a new listener, welcome, welcome, welcome, welcome. This podcast has been going since 2013, so we have an incredible catalog of incredible people to listen to in the Mindful Parenting podcast.

In just a moment, I'm going to be sitting down with Sasha Ayad, a therapist who has been working with gender dysphoric youth and families. Since 2016, using a groundbreaking approach, which combines compassion with deep, insightful exploration. And we're going to talk about what to do if you're the parent of a gender questioning child.

That can be really confusing, right? How can we parents best support our children who are gender nonconforming when they're little kids? When about when they're adolescent? So we're going to have a compassionate conversation about parenting gender nonconforming kids And I know that this can be a hard conversation to have.

It may be really controversial. And I know that right now we live in a cultural climate where trans people are under attack. From the right, there are states that are banning gender affirming care across the board, banning prescriptions for people. And, I want to state here that we support any individual's desire to be who they want to be and express themselves however they'd like.

Gender is between the ears, not the legs, so let us all be accepting of however people would like to call themselves, dress, etc. However, a lot of fair minded, thoughtful people question whether hormones and surgery are appropriate for the growing number of young people who are distressed about their biological sex.

I personally live in a very liberal area of the country and I have a gay daughter, so I'm aware that a number of kids seem to be questioning their gender. I support each of them, yet I also question large numbers of them. It's something that's really hard to talk about in this black or white, for or against political climate.

You can't ask questions without seeming to be anti or not supportive. If you find yourself disagreeing with my guest, that's fine. I ask that every listener understand that my intention is to open up space for a wide array of questions that are in the messy middle of this issue. My intention is to give parents a more nuanced conversation than just for or against.

I want parents to be able to support their children in the best way possible for everyone. Okay. On to my conversation with Sasha Ayad.

Sasha, thank you so much for coming on the Mindful Parenting podcast. I'm so glad you're here. Me too. Thank you so much for having me. Well, the listeners heard sort of my statement about this and my poor daughter's so worried. I'm gonna be canceled for talking about this, but the, there's been a really rapidly changing landscape as far as it goes with kids and gender ident gender identity in the last 10 and 20 years.

Maybe you could just before we. Talk about some of my questions. We could dive into that a little bit.

[00:04:37] Sasha Ayad: Sure. Yeah, absolutely. I mean, I'd like to start off by saying, as your listeners probably know, gender non conformity in childhood is a phenomenon that we've observed all over the world in all different parts of Um, the planet and at different points in time.

So it's not new that some children are really, really gender non conforming and sometimes even kind of describing that they have a cross sex identity or something along those lines. I think what has changed very rapidly, as you alluded to, Are the, the kind of intervention or treatment recommendations that are being kind of shared with parents about if you have a kid like this, what is the best approach?

So I think it's really helpful to kind of start there and I'll just, um, give your listeners a little bit of boring statistics and then we'll get into some of the more interesting parenting questions. And so when kids. Kind of naturally out of the blue, just have very strong gender nonconformity. Um, 60 to 90 percent of those kids, what's really interesting is that if they are kind of allowed to go through their natural puberty.

They will often come to comfort with their biological sex, and many of them, if not most of them, will be gay, right? So I think many of us kind of intuitively might recognize that. Like, there's a really, really gender nonconforming little boy who loves to play with dresses and hangs out with girls. Many of us may kind of intuitively feel like this kid might end up being gay.

And that's actually a perfectly normal, healthy developmental pathway for that child. And historically, about 30% Or less of kids like that may go on to continue experiencing distress around their biological sex and may choose to transition. So there's kind of big split that happens around adolescence as sexuality gets consolidated and young people figure out who they're attracted to, who they want to be with.

Oftentimes that can clarify the gender dysphoria. So historically we've used what's called a kind of watchful waiting approach, which means, you know, don't make a huge deal of it. Let the kid express him or herself however they like. Don't. take everything too seriously because this is a time of flux and change and growth, and many of these kids will kind of resolve the gender issues, but then end up perhaps just being like a gender non conforming adult or a gay adult or whatever.

But something happened in the early 2000s where kind of a new model of, of intervention came into the picture called gender affirmation. And so the idea was, well, we want to kind of affirm and confirm whatever the child is saying about him or herself with the idea that, you know, if this child is destined to go on and transition, this will help them kind of get solid in that identity.

And I think the theoretical. Foundations of this kind of make sense if we work retroactively, right? So if you take an adult who did decide to transition, and you think about like how they might have been supported as children, we might say, yeah, let's affirm their identity. But I think the trick is that we have this 60 to 90 percent desistance rate.

So what we've noticed, and as you mentioned, the landscape has changed a lot, we've noticed in the last few years that this affirming model seems to kind of lock in the child's trans identity. and might be interfering with that natural consolidation process that has historically happened for 60 to 90 percent of those kids.

So our colleagues in Europe who have started looking at the data around things like puberty blockers and hormones and social transition and this early affirmation have found some really startling results and I think here in the U. S. we are just Um, a little bit insulated from that information, so I think a lot of your listeners will be really surprised if they start to go and do some of this research themselves.

The most progressive countries in the world like Finland, Denmark, the UK, Sweden, these are pioneers of kind of gender affirming care, and they're looking at the data now and some of the medical complications and some of these other really serious long term impacts, and they are sometimes slowing down and sometimes banning altogether the use of certain medications in childhood.

So we're kind of recognizing that this watchful waiting approach and psychological support was actually the best strategy and that is what we had been doing with gender non conforming kids for decades.

[00:09:04] Hunter: And, and it, but it's changed. So now the United States in general has a different approach than what's happening in Europe, you're saying?

[00:09:12] Sasha Ayad: Yeah. So, I think Europe and the U. S. kind of together in the early 2000s adopted this gender affirming approach, which includes things like puberty blocking drugs and hormones. And now Europe is looking at the research and they're starting to pull back and go back to a kind of psychological support model.

But in the U. S., unfortunately, We are just continuing to plow forward with gender affirmation, although the evidence is not there to support it. So it's unfortunately become a really political issue here in the US, whereas I think parents on any side of the aisle love their children. They just want to do what's best and they trust the treatment recommendations of providers.

So, um, you know, there's this idea that the only people who have concerns about gender affirmation are like these very conservative Republicans who maybe have a an old fashioned view of gender. You know, we have to be like men have to be masculine and women have to be feminine. And in fact, that's so far from what we're seeing.

So myself, a lot of my colleagues, we are all liberal minded people. We have very supportive relationships with trans patients, gender non conforming patients, gay patients, but the science is really not there to back up the way, um, gender affirmation is kind of continued to be rolled out here in the U. S.

as like the only model of care. So I imagine we're catching up. I think we're in the process of catching up now.

[00:10:36] Hunter: Okay. Yeah. Cause I mean, you know, as I've said, this is, can be a such a hard issue to talk about because it's been so politicized and that's absolutely my, my intention finding you, um, to talk about it because it's so hard to find someone, but, uh, you have a section in your book, um, when kids say they're trans.

Uh, by Lisa Sellen Davis, author of Tomboy, and she writes about her gender non conforming young daughter, like, their experience starting in preschool, when their doctor was asking if she felt like a boy or a girl, the parent coordinator at school asked if she wanted to change to the boys locker room, And, um, the, and Lisa said that these offers struck her as strange.

Why were they assuming that a short haired kid who played baseball and wore sweatpants wanted to disavow her sex? It's so funny because I was like, I totally had like short hair and a rat tail and all I would wear is sweatpants in third grade, but, and so I'm just wondering, like some of the, what you describe here is like, Are we as a society kind of becoming more rigid about gender norms and stereotypes and kind of pushing kids to be either one thing or the other?

Like, are we, is it hard for us to accept, um, I don't know, talk to me a little

[00:11:49] Sasha Ayad: bit about that. Yeah. Yeah. I think it's really interesting because people are really well meaning. I think anybody who Lisa's referring to who's asking her kid these questions, they probably have the very best of intentions.

[00:12:00] Hunter: Mm

[00:12:00] Sasha Ayad: hmm.

But it's true that we, we have kind of. In some ways, gone backwards to this time when stereotypes really dictate everything. So if you see a little girl who seems to be on the tomboyish side, or in Lisa's daughter's case, quite masculine, like I know Lisa well, and you know, people look at her and maybe assume that she doesn't really think of herself as a girl.

And I remember growing up, you know, I was born in the 80s and I remember just growing up at a time where we were told, you know, girls can do anything. If you like to be sporty or if you prefer guy toys, there's nothing wrong with that. And so it's, it's ironic because I think people are well intentioned, but we do seem to be really relying on old fashioned stereotypes.

to, let's say, slot a kid into a certain gender identity. So, I agree. I think it's a, it's really a problem when we do that to kids because, of course, I'm sure you talk about this a lot on your show, kids look to adults for cues on how to make sense of themselves, right? So, if we are accidentally sending kids the message that you're not a real girl, If you have short hair, if you like cargo pants, that's a real problem because we want everybody to feel comfortable expressing themselves and being natural, being whoever they kind of naturally gravitate towards.

So, um, yeah, I think it's an issue.

[00:13:22] Hunter: Stay tuned for more Mindful Mama podcasts right after this break.

Yeah, actually, that is something we talk about in Mindful Parenting is our issue with labeling. And I know, you know, it can happen with Gender, obviously. So when we're talking about a parent of a preschooler, like a little kid who is dressing in opposite gender clothes, they want their hair long or short or whatever, the best way to handle these little kids is to just accept them as they are.

Talk to me about how, what, you know, for parents who are like, Oh my gosh, I'm worried. I have a doctor saying, does my child need to use the opposite sex locker? How should parents handle that with little kids?

[00:14:05] Sasha Ayad: Yeah. It's really tricky because I would say if we were living in like a thought experiment and we had norms in which people just let kids express themselves and didn't make a huge deal of it.

I would say parents really don't need to be concerned about something like that. But when you do have other adults in your child's life kind of maybe asking you these questions or asking your child these questions, it's really tricky because you may be trying to create kind of a normalizing of your child's behavior, but those questions can inadvertently pathologize the child.

So, you know, what I might Kind of split this question up into like two things. So how do we help the child? How do you support the child if you're the parent? And then how do you deal with the other adults in the child's life that may be inadvertently sending them these messages? I'd say for the child, I think it's really great to say, um, to kind of explicitly note that, you know, you are an expressive, creative child.

I love the way you play with your hair or your clothes, and I want you to feel comfortable expressing yourself however you feel comfortable. And, um, It's also okay that you have, you are a girl and girls can do that. Or in the case of boys, of course, right? Like if you are a boy who really likes makeup and princessy things, it's okay to be a boy who loves those things because being a boy is awesome.

And there's lots of different ways to be a boy. Um, you may also want to think about something called sex constancy. So this is kind of a cognitive, uh, skill or ability that comes online kind of between the ages of five and eight, depending on the child. And sex constancy is the ability for a child to understand that your biology doesn't change, right?

So if you take a four year old in a kindergarten classroom and you put him, uh, in a wig and a dress, a male child. His other peers will say, Oh, Johnny's become Susie now, right? So they actually think he's like kind of transformed to be a girl. And then only when the kid develops sex constancy will the peers recognize, Oh, that's still Johnny.

He's just wearing a dress and a wig. So this is actually like a capacity that very young children don't really have. So if you have a child who's experiencing, let's say, Cross sex play or cross sex behavior, you may have to explicitly help them understand that those behaviors and that play are totally fine and natural, but that they're still biologically whatever sex they are, and that's okay, right?

So we want to avoid pathologizing that behavior. And then back to your question about the other adults in your child's life. You know, I think it's really hard sometimes, especially for mothers, to assert themselves with authority figures. Like, if you as a mom, in your gut, know that, you know, just like Lisa said in her book, I know that my child is perfectly fine just the way she is, and I feel like these other adults are kind of infringing upon.

You know, the way we have chosen to kind of raise her in this, like, healthy gender nonconformity, you really have to find your own authority to be able to speak with other adults and say, you know, I understand you're coming from a really good place, but I'm very concerned that these sorts of questions may confuse my child, who's doing really well.

She's happy, she's healthy, she's gender nonconforming, and we totally support her. So, I would really like for you to just stick with the basic questions or please don't confuse her about her identity or please don't ask questions about identity because I'm concerned about her mental health or whatever.

So I would just encourage parents to feel confident kind of asserting their stance with other providers or adults in the child's life.

[00:17:41] Hunter: Yeah, I think that makes sense. You know, it's interesting, like, this all is like kind of coming home to roost in so many ways because my, uh, my oldest, I have two, my daughters are teens now, 14, 17.

My oldest daughter is gay. She came out to me when she was 14. Yeah. But when they were young, when they were little kids, they were like, For me, it was very important to just let them be open to whatever was happening. Like they, they, I'd see them as babies and green and blue and whatever, you know, like, and pink and, you know, and the different things.

And so I feel. I feel happy that she, you know, my gay daughter particularly feels comfortable being who she is, you know, exactly. Um, so when we're thinking then about little kids and we were wanting to, you know, accept them, support them, however they are, you know, maybe even showing, you know, showing the models of maybe adults who are also not, it's presenting in the stereotypes of a gender, um, should parents be using opposite sex pronouns for little kids, in your opinion? 

[00:18:51] Sasha Ayad: You know, my opinion is that kids are quite malleable and some of the data is also bearing this out. It seems like using opposite sex pronouns, which is a protocol used in kind of social transition, right? So social transition is this process that again, here in the U.S. is often recommended whereby Parents raise the child as though they are the other sex, right? And there's some, some, you know, the idea is if the child comes to feel like this isn't who they are, they will let you know and they will kind of navigate their way out of that. But in fact, it, it seems to be that when we do use opposite sex pronouns or socially kind of transition a child, it puts them on a pathway towards the medical process.

So, I mean, I certainly would not make a prescription to a family on what to do. Every parent knows their child best and has to trust their instinct, but it is worth just kind of having that information so that you can be informed about it. So, if you decide to use opposite sex pronouns, it may inadvertently tell your child that there's something wrong with their biological body.

It may inadvertently tell your child that you are going to continue experiencing this, let's say, cross sex identity, when in fact we don't know, right? That 60 to 90 percent data is really important. We don't know what the outcome will be for all of these kids. We kind of have to wait, you know, we have to be patient and kind of hold space for flexibility.

And sometimes when we make such a radical change as to change their social identity, It can be kind of like locking something into a pathway.

[00:20:27] Hunter: What I'm kind of hearing you say is that sometimes, I think sometimes parents think using pronouns or a social transition is a fairly harmless thing. And what you're saying is that actually it's something that if you, you're a parent of a little kid or what, that you should use caution with because it, it may, it may, you know, lock them into this.

You know, get them in this medical pathway or may sort of change their mind in some ways that maybe they're, they might, they might not have gone down, uh, uh, may kind of like reinforce this path that maybe they might have ultimately backed out of.

[00:21:11] Sasha Ayad: Yeah, I, I totally think that's a great summary. And I would also add that kids will believe what adults tell them.

[00:21:19] Hunter: Mm hmm, yeah.

[00:21:23] Sasha Ayad: So that's why we weren't against labeling, because you want to just, 

they're going to live up to what you label them. Mm hmm. Right, right. And kind of in light of this sex constancy question, they may not have, no matter how brilliant and smart and gifted your kids are, they just may not have the capacity to understand what it means to kind of say that you are a different sex, because biologically you are kind of.

potentially setting your child up for puberty becoming a disaster, right? So if you have a kind of typical child that's not experiencing any gender identity, you know, uh, stuff, you kind of anticipate that puberty is going to be hard, but we all have been through it and we'll all get through it. If you start socially transitioning and kind of affirming a child's cross sex identity, you kind of accidentally make puberty a real, real crisis.

Because if you tell a little girl, for example, that she's actually a boy and she's kind of living stealth, as they say, right? So it's pretty easy for children who are really young to pass as the other sex. And she has really short hair and everyone thinks she's a boy. Nobody really knows. Well, when puberty is coming around, You and your family may find yourselves kind of locked into this situation where, oh gosh, now puberty blockers are almost like the only option because we've been affirming that this child is actually male all this time.

And again, she's just a kid, she doesn't understand. There's maybe a metaphor here, right? Like when, when we use pronouns for a child, we're metaphorically trying to be supportive, you know, like we know she's actually literally female, but we're going to say he because we want to help support her. But a child doesn't understand that.

A child believes exactly what you're saying. So, I'm, I'm also, you know, I've heard from so many families who started their kids, um, down this pathway because the, you know, professionals have really pushed them to do so. And, and I don't know if your listeners are aware, but sometimes professionals are told, would you rather have a live son or a dead daughter?

I mean, that's a devastating, And really, I think, manipulative thing because there's no evidence to indicate that if you socially transition your child, they're, you know, going to be healthy and if you don't, they're going to kill themselves. It's just a really manipulative tactic. So I've met so many families now who go down that pathway and then when they get to the puberty blocker stage, they feel they have no choice.

And then, you know, a few months or a few years into that, there are pretty serious health consequences that they weren't fully aware of. And so then they kind of are in panic mode where You know, when you love your child, the worst thing that you can possibly imagine is that you've made a decision that may have hurt the child, right?

And when authority figures are really pressuring you into it, it's just such an unfair position for parents. But, um, this is becoming more and more common dilemma that parents find themselves in. Like, we did the best with the information we had at the time. And now we're seeing some health consequences or this, the mood has not improved at all, or we just seem to be getting further and further into a process here that doesn't seem to be supportive or helpful for our child.

[00:24:26] Hunter: Okay, so I want to guess it's consequential. Yeah, yeah, yeah. I get that. I mean, I'm going to get to puberty blockers and all that in a second, but I just want to kind of summarize what you're saying in that is that, you know, we, there's this, the affirming model where we could transition or we could socially transition and call kids by their other name, but we could also have this, what you're presenting is an alternative, uh, idea of just like opening Uh, you know, letting kids know, you know, yeah, your, your biology is this, uh, you are a girl or a boy, and girls and boys are allowed to be whatever they want to be.

They can be long haired, short haired, nail polish wearing, soccer playing, football playing, whatever, right? And we're, so we're, we're practicing a really, on one hand, a great acceptance and, uh, role modeling of lots of diversity, uh, of ways of being, but on the other hand, we're saying, And, and yeah, biologically you are a boy or a girl.

Yeah, exactly. Okay. That's exactly right. Okay. So let's talk about then adolescence. And it's interesting cause it's, it's tricky to talk about this. Sometimes I, because sometimes I talk about this with my kids. My, my, my two daughters are very, you know, you know, very smart and very with it. They, they know a lot of, you know, they're very much in an LGBTQ accepting world, very.

you know, left and open and things like that. And so they don't really seem to see that, like the landscape has, but they're only, you know, 14, 17, so they don't know that the landscape has changed rapidly. And there seemed to be like so many more people. I mean, at least from my point of view, where I live, I mean, as far as all the, uh, the teens that I see, and of course, adolescence is a super hard time.

Bodies are changing rapidly and pretty much everybody is uncomfortable in our bodies. Is it true that a lot more kids, uh, adolescents are identifying as trans and non binary now?

[00:26:29] Sasha Ayad: Well, first of all, non binary was something completely unheard of up until very contemporary times. That's a label that's actually quite new, like in all of the literature about childhood gender dysphoria, I mean, there was no such thing.

It was like not unheard of. So that's definitely a contemporary label, as are things like pansexual all these things. And it's really interesting. I'm happy to send you a graph. If you look at the graph over the last, let's say, 20 years of kids. presenting with a different gender identity. The boys go up and the girls just start.

I mean, it's a steep, steep, steep rise. So it's, it's absolutely true. And so of course, some people might say, well, it's because we have more societal acceptance. And so these kids otherwise would have been closeted and now they feel comfortable coming out. And I'm, I'm happy to say that that's probably a portion of it.

But epidemiologists who look at this data say there's no way that societal acceptance can account for all of that. Yeah. So I think, you know, what's a natural part of adolescence, particularly for girls, is to experiment with where you fit in in the world, right? I remember being young and kind of exploring different labels.

I think at the time of my generation, it was like, what bands are you into or what music do you like, right? And what's your kind of style? And so that's a normal part of adolescence. There's nothing wrong with it. And teenagers are doing what teenagers have always done. I think some of the differences are that, you know, kids who are part of this generation that is experimenting with identity at such a faster rate They grew up online and on social media, and we didn't have that.

You know, I remember getting my first cell phone. It was like a slide phone in high school, like sometime towards the end of high school. And social media can be a really powerful way for kids to connect. But I mean, I'm sure your parents who listen to this will know. Most parents tell me, you know, my kid is on her phone a lot, but it doesn't feel like she has really strong, sustained friendships.

Sometimes they do, right? But particularly vulnerable kids who might be a little bit awkward. Some of the kids that we work with have autism. There's a pretty high percentage of kids questioning their gender who have autism spectrum disorder. So They tend to really struggle socially, and so I think the desire to fit in and the natural propensity for experimenting with labels can make it really, uh, powerful and potent to kind of be part of the LGBT group.

And as you mentioned, you know, your daughters have a really different, really accepting mindset around this, which I think is beautiful. And it's great as long as the experimentation is healthy and it's improving the quality of life for the child. And it's not locking in anything permanently that may be just a natural part of that adolescent development and flux.

[00:29:23] Hunter: Yeah. Yeah. I mean, yeah, I mean, I think that a lot of people, you know, like for me personally, I see a lot of people in my neighborhood, in my direct community who have kids who are experimenting with gender identity. Um, and individually I support, of course, every single one of them. But then I also question, like, why there's so many of them?

You know what I mean? Like the large number, but I can't say that out loud because that would. Supporting those individual people, and I've also, my, I also have had questions because, and I've been hesitant to bring someone onto the podcast before, because I had someone come on to the, on the podcast and talk to me about their trans child and say to me that puberty blockers were safer than ADHD drugs.

And I felt, I feel really sort of burned by that because I, I, I am responsible, ultimately, for putting that, what comes out on this podcast, out into the world, and I, and I've learned that that is misleading, and so, so what are, let's go there, what are some of the dangers that should be considered when parents are considering parenting.

Thanks. Things like puberty blockers are looking at this whole question.

Stay tuned for more Mindful Mama podcasts right after this break.

[00:30:53] Sasha Ayad: It's a huge topic and I mean, there's so much to kind of explore here and if you would like, I'm happy to send you some resources that you can kind of dig into further after. Um, we really don't have a ton of data on puberty blockers because again, they're so new. The historical use for these particular drugs were for precocious puberty, which is when a child begins puberty under the age of nine.

And so doctors would give them these drugs that halt their development until it's time for puberty. And these drugs were also used to castrate sex offenders because they are really powerful in suppressing any kind of sexual, uh, hormones. So, these drugs have only been used for gender identity issues very recently, and we don't have a ton of information.

Some things we do know is that if a child goes on puberty blockers and then follows that with cross sex hormones, They will be completely sterilized. That means that they will not be able to have their own children. And that's why if you start looking at gender affirming protocols, they're supposed to do things like banking sperm and freezing eggs, which is a remarkable kind of medical ethical question to impose on children in the first place, right?

But it's really serious. Yeah. And we also know that they can cause really serious problems with osteoporosis and bone health. So kids who go on puberty blockers end up developing really brittle bones pretty young, and then they have to take other drugs to try to counteract the bone effects. And we also see that, uh, particularly with males, if there's a male who identifies as a girl and he's put on puberty blockers, and you can see this with the story of Jazz Jennings.

The genital development actually stops as well. So you have a child who's growing older, and yet the genitals are still the size of however old they were when they were put on puberty blockers. And so in the case of Jazz Jennings, What really unfortunately happened there was that Jazz did not have even enough genital tissue to have the vaginoplasty that she wanted as an older teen.

And so there were really serious complications with that surgery. And this is unfortunately something we see quite commonly. And in the original study that first first pioneered the use of puberty blockers, which happened in the Netherlands in the early 2000s, One of the boy patients died precisely because of this complication, because if there's not enough penile tissue, they have to use rectal tissue to construct the neovagina.

It's pretty, pretty gruesome, but this is a really serious issue. So even if we know that somebody is going to later want to transition, the use of puberty blockers can directly impede their ability to do so. Okay. These are serious things. And you know, we, on our podcast, we interviewed a lovely young man who's now in his early twenties and he started puberty blockers and cross sex hormones at the age of 13.

And he shared with us some really troubling health concerns that he has now. Um, he's kind of gone back to his, a more androgynous identity. So I'm, I'm using the term he, but you know, his name is Scarlett and he lived as a girl for many years. And Scarlet now has, you know, breast tissue from the estrogen.

This is a male person, right?

[00:34:09] Hunter: Mm-Hmm. .

[00:34:09] Sasha Ayad: And there's a lump, and we know that when you put males on estrogen, it increases the risk of breast cancer. So, you know, Scarlet's still in the process of getting that checked out. Scarlet's had really bad problems with like genital pain and incontinence, which means kind of like urinating on oneself.

So these are really serious consequences. Yeah.

[00:34:29] Hunter: Okay. All right. And I, I thought that was important to. to bring up. Hard to hear. Very, very hard. Because, yeah, because it's, it's in, uh, especially in the, the context of the person who came on the podcast, it was presented as a really, very, very safe alternative.

And, um, and I think that it's important, but let's look at kind of like the other side, like, so, you know, there's research by like, They're the American Society of Plastic Surgeons who shows that adults, gender dysphoria, maybe you can explain what that is and why that's challenging, um, because they have an increased risk of all kinds of things, psychiatric conditions, depression, substance abuse, self injury, suicide, compared to cisgender individuals.

And according to this research, approximately 0. 6 percent of adults Um, and the United States identify themselves as transgender and that the overall regret rate for people who have gone through surgery was of just 1%, right? So we know, right, that discrimination continues to really affect the daily lives of these individuals.

And like, with that in mind, kind of balancing out obviously what we just learned about puberty blockers, et cetera. It's such a tough question for parents, right? Because we, we parents want to be fully supportive of our kids, right? We want to be. fully on their team. How, how do we be supportive without necessarily then going, maybe if we are choosing to do something like hold a boundary around something like puberty blockers?

[00:36:14] Sasha Ayad: Yeah, well, I mean, I'd love to just start by there is a kind of statistic in there that you shared that there's, um, unfortunately, like a not, not a lot of evidence to back it up. So the 1 percent regret rates are often kind of stated, particularly in like, advocacy, advocacy organizations. And unfortunately, unfortunately, The studies that come up with the 1 percent regret rate have a really big problem with loss to follow up, meaning that something between, you know, 60 and 40 percent of participants aren't coming back, so they don't know.

And in a recent study, people who did have regret around their transition report that 25 percent of them went back to tell their physicians. So that means 75 percent of them were just out in the world and their physicians had no idea that they were having regret or that they stopped the intervention.

So, frankly, we, again, this is all really new and I'm not going to say, Oh, the regret rates are so high. We actually don't know. We just don't know. There's so much loss to follow. Okay. So that's kind of one thing to keep in mind. Um, and I think, you know, in terms of how parents can support their children, it's really tough because I think we are in the middle of a historical moment, right?

As you said, you're observing it too, listeners have seen it, a lot has changed really, really quickly in youth with gender identity and a lot of brand new interventions that have never really been used on minors before have been used in pretty high quantities and we are just kind of now getting our bearings with what this means, what does this look like.

So when, when parents recognize that we're in the midst of some really fast changing landscape It's important to be that kind of confident, loving, grounding source for your children. And you might say something like, you know, honey, I, I love, I love how accepting and warm and compassionate you are to all the different friends you have in different groups of people.

And part of my job as a parent is to kind of think about the big picture and keep you safe and understand the science here. And even though this is something you see around you, that's really, really common, There's a lot of concern that I have about the safety of this or that intervention. And so we love you.

We want to support you, but just because everybody around you is doing something, it doesn't necessarily mean it's the safest or best thing to do. And frankly, I mean, this is really hard. Like we, we see many trends like this, you know, so when microwave dinners came out in like the seventies, like everybody was eating them and everyone thought it was so great, but actually we realized that's not the most nutritious food.

Or, you know, when cell phones, like all these kids have cell phones and now the data starting to show maybe this is not super great for their development. So it's not new for us to be in the middle of a quickly changing landscape. And as parents get more information and as things become clearer, you may have to set some loving boundaries with your child and say, honey, you know, when we had different information, we did our best with that.

But now that we have this information, it's really important that we think about your wellbeing, think about your safety, think about your. overall kind of whole person health, right? Um, you know, it's okay to acknowledge that you're learning new things and you know, you want to model for your child too, that when we learn new information, we can change our minds about a decision we made or we can take a different direction.

[00:39:46] Hunter: Yeah. Okay. I appreciate that. Response. And I think that's, it's in some ways like I can see how my kids get. So, you know, they learn something and get really gung ho about things. And part of my job is often to say, um, well, this, may be more complex than you think. What about this part of it? Or what about this part of it?

Or what about this down the line? And to, you know, as they get really, um, yeah, I mean, with all kinds of issues, but you suggest that, uh, parents and teens, they take a moratorium on all major decisions on the teen's unfolding identity decisions like. socially transitioning or hormone blockers. Is that what you mean by major decisions?

Tell me about the idea of a moratorium as when, when parents and teens are, are going through this.

[00:40:43] Sasha Ayad: Yeah. I mean, this is really a somewhat subjective, right? Because each family has to decide for themselves. what feels like the right step for us at this moment. And, and something that we also say in the book is you really have to clear the noise because, I mean, ironically, I'm here on a parenting podcast.

Obviously you share thoughts and ideas with parents, but parents really need to tune in with their own instinct about their child and figure out what do I think is best for this kid, right? So take everything that I'm saying with a grain of salt. I would say one kind of guiding principle might be.

Anything that seems to have kind of a permanent or solidifying impact, meaning, is this move going to lock things into a particular direction that's really hard to get out of? And only you know your child. So, for example, some kids. have a really big emphasis on saving face. So if I am one of those kids and I've told all my friends, by the way, I am trans and I need you to call me this or that pronoun.

If I'm afraid of being called a fake or a trans trender or something like that, I may never be able to walk that back, even if I no longer feel like it's serving me. Right? Other kids are very comfortable saying like, no, I thought I was trans, but this, this week I'm non binary or this week I'm just like, whatever.

If you have a child that's flexible and able to kind of make decisions for him or herself based on what's best at the moment, then that's fine. So you kind of have to know your child about, is this decision going to lock us into a pathway that's really hard to get out of? And that has to do with like your friends, you know, do you have a peer group that is will totally ostracize you if you're not part of LGBT.

Or do you have a peer group that has your back no matter how your identity evolves? Right? So there's lots of different factors to consider there. I would say medicalization is really a kind of concrete way of moving in a precise direction. and has such complications associated with it that I would say that's probably a good place to definitely have a moratorium on permanent decisions, like permanent impacts on the body.

[00:42:57] Hunter: And for a parent of a teen, maybe, say a parent of an adolescent has, um, noticed their child has been experimenting, noticed maybe their child's, you know, is influenced by their peers and may You know, people have different instincts about their kids. Obviously, some, some, you know, for me, when my daughter was, said she was lesbian, I was like, Oh, that makes so much sense for you.

Right. Like it was just totally in line with who she was. And, you know, so say a parent who's saying, Oh, this may be experimentation. It doesn't necessarily, if I check in with my instincts, feel like this may be totally my child in the future. How long would you suggest, um, uh, they do a moratorium? Like what does, what does a time period look like for something like that?

[00:43:44] Sasha Ayad: Well, I think, I mean, I don't want us to get tripped up on the term moratorium. I think what I'd, I'd like to say is you want to, I think about Diana Baumrind's parenting styles, right? So like love and structure, you know, warmth and boundaries. Just because you are, let's say, I'm going to say no to a request for puberty blockers.

It doesn't mean that you can't engage in conversation, you can't explore things together, you can't, you know, watch different videos and have conversations. I think keeping the dialogue open is really important. Sometimes kids won't want to do that, right? Partially because they're teenagers and maybe that's not what, you know, what they want to do is talk to mom about these identity things.

You know, in my experience. sometimes exploring gender identity is a more of a peer mediated thing. So some kids are like, I don't want to talk to my parents about it, but like in the context of school, I'm this other person. So that's, that's really interesting. And I would still think it's worth having a conversation.

Um, you know, there are, there are so many kind of unhelpful messages I think that young people may get from the various online websites, just like you would with anything else. You know, if your child is. Kind of reading certain websites about flat earth or something and you realize she's going down a rabbit hole with things that are not helpful or, or true, you'll want to talk with her about it and just have a conversation.

And, you know, something that I don't know if Hunter, if we can maybe spend a few minutes here. I think some parents have come to, to believe that identifying as trans is the same exact thing as coming out as gay or lesbian. And I'd love to just spend a common Um, I think idea that comes from a good place, but it's different in so, so, so many ways.

First of all, I think the most gl the glaring way is that, as we talked about earlier, many kids who are gender non conforming, or even gender questioning, will end up being gay. And you know, just like the example I shared earlier about Scarlett, there's just dozens and dozens of young people I've met now.

who they were really uncomfortable with having same sex attraction and they were feeling really awkward, or they lived in really conservative communities where they were bullied for being gay or for being, you know, seeming to be gay. So sometimes the trans identification is actually a way to escape the bullying or the ostracizing of being gay or just the discomfort with coming to terms with that.

So that's a really important thing to understand. And secondly, you know, when, when a young person comes out as gay or lesbian, they, they get to still be perfectly kind of congruent with their body and it doesn't require any kind of intervention. It doesn't require anybody else to really do anything. All it requires is for parents to say, great, honey, I love you and I've got your back.

You know, this is just like such a common, um, area where I think people have gotten Kind of just a little confused because gender is often presented in this kind of umbrella of like kids, some kids come out as gay, some kids come out as trans, and there's like no difference, but actually there, there are some major differences and sometimes there's an overlap.

[00:47:05] Hunter: Yeah, yeah. I mean, I'm glad you brought that up. I'm, I'm really glad because yeah, that there's a huge difference. Um, between, you know, changing your body and going down this, this, this whole route versus, um, having, uh, you know, uh, an attraction to a particular sex or gender and accepting that. Um, There's so much here and there's so much in your book, um, When Kids Say They're Trans.

It's a, a guide that Sasha wrote with Lisa Marciano and Stella O'Malley. And for, you know, for parents who, um, have more questions, I highly recommend that you get the book. You guys go into many, many details and questions that we were not, do not have time to, to talk about here. Um, Do you have any final thoughts that you'd like to share with parents who are dealing with these issues, whether they have kids young or older?

[00:48:06] Sasha Ayad: Yeah, I think one thing that I've been thinking a lot about recently, Hunter, is just the way that parents have become so disempowered. I think resourceful, intelligent parents often turn to Experts and other authority figures for guidance and support. I mean, the parents that I work with are just brilliant.

They've read every parenting book you can get your hands on. They're really dedicated to the job of parenting, right? And I think that's, that's, that's beautiful. And I think that comes from a really amazing place. And, It's a contemporary kind of, uh, phenomenon for parents to be seeking out so much professional advice on parenting.

Like, humans have parented their children for the history of time and have raised great people. So I, I like to just empower parents that their, their own relationship with their child, their own instinct about their child, and their own ability to, like, lovingly guide their child. is something that they possess within themselves.

So even though, you know, we wrote this book and, and I'm, I'm all about, you know, sharing information with parents. I don't want parents to totally outsource their, their power and their authority to everybody else. You know, like, you know, your kid best. And just trust your instinct.

[00:49:28] Hunter: Sasha, I'm really appreciate you coming on the podcast to talk to me about this.

Like I said, I've been kind of searching for the right person to talk about this issue for a while now, um, because I wanted to find, uh, somebody who could talk about the issue in a nuanced way that is, is, talks about the middle path and is, you know, really important. is not on a necessarily a political agenda and can talk to parents about the questions that we naturally have that we feel scared to ask because of the political climate.

So I really, really appreciate this. Um, you know, dear listener, I hope that this has helped you to, to clarify some issues and I wholeheartedly agree with what Sasha said about, you know, I hope this. Listening to this conversation has helped build your awareness, helped you look inside at your own relationship and, and create some clarity for you.

And um, so yeah, take what is working for you, leave the rest. Yeah. Thank you. Thank you so much for taking the time for Bravely. Speaking out in a country that can will tar and feather you sometimes for doing that. I know that it takes a lot of chutzpah, so I appreciate you for the

[00:50:48] Sasha Ayad: work that you do. Thank you so much.

I really appreciate the chance to talk with you today. Thanks.

[00:50:58] Hunter: Hey, I hope that you found this conversation helpful. I hope that you, that it opened up some thoughts and some questions and some perspective for you, and I invite you to take what works for you and to leave the rest. My intention for this episode is to just open up this nonjudgmental space to explore parents natural questions.

And just to create more understanding in general, it's totally okay if you disagree with my guest. And, you know, I just want you to know that my intention is to open the space for these questions that are in the messy middle of this issue. and to give parents a more nuanced conversation than just like for or against.

So I just want us to be able to support parents, all as parents, to support their kids in the best way possible for everyone. So I hope this conversation helped. I hope that, and if it did, please do let me know. Uh, of course, I've been very anxious about releasing this conversation. I've had conversations 14 year old about, you know, about it and what she thinks about it.

She's already listened to the episode. Um, so yeah, so I'm curious to see what you think is, is, was this helpful for you to have this conversation? Um, I'd love to know, let me know. Of course you can find me at mindfulmamamentor. com and on Instagram at mindfulmamamentor. All of those places, but yeah, my general hope is that this helps, that this helps bring you some, some compassion, some insight, and a more nuanced exploration of the complexities of this issue, because it's very complex in a lot of ways, you know, as, as people.

All things are for us humans. So anyway, I'm wishing you a great week. Thank you so much for listening. Thank you for listening all the way here to the end. And um, if this podcast has helped you, please, please do let me know because I've been so worried about it. And I hope it has. I, you know, felt like this was an important conversation to have, so, um, I hope it is.

Wishing you a great week, my friend. Thank you so much for being here. Namaste.

I'd say definitely do it. It's really helpful. It will change your relationship with your kids for the better. It will help you communicate better. And just, I'd say communicate better as a person, as a wife, as a spouse. It's been really a positive influence in our lives, so definitely do it. I'd say definitely do it.

It's really helpful. It's so worth it. The money really is inconsequential when you get so much benefit from being a better parent to your children and feeling like you're connecting more with them and not feeling like you're yelling all the time or you're like why isn't things working. I would say definitely do it.

It's so, so worth it. It'll change you. No matter what age someone's child is, it's a great opportunity for personal growth and it's great investment in someone's family. I'm very thankful I have this. You can continue in your old habits that aren't working or you can learn some new tools and gain some perspective to shift everything in your parenting.


you frustrated by parenting? Do you listen to the experts and try all the tips and strategies, but you're just not seeing the results that you want? Or are you lost as to where to start? Does it all seem so overwhelming with too much to learn? Are you yearning for community people who get it, who also don't want to threaten and punish to create cooperation?

Hi, I'm Hunter Clark Fields, and if you answered yes to any of these questions, I want you to seriously consider the Mindful Parenting Membership. You will be joining hundreds of people. Hundreds of members who have discovered the path of mindful parenting and now have confidence and clarity in their parenting.

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