Thank you very much for your positive comments - and huge congratulations on having battled this illness with so little support and come out the other side of it. You should be very proud of all you have achieved, and of having got your life back on track. I am so very pleased for you.
You make some very valid points and I am glad you have raised the issue of gender identity as I have come across one case where this is 'in the mix' and when I went online and researched this question, there are some areas of huge concern. Evidently it is not uncommon now, when a young person wishes to change gender, of delaying adolescence with hormone treatment because, if there is later going to be a sex change, it is easier before the person has moved into a fully developed adult body. I find this highly disturbing, not least because how can you be sure that this is not a 'passing phase', and when there is no brain maturity or life experience, how can the child/young person know how he/she will feel later in life? When I read an article about sex change individuals - there is a high rate of mental health issues and suicide after gender change - so is it really the answer?
The other thing that worries me that, if you delay growth in any way in an adolescent - that will surely involve not enforcing weight gain in a person suffering from anorexia nervosa in particular, but with other eating disorders as well? So how on earth are you going to ensure a recovery?
I think that this will become a question which will start to appear more in an ed setting, and clinicians will have to have some kind of training on how to deal with it - prioritising gender discussions in a gender clinic setting above re-feeding and weight gain could be dangerous.
While I sympathise with anyone who feels they have been born 'in the wrong body' - the consequences of providing gender change operations/treatments at such a young age have yet to be reviewed in any detail to see if it genuinely is the way forward. Also, given that risk-taking annd not thinking about the consequences is a part of adolescence, the experience of gender change is likely to be viewed with less than a full understanding of all the issues involved, and I remain apprehensive about the way society is going with regard to this 'problem'.
I totally agree with you about a lot of this! It is incredibly complicated and, like many other aspects of puberty/adolescence, is even further complicated by the presence of an eating disorder. I also agree that replacing a qualified ED treatment team with a therapist who only specialized in gender identity issues would be completely irresponsible. I do want to clarify a few things (as someone who has personal experience, has been researching this for almost a decade, and has a master’s degree in a related field).
First, and I think most importantly, you’re absolutely correct that suicide rates and the presence of other mental illnesses are statistically MUCH higher in those with gender identity issues. But, these rates actually go down in people who transition or take other measures to align their expression of gender with their gender identity AS LONG AS such measures are supported by those around them. The rate of mental illness does remain very high in individuals who continue to be bullied, harassed, misgendered, or otherwise discriminated against. Studies have shown that the percentage of people who, for whatever reason, regret transitioning is actually pretty low. So if your child comes to you with gender identity questions, assuming it is a phase or otherwise shutting those down completely will ultimately increase the possibility of suicide or other mental illnesses.
The psychiatric and medical response to kids with gender identity issues is also complicated and like ED treatment, depends on the practitioner, the parents, and the child in question. And like ED professionals, gender identity professionals range from excellent to downright harmful. Generally when a child or adolescent has persistent gender identity questions and is taken to a qualified professional, that professional’s first step is not going to be putting them on a puberty blocker or scheduling a surgical intervention. Good gender identity therapists are trained to determine with the child or adolescent whether what they’re feeling is true, genuine, and persistent, and such practitioners (like other doctors) only move forward with medical or surgical interventions if they feel it is in the best interest of the child. And while changed cause by surgery or cross-hormones are permanent, puberty blockers have been found to be very safe, temporary, and able to be stopped/reversed at any time.
Of course bringing an ED into all of this (or bringing all of this into an ED) makes a complex situation even more complicated. Like you, I hope that eventually all gender identity practitioners have a solid understanding of eating disorders and vice versa. And I also agree that weight restoration takes precedence over pretty much everything else. But my ultimate hope is that parents of kids, adolescents, and young adults with eating disorders ALSO take gender identity issues seriously. Even if you think it is a phase or peer influence or the product of malnutrition — take them to someone trained to help determine those things. Because just like an eating disorder, ignoring it can be deadly.