Jennifer Bauwens, Ph.D. Center for Family Studies at Family Research Council
Chairman Johnson, Ranking Member Scanlon, and members of the Sub-committee:
Thank you for the opportunity to speak with you today. My name is Dr. Jennifer Bauwens. I am a licensed therapist and clinical researcher currently serving as Director of the Center for Family Studies at Family Research Council. Based on over 25 years of experience as a clinician providing trauma therapy to children and as a researcher investigating the psychological effects of traumatic stress, I am here to express my concern about what has been termed “gender-affirming care” for children. I have considered it a privilege to practice, research, and train future clinicians and be a part of a discipline aimed at protecting and bringing healing to the most vulnerable in our society—children. But when it comes to gender transition procedures, my field is not operating as a helping profession. Instead, it is actively causing harm.
Historically, children have been treated as a special and vulnerable class in the psychological and research fields. This followed a series of highly unethical and dangerous medical studies that came into public view (e.g., Tuskegee). The need for ethical research standards culminated with the passage of the National Research Act of 1974 and the subsequent Belmont Report of 1979. The Belmont Report gave guidance for ensuring that research practices were nonexploitative. For this reason, children, as well as those with intellectual disabilities and other groups of people who could be targeted with coercive treatment and research protocols, were to be afforded extra precautions. Of course, greater caution was applied to children in light of the fact that they do not have the developmental capacity to understand life-long decisions. How many of you wish you could change something you did in elementary or high school?
Even if natural observation wasn’t enough to confirm the need for extra precautions for children, neurological science tells us why this is the case. A large-scale study of 20,000 brain scans funded by the National Institutes of Health found that the brain continues to develop into a person’s mid-twenties.1 Some of the greatest developmental strides occur within complex neurological structures during adolescence. The limbic system, also known as the seat of our emotions, relates to emotional processing, learning, and memory and is still undergoing major change. Importantly, this structure is known to play a role in many mental disorders. It also takes the longest to reach structural norms. Again, most people do not reach these norms until their twenties. Hence, the reason why the psychological, medical, and research fields have instituted ethical safeguards to move conservatively with regard to interventions, particularly when the evidence is weak, or the research methods and agenda are in the early phases (which is the case in transgender research).
Sadly enough, some in my profession have set aside this basic understanding of child neurological, emotional, and cognitive development. Instead, they have embraced what has been referred to as “gender-affirming care,” which permanently alters the human psyche and physiology through puberty blockers, cross-sex hormones, and surgical procedures to remove healthy body parts.
Incidentally, compared to other psychological disorders found in the DSM V-TR, gender-affirming care is the most invasive and unnecessary physiological intervention connected to a psychological issue. Gender-affirming care is also in direct opposition to the basic practices of good mental health treatment.
1) As I already mentioned, this experimental practice has been administered to children despite our understanding of a child’s developmental capacity to truly give informed consent for social and physiological interventions that have life-long consequences.
2) The state of the scientific literature is based on consensus, not evidence. This means that people who have an interest in transgenderism joined a committee on the topic and voted on the use of gender-affirming care rather than promoting it based on the merits of the research findings addressing gender dysphoria, which are quite poor.
In fact, based on the research methods alone, never mind the topic of inquiry (i.e., cross-sectional, selfselected samples, no RCTs, missing significant variables), gender-affirming practices should never have been allowed on anyone, particularly a child.
3) Therefore, it is no surprise that the benefits do not outweigh the risks. If I told you that 85 percent of research participants no longer had anxiety, posttraumatic stress, etc., after going through my treatment program, I’d be the next multimillion-dollar grant recipient of NIH funds, and suddenly you’d see clinics everywhere adopting my new treatment. This success rate is already true for gender dysphoric children.2 If we provide basic supportive therapy or simply leave children alone, they will desist. Given this, gender-affirming care is not only unnecessary but potentially interrupts a natural developmental process.
4) Good mental health assessment and research accounts for competing diagnoses (variables in the research context). This one-size fits all approach to gender dysphoria emphasizes the source of psychological distress as related to an issue of acceptance. This is done at the expense of a thorough understanding of other psychological phenomena that may play a significant role with gender dysphonia (i.e., neurodevelopmental and other mental disorders, substance use, self-harm, and traumabased responses). The problem with this premise is that it explains away other sources of distress, not giving proper weight to other issues known to be prominent in the trans-identifying person may experience.3 Without including these known factors, the clinician and the researcher will almost always have an incomplete picture of the problem.
For example, gender-affirming practice and research do not account for the high rates of early childhood trauma (ACEs) found in the transgender-identifying population.
The UCLA Williams Institute, an LGBTQIA+ advocacy group, found that:
- 45 percent of transgender-identifying people reported childhood sexual abuse.
- 44 percent of transgender-identifying people reported childhood physical abuse.
- 75 percent of transgender-identifying people reported childhood emotional abuse.4
As a trauma clinician, I can tell you that when someone has endured a traumatic event, particularly one sexual in nature, it is not uncommon for a person to hate the parts of their body or want to get rid of those aspects of themselves that made them vulnerable.
For the trauma survivor, an ideology that suggests a child can be born in the wrong body, unfortunately, fits hand-in-glove with the mentality of a person who self-harms and wants to dissociate from any aspect of their being or body that highlights vulnerability. Yet, despite this knowledge, clinical settings and research studies promoting transgenderism have not properly accounted for this significant variable and how it relates to gender dysphoria.
5) Empowerment and self-management are aspects of good mental health practices. We often hear that suicide will be the result if someone struggling to embrace their biological sex isn’t offered transgender physiological procedures. It is entirely inappropriate and unethical for anyone in my profession to plant the idea that an inevitable outcome will be suicide (even in the absence of expressed suicidal ideation) if the clinician’s counsel for gender-affirming care is not followed. This is blatantly manipulative and has no part in promoting psychological or relational health.
Scientifically, based on the research methods alone, it is impossible to establish a causal relationship between the absence of gender-affirmative procedures and suicide. A recent meta-analysis from the suicide literature, which has been around a lot longer than research addressing gender dysphoria, notes a number of risk factors for a completed suicide, which curiously happen to be the same risk factors that are prominent in the trans-identifying community. This literature frequently reports that although we have identified risks, it is unclear which combination will ultimately lead someone to suicide.5
In the practice setting, using the threat of suicide to motivate a client or family member to engage in an intervention would be considered egregious when dealing with any other issue. I worked on a suicide hotline early in my career. We know someone who gambles often can be at risk for suicide, especially after a big loss. As a clinician, it would be bad practice for me to tell someone who gambles that if they don’t get more money to gamble, they will probably commit suicide. Yet, this threat is given every day in settings all over where gender dysphoria is the focal point.
Taken together, the onus should be on the transgender theorists and researchers to tell us (with overwhelming results from RCTs, clinical practice reports, and long-term studies that report on five to seven years after the procedures) that this practice significantly benefits children and far outweighs the harms. Instead, this research body leaves many unanswered questions on the mental health front. Contrary to some political opinions, this matter is far from settled. Here are a few of the countless unanswered questions:
- What factors are responsible for the new cohort of biological females presenting as gender dysphoric rather than the historic numbers who were primarily biological males?
- Are there comorbidities that affect the outcome?
- Do biological males and females have different outcomes as a response to gender affirmation and different responses to components of these interventions?
- Is there an aspect of gender-affirming care that affects a quantifiable rate of those with gender dysphoria?
- Who will fare best after surgery, cross-sex hormones, or puberty blockers?
- No common program evaluation questions have been answered. For example, what effect does attending treatment alone have on mental health outcomes (without gender-affirming care)?
- Who are the people who regret each one of these unique interventions (i.e., puberty blockers,hormones, and surgeries)?
- What effect do transgender physiological procedures have on trauma symptoms, the desire to self-harm, or other mental distresses?
- Who is most likely to benefit or be harmed by these procedures?
Instead of answers to these questions, we’ve plowed ahead with practices that break ethical research and practice boundaries. Gender-affirming care creates an illusion that there is only one choice for children and their families to experience relief from their distress, and that is to become someone else.
Please look at www.cochrane.org, the website of the healthcare information organization the Cochrane Collaboration, and type in the name of any mental disorder (i.e., depression). You will see a multitude of treatments that have been researched to help children through depression.6 When it comes to gender dysphoria, there’s only one path.7 That is, to make yourself look like someone else. These kids deserve better. We should be innovating solutions to heal their distress, not coercing them onto a path that tells them they need to remove or change parts of who they are in order to be whole.
I’m calling on you to please act on behalf of children. Please see Appendices A-C for more information on this issue.
Jennifer Bauwens is Director of the Center for Family Studies at Family Research Council.
1 Ajay Nadig et al., “Morphological integration of the human brain across adolescence and adulthood,” Proceedings of the
National Academy of Sciences of the United States of America 118, no. 14 (2021): e2023860118,
https://www.pnas.org/content/118/14/e2023860118.
2 Jiska Ristori and Thomas D Steensma, “Gender dysphoria in childhood,” International Review of Psychiatry 28, no. 1
(2016): 13-20, https://doi.org/10.3109/09540261.2015.1115754; Devita Singh et al., “A Follow-Up Study of Boys With
Gender Identity Disorder,” Front Psychiatry 12 (2021): 632784, https://doi.org/10.3389/fpsyt.2021.632784.
3 Chris Rowe et al., “Prevalence and correlates of substance use among trans female youth ages 16–24 years in the San
Francisco Bay Area,” Drug and Alcohol Dependence 147 (2015): 160–66, https://doi.org/10.1016/j.drugalcdep.2014.11.023.
4 Ilan H. Meyer et al., “LGBTQ People in the US: Select Findings from the Generations and TransPop Studies,” UCLA School of Law – Williams Institute, June 2021, https://williamsinstitute.law.ucla.edu/wp-content/uploads/Generations-TransPop-Toplines-Jun-2021.pdf.
5 Christine B. Cha et al., “Annual Research Review: Suicide among youth – epidemiology, (potential) etiology, and
treatment,” Journal of Child Psychology and Psychiatry 59, no. 4 (2018): 460-82, https://doi.org/10.1111/jcpp.12831.
6 “Site search: Depression,” The Cochrane Collaboration, accessed January 23, 2023,
https://www.cochrane.org/search/site/depression.
7 “Site search: Gender dysphoria,” The Cochrane Collaboration, accessed January 23, 2023,
https://www.cochrane.org/search/site/gender%20dysphoria.
