Mental health professionals have ‘abandoned’ duty of care in treatment of trans youth, therapist says

Mental health professionals have abandoned their duty of care when it comes to treating trans-identifying youth, and the long-term effects could be disastrous, a family therapist said. 

“We’ve allowed our role to be changed in the public eye,” Stephanie Winn, a licensed marriage and family therapist in Portland, Oregon, told Fox News. Therapists’ new role is “essentially green lighting or rubber-stamping people along into these medical procedures when that’s never been our role in the treatment of any other issue.”

Youth access to gender transition medical therapy such as puberty blockers, cross-sex hormones and surgery have been widely debated in recent years with critics saying minors are too young to be altering their bodies, sometimes permanently. Advocates, however, argue that such care is life-saving since untreated trans youth face higher rates of depression and suicide. 

Winn argued that a narrative has been established that encourages mental health professionals to accept a child’s trans identity without scrutiny, leaving potential mental illnesses untreated. Youth experiencing suicidal ideation and other distress, consequently, aren’t always getting proper care, and in some instances, may receive life-altering treatment that could cause additional issues later on, she said.

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The number of transgender teens under 18 doubled between 2017 and 2020, from .7% to 1.4%, according to UCLA research. The June report, based on government health surveys, also found that just under 43% of the 1.6 million people who identify as transgender in the U.S. are between 13 and 25.

Winn said she’s becoming “increasingly concerned” about the trend of youth identifying as transgender or non-binary and “the lifelong, irreversible medical experiments that are happening to children as a result of this ideology.” She added that in 10-15 years, “we’re going to see a transition regret crisis, and unfortunately, we are going to have to worry about some of the most frightening mental health outcomes as part of that.”

In the past two years, 25 states have introduced legislation that would restrict access to gender transition medical therapy for minors. Meanwhile, 27 states have passed legislation restricting “conversion therapy” for trans youth, which GLAAD defines as “any attempt to change a person’s sexual orientation, gender identity, or gender expression.”

Mental health professionals fear backlash and could risk losing their licenses if they try to treat gender dysphoria patients with anything besides transition therapy, according to Winn, who herself has faced such trouble.

“Many of my colleagues have abandoned our duty of care, either due to ignorance or cowardice,” she told Fox News.

Gender dysphoria, as defined by Mayo Clinic, is “the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth.” Diagnosed teens may be treated with puberty blockers to prevent unwanted changes, such as periods or the deepening of their voice. Later, they may receive cross-sex hormones to develop characteristics of the opposite gender — such as facial hair — as well as chest and genital reassignment surgeries.

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“A completely different standard of care” has been established for treating gender dysphoria compared to other mental health disorders as a result of public pressure and trainings from trans activists, Winn said.

The therapist believes mental health professionals, as a result, aren’t doing their due diligence when treating trans-identifying youth and are prematurely affirming and ushering kids down a path of medicalization. She said such professionals aren’t adequately trying to determine if their patients’ feelings of gender dysphoria are manifested from other frequently associated mental illnesses, rather than the other way around. 

Assistant Secretary for Health Rachel Levine said in an April interview with NPR that “there is no argument among medical professionals — pediatricians, pediatric endocrinologists, adolescent medicine physicians, adolescent psychiatrists, psychologists, etc. — about the value and the importance of gender-affirming care.” 

Levine, who is transgender, pointed to numerous medical organizations that — including the American Academy of Pediatrics, the American Medical Association, the American Psychiatric Association and the American Academy of Child & Adolescent Psychiatry — support “evidence-based standards of care” for gender transition therapy.

“We’re just told that if someone tells you they identify in this way, that’s the end of the story,” Winn told Fox News. “Don’t ask any questions, just affirm, just agree, and then usher them along this path of medicalization.”

Winn used to treat trans-identifying youth but said she stopped after activists targeted her. She told the Oregon Board of Licensed Professional Counselors and Therapists in December that “strangers online,” often anonymously, were threatening her and claiming that “my behavior is illegal and they have grounds for making reports because they believe I am in violation of the ban on conversion therapy.”

The board opened an investigation into Winn in April but dismissed it in June, the therapist wrote on her blog.

In addition to affirming patients, Winn said mental health professionals are expected to “drive a wedge between families.”

“We’re expected to tell parents that they must let their children lead, even though children need structure, rules, discipline and boundaries,” she told Fox News. “And that if they don’t, they’re bigots.” 

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‘A very dangerous narrative’

Failure to properly root out the cause of a child’s distress isn’t just irresponsible — it can be dangerous, according to Winn.

Transgender youth suffer from mental disorders including anxiety, depression, PTSD, ADHD, autism than their peers, and also face a higher risk of suicide, studies have shown. According to survey by the Trevor Project, nearly one in five transgender and non-binary youth attempted suicide in the past year — about double the rate of cisgender youth.

“Our research shows that just a single affirming adult in a young person’s life makes them 40% less likely to attempt suicide in the past year,” Troy Stevenson, the Trevor Project’s senior campaign manager for advocacy and government affairs, told The Washington Post in August.

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Winn argued that the high rate of suicidal ideation among trans youth is often falsely attributed to stigma and discrimination. She said the stat is used to pressure doctors and parents toward affirmation.

“I think it’s a very dangerous narrative,” Winn told Fox News. By accepting that discrimination is a major driver behind suicidal tendencies in these instances, Winn said professionals are “ignoring the real problems” and “abdicating our responsibility” of psychoanalyzing kids to determine if there are other or additional underlying issues causing distress.

Winn, however, does not downplay the risk of suicide among troubled youth.

“Are youth expressing suicidal ideation? Absolutely. But are we treating that correctly? No,” she said. 

“We need to look at—how do we do the least amount of harm, how to provide the least invasive, most effective treatments, and that means psychotherapy, not medicalization,” Winn told Fox News. Rather than immediately affirming, mental health professionals should perform an assessment and investigate how long the child has experienced dysphoria and how mental health issues or life changes might be contributing, she said.

The family therapist, who often sees parents with trans-identifying children, warned that there could later be an even worse mental health crisis stemming from transition regret. 

“You have this epidemic where the barriers are getting lower and lower. There’s less and less screening,” Winn said. “The age of transition is getting younger. More kids are doing this. So the rate of transition regret down the line can only be expected to get higher.”

Winn fears that in 10 years, we will have “a generation of 20- and 30-somethings who feel betrayed by their parents, their teachers, doctors, therapists, friends, everyone who ‘affirmed them.’” 

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Common suicide risk factors include chronic pain, loss of relationships, and an unfulfilling romantic and sex life, according to the Centers for Disease Control and Prevention. Winn warned that kids who undergo medical gender transition therapy will face a higher risk of these down the line. 

“They’re going to be facing the reality that they can’t have kids, that they can’t have sex, that their bodies feel hurt and broken and scarred and they feel embarrassed and ashamed and regretful,” she said.

Advocates for Youth declined an interview with Fox News. The following trans youth advocacy and support organizations did not respond to interview requests: Equality Federation; Human Rights Campaign; National Center or Transgender Equality; National LGBTQ Task Force; Trans Youth Equality Foundation; the American College of Obsetricians and Gynecologists; Gay, Lesbian, and Straight Education Network; Log Cabin Republicans; Columbia’s Gender Identity Program; and NYU Langone’s Transgender Health unit.