A Cause, Not a Cure: Though the New York Times touts its findings, a new study provides further evidence that “gender-affirming” therapy creates or prolongs the very problem it purports to solve.

The deeper problem here is that psychiatry since the 1980s has steadily moved from etiology-based to symptom-based classification and diagnosis. In branches of medicine dealing with the body, we would think it absurd and dangerous if doctors diagnosed and treated patients based purely on their symptoms. Doctors would prescribe chemotherapy for patients presenting with fatigue, stomach cramps, and constant vomiting (symptoms of colon cancer), even if the true cause of their symptoms was, say, chronic work-related anxiety.

The inherent difficulty of understanding the causes of mental disorder and the diverging theoretical approaches to this question that emerged within psychiatry over the twentieth century prompted leaders in the field to broker a compromise. “By providing clear, explicit descriptions of diagnostic criteria,” writes Harvard professor of psychology Richard McNally, the symptom-based approach “allowed clinicians and researchers of diverse theoretical persuasions—psychodynamic, cognitive, behavioral, and biological—to agree, at least in principle, whether someone qualified for a certain diagnosis, even if they could not agree about its causes.” In short, symptom-based psychiatry represents a pragmatic effort to achieve uniformity across the field, but it does so, experts have argued, at great expense. “The concept of mental disorder,” McNally reports, “implies that something internal to the person’s psychobiology is not functioning properly.” But psychiatry’s current emphasis on symptoms at the expenses of causes increases “the risk of classifying people as disordered whose suffering does not arise from mental illness at all.”

Pediatric gender transition illustrates the agonizing downsides of symptoms-based psychiatry. Medical practitioners are now giving puberty blockers, cross-sex hormones, and surgeries to teenage girls with no history of gender-related distress simply because they present with symptoms similar to the ones observed in the preteen boys in the original Dutch studies of the 1990s. The fact that the girls begin presenting around puberty (whereas most of the boys desist around then), and that they arrive at gender clinics often after prolonged social isolation and exposure to social media, are crucial contextual points. They might suggest that “gender dysphoria” in the case of girls is a result of social contagion—and thus a temporary phase. Clinicians focusing on symptoms alone tend to be oblivious to these confounding factors.

The patient population Olson and her colleagues followed was made up of children who began “social transition” on average between ages six and seven, who were supported in that transition, and who were still “identifying” as the opposite sex around the onset of puberty five years later. The study’s major flaw is that it fails to consider that “social transition” may itself contribute to the persistence of gender dysphoria—something that the Dutch pioneers of pediatric gender transition, as well as the recently published Cass Review study of the U.K.’s Tavistock Clinic, have both emphasized. In other words, the Olson study treats the practice of giving children a new name, using pronouns and words like “son” and “daughter” in accordance with the opposite sex, dressing them as that sex, and encouraging them to engage in activities conventionally associated with that sex, as mere background supports rather than as an active form of intervention in a child’s psychosocial development.

Considering how impressionable children are, how susceptible to messaging from the adults in their lives, and how invested they and those adults often become in maintaining the transgender identity, is it any wonder that the vast majority of the children in Olson’s study continued perceiving themselves as “trans” five years on? Indeed, the more striking finding is that 2.5 percent of these children managed to revert back to “identifying” as their biological sex. Imagine the courage it takes for an 11-year-old boy to say to his parents, teachers, and psychologist: “I guess I was wrong. I guess you were all wrong.”