The Gender Affirmative Model: What We Know and What We Aim to Learn

Abstract

In the summer of 2013, Dr. Jack Drescher published an editorial opinion about gender-nonconforming children in the New York Times in which he stated: ‘‘Currently experts can't tell apart kids who outgrow gender dysphoria (desisters) from those who do not (persisters), and how to treat them is controversial'' [Drescher, 2013, p. 1]. As members of a four-site child gender clinic group, we concur with Dr. Drescher regarding the controversy, but take issue with his assessment of experts and their inability to differentially assess ‘‘persisters'' and ‘‘desisters'' in childhood. We would like to take this opportunity to outline the gender affirmative model from which we practice, dispel myths about this model, and briefly outline the state of knowledge in our field regarding facilitators of healthy psychosocial development in gender-nonconforming children. The major premises informing our modes of practice include: (a) gender variations are not disorders; (b) gender presentations are diverse and varied across cultures, therefore requiring our cultural sensitivity; (c) to the best of our knowledge at present, gender involves an interweaving of biology, development and socialization, and culture and context, with all three bearing on any individual's gender self; (d) gender may be fluid, and is not binary, both at a particular time and if and when it changes within an individual across time; (e) if there is pathology, it more often stems from cultural reactions (e.g., transphobia, homophobia, sexism) rather than from within the child.