The Four Step Affirmative Care medical treatment for Gender Transitioning

Name changing and changed pronouns

Name changing and changed pronouns are part of the 1st step in the process of transitioning from one’s biological body to another gender. Parents should familiarise themselves with the policy of the WCED as expressed in its Guidelines as this 1st step in transitioning usually begins at school when a child changes his or her name and requests to be addressed in the preferred pronouns by teachers and classmates.

The Guidelines covers “Gender Expression” as “…the right to choose the first name by which he or she wants to be known to educators, school staff and fellow learners, irrespective of his or her gender characteristics or assigned sex at birth.” Note WCED use the word “assigned” as well.

Dress code and physical appearance and use of toilets and changing room facilities are all part of this 1st step in transitioning and addressed in the WCED Guidelines.

The child is then usually referred to a school counsellor who will probably contact the parents and suggest a psychologist who is part of the affirmative care camp for assessment. The assessment sessions may be one, perhaps two and seldom more than three. Invariable at the end of the sessions the child’s belief of being in the wrong body is affirmed. Parents attending these sessions find themselves cajoled into affirming the child’s desire to transition because “affirmative care reduces the rates of suicide ideation and prevents suicide in children with gender dysphoria”.

This is a powerful coercive untruth told to parents. [19] The parents own knowledge of their child, which may include serious mental health issues are often ignored and are not investigated or taken into consideration. This is where your child is put on the conveyor belt to the ultimate goal, namely sex-reassignment surgery.

This is the only step where a parent can still rescue their child from “irreversible damage” as from the 2nd step onwards, damage will be done, if not in the short term then in the long-term.

introduction to puberty blockers

When the child’s gender transitioning has been affirmed by an affirmative care clinician, (in the US they are often transgender persons), he or she will be introduced to puberty blockers. This is the 2nd step in the transitioning process and where the pharmaceutical intervention begins. The goal of puberty blockers is to stop a girl or boy’s natural development from a female or male child into a female adult or male adult. This 2nd step in the transitioning process is a drastic step. It can cause serious bodily damage such as osteoporosis, liver damage, brain dysfunction and possibly any future hope of pregnancy. Leo [20] in Sweden who developed severe osteoporosis at age 15 is a case in point. Governments approve this drastic intervention to a child’s body without any scientific proof of its efficacy to help a child with gender dysphoria.

Dr Michael Biggs, Ph.D. and a sociology professor at Oxford University UK, has spent years of research on transgender issues with emphasis on puberty blockers. 

He discovered that the world’s largest Paediatric Clinic in London started doing research on puberty blockers in 2010 but the results were suppressed and in 2018 he began a campaign to force the clinic to publish the research. His own research has been published in “Archives of Sexual Behaviour” and the “Journal of Paediatric Endocrinology and Metabolism.”

His witness testimony to the Florida Board of Medicine in the State of Florida, USA in 2023 [21] regarding puberty blockers is noteworthy and worth listening to. Puberty blockers stop the production of sex hormones, namely oestrogen for females and testosterone in males and boys literally achieve chemical castration. The drugs are licensed for conditions such as prostate cancer and precocious puberty (early) in children (this is when a girl of 5 starts developing breasts and the treatment delays the “abnormal” arrival of puberty so the child can undergo puberty at a normal age). The drugs have never been licensed to treat gender dysphoria. Nowhere in the world has it been licensed for gender dysphoria treatment, simply because there are no reliable trial studies available. Please take note of this very important fact.

According to Dr Michael Biggs early use of puberty blockers, followed by cross-sex hormones, prevents the development of sexual functioning and low libido and having no capacity for orgasm, is a very likely outcome. Another unknown is the effect on emotional and cognitive development of the child. A recent randomized control trial of mice on GnRHA [22] showed they manifested high levels of stress and high levels of anxiety. He recommended that any trial the Florida Board of Medicine undertook should guarantee follow-up to continue into adulthood and it must guarantee to publish all the data collected.

introduction of cross-sex hormones

The 3rd step in transitioning is the introduction of cross-sex hormones, namely testosterone for girls and oestrogen for boys. This next step happens approximately two years after a child began taking puberty blockers, but it may run in conjunction with puberty blockers. This 3rd step brings irreversible results such as a girl’s voice becoming like a man’s, hair growth increases on body and on face, muscle mass increases, development of female reproductive organs are halted as well as breast development.

During this 3rd step, the girls usually have a double mastectomy. This is radical. Removing breasts is something that used to be, and still is, traumatic for women with breast cancer. Now girls of 15 are doing it because they hate the “fatty lumps”, not realising what a radical, life altering step this is in light of the real possibility that she will grow out of her gender dysphoria. Apparently some of these girls parade their scars on social media as though the removal of their breasts proves that they are not “the gender assigned to them at birth” and they are now well on the path of transitioning to their own preferred gender, namely male.

It is heart-breaking to listen to a male voice speaking out of the mouth of a beautiful young woman who has come to realise, at age 18 or 22, that she made a mistake and do not want to transition into a man by proceeding to step 4. The tragedy is she will never have a sweet female voice and she will most likely never have children of her own, and if she does, she will not be able to breastfeed. Furthermore she will have to take testosterone for the rest of her life! Yes, that is a burden for life.

The same is true for a boy. Breasts will begin to develop as he takes oestrogen and his voice will not develop into that strong male tone. The growth of his reproductive organs would already have been halted through puberty blockers and he will not produce sperm should he ever, in adulthood, wish to father a child of his own. He has to take oestrogen for life.

Few people realise that testosterone and oestrogen does not only play a role in sexual development but also in cognitive brain development and other bodily functions and medical science is not clear on what the optimal amount should be, yet they give it to children who are in puberty. “Testosterone is so much more than its reputation would suggest. Men and women need the proper amount of testosterone to develop and function normally. However, the optimal amount of testosterone is far from clear.” [23]

During interviews of “regretters” i.e. those who turned away from taking the full 4 steps but probably proceeded to step 3, and then de-transitioned [24], invariable state that the risks and irreversible changes (i.e. you cannot get back what you lost), are downplayed by clinicians at affirmative care clinics.

sex re-assignment surgery

This 4th step may be final but quite possibly, for many, never ending and is called sex re-assignment surgery. This is where the conveyor belt of gender transitioning can go on for years and again, irreversible damage is caused. The general guide is that sex re-assignment surgery will only be undertaken after the “patient” has been on hormone treatment for a year and lived in his or her preferred gender lifestyle for the same period, i.e. during step 3. Gender affirmation surgery, as it is also called, may involve surgical procedures on the face, throat (Adam’s apple reduction), chest (breast reduction or enhancement) and invariably the genitalia.

Plastic surgery may be requested by the girl or the boy to give her or him a face that looks either more masculine or more feminine. Chest or “top” surgery is normally the first surgery a biological girl undergoes from as young as 13 depending on how early puberty starts and how desperate she is to get rid of her developing breasts. In boys “top” surgery may involve breast implants to enhance breast size and shape for a more feminine appearance.

Not all gender dysphoria adolescents opt for the final “bottom” surgery but according to surveys 1 in 4 transgender and non-binary persons choose it. The full spectrum of these irreversible changes to the body will not be discussed here as it is quite extensive and invasive. Please refer to the Cleveland Clinic [25] referenced below for detailed explanations and even photos. Suffice to say that from information gathered it is clear that these surgeries can carry on for up to 8 years of a transgender’s life, depending on how far the person wants to make changes to the body.

Although the “bottom” surgeries are performed by highly skilled surgeons the risk of complication is high causing pain, discomfort and suffering (even death) and for far longer than the 7 days prescribed in hospital. According to Tulip Richie [26], a transitioned female who was 27 when he had the surgery done, he haemorrhaged after surgery, was sent home with a catheter and could not urinate normally for 3 months after surgery .He had to have revision surgery in 2019 to fix the labia and urinary tract. In 2022 he decided to go public to warn others because, “transitioned friends never warned him about the possible negative consequences.” He lost transgender friends and became a “social media pariah” since he went public. He says that of the 6 friends he has, only 2 have sensation with sex as nerves were severed.

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