From: Sent: To: Cc: Andre Van Mol 10/30/2019 8:15:53 PM "Grossman Miriam" <miriamgrossmanmd@hotmail.com> "Haynes Laura" <laurahaynesphd3333@gmail.com>, "Deutsch Fred" <Fred.Deutsch@sdlegislature.gov>, "Vernadette Broyles" <vbroyles@childparentrights.org>, "Cretella Michelle" <drmcretella@gmail.com>, "Laidlaw Michael" <mike@drlaidlaw.com>, "Paul Hruz, MD, PhD" <hruz_p007@att.net>, "Monique Robles MD" <pamosa27@comcast.net>, "McHugh Paul" <pmchugh1@jhmi.edu>, "William Malone" <malone.will@gmail.com>, "Sharp Matt" <msharp@adflegal.org>, "Brooks Roger" <rbrooks@adflegal.org>, "McCaleb Gary" <gmccaleb@adflegal.org>, "Shafer Jeff" <jshafer@adflegal.org>, "Keller Jonathan" <jonathank@californiafamily.org>, "Burt Greg" <gregb@californiafamily.org>, "Jax Rene" <renejaxiwritebooks@gmail.com>, "Horvath Hacsi" <birdcatcher9@yahoo.com>, "Shupe Jamie" <jamie.shupe@yahoo.com>, "Mary McAlister" <mmcalister@childparentrights.org>, "Quentin Van Meter" <kidendo@comcast.net>, "Robbins Jane" <rlrobb123@gmail.com> Subject: Re: Kaiser study Miriam, since you are testifying and this subject is of potential use to the whole team, please find below the mental section of my GD/TGism summary paper I put together for the Harris SCOTUS case amicus. Andre MENTAL HEALTH/CO-MORBIDITIES IN GENDER DYSPHORIA 1. THEY ARE PRESENT AND THERE CAN BE MANY. 2015 Finland’s gender identity services · “75% of adolescents [assessed] had been or were currently undergoing child and adolescent psychiatric treatment for reasons other than gender dysphoria†· 26% had an autism spectrum disorder · 87% were female, far disproportionate to past ratios of F:M. (Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N. Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health (2015) 9:9.) 2018. Lisa Littman’s parental survey of Rapid Onset Gender Dysphoria: · 62.5% of gender dysphoric adolescents had “a psychiatric disorder or neurodevelopmental disability preceding the onset of gender dysphoriaâ€. · “Many (48.4%) had experienced a traumatic or stressful event prior to the onset of their gender dysphoria.†· 83% female. · 12.3% prevalence of autism spectrum disorder. (Littman, L. “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports,†journals.plos.org, Aug. 16, 2018. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330) 2014: “83 patients requesting sex reassignment surgery (SRS) were assessed for DSM-IV Axis I disorders. 62.7% has one or more.†(Major depression, phobias, and adjustment disorders were the 3 most common). “Consistent with most earlier researches, the majority of patients with gender dysphoria had psychiatric Axis I comorbidity.†(Mazaheri Meybodi A, et al. “Psychiatric Axis I Comorbidities among Patients with Gender Dysphoria.†Psychiatry J, 2014, Article ID :971814. doi: 10.1155/2014/971814.) 2014. Four nation European study found “People with gender identity disorder show more psychiatric problems than the general population…†“Nearly 70% had “a current and lifetime diagnosis.†(Heylens G, et al. “Psychiatric characteristics in transsexual individuals: multicentre study in four European countries,†The British Journal of Psychiatry Feb 2014, 204 (2) 151-156; DOI: 10.1192/bjp.bp.112.121954.) “Eight other studies that used structured clinical interviews for data collection (Colizzi et al. 2015; G´ omezGil et al. 2009; Guzm´an-Parra et al. 2015; Haraldsen & Dahl 2000; Hepp et al. 2005; Madeddu et al. 2009; Mazaheri Meybodi et al. 2014a,b) reported generally similar results (see Supplemental Table 1): Most found about a 30–40% prevalence of current comorbid psychopathology and about a 50–80% prevalence of lifetime comorbid psychopathology in adults with GD, including a 20–60% prevalence of personality disorders.†(Zucker, KJ, et al. Gender Dysphoria in Adults. Annu. Rev. Clin. Psychol. 2016. 12:217–47.) (P. 227.) “GD in adults is associated with an elevated prevalence of comorbid psychopathology, especially mood disorders, anxiety disorders, and suicidality.†(Zucker, KJ, et al. Gender Dysphoria in Adults. Annu. Rev. Clin. Psychol. 2016. 12:217–47.)(P.217.) Personality Disorders Iran. 2014. Among people requesting sex reassignment surgery (SRS): “The frequency of personality disorders was 81.4%. The most frequent personality disorder was narcissistic personality disorder (57.1%)… The average number of diagnoses was 3.00 per patient.†(Meybodi AM, Hajebi A, Jolfaei AG. The frequency of personality disorders in patients with gender identity disorder. Med J Islam Repub Iran. 2014;28:90. Published 2014 Sep 10.) “Eight other studies that used structured clinical interviews for data collection (Colizzi et al. 2015; G´ omezGil et al. 2009; Guzm´an-Parra et al. 2015; Haraldsen & Dahl 2000; Hepp et al. 2005; Madeddu et al. 2009; Mazaheri Meybodi et al. 2014a,b) reported generally similar results (see Supplemental Table 1): Most found about a 30–40% prevalence of current comorbid psychopathology and about a 50–80% prevalence of lifetime comorbid psychopathology in adults with GD, including a 20–60% prevalence of personality disorders.†(Zucker, KJ, et al. Gender Dysphoria in Adults. Annu. Rev. Clin. Psychol. 2016. 12:217–47.) (P. 227.) 40% of MFs and 22% of FMs had a comorbid personality disorder. De CuypereG, Elaut E,HeylensG, Van MaeleG, Selvaggi G, et al. 2006. Long-term follow-up: psychosocial outcomes of Belgian transsexuals after sex reassignment surgery. Sexologies 15:126–33 70% of MFs and 23% of FMs had a personality disorder; De Cuypere G, Janes C, Rubens R. 1995. Psychosocial functioning of transsexuals in Belgium. Acta Psychiatr. Scand. 91:180–84 Cited here: Zucker, KJ, et al. Gender Dysphoria in Adults. Annu. Rev. Clin. Psychol. 2016. 12:217–47. Supplemental Table 1: Studies Reporting an Increased Prevalence of Associated Psychopathology in Adults with Gender Dysphoria. Common themes: prior to GD onset patients had “experienced teasing/bulling, exclusion, isolation, difficulty in social communication, distress in relation to awareness of a developing sexed body.†The majority “had an existing diagnosis of an autism spectrum condition (ASC) or would be likely to obtain one.†(Clarke, Anna Churcher, and Anastassis Spiliadis. “‘Taking the Lid off the Box’: The Value of Extended Clinical Assessment for Adolescents Presenting with Gender Identity Difficulties.†Clinical Child Psychology and Psychiatry, vol. 24, no. 2, 2019, pp. 338–352., doi:10.1177/1359104518825288.) 2. AUTISM A 2015 survey of adolescents applying for sex reassignment surgery (SRS) in Finland found 26% had an autism spectrum disorder · 87% were female, far disproportionate to past ratios of F:M ratio. (Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N. Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health (2015) 9:9.) Dr. Lisa Littman’s study of adolescents and young adults (AYAs) with rapid-onset gender dysphoria found a 12.3% prevalence of autism spectrum disorder. (Littman L. Rapid-onset gender dysphoria in adolescents and young adults: a study of parental reports. PLoS One. 2018;13(8):e0202330.) Almost 8% of children and adolescents referred to the Netherlands’ multidisciplinary clinic for gender dsyphoria in this age group had autism spectrum disorders (ASD). (de Vries AL, Noens IL, Cohen-Kettenis PT, van Berckelaer-Onnes IA, Doreleijers TA. Autism spectrum disorders in gender dysphoric children and adolescents. J Autism Dev Disord. 2010;40(8):930–936. doi:10.1007/s10803-0100935-9.) A UK survey of self-reported gender identity found, “Individuals with autism spectrum disorder (ASD) or meeting the AQ [Autism Spectrum Quotient] cut-off score for ASD were over-represented in both the transgender and nonbinary groups.†(Stagg, Steven D. et al. Autistic traits in individuals self-defining as transgender or nonbinary. European Psychiatry, Volume 61, 17 – 22. ) UK. An 18-month review of authors’ cases at the NHS Gender Identity Development Service (GIDS) Tavistock found the majority of adolescents presenting with “gender identity difficulties†also “had an existing diagnosis of an autism spectrum condition (ASC) or would be likely to obtain one.†(Clarke, Anna Churcher, and Anastassis Spiliadis. “‘Taking the Lid off the Box’: The Value of Extended Clinical Assessment for Adolescents Presenting with Gender Identity Difficulties.†Clinical Child Psychology and Psychiatry, vol. 24, no. 2, 2019, pp. 338–352., doi: 10.1177/1359104518825288.â€) 3. AUTOGYNEPHILIA “Since the beginning of the last century, clinical observers have described the propensity of certain males to be erotically aroused by the thought or image of themselves as women.“ (Blanchard, Ray. (2005). Early History of the Concept of Autogynephilia. Archives of sexual behavior. 34. 43946. 10.1007/s10508-005-4343-8.) “Autogynephilia is defined as a male’s propensity to be sexually aroused by the thought of himself as a female. It is the paraphilia that is theorized to underlie transvestism and some forms of male-to-female (MtF) transsexualism.†(Balon R (ed): Sexual Dysfunction: Beyond the Brain-Body Connection. Adv Psychosom Med. Basel, Karger, 2011, vol 31, pp 135–148 https://doi.org/10.1159/000328921.) 4. ROGD (RAPID ONSET GENDER DYSPHORIA) Rapid-Onset Gender Dysphoria is the sudden onset of dysphoria during or after puberty with no prior sign of it. Lisa Littman’s 2018 survey on this showed a commonality of this occurring in adolescents and young adults (AYAs) where one or more friends became gender dysphoric or trans-identifying; and whose parents report increasing social media and web use before it, worsening of their child’s mental health, worsening isolation from family and non-transidentified friends; and distrust of information from non-trans-affirming sources. ROGD has become a social contagion, as is now self-evident. (Littman, L. “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports,†journals.plos.org, Aug. 16, 2018. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330) UK. “Inquiry into surge in gender treatment ordered by Penny Mordaunt,†thetimes.co.uk, Sept. 16, 2018. “An investigation has been ordered into why so many girls are seeking gender reassignment after the number referred for treatment rose by more than 4,000% in less than a decade.†“Official figures show the number of girls being given gender treatment has risen from 40 in 2009-10 to 1,806 in 2017-18.†——————————————— On Oct 30, 2019, at 3:46 PM, miriam grossman <miriamgrossmanmd@hotmail.com> wrote: Laura, thank you ! I'm testifying soon for a case in Colorado and this data will be very useful. Miriam Grossman MD Sent from my iPhone On Oct 30, 2019, at 5:38 PM, Laura Haynes, Ph.D. <laurahaynesphd3333@gmail.com> wrote: Quentin and All, Here is recent and truly excellent research on trans children and minors among Kaiser-Permanente members in Georgia, northern CA, southern CA. From a presentation I just gave at the conference of the Society of Catholic Social Scientists, Oct. 29, 2019, Steubenville, Ohio (held at Franciscan University): Recommended messaging for Georgia: Kaiser-Permanente studied non-conforming gender identity in its members from 2006 to 2014. It found that 70%-71% of adolescents (ages 10-17) who later identified as gender non-conforming had high rates of other psychiatric diagnoses prior to first evidence of gender non-conformity, and most of those (60-66%) were in force during the 6 months before onset of gender non-conformity. Prevalence [prevalence ratios] of these diagnoses, and of hospitalizations for these disorders, compared to gender conforming boys and girls, mostly ranged from moderate to astronomically sky high. Children (ages 3-9) who later became gender non-conforming had a similar pattern of higher prevalence for lifetime disorders and 6-month-before-onset diagnoses, but in lower absolute numbers. Some children did not have other psychiatric disorders. Kohlberg said children are simply still developing their concept of gender identity up to age 7. Over the 8 years of the study, from 2006 to 2014, the number of gender non-conforming minors rose 800% in Georgia. Additional information: (Number of TGNCs roses 1100% in northern CA, southern CA was between northern CA and Georgia). This retrospective and prospective, longitudinal study used the complete set of electronic medical records for an entire cohort of Kaiser-Permanente members at three sites (Georgia, northern California, and southern California) for the years 2006 - 2014. It may be the first research that found onset dates of psychiatric disorders and first evidence date of gender non-conforming identity. There were 427 TF (bio Ms) and 655 TM (bio Fs) children and adolescents = 1,082 GNCs (gender identity non-conformers means TFs + TMs). (TF = trans female/bio male; TM = trans male/bio female) Each was matched to 10 controls of the same bio sex + 10 of opposite bio sex. Becerra-Culqui TA, Liu Y, Nash R, et al. Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers. Pediatrics. 2018;141(5):e20173845 Blessings, Laura Laura Haynes, Ph.D., California Licensed Psychologist USA Representative, International Federation for Therapeutic and Counselling Choice (IFTCC.org) Chair of Research and Legislative Policy, National Task Force for Therapy Equality (TherapyEquality.org) Consultant, American College of Pediatricians (ACPeds.org) Member Research Committee, Alliance for Therapeutic Choice and Scientific Integrity (TherapeuticChoice.com) Member, Coalition for Counseling Choice Former President, Christian Association for Psychological Studies—Western Region Lifetime Member, American Psychological Association Member, California Association of Marriage and Family Therapists P.O. Box 653, Tustin, CA 92781 714-665-3333 On Oct 30, 2019, at 8:43 AM, Fred Deutsch <Fred.Deutsch@sdlegislature.gov> wrote: Fantastic! I believe Georgia will be the forth state to introduce the bill! – Fred Deutsch