The Emotional Blackmail of ‘Gender-Affirming Care’

No parent can give true informed consent if they are presented with the false ultimatum of choosing between a trans kid or a dead kid.

Image by Christina Buttons (@buttonslives)

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About the Author

Pamela is a California licensed social worker (LCSW) with over 20 years of experience. She has worked in a variety of settings including schools, clinics, residential programs, and hospitals. In 2022, she publicly started questioning the direction the mental health field is going. Pamela believes in working collaboratively with families when treating minors and advocates treating patients holistically, rather than using a one-size-fits-all approach. She has starred in three documentaries about the harms of gender medicine.

The following essay is an excerpt from her new book, A Practical Response to Gender Distress, about understanding and fighting back against the emotional manipulation of ideologically-captured therapists.

“Would you rather have a dead daughter or a live son? That question is asked over and over again, and therapists are trained to say that.” 

—Author in the Epoch Times docu-drama, Gender Transformation, The Untold Realities

One of the most common lies told by therapists and clinicians to colleagues, the general public, the media, and ultimately hurting families is that if parents don’t affirm their child’s new identity, their child will die by suicide. These emotional statistics are found on the Trevor Project Website: Top-Line Statistics (note that most statistics group Trans with the entire LGB+ population): 

Suicide is the second leading cause of death among young people aged 10 to 24 (Hedegaard, Curtin, & Warner, 2018)—and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth are at significantly increased risk.

LGBTQ youth are more than four times as likely to attempt suicide than their peers (Johns et al., 2019; Johns et al., 2020).

The Trevor Project estimates that more than 1.8 million LGBTQ youth (13-24) seriously consider suicide each year in the U.S. — and at least one attempts suicide every 45 seconds.

The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health found that 45% of LGBTQ youth seriously considered attempting suicide in the past year, including more than half of transgender and nonbinary youth.

Transition allies ask parents of transgender identifying youth the shocking question, “Would you rather have a living son than a dead daughter?” A new slogan that is being repeated by media and politicians is “gender affirmative care saves lives.” 

But is this true? 

Due to the fact that trans activists often prevent studies on this subject, the studies that are quoted are generally small sample sizes, do not have control groups, and don’t follow the patients for very long—so they prove little. Also, many of the headlines regarding these studies do not differentiate between suicidal thoughts, suicidal gestures, and actual suicide. You must read the fine print to find that information. 

The truth is that there is a large correlation between people who have other mental health diagnosis and gender dysphoria. Causality is the claim but is never adequately addressed in the studies cited. Though it’s true that statistics of suicidal thoughts and actions are higher in this population, we need to ask if it was the lack of “affirmation” that caused a suicide, or a symptom of another mental health issue, such as depression or anxiety. That answer is not clear in the murky discussions of this topic. Finally, notice that the LGBTQI+ are all lumped together. When you start to think critically, you realize that a gay boy is vastly different from a girl who says she is non-binary. Both are completely different from a person who was born with a rare birth defect that qualifies them to be intersex. These broad statistical claims do not give the real information you need. 

One of the few rigorous studies, which was completed in Sweden, followed a transgender group of adults from 1973-2003. This study found:

Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.

The study concluded that, “The overall mortality for sex-reassigned persons was higher during follow-up than for controls of the same birth sex, particularly death from suicide.”  

This study still doesn’t give all the information we need because it did not have a control group of transgender people who did not get hormones and surgeries. It also only follows adult patients, and it does not represent the majority of today’s demographic who are teenage girls influenced by the internet and their environment. 

Anecdotal experience shows that suicide rates are not reduced by affirming a new gender identity, rather, the mental health of the young person declines. In some cases, there is an initial “euphoria” (a term more widely used by trans influencers), especially if they gain attention and status, but eventually that feeling fades and the underlying issues the person had been avoiding are still there. In many cases it takes time, about seven to eight years or more, for the patient to figure out that hormones and surgeries did not solve their mental anguish. More unbiased research is needed on the subject, but unfortunately, in this climate, politically neutral research is nearly impossible to carry out. 

Interestingly, there has been a ban on affirmative care on children in other countries such as UK, Sweden, France, and Finland, but there have been no reports of suicide spikes. Paradoxically, according to this narrative, with all the new celebrations, trans visibility days, and media representation, suicide rates in LGBTQ youth should have decreased, however, the rates continue to increase, and the media reinforces that. Plus, there have never been such high suicide rates in any marginalized population like this in the past, which suggests the suicidality is not from lack of acceptance, but other variables such as co-morbid mental health issues and the repetition of this idea. 

Throughout modern therapy, threatening suicide to get something (in this case gender affirmation) was recognized as maladaptive and considered unethical to be reinforced by a therapist. This behavior is often learned from online influencers, but sadly, it is deliberately practiced by many therapists and school personnel, particularly those who hold themselves out as “gender therapists.” Kids are coached to say, “I will kill myself,” to get hormones or other components of affirming care. Previously, this threatening behavior was typically done by those with conditions such as borderline personality disorder. 

A therapist must assess whether the suicide threat is genuine, or an unhealthy way to seek help or attention. If it is attention-seeking, the therapist and family should show compassion by acknowledging mental anguish and guide the individual to find healthy ways to ask for help. Those who demonstrate this pattern also tend to crave a lot of external validation, which means the treatment would include ways to help the person manage the desire with learning self-validation and self-soothing techniques. Also, when people get distressed, they tend to get tunnel vision or engage in black and white thinking. It is the therapist’s job to help the patient reality-check and see shades of grey.

Unfortunately, with the affirmative model, this learned suicide threat, and the demands for others to conform with forced pronouns and new names, we are reinforcing unhealthy thinking and behavioral patterns. In addition, no parent can give true informed consent if they are presented with the false ultimatum of choosing between a trans kid or a dead kid. 

If a therapist asks if you would “rather have a dead daughter or a live son,” here are a few suggested responses.

• Can you please show me the data you are referencing? (If the therapist presents a study, look at it closely because it will be flimsy with no control group or solid conclusions because there is no valid study that proves this theory).

• Did my child already threaten suicide? If she did, why wasn’t I notified? If she did not, then it sounds like you are giving her scary ideas which do not sound therapeutic.

• If you believe she is so unstable, then we should be discussing a higher level of care, which you have failed to do. I find it difficult to trust your judgment now.

• I thought that therapists believed that threatening suicide to influence someone to change their behavior was emotional manipulation. In fact, Marsha Linehan, the founder of Dialectical Behavioral Therapy (DBT) and an expert on people with suicidal and self-harm behaviors, teaches skills on how to get needs met appropriately, without suicidal threats, in the Interpersonal Effectiveness module of her therapy. 

• (If you know there are other major issues) Why isn’t therapy addressing them? Why isn’t therapy addressing my child’s eating disorder or the recent social group changes she just had? 

• I would rather not lead my child on a path that would lead to sterilization, chronic pain, disability, and making her a life-long medical patient. 

If your child’s therapist uses this tactic, my professional opinion is to pull your child from that provider as quickly as possible.

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The above essay is a sample from my new book, A Practical Response to Gender Distress, about understanding and fighting back against the emotional manipulation of ideologically-captured therapists. You can order it by clicking the image below.

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