Talk:Gender dysphoria in children: Difference between revisions

A reference

This reference might have some info for the article: Sex differences in referral rates of children with gender identity disorder: some hypothesis. GregManninLB (talk) 22:13, 7 July 2008 (UTC)

Capitalization?

The title of the article is "Gender identity disorder in children" while the first line contains "Gender Identity Disorder in Children". Consistency in this aspect would be better. - House of Scandal (talk) 15:10, 8 July 2008 (UTC)

Opinions of non-experts on controversial topics.

WP:Opinion says "At Wikipedia, points of view (POVs) – cognitive perspectives – are often essential to articles which treat controversial subjects. The article should represent the POVs of the main scholars and specialists who have produced reliable sources on the issue." The authors of opinion pieces in blogs or in The Atlantic do not meet that criterion. I have therefore removed Jokestress' insertion of quotes from those sources.
— James Cantor (talk) 11:52, 17 October 2008 (UTC)

WP:OPINION is an essay and not even a guideline, let alone policy. Your belief that we can't cite journalists and authors seems rooted in what these two journalists say, since elsewhere you vigorously press for inclusion of journalists' favorable coverage of related controversies. Shall I reinstate those two reliable tertiary sources, or do you plan to insist you are correct? Jokestress (talk) 16:01, 17 October 2008 (UTC)

I neither said, nor do I believe, that we couldn't cite journalists. I am aware that WP:OPINION is an essay; I point it out only to demonstrate that other WP editors, independent of this dispute, share my conclusion. If a consensus for including the aforementioned opinions on this page develops, then so be it. Until then, however, there is no such consensus for inclusion. To begin, perhaps a third opinion might be sought.
— James Cantor (talk) 16:07, 17 October 2008 (UTC)

The dispute, it seems to me, concerns not just the quality of sources but the sheer number of sources used to support the same few points. For example, the Salon quote is almost identical to a better-supported opinion in your reference #11. The Atlantic quote is a sort of ad populum argument, essentially the same as others in your article but more dramatic in tone. Some degree of repetition is fine, but this is a little excessive. I would say that eliminating those two sources improves the quality of the article by reducing duplication. Rose bartram (talk) 13:08, 18 October 2008 (UTC)

Thank you; that's very helpful.
— James Cantor (talk) 15:04, 18 October 2008 (UTC)

Coverage in Salon.com and The Atlantic

Per the section above, User:James Cantor has removed the following two tertiary sources published this week:

• Journalist Tracy Clark-Flory wrote, "[T]he therapy certainly is frighteningly reminiscent of past attempts to 'cure' homosexuals."

• Journalist Hanna Rosin reported in 2008 that Zucker had "become a pariah to the most-vocal activists in the American transgender community" because of his views on gender identity disorder: "He seems unlikely to bless the condition as psychologically healthy, especially in young children."

We are seeking additional opinions, as he claims only "experts" are allowed to comment on controversial topics. Jokestress (talk) 16:16, 17 October 2008 (UTC)

I think a more accurate description of my point is that the opinions which merit mention in WP are those of individuals who are expert on the topic, as described in WP:Opinion. Because WP:Opinion is not "binding", the input of other editors would be appreciated.
— James Cantor (talk) 16:24, 17 October 2008 (UTC)

DSM-V controversy quotes

The quotation marks in this section is very confusing if not wrong. Please someone fix it, I'm not an expert.

Professor314 (talk) 19:27, 14 April 2010 (UTC) ´

Confused criteria and misdirected therapy

I think the controversial criteria comes from a confusion between external behaviour an self-identification. External behaviour can be changed to some extent but core gender identity is unchangeable. If you identify yourself as a woman you will always do so regardless how people treat you. Similarity, if you identify yourself as a man you will always do so independent of other people's treatment. Some people are unhappy because there is too much difference between how they look an what they feel like. In such cases we have to ask: can the mind be changed to better fit the body? If not we have to change the body to better fit the mind in order to make them happier. Consequentially, the cure to gender identity disorder consists of hormones and surgery. If the treatment is started before or during the earliest stage of puberty the end result is better since the person will only develop secondary sex characteristics matching his or her self-identification. However, this should only be done on physical girls which seriously claim to be boys and physical boys claiming to be girls.

The claim that therapists' want to help instead of harm is not a valid argument to me. In my opinion there is nothing more harmful than misdirected benevolence. Many people have had their lives destroyed by misdirected attempts to cure them. I can well see the analogy with conversion therapy. I don't think that this “therapy” works. It may subdue bisexuals to only have sex with persons of the opposite gender or subdue homosexuals to believe that they have to live in celibacy. However, it does not change the general direction of people's sexual emotions which is the definition of sexual orientation. (The amount of sex drive a person feels can be modified with medication but this is something entirely different from turning homosexuals into heterosexuals.) Trying to force people to conform to sexist stereotypes tend to be more harmful than helpful. This simply means forcing people to participate in unnecessary activities which they do not enjoy. Too much difference between what you do and what you want to do can even cause mental problems in the long run. Like homosexuality gender-atypical behaviour is something you have to learn to deal with. I suggest affirming these people that they are not abnormal and building up their self-esteem. Since the malleability of the human mind is rather limited trying to replace aberrant behaviour will cause the person more suffering and is consequentially objectionable.

2011-01-05 Lena Synnerholm, Märsta, Sweden.

Proponent Views in Opponents Section?

I am curious about why there are so many proponents views (namely Dr. Ken Zucker's views) included in the "opponents" section. The reverse is not true for the "proponents" section and this appears to give additional weight to the pro GIDC diagnosis / treatment position. Jake Pyne (talk) 19:10, 2 October 2011 (UTC)

IMHO it's from bias in article, not that treatment of gender variant youth is a bad thing, but the article content is more skewed to "zucker is bad!" then presenting information/currently used treatment options neutrally (and showing the research on how forced gender roles is harmful to the minority of gender incongruant youth). Reset by peer (talk) 07:12, 22 October 2011 (UTC)

Gender Creative children

Hi there,

To this page I added a section on gender creative children, therapy and the idea of being supportive parents. There is so much more research that needs to be done, any comments would be a great help! Tarak7 (talk) 00:38, 19 November 2013 (UTC)

Reverted. Typos in my WP:Edit summary, but it's clear what I'm stating in it. Flyer22 (talk) 00:46, 19 November 2013 (UTC)

Hi Tarak7, I think you did a great job on your article, you have a lot of good facts written in your work. From what I see there is only one part starting with "Referencing contemporary Western views on gender diversity....." is this the only section that you added? If so I think extending it a little more may be helpful, the section is a good topic and I think that there is probably more to elaborate on. To do this maybe go into more detail in between each fact add some explanation because it seems that a lot of the section is just fact after fact and it makes it hard to follow along. You do have a lot of good sources though and I think that the topic is something that I would not have thought of, so it is interesting. Lauren Taylor 455 (talk) 06:17, 20 November 2013 (UTC)

Referring to GIDC in the past tense?

What do others think about revising the whole GIDC entry to refer to the diagnosis in the past tense? I have begun this in the opening paragraph but have not continued.

Gender Dysphoria in Children and Adolescents

A full wikipedia article for Gender Dysphoria in Children and Adolescents is needed because GIDC and GD are not synonyms but different concepts. I attempted to demarcate them in the opening paragraph of GIDC. GIDC referred to how children behaved and understood their own gender. GD refers to the experience of the body that leads one to desire transition. I could begin a Gender Dysphoria article in the near future but am interested in others thoughts. Jake Pyne (talk) 18:33, 25 July 2014‎ (UTC)

Jake Pyne (talk · contribs), I reverted considering that basing the Gender identity disorder in children article on the DSM-5 changes is incorrect. It's not as though gender identity disorder is a matter that was restricted to what the Diagnostic and Statistical Manual of Mental Disorders (DSM) states. The term gender identity disorder is widely used in medical literature outside of the DSM, and interchangeably with gender dysphoria. Furthermore, gender dysphoria is the same diagnosis as gender identity disorder in the DSM-5, except that it has a different name and slightly different criteria. That stated, I know that gender identity disorder in children is somewhat clinically distinct from gender identity disorder in adults. For more on what I mean regarding gender identity disorder vs. gender dysphoria, including whether or not a Gender dysphoria article should be created, I suggest you check out the discussions at Talk:Gender identity disorder, especially this latest discussion where I and Zad68 weighed in. And this other discussion was recently archived.

On a side note: Remember to sign your username at the end of the comments you make on Wikipedia talk pages. All you have to do to sign your username is simply type four tildes (~), like this: ~~~~. I signed your username for you above in this section. Flyer22 (talk) 21:08, 25 July 2014 (UTC)

Agree with Flyer's comments here... Also see Colin's points here, similar issue. Zad68 21:37, 25 July 2014 (UTC)

Also, regarding this, she has not edited Wikipedia (as least under that account) since the matter shown here. Flyer22 (talk) 23:41, 25 July 2014 (UTC)

Flyer22 (talk · contribs) and :Zad68 (talk · contribs), the opening sentence of the article is currently incorrect. Gender Identity Disorder in Children is not a current diagnosis and when it was a diagnosis, for example in the DSM IV TR, it included criteria that we might call "gender dysphoria" only in part. The DSM III and IV criteria for GIDC included gendered behaviours like the way children dress and act and who they like to play with, whereas Gender Dysphoria refers to a somatic experience of the body, a discomfort / distress. GIDC was a lifetime disorder of the identity whereas GD is a time-limited experience of the body that can be "remedied" via transition, should someone desire. These are not synonyms and the conflation of them is inaccurate. Kelley Winters writes about this on the GID Reform Blog: http://gidreform.wordpress.com/2011/06/07/the-proposed-gender-dysphoria-diagnosis-in-the-dsm-5/ and Arlene Lev writes about the differences here: http://choicesconsulting.com/wp-content/uploads/2013/08/Gender-Dysphoria-Two-Steps-Forward-One-Step-Back-FINAL.pdf Those who do the diagnosing look for something different now - that was the whole point of the mobilizing around the DSM-5change. I am currently writing this from a conference about gender non-conforming kids with physicians who do the diagnosing - which I realize is not a verifiable source and I am happy to go digging for references but am not able to do that in this moment - I did want to point out though that in reference to your comment Flyer, about me "basing the GIDC article on the DSM-changes" in fact, that is what the opening sentence of the article is currently doing and the problem I am trying to fix. The first sentence currently conflates the GIDC and GD criteria. Also, when you say "it is not as though the matter of GIDC is restricted to what the DSM had to say", what do you mean? Do you mean the diagnosis spoke to a "real" disorder? Of course many would say that the designers of the DSM diagnosis precisely did invent the concept with the help of the clinical treatments and research that fed into it from 1960-1980. It was mentioned in "medical literature outside of the DSM" as you say, only because it was in the DSM in the first place, and now it is out. See Karl Bryant's article about the making of the GIDC diagnosis: https://faculty.newpaltz.edu/karlbryant/files/Bryant-srsp.2006.3.3.pdf and to some extent I write about this as well: http://www.discourseunit.com/arcp11/5-governance.pdf and http://connection.ebscohost.com/c/articles/95572517/gender-independent-kids-paradigm-shift-approaches-gender-non-conforming-children. I don't require that my wording be the final say but the current opening of the article is incorrect and shouldn't stand Jake Pyne (talk) 03:51, 26 July 2014 (UTC).

Thanks for the reply Jake. I am wondering whether this is just a matter of the consensus among the thought-leaders currently in the process of changing, and the rest of the world lagging behind this change in thought (as is normal). I am looking at for example the ICD-10 definition which appears to support the opening sentence. Will this be a case where because WP is an encyclopedia that reflects current wide consensus, that we will get to modifying the definition here but maybe not for another year or so? Zad68 03:26, 28 July 2014 (UTC)

Zad68 (talk · contribs), thanks very much for your thoughtful reply! I think you are right that there is a difference between new thought vs. the wider consensus that lags behind. Though I do think the term consensus is hard to apply to a controversial topic which is so polarizing! I'm not sure I understand your point re the ICD-10. Do you mean that the ICD-10 conflates gender dysphoria and gender identity disorder and that this conflation supports this article as well? Looking at the ICD-10 diagnosis for "male" children, my point is clearer that something called distress is only part of the gender identity disorder for children diagnosis, with the other component referencing how children dress and behave. In any case, the ICD diagnosis that applies to gender non-conforming children is currently in revision and the subject of very heated debates as well. My main point is that the conceptual differences between gender dysphoria and gender identity disorder are important and should be featured in the wikipedia entry, even if those differences are debatable. Moreover, the fact that gender dysphoria is the current diagnosis is not debatable. The first sentence of this article conflates them and I'm going to say again, this is inaccurate.  :Flyer22 (talk · contribs), I'm still seeking a reply from you on this as you were the one who reverted my edit. As you know, Wikipedia policies state that full reverting of edits should only be done when necessary and are most appropriate for cases of vandalism, which my edit was clearly not. My edit again, was primarily to the first sentence which is currently incorrect. GIDC is not the formal diagnosis. It is the former formal diagnosis. You stated that basing the GIDC article on GD is inaccurate. But that is not what I have proposed. I have proposed the opposite - to demarcate GIDC from GD in the opening passage of the article. My proposed edit, so that others can see it is as follows:

Gender identity disorder in children (GIDC) was the formal diagnosis used by psychologists and physicians to describe children with cross-gender behaviour or identification between the years of 1980 – 2013. This differential diagnosis for children was formalized in the third revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 but was replaced with the diagnosis of Gender Dysphoria in the 2013 fifth revision (DSM-5), in an effort to diminish the stigma attached to gender variance, whilst maintaining a diagnostic route to gender affirming medical interventions such as hormone therapy and surgery. Jake Pyne (talk) 21:39, 20 August 2014‎ (UTC)

Jake Pyne, I've taken so long to get back to you on this because I was going through a stressful time. Still am. And I therefore decided to take a break from this discussion, and did not read your replies until minutes ago. Before interacting with you, I had just not that long ago gotten out of a lengthy gender identity disorder vs. gender dysphoria discussion at Talk:Gender identity disorder (I noted that discussion above). I see that you pinged me via WP:Echo minutes ago, but I didn't get it. I don't need it, though, considering that I watch this article/talk page. As for your commentary above, your argument that the terms gender identity disorder and gender dysphoria are not synonyms is not exactly correct; again, I've already extensively addressed that matter at Talk:Gender identity disorder. Are these terms always synonyms? No, but they are synonyms often enough. GIDC being renamed (I know that you consider the term replaced more accurate than renamed) in the DSM-5 (a highly disputed manual) and now having slightly different criteria does not mean that children are no longer assessed for gender identity disorder; from what I see, just like gender dysphoria is the same diagnosis as GID for adults, but with a different name due to stigma issues and slightly different criteria, gender dysphoria is the same diagnosis as GIDC, but with a different name due to stigma issues and slightly different criteria. I don't see the term GIDC being fazed out of medical literature any time soon; the DSM is not the only medical source or medical authority that has used that term. That is what I meant by "it is not as though the matter of GIDC is restricted to what the DSM had to say." The DSM-5 renamed and reorganized a lot of things, and much of the medical community has rejected this (which is clear from the DSM-5 Wikipedia article) and will not be quick to follow these changes. This is why Zad68 pointed to the discussion that he pointed to above. We don't base medical matters solely on what the DSM states. However, since the DSM-5 does not use the term GIDC, I would not mind changing the "is the formal diagnosis" part of the lead to "is a formal diagnosis," to indicate that not all psychologists and physicians will use the term GIDC for children who experience significant gender dysphoria (discontent with their biological sex and/or assigned gender). I also don't mind you adding something to the lead about the DSM-5 changing their GIDC listing and why they did this, but this should also be addressed (elaborated on) lower in the article; per WP:Lead, things discussed in the lead should generally also be covered lower in the article.

As for your sources above, blogs are not WP:Reliable sources (unless a news blog). As for reverting you, there is no Wikipedia policy that states that full reverting of edits should only be done when necessary and are most appropriate for cases of vandalism. Flyer22 (talk) 22:26, 20 August 2014 (UTC)

Thanks for the replies, Jake and Flyer. Jake I get what you're saying but I still think the edit you're proposing is moving too quickly for an encyclopedia, it's ahead of reality. This isn't exactly on the DSM-4 to 5 update, but it's similar: In the United States, ICD-9 is still used for 99.9999% of diagnosis coding, even though ICD-10 has been out for years and ICD-11 is in the works. I think the same thing is happening here, DSM-5 is brand-new and DSM is updated even less frequently than ICD, use of DSM-4 is heavily entrenched. I think that's the point Flyer22 and I are getting at. So I like Flyer's suggestions to reflect that things have changed in DSM-5 but practice hasn't caught up yet and likely will take quite a bit of time before it does. Zad68 14:26, 21 August 2014 (UTC)

Flyer22 (talk · contribs) and :Zad68 (talk · contribs), now it is my turn to apologize if you are still watching this page. I got caught up in other things but appreciate the replies you left here. You may be right that physicians and other clinicians are still using GIDC from the DSM-IV or the ICD-9 codes, but I am not aware of that and so am very curious about where that information is coming from and what medical literature you are finding that still uses GIDC. To my knowledge, and thus why I am pursuing it, diagnostic practices have shifted over to using Gender Dysphoria, which as I have said above, at the risk of sounding like a broken record, is conceptually a very different thing from Gender Identity Disorder, and not just a new name for an old thing. This was the whole point of the DSM-5 change and as the DSM-5 guidebook states, the change was “in response to criticisms that the term gender identity disorder was stigmatizing.” To recognize that change seems both factually correct and appropriate.

I think the above suggestion that I may be “ahead of reality” is very interesting. I understand what you are trying to say, but in order for us to assess this, we would have to have already agreed on what constitutes reality. I sense there is no such agreement. In my opinion, the only reality is that some children behave in ways that challenge other people’s beliefs about gender. Everything else, including both of these diagnoses, is simply an interpretation. The DSM offers a particularly unhelpful interpretation.

I will change the lead from “is the diagnosis” to “is a diagnosis” and add a statement about the DSM-5 change and another below in the article. But I still think we need a Gender Dysphoria article.

While I appreciate both your points and the discussion on this, regarding the earlier matter of whether reverting my July changes without discussion was appropriate, I think it was not. Wikipedia states “Reverting is mostly appropriate for vandalism” http://en.wikipedia.org/wiki/Wikipedia:Reverting My changes were clearly not vandalism. They were well thought out, however contentious. I added approximately 1/3 of the text to this article several years ago in order to improve it, and the changes I propose now are for the same purpose. Full reverts despite well thought out edits is exactly why it is increasingly said that Wikipedia is on the decline with a culture of hostility and bureaucracy, exactly the opposite of what Wikipedia purports to be. Cheers! http://www.technologyreview.com/featuredstory/520446/the-decline-of-wikipedia/ Jake Pyne (talk) 23:07, 30 December 2014‎ (UTC)

Hello again, Jake Pyne. Instead of repeating my thoughts on this matter, I'll simply state that I stand by what I stated in my "22:26, 20 August 2014 (UTC)" post above. Also see Wikipedia:Redirects for discussion/Log/2014 August 31#Gender dysphoria, where gender identity disorder usually or often enough essentially meaning the same thing as gender dysphoria was again debated, and the suggestion to create a Gender dysphoria disambiguation page or Gender dysphoria article was rejected. That discussion involved WP:Med editors and non-WP:Med editors. It's best to overlook my bickering with one of the editors in that discussion, however; we have since been on better terms. Although I again reverted you here, I am mostly fine with your latest changes to the Gender identity disorder in children article. That is why I restored the vast majority of the content; I then made followup tweaks after that. These changes I made include formatting the first sentence similar to the Gender identity disorder article, better organizing content, and removing WP:Weasel words and WP:Claim violations. You can see that here, here, here, here and here. As for reverting, Wikipedia:Reverting is a Wikipedia essay, not a policy or guideline; see WP:Essay and WP:Policies and guidelines. There are various cases where reverting is most appropriate. Again, I stand by what I stated in my "22:26, 20 August 2014 (UTC)" post above. Flyer22 (talk) 01:16, 31 December 2014 (UTC)

Flyer22 (talk · contribs) thanks for your reply here. I have changed the word "the" formal diagnosis back to "a" formal diagnosis because you suggested this yourself in your August post to acknowledge that it is only in use by some clinicians. I also moved the Bryant comment about "harming the children it purports to help" back to where it was in the DSM-5 controversy section because he said this about the GIDC diagnosis and not the Gender Dysphoria diagnosis so I don't want to put words in his mouth. Where you moved it, it appeared he was saying this about the DSM-5 but his work came out in 2006 well before there was any talk of a diagnosis change. Cheers! Jake Pyne (talk) 15:27, 31 December 2014‎ (UTC)

Jake Pyne, thanks for explaining the changes you made here and here. As shown above (my "22:26, 20 August 2014 (UTC)" post), I suggested "a" in place of "the" before I reworded the first sentence to state "Gender identity disorder in children (GIDC) or gender dysphoria is a formal diagnosis used by psychologists and physicians to describe children who experience significant discontent with their biological sex, assigned gender, or both." That first sentence is clearly speaking of either the diagnosis of gender identity disorder or gender dysphoria, which is why I no longer see a need to use "a" instead of "the." Those are the two diagnoses for children who experience significant discontent with their biological sex, assigned gender, or both. Well, the usual diagnostic tools for that topic. But I left in "a," and am okay with it. As for the Bryant comment, it flowed better to me where I placed it, and, before reading why you moved it, I was going to object, but I now see your point on that placement. Still, it could go where I placed it, but with a qualification that it is about GIDC.

On a side note, I signed your time stamp here and I signed your latest post. I ask that you try better to remember to sign your posts. Again, all you have to do to sign your username is simply type four tildes (~), like this: ~~~~. And there's no need to ping me to this talk page via WP:Echo since it's on my WP:Watchlist. Your pings haven't been working for me, though. Flyer22 (talk) 00:50, 1 January 2015 (UTC)

Four out of five?

This part makes no numerical sense to me:

The child needs to demonstrate four of the five following symptoms: 1.dressing as a member of the opposite sex, 2.primarily befriending members of the opposite sex, 3.demonstrating a desire to engage in play activities characteristic of the opposite sex, and 4.actively stating that they wish to be the opposite sex.

What's the fifth? Or is it three out of four? — Preceding unsigned comment added by 64.18.87.72 (talk) 14:58, 14 October 2014 (UTC)

Reliability of Green (1987)

As of 8 January 2015, the lead contains the following statement:

According to limited studies, the majority of children diagnosed with GID cease to desire to be the other sex by puberty, with most growing up to identify as gay or lesbian with or without therapeutic intervention.<ref>Green, R. (1987). The sissy boy syndrome. New Haven, CT: Yale University Press.</ref>

1. I dispute that this is a reliable medical source and request the citation's proponents offer an affirmative defense of this source's quality and relevance. Considering the markedly increased social acceptance of transsexuality in the 28 years since the publication of this book, I assert a burden of proof to show that these studies' outcomes remain relevant and have not been superseded by the more recent work cited elsewhere in this article.

2. The attributed statement is unacceptably vague. Which studies? Who conducted them and under what circumstances? What sort of "therapeutic intervention"? At minimum I request a pertinent inline quotation from the source. --April Arcus (talk) 01:34, 9 January 2015 (UTC)

Like I stated here, there are various WP:Reliable sources, including WP:MEDRS-compliant ones, that can be used to support that statement, and it is essentially supported by other sources in that paragraph. It is repeatedly documented that the vast majority of gender nonconforming children, including transgender children, identify as gay or lesbian instead of as transgender later in life. I'm sure that James Cantor has additional sources that can be used for that material. Flyer22 (talk) 02:05, 9 January 2015 (UTC)

If it is redundant with other sources in that paragraph then it can be removed. If it is making a strong, verifiable statement from a secondary source, it must be quoted. --April Arcus (talk) 02:22, 9 January 2015 (UTC)

Quoting is not necessary when the information is supported by various WP:Reliable sources in the literature. Attributing the matter to one source in the text would make it seem like it is only an "According to [so and so]" matter; it is not. See WP:Intext attribution; it explains when intext attribution is appropriate, and when it is not appropriate. Flyer22 (talk) 02:42, 9 January 2015 (UTC)

According to WP:OFFLINE,

Special care should be taken when using offline sources. Provision of full bibliographic information helps Wikipedia's readers and editors find the source when they need it, and also increases the source's credibility as a reliable source. This is often done by using a fully-filled out citation template such as {{cite book}} or {{cite news}}. Use of the quote= parameter within those citation templates provides some context for the reference. This is especially important when using the off-line source to support a fact that might be controversial or is likely to be challenged.

I am challenging the citation on the grounds of vagueness and WP:MEDDATE concerns, and repeat my request for a pull-quote. --April Arcus (talk) 02:52, 9 January 2015 (UTC)

WP:OFFLINE is an essay, not a policy or a guideline; WP:SOURCEACCESS, a policy, is more relevant. I stand by what I stated above. Whether the source in question is removed or not, it can be replaced by one or more other sources. And if James Cantor does not replace it, I will. Flyer22 (talk) 03:23, 9 January 2015 (UTC)

If you know a more accessible and recent study with a clear finding, by all means don't hesitate to cite it. I'd be equally delighted to see a quote from Green (1987) as well. --April Arcus (talk) 03:55, 9 January 2015 (UTC)

This New York Times article is the best summary of Green (1987) that I have been able to find. Here's what we can glean from it:

• From 1972-1987, Green studied a cohort of 44 "extremely feminine boys" from "from early childhood to adolescence or young adulthood". "Many of the boys also repeatedly said they wanted to be girls."
• By adulthood, 3/4ths of this cohort identified as gay or bisexual. 1/4 identified as heterosexual. "Only one of the feminine boys became a transsexual". (n.b. defined in Zucker (1995) as "seriously considering sex-reassignment surgery", a fairly stringent criterion for identification as transsexual)

There was apparently no proper control group:

• In a "comparison group" of "typically masculine" boys (n.b. not a negative control group selected from the general population at random), one member identified as bisexual in adulthood and none as gay. However it is also claimed that "the study did not examine the development of homosexuality in boys whose childhoods are typically masculine".
• This single "masculine boy" who later identified as bisexual was apparently the identical twin to one of the "feminine boy" subjects.

We can glean from this article that some (but not all) of the boys involved in this study were tampered with, subject to what would now be understood as conversion therapy of one degree or another:

• Feminine boys came into the study when "parents became concerned about the boys' persistent feminine behaviors", indicating that the subjects were considered as abnormal by their family members from the start.
• "when parents actively discouraged [feminine behavior] and took other steps to enhance a male self-concept, homosexual tendencies of the feminine boys were lessened, although not necessarily reversed".
• "professional counseling [did not] divert a tendency toward homosexuality, although it resulted in more conventional masculine behavior".
• "some [boys] were seen several times a year in therapeutic counseling aimed at intercepting the boys' feminine tendencies and encouraging more "gender-appropriate" activities."

However, some of the child participants had supportive families:

• "Many of the parents, Dr. Green said, thought it was cute and directly or indirectly encouraged the cross-gender behavior."

Dr. Green himself notes that the prevailing gender-conformist attitudes of the 1970s and 1980s have undoubtedly influenced his subjects:

• "If the culture were less condemning of cross-gender behavior, social stigmatization would be less and perhaps these boys could socialize more with other boys," [Green] remarked. "Certainly that is the case with tomboys, who are treated by society as normal girls."

--April Arcus (talk) 03:37, 11 January 2015 (UTC)

Hi, folks. The conclusion that Green came to in 1987 is indeed still current today. There have been several studies conducted in the years since that book, and they have all come to the same conclusion as then: The great majority of trans-kids cease feel trans by puberty. Most grow into cis-gendered gay men/lesbians.

• Wallien, M. S. C., & Cohen-Kettenis, P. T. (2008). Psychosexual Outcome of Gender-Dysphoric Children. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1413–1423. "Most children with gender dysphoria will not remain gender dysphoric after puberty. Children with persistent GID are characterized by more extreme gender dysphoria in childhood than children with desisting gender dysphoria. With regard to sexual orientation, the most likely outcome of childhood GID is homosexuality or bisexuality."
• Drummond, K. D., Bradley, S. J., Peterson-Badali, M., & Zucker, K. J. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44, 34–45. "At the assessment in childhood, 60% of the girls met the Diagnostic and Statistical Manual of Mental Disorders criteria for GID, and 40% were subthreshold for the diagnosis. At follow-up, 3 participants (12%) were judged to have GID or gender dysphoria."

— James Cantor (talk) 15:54, 14 January 2015 (UTC)

Thanks for the cites, James. Taking the time to read through these one at a time. Regarding Wallien & Cohen-Kettenis (2008):

• The nonresponder group (n = 23) is twice as large as the difference in size between between the persistence group (n = 21) and the desistance group (n = 33). The nonresponder group therefore represents an enormous margin of error.
• The desistance group's numbers have in been inflated by pooling both self-responding subjects (n = 23) and parents responding on subjects behalf (n = 10), while no equivalent attempt to solicit parents for data was made in the case of the persistence group, because...
• The criteria for inclusion in the persistence group is specifically tied to a desire for surgery: "Desistance group consists of children who had not applied for sex reassignment when approached by us at 16 years or older. Persistence group consists of children who were still gender dysphoric at 16 years or older." The possibility of being dysphoric past the age of 16 but not applying for surgery is not discussed at all. This leads me to suspect that non-ops and non-binary identified subjects were overcounted in the "desistance" group.
• The desistance group have convincingly lower UGS (Utrecht Gender Dysphoria Scale) and BIS (Body Image Scale) scores than the persistence group, but these scores are not compared to a sample of self-identified cis people or a background population sample, so a claim that the desistance group is cisgender-like in these attributes is not backed by any data.
• The survey authors make a truly remarkable claim: "Most of the subjects in the desistance group were dissatisfied with 'sex neutral' body characteristics such as nose, shoulders, or feet, and they were satisfied with their primary sex characteristics." Noses, shoulders, and feet are highly dimorphic secondary sex characteristics, and to claim that they are "sex-neutral" is specious. Being happy with one's genitals and unhappy with one's secondary sex characteristics is in fact an apt description of a non-operative trans identification.

To summarize, Wallien & Cohen-Kettenis is methodologically suspect (allowing parental responses for desisters but not persisters), and places an improperly high bar for inclusion in the persistence group (desire for sex reassignment). This study cannot be used to back a claim such as "the great majority of trans-kids cease [to] feel trans by puberty". It could instead be used to back a narrower claim such as, "A large minority of children presenting with gender identity disorder seek genital reassignment by late adolescence. Among those who do not seek surgery, feelings of dissatisfaction with secondary sex characteristics persist into adulthood and a homosexual or bisexual orientation is common." --April Arcus (talk) 20:14, 14 January 2015 (UTC)

Thank you for bearing with me. I now turn my attention to Drummond et al (2008):

• In their introduction, the authors note that Green (1987)'s findings were never duplicated by subsequent studies. "In contrast to Green’s (1987) study, however, [seven other follow-up reports on a total of 82 behaviorally feminine boys] found the rate of GID persistence was higher, with rates ranging from 12% to 20%" (n.b. criteria for "GID persistence" not specified in text)
• Subject selection: of 37 eligible candidates, 25 agreed to participate, 5 declined, 4 were "not available" and 3 could not be located. 15 of 25 subjects "met complete DSM criteria for GID in childhood". 4 of 25 subjects were intersex and surgically assigned female at birth. One of these four had childhood GID.
• "A preliminary analysis compared the assessment information from childhood of the 25 girls who participated in the study with that of the 12 girls who did not participate. There were no significant differences between the participants and nonparticipants on any of these variables."
• Zucker's practice at the CAMH is known to engage in "reparative" or "conversion" therapy, but the paper pointedly declines to report this data: "It is beyond the scope of this report to describe the types of therapies (as well as their frequency and duration) that the girls and/or their parents may have received […] From the participants’ clinic files, 13 of the 25 girls had at least some contact with our clinic during the interval between assessment and follow-up […] 5 were patients of staff within the Gender Identity Service."
• As adults, the GID-diagnosed and "subthreshold" populations displayed statistically identical scores on a "Recalled Childhood Gender Identity/Gender Role Questionnaire", which were distinct from a variety of well-selected control populations. Only 11 of 15 GID subjects and 9 of 10 subthreshold subjects completed this instrument.
• As adults, 3 of 25 participants reported "any" gender dysphoria. None of them had intersex history.
• In comparison to a base rate of 2.0%-5.0% of bisexual or lesbian fantasy and/or behavior, assembled from six studies, "the odds of reporting bisexual/homosexual sexual orientation in behavior in the present sample was 6.0-15.5 times higher than it is in women in the general population."

Overall I find this to be an impressively rigorous study whose conclusions are backed by the data. If we could hold all social science sources to this standard, I would be thrilled. --April Arcus (talk) 03:12, 29 January 2015 (UTC)

Why are we relying on and/or judging the article content on WP:Primary sources? WP:MEDRS is clear that we should be going by WP:Secondary sources when we can. Although because the study of gender identity disorder/gender dysphoria in children is not very active, and we therefore should be applying WP:MEDDATE to this matter, especially regarding the study of gender identity disorder in children and its connection to homosexuality, there are various WP:Reliable/WP:MEDRS-compliant sources that cover this topic. The part of WP:MEDDATE that I am referring to is the following: "These instructions are appropriate for actively researched areas with many primary sources and several reviews and may need to be relaxed in areas where little progress is being made or few reviews are being published." Because there are relatively few studies on the connection between gender identity disorder in children and homosexuality/"growing out of" gender identity disorder, it's common for the WP:Reliable/WP:MEDRS-compliant sources to mention Green's 1987 source. I have removed the Green source from the article, and I moved the sexual orientation content into its own section since the WP:Lead is supposed to summarize the article content. While it is best not to use the Green source directly, we can use WP:Reliable/WP:MEDRS-compliant sources that cite Green. I noted in the #Improper Synthesis in Lead discussion below the following: "It's not WP:Synthesis because the sources ... support the statement that 'Gender identity disorder in children is more heavily linked with adult homosexuality than adult transsexualism.' I fail to see how the statement is covert, or how it lacks relevance. It's noting a matter that has been consistently replicated by studies on gender identity disorder in children; it's relevancy is the fact that gender identity disorder in prepubescent children is distinct from gender identity disorder in adolescents and adults because the children are likely to 'grow out of' their gender dysphoria, while the adolescents and adults are not likely to do so. In other words, if a person still has gender dysphoria past puberty, that person is likely to continue to identify as transgender throughout their life." This is true. And the following sources show that:

This 2006 Women's Mental Health: A Life-cycle Approach source from Lippincott Williams & Wilkins, page 77, states, "There are few systematic studies of female GID. As indicated above under 'Course and Outcomes,' many children with GID ultimately develop a homosexual orientation. Retrospective studies of homosexual adults suggest that many displayed cross-gender interests and behavior as children (15). However, not all did, and there are no studies that clearly document what proportion of individuals with a homosexual orientation would have met the criteria for GID in childhood. Thus, homosexuality and GID are not synonymous, as has sometimes been suggested. However, because of the clear connection between GID and homosexuality, there has been interest among GID researchers in examining those factors that are thought to play a role in the development of homosexuality. In this section, we will briefly review some of the literature related to homosexuality, specifically where it may provide etiologic links relevant to GID."

This 2008 The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health source from ACP Press, page 339, states, "Diagnosing a child with GID can be tricky, as research shows that the majority of children with cross-gender behavior do not grow up to qualify for the diagnosis of GID in adulthood."

This 2012 Assessment and Treatment of Childhood Problems, Second Edition: A Clinician's Guide source from Guilford Press, page 229, states, "Although GID is relatively rare, its significance as a clinical problem lies in the strong relationship between early cross-gender behavior and later homosexuality. This link has been shown in both prospective and retrospective studies for boys and in retrospective studies for girls (for a summary, see Bailey & Zucker, 1995). Prospective work indicates that a substantial majority (60-80%) of boys with GID have a homosexual or bisexual orientation as adults (Bailey & Zucker, 1995; Green, 1987). The association between cross-gender behavior in childhood and later homosexuality is not absolute, however. Many homosexual adults do not recall engaging in cross-gender behavior during childhood, and some children with gender disturbance do not adopt a homosexual orientation as adults. It would be reasonable to expect that similar strong association between GID and transsexualism (i.e., persistent gender identity problems in adulthood and a wish to undergo sex reassignment); however, research indicates a somewhat different picture. Although retrospective studies show that almost all adults with a transsexual orientation (both males and females) recall cross-gender behavior as children (e.g., Blanchard, Clemmensen, & Steiner, 1987), prospective studies of children with GID indicate that very few develop transsexualism as adults (Green, 1987; Money & Russo, 1979). Zucker and Bradley (1995) suggest that the transition from childhood to adolescence may be a critical time for the development of transsexualism."

This 2013 Endocrinology Adult and Pediatric: Reproductive Endocrinology source from Elsevier Health Sciences, page 483, states, "A reliable estimate indicates that 80% to 95& of prepubertal children with GID will no longer experience gender dsyphoria in adolescence, but if the GID persists into early puberty, it is almost certainly permanent.

This 2014 Nelson Essentials of Pediatrics source from Elsevier Health Sciences, page 254, states, "Forty to 80% of children with GID will have a bisexual or homosexual sexual orientation as adults. However there is no reliable way to predict adult sexual orientation, and there is no evidence that parental behavior would alter the developmental pathway toward homosexual or heterosexual behavior. Long-term follow-up studies of children with GID suggest that only 2% to 20% have GID as adults, but gender dysphoria that intensifies with the onset of puberty is likely to persist."

And for prevalence information on gender identity disorder, see this 2012 Child and Adolescent Mental Health: Theory and Practice, Second Edition source from CRC Press, page 330.

The sources I've cited above are not stating that people who identify as homosexual or bisexual as adults are still transgender; it's stating that most or the significant majority of children who had GID "grow out of it" before puberty and identify as homosexual or bisexual (usually as gay or lesbian) as adults. Yes, this data is based on relatively few studies; but these studies have consistently found a strong tie between GID in childhood and homosexuality in adolescence/adulthood. We are supposed to use what WP:MEDRS-compliant sources we can for this topic; we are not supposed to heavily analyze and/or discard the sources to essentially state, "Not enough research has been done in this field, so I don't trust the reliability of these sources and we should therefore downplay the homosexuality aspect." Again, all that we need to do is report what the WP:Reliable sources state, preferably via WP:Secondary sources. If they don't report the details, we don't need to report the details. I hope that whatever proposed wording you are aiming for is in compliance with that...with WP:Due weight in mind. Flyer22 (talk) 09:21, 29 January 2015 (UTC)

Improper Synthesis in Lead

As of 8 January 2015, the lead contains the following statement:

Gender identity disorder in children is more heavily linked with adult homosexuality than adult transsexualism

I claim that this statement represents improper synthesis.

1. What precisely does this mean? That more individuals with GIDC identify as "homosexual" adults than "transsexual" adults? How were gay-identified transsexual adults counted in these studies? How were bisexual adults counted in these studies?

2. What is the relevance of this claim, if true? It seems to contain a covert but unclear statement on the relationship between homosexuality and transsexuality.

3. I request substitution with a more verifiable claim: "Gender identity in children is strongly linked with both adult homosexuality and adult transsexualism". --April Arcus (talk) 02:20, 9 January 2015 (UTC)

Regarding your tagging on this matter, it is not WP:Synthesis, and your edit should be reverted. It's not WP:Synthesis because the sources after that statement support the statement that "Gender identity disorder in children is more heavily linked with adult homosexuality than adult transsexualism." I fail to see how the statement is covert, or how it lacks relevance. It's noting a matter that has been consistently replicated by studies on gender identity disorder in children; it's relevancy is the fact that gender identity disorder in prepubescent children is distinct from gender identity disorder in adolescents and adults because the children are likely to "grow out of" their gender dysphoria, while the adolescents and adults are not likely to do so. In other words, if a person still has gender dysphoria past puberty, that person is likely to continue to identify as transgender throughout their life. Flyer22 (talk) 02:32, 9 January 2015 (UTC)

Please do not revert this tag before concluding this good-faith discussion. How were participants counted who fell into both bins? If we don't know the answer to this, how can we make such a statement definitively? What is the substantive relevance of the synthesized statement ("more strongly linked to homosexuality than transsexuality") over the composite statements ("strongly linked to both homosexuality and transsexuality")? If it is related to GIDC children "growing out of" gender-nonconforming behavior and becoming gay cisgender adults, shouldn't the converse possibility of GIDC children "growing out of" homosexual behavior and becoming straight transgender adults also be noted? If the real substance of the matter is that GIDC is diagnostically indistinct between homosexuality, transsexuality, or both before puberty, this can be stated more clearly and overtly. --April Arcus (talk) 02:37, 9 January 2015 (UTC)

April Arcus, I've asked you before to be mindful of WP:Advocacy on transgender topics; I'm asking you again. Like I stated, your WP:Synthesis tags should be reverted. As for your questions about the sources, all that we need to do is report what the WP:Reliable sources state, preferably via WP:Secondary sources. If they don't report the details, we don't need to report the details. And the lead is for summarizing anyway, per WP:Lead; the lower body of the article is for in-depth detail. There is no converse argument that should be made, and I don't understand your converse arguments; do see WP:Due weight and its subsections, WP:BALASPS and WP:VALID. You are trying to give matters the same weight when they do not have the same weight at all. You used the words "homosexual behavior" instead of "homosexual." Yes, those matters are distinct. While people may stop displaying homosexual behavior, it is highly unlikely that a person stops being homosexual, which is why sexual orientation change efforts are highly disputed by the medical community. It is not highly unlikely that a prepubescent child will "grow out of" gender dysphoria; it's significantly documented that they do, as noted in the Gender variance and Childhood gender nonconformity articles. For years, I've met gay and lesbian people who are clear that they were gender nonconforming as children and wanted to be the opposite sex/gender, and that they "grew out of it" at some point. James Cantor has had the same experience with the gay and lesbian communities. Furthermore, "growing out of" gender dysphoria does not necessarily mean growing out of gender-nonconforming behavior; many gay men and adult lesbians still exhibit gender-nonconforming behavior. And let's not forget people who identify as genderqueer. And if by "homosexual behavior," you mean "homosexual sexual activity," what children predominantly engaged in homosexual sexual activity, "grew out of it" by puberty, and identified as transgender later in life? By contrast, and as I noted above, "the majority of children diagnosed with GID ceas[ing] to desire to be the other sex by puberty, with most growing up to identify as gay or lesbian with or without therapeutic intervention" content can be supported by various WP:Reliable sources.

I will wait and see if James Cantor takes care of your changes to the lead. If he does not, I will eventually deal with them myself. Flyer22 (talk) 03:21, 9 January 2015 (UTC)

In order to stay on topic, I will respond piecewise to your lengthy remarks:

I've asked you before to be mindful of WP:Advocacy on transgender topics; I'm asking you again.

I will continue to be mindful of this and encourage you to assume good faith in return. Please note that I am keeping my points narrowly focused and appreciate your own effort to remain on topic.

If they don't report the details, we don't need to report the details.

If the details are irrelevant then that is of course fine; but if they are too vague to meet the standards of WP:MEDASSESS, this must also be considered.

I don't understand your converse arguments

I will reiterate: a strong claim is being made that among two specific outcomes:

1. adults attracted to members of the same-sex
2. transgender adults

GIDC children are more likely to have outcome (1) than outcome (2).

I assert that this claim is logically dubious for the following reasons:

1. The two sets are not disjoint. Some transgender adults are attracted to members of the same sex. Since these could be counted in either or both groups, we must determine how such individuals are being counted before making strong claims about demographics.
2. It is not clear how bisexuals are counted.
3. As you correctly note, it is not clear how genderqueer and nonbinary individuals are counted.

Additionally,

4. It is not clear that the sample sizes involved in the three cited studies are sufficiently large and controlled to make strong demographic assertions. Ideally a recent metastudy should be cited; the use of three primary source citations for such a claim in the lead paragraph is strongly indicative of original research.

I will wait and see if James Cantor takes care of your changes to the lead. If he does not, I will eventually deal with them myself.

I have every faith that we will be able to achieve consensus by maintaining a cordial attitude, a narrow focus, and attending to Wikipedia's settled policies. --April Arcus (talk) 03:48, 9 January 2015 (UTC)

You are not being mindful of WP:Advocacy, and pointing that out is not a WP:Civility issue. For example, this (tagging "proponents" with the Template:Who but not "opponents" with Template:Who) and this (changing the "intervention (counseling)/therapeutic intervention" link to "conversion therapy") is more WP:Advocacy to me. The lead is for summarizing, and, per, WP:CITELEAD, may validly have references or validly be absent of references. Having the content sourced lower in the article is the main point. And, like Template:Who states, "Use good judgment when deciding whether greater specificity is actually in the best interests of the article. Words like 'some' or 'most' are not banned and can be useful and appropriate. If greater specificity would result in a tedious laundry list of items with no real importance, then Wikipedia should remain concise, even if it means being vague. If the reliable sources are not specific—if the reliable sources say only 'Some people...'—then Wikipedia must remain vague." WP:Weasel words is also clear that such words may be appropriate for the lead or for a topic sentence. And as for therapeutic intervention, it is not necessarily the same thing as conversion therapy. Therapeutic intervention with regard to gender identity disorder in children, for example, can simply be about making sure that the child is not uncomfortable with their assigned sex/gender because the child truly wants to be the opposite sex/gender. Therapeutic intervention is often to make sure that a mistake does not happen; for example, if the child goes through the transition process before puberty, but wants to remain their assigned sex/gender during or after puberty because they now identify as gay or lesbian, or otherwise, then a mistake has been made. The term conversion therapy usually refers to sexual orientation matters instead of transgender matters, which is why transgender matters are barely covered in the Conversion therapy article. The mention of transgender people was recently added to the lead of the Conversion therapy article.

You are not applying Wikipedia's rules, such as WP:MEDASSESS, appropriately. How you want to analyze the sources should not factor into the article content. Because of all of that, I will cease this discussion with you for now and wait until James Cantor comments. I might also eventually ask WP:Med to weigh in on this matter. Flyer22 (talk) 04:15, 9 January 2015 (UTC)

Furthermore: Take note that what WP:Original research means, as made clear in its introduction, is the following: "Wikipedia articles must not contain original research. The phrase 'original research' (OR) is used on Wikipedia to refer to material—such as facts, allegations, and ideas—for which no reliable, published sources exist." The policy clarifies with a note: "By 'exists', the community means that the reliable source must have been published and still exist—somewhere in the world, in any language, whether or not it is reachable online—even if no source is currently named in the article. Articles that currently name zero references of any type may be fully compliant with this policy—so long as there is a reasonable expectation that every bit of material is supported by a published, reliable source." Flyer22 (talk) 04:32, 9 January 2015 (UTC)

Note: This discussion is continued in the #Reliability of Green (1987) discussion above. Flyer22 (talk) 09:21, 29 January 2015 (UTC)

Conversion Therapy

Flyer22, I wish you would allow me to fork your comments upthread so that the discussion of Improper Synthesis can remain on topic. Since you will not, I am starting a new section and will reply to your two points here:

1. I tagged "proponents" with {{who}} and not "opponents" because the opponents are clearly identified in citation 6, "American Psychiatric Association Rebukes Reparative Therapy", while the proponents are not identified by name. This is an appropriate use of the template, not advocacy.
2. I used the word "conversion therapy" because in my judgement that is clearly and unambiguously the topic under consideration, in context. If you believe in good faith that the paragraph now improperly ignores a legitimate treatment modality, feel free to name and cite it. The process you describe above, however (psychiatric evaluation followed by medical services at appropriate age points) is nothing other than the WPATH standards of care as they currently exist.

--April Arcus (talk) 05:01, 9 January 2015 (UTC)

I repeat that "therapeutic intervention" is being used as a WP:EUPHEMISM for conversion therapy in the current text. --April Arcus (talk) 21:07, 14 January 2015 (UTC)

Note: This section relates to the #Improper Synthesis in Lead section above, and to a discussion April Arcus and I had on my talk page.

April Arcus, in the #Improper Synthesis in Lead section above, I pointed to what Template:Who states; I also pointed to what WP:Weasel words states about a topic sentence. WP:Weasel words acknowledges that such wording may be validly placed in the lead. What the template and guideline states is that vague words, supposed WP:Weasel words, do not automatically need to be tagged with such "language violation" templates. The "Proponents argue that therapeutic intervention" line that you tagged with Template:Who is sourced below in the Therapeutic intervention section. And like Template:Who states, "If the reliable sources are not specific—if the reliable sources say only 'Some people...'—then Wikipedia must remain vague." Clearly, by what Template:Who and WP:Weasel words state, I was not going off-topic...as you stated of my "04:32, 9 January 2015 (UTC)" post on my talk page. As for conversion therapy, I was also clear above about what conversion therapy usually refers to; in fact, an editor recently removed mention of transgender/gender identity from the lead of the Conversion therapy article partly because of what conversion therapy usually refers to; like in that case, we need WP:Reliable sources that refer to the transgender aspect as conversion therapy. I can easily find such sources, but WP:Due weight is also a factor. As for mentioning conversion therapy in the Gender identity disorder in children article: If it's about trying to change the person's transgender identity, there are sources that refer to that matter as therapeutic intervention; some opponents liken it to conversion therapy, as is made clear in the Opponents section. We can clarify both in the lead. But, like I noted in the Improper Synthesis in Lead section above, there are also psychologists that don't consider therapeutic intervention to be about trying to change a person's transgender identity. Flyer22 (talk) 09:21, 29 January 2015 (UTC)