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For those new to this issue it’s best to know these terms before reading.

7) Conversion therapy laws

This website covers the phenomenon of the large increase of young people being medically treated for gender dysphoria in Western countries. Many jurisdictions in the Western world have also passed or in the midst of passing anti-conversion therapy laws to include “conversion of transgender individuals to cisgender”. Such conversion therapy bans are modelled on gay conversion therapy practiced decades ago and even more recently in fundamentalist Christian organizations. These conversion practices are not only harmful, but have been shown to be ineffective. The new conversion therapy laws, however, include gender identity and often gender expression. These bans are an understandable goal for trans adult who feel that transition was the best thing for them. Any shaming, devaluing, or failing to acknowledge real feelings of a gender dysphoric youth is harmful and not advocated here.

However, limiting the response to young people to only affirmation with social and medical transition, is misguided and does not take into account significant research that indicates that without affirmation, that for the majority of children who experience gender dysphoria their dysphoria resolves naturally, with many growing up to be same sex attracted. Thus, it is a disservice to treat children the same was as adults for who their gender dysphoria did not resolve. Given that medical treatments for gender dysphoria cause permanent changes, often with serious side effects, making an analogy to homosexual conversion therapy is not appropriate. Sexuality and gender identity are entirely different. Homosexuality does not involve drugs and surgeries, that may result in sterilization, risk to cognitive, physical and sexual function. Including gender identity in conversion therapy laws risks minors making permanent decisions about their health, sexual development and fertility

A. Conversion therapy laws

Given the international focus of Gender Health Query, it is not possible to review the specifics of laws in all countries. However, we provide a few examples of these laws, their wording and the implications on trans-identifying young people.

From Quadrant:

In California, in September 2012, a law was passed “to prohibit a mental health provider … from engaging in sexual orientation change efforts … with a patient under 18 years of age” which included “lesbian, gay, bisexual and transgender youth”. Such efforts included “efforts to change behaviors or gender expressions” which were deemed “unprofessional conduct and shall subject the provider to discipline”. The Bill cited various national organizations of pediatricians, psychologists and psychiatrists which described such activities as conversion or reparative therapies.[39]
Similar laws have been enacted in New Jersey, Illinois, Oregon and Washington and, in 2015, in Ontario, Canada. Known as “anti-reparative” and “anti-conversion” laws, they oppose any attempts to re-orientate sexuality and to suppress gender identity and expression in order “to save children’s lives”.
In effect, Former President Barack Obama has joined the affirmation team. Responding to a petition for banning “dangerous … conversion therapy” after a prominent suicide by a fifteen-year-old adolescent male who had sought to identify as a female and allegedly underwent “conversion” therapy at his parents’ church, the White House declared that the “Obama administration supports efforts to ban conversion therapy for minors “because overwhelming evidence demonstrates” it “is neither medically nor ethically appropriate”[40].
Ontario Bill 77 or the “Affirming Sexual Orientation and Gender Identity Act, 2015” was passed unanimously and in a “miraculously” short time according to its promoter, parliamentarian the Reverend Cheri DiNovo, who explained, “Bills may take up to years to pass but this one succeeded in only two months”. According to Wikipedia, DiNovo entered Parliament in March 2006, has been prominent in many issues including recognition of the Stalin-imposed famine on Ukraine as “genocide”, has “passed most LGBTQ legislation in Canada”, has conducted a weekly radio program, received literary awards, earned a masters degree in divinity and a doctorate in ministry from the University of Toronto, and has been a minister of the United Church since 1995. In 2001, she officiated over the first same-sex marriage in Canada[41]. Recitation of these educational achievements is relevant to some of the discussion we shared.

Dr. Ken Zucker notes an inconsistency in approaches to treating gender dysphoria in “The Myth of Persistence:”

Now, of course, it would not come as a surprise if Temple Newhook et al. (2018) took umbrage at the mere idea of a treatment arm designed to reduce a child’s gender dysphoria via psychotherapeutic methods. They might, for example, offer up the following from the seventh edition of the Standards of Care:
Treatment aimed at trying to change a person’s gender identity...to become more congruent with sex assigned at birth has been attempted in the past without success (Gelder & Marks, 1969; Greenson, 1964)....Such treatment is no longer considered ethical.” (Coleman et al., 2011, p. 175)
Yet, on the very same page of the Standards, one finds the following: “Psychotherapy should focus on reducing a child’s...distress related to the gender dysphoria...” (p.175) or “Mental health professionals.... should give ample room for clients to explore different options for gender expression” (p.175). The lack of internal consistency between the first statement and the second and third statements is rather astonishing.

Such laws have serious consequences as mental health counsellors will be prevented from conducting proper mental health assessment and counselling, closing alternative coping strategies and less invasive pathways. These laws are prohibiting trained, licensed practitioners from ethical, evidence-based practice. There are various questions about the ways in which these laws are specifically worded and where the line is between proper mental health support and coercive attempts to change a youth’s identity. The unclear wording on many of these laws has had a chilling effect on practitioners working with gender dysphoric youth. Some have stepped away from working with this population entirely as they do not feel that they can practice in an open, exploratory manner, which may be construed as conversion therapy, putting their licence at risk. In some jurisdiction, such as Canada, practicing conversion therapy is punishable by jail time.

B. Inappropriate comparison to anti-conversion therapy laws for homosexuality

Some trans activists have done a good job of associating any therapy that treats medical transition as a last resort as conversion therapy. Many parents, however, are skeptical of the rush to transition their children. These parents are often pro-gay liberals whose children later desisted, not right-wing Christians highly motivated to enforce Bible-based gender norms. In some cases, the parents supported their child through developmental milestones and in other cases they found therapists who were not gender therapists who helped their child work through issues. Such approaches work with the youth’s gender nonconformity and fosters a body acceptance, possibly until treatment becomes necessary and the child is mature enough to give true informed consent.

If gender identity is fluid, as even Diane Ehrensaft admits, why deny the youth an opportunity to heal without hormones and surgery. Homosexuality involves no long-term changes. It is a fixed orientation in the majority of cases and not dependent on the medical industry for treatment. A sexually fluid or bisexual orientation is, in fact, more common in females than lesbianism, with females often moving between these labels. If a lesbian goes through a stage of identifying as bisexual due to growing up in a hetero dominant environment or if a lesbian identified women falls in love with a man and realizes she has a fluid orientation, there are no health consequences and there is no permanent medical disfigurement. Gender fluidity in minors has much more serious consequences if the youth is socially and medically affirmed.

Sexologist (and gay man) James Cantor summarizes below some of the reasons why the coupling of homosexuality and gender identity in the policy statements such as that of the American Academy of Pediatrics and in laws for treating minor’s gender dysphoria is inappropriate. He highlights the fact that we do not know if therapy for minors would be harmful or if it would be helpful in minors avoiding hormones and surgeries which may turn out to be unnecessary and have known harmful side effects. He also exposes the generally sloppy conflation of homosexuality and gender identity in the minds and policy statements of affirmation model advocates. It is worth reading this whole “fact checking” piece in its entirety.

These claims struck me as odd because there are no studies of conversion therapy for gender identity.  Studies of conversion therapy have been limited to sexual orientation—specifically, the sexual orientation of adults—not gender identity, and not children in any case.  The article AAP cited to support their claim (reference number 38) is indeed a classic and well-known review, but it is a review of sexual orientation research only.  Neither gender identity, nor even children, received even a single mention in it.  Indeed, the narrower scope of that article should be clear to anyone reading even just its title: “The practice and ethics of sexual orientation conversion therapy” (Haldeman, 1994, p. 221, italics added).
AAP continued, saying that conversion approaches for GD children have already been rejected by medical consensus, citing five sources.  This claim struck me just as odd, however—I recalled associations banning conversion therapy for sexual orientation, but not for gender identity, exactly because there is no evidence for generalizing from adult sexual orientation to childhood gender identity.  So, I started checking AAP’s citations for that, and these sources too pertained only to sexual orientation, not gender identity (specifics below).  What AAP’s sources did repeatedly emphasize was that:
(1)   Sexual orientation of adults is unaffected by conversion therapy and any other [known] intervention;
(2)   Gender dysphoria in childhood before puberty desists in the majority of cases, becoming (cis-gendered) homosexuality in adulthood, again regardless of any [known] intervention; and
(3)   Gender dysphoria in childhood persisting after puberty tends to persist entirely.
That is, in the context of GD children, it simply makes no sense to refer to externally induced “conversion”: The majority of children “convert” to cisgender or “desist” from transgender regardless of any attempt to change them.  “Conversion” only makes sense with regard to adult sexual orientation because (unlike childhood gender identity), adult homosexuality never or nearly never spontaneously changes to heterosexuality. Although gender identity and sexual orientation may often be analogous and discussed together with regard to social or political values and to civil rights, they are nonetheless distinct—with distinct origins, needs, and responses to medical and mental health care choices.  Although AAP emphasized to the reader that “gender identity is not synonymous with ‘sexual orientation’” (Rafferty, 2018, p. 3), they went ahead to treat them as such nonetheless.
To return to checking AAP’s fidelity to its sources: Reference 29 was a practice guideline from the Committee on Quality Issues of the American Academy of Child and Adolescent Psychiatry (AACAP).  Despite AAP applying this source to gender identity, AACAP was quite unambiguous regarding their intent to speak to sexual orientation and only to sexual orientation:“Principle 6. Clinicians should be aware that there is no evidence that sexual orientation can be altered through therapy, and that attempts to do so may be harmful.  There is no established evidence that change in a predominant, enduring homosexual pattern of development is possible.  Although sexual fantasies can, to some degree, be suppressed or repressed by those who are ashamed of or in conflict about them, sexual desire is not a choice.  However, behavior, social role, and—to a degree—identity and self-acceptance are. Although operant conditioning modifies sexual fetishes, it does not alter homosexuality.  Psychiatric efforts to alter sexual orientationthrough ‘reparative therapy’ in adults have found little or no change in sexual orientation, while causing significant risk of harm to self-esteem” (AACAP, 2012, p. 967, italics added).
Whereas AAP cites AACAP to support gender affirmation as the only alternative for treating GD children, AACAP’s actual view was decidedly neutral, noting the lack of evidence: “Given the lack of empirical evidence from randomized, controlled trials of the efficacy of treatment aimed at eliminating gender discordance, the potential risks of treatment, and longitudinal evidence that gender discordance persists in only a small minority of untreated cases arising in childhood, further research is needed on predictors of persistence and desistence of childhood gender discordance as well as the long-term risks and benefits of intervention before any treatment to eliminate gender discordance can be endorsed” (AACAP, 2012, p. 969).  Moreover, whereas AAP rejected watchful waiting, what AACAP recommended was: “In general, it is desirable to help adolescents who may be experiencing gender distress and dysphoria to defer sex reassignment until adulthood” (AACAP, 2012, p. 969).  So, not only did AAP attribute to AACAP something AACAP never said, but also AAP withheld from readers AACAP’s actual view.
To return to checking AAP’s fidelity to its sources: Reference 29 was a practice guideline from the Committee on Quality Issues of the American Academy of Child and Adolescent Psychiatry (AACAP).  Despite AAP applying this source to gender identity, AACAP was quite unambiguous regarding their intent to speak to sexual orientation and only to sexual orientation:“Principle 6. Clinicians should be aware that there is no evidence that sexual orientation can be altered through therapy, and that attempts to do so may be harmful.  There is no established evidence that change in a predominant, enduring homosexual pattern of development is possible.  Although sexual fantasies can, to some degree, be suppressed or repressed by those who are ashamed of or in conflict about them, sexual desire is not a choice.  However, behavior, social role, and—to a degree—identity and self-acceptance are. Although operant conditioning modifies sexual fetishes, it does not alter homosexuality.  Psychiatric efforts to alter sexual orientationthrough ‘reparative therapy’ in adults have found little or no change in sexual orientation, while causing significant risk of harm to self-esteem” (AACAP, 2012, p. 967, italics added).
Whereas AAP cites AACAP to support gender affirmation as the only alternative for treating GD children, AACAP’s actual view was decidedly neutral, noting the lack of evidence: “Given the lack of empirical evidence from randomized, controlled trials of the efficacy of treatment aimed at eliminating gender discordance, the potential risks of treatment, and longitudinal evidence that gender discordance persists in only a small minority of untreated cases arising in childhood, further research is needed on predictors of persistence and desistence of childhood gender discordance as well as the long-term risks and benefits of intervention before any treatment to eliminate gender discordance can be endorsed” (AACAP, 2012, p. 969).  Moreover, whereas AAP rejected watchful waiting, what AACAP recommended was: “In general, it is desirable to help adolescents who may be experiencing gender distress and dysphoria to defer sex reassignment until adulthood” (AACAP, 2012, p. 969).  So, not only did AAP attribute to AACAP something AACAP never said, but also AAP withheld from readers AACAP’s actual view.
Next, in reference 39, Byne (2016) also addressed only sexual orientation, doing so very clearly: “Reparative therapy is a subset of conversion therapies based on the premise that same-sex attraction are reparations for childhood trauma. Thus, practitioners of reparative therapy believe that exploring, isolating, and repairing these childhood emotional wounds will often result in reducing same-sex attractions” (Byne, 2016, p. 97).  Byne does not say this of gender identity, as the AAP statement misrepresents.

An academic and philosopher, Kathleen Stock, in reviewing Stonewall UK’s statement on anti-conversion therapy laws draws attention to the reality that there are gay and lesbian people who have said they had gender dysphoria as minors. If a minor isn’t given proper psychological support, he or she will be “converted” or “repaired” out of a homosexuality that would have normally evolved.

Since July, the Government have been publicising a Stonewall-approved major initiative against ‘conversion therapy’. What seems to have been missed is that, according to the definition of conversion therapy endorsed by Stonewall and others, every single therapist working in the area of gender identity is likely to count as engaging in the very practice which the Government is supposedly keen to outlaw…
To illustrate, Imagine a 14 year-old biological female called Margie. Margie’s becoming aware that she is sexually attracted to women (or at least, to females like her). Simultaneously, Margie is developing dysphoria: strong disgust for her changing body. She wishes her breasts and other curves to disappear: she longs to be straight-hipped, angular, muscular. She starts to tell people ‘I’m a boy’...
How should therapists respond? Current guidelines tell them to avoid both kinds of conversion therapy just described. But here’s the rub: according to the terms set out by the new paradigm, you can’t avoid both. If Margie’s self-diagnosis (‘I’m a boy’) is questioned by the therapist, the therapist can be construed as failing to affirm, and so putatively ‘converting’, a trans child to a ‘cis’ one. If, on the other hand, Margie’s self-diagnosis is affirmed unquestioningly, the therapist is effectively failing to affirm Margie in a sexual orientation of lesbianism; something which also looks like conversion by omission.

She further points out that the concept of an innate gender identity is not true for all people.

This assumption is unfounded, however. Perhaps it gets a gloss of legitimacy from a point made earlier: that homosexual orientation (in the old-fashioned sense, involving same-sex attraction) gets fixed early in life. It also seems reasonable to assume that teens and adults can – at least, if unaffected by heteronormative social influences - identify their own sexual desires correctly, and so reliably draw conclusions about their orientations, in the older sense. But this point is of no relevance to what we should say in the case of Margie deciding whether she is a ‘lesbian woman’ (in the new sense) or a ‘straight man’. This isn’t a question about whether Margie exclusively fancies females, for this is a constant in both outcomes. There’s no prior underlying psychological story to give us the ‘real’ fact about Margie’s transness, or lack of it; nor to tell us why Margie would reliably know that fact. What Margie knows is that she’s dysphoric, and fancies females. But such facts alone don’t make you trans. Lots of now-proud and happy female lesbians report a past history of dysphoria.
So: there’s an inherent tension in new definitions of conversion therapy. With a same-sex-attracted person questioning her gender identity, therapists have to convert her, either by act or by omission. If they accept her trans narrative without question, they are converting her out of lesbian sexual orientation. If they therapeutically question that narrative, they are converting her (or rather, him) out of being trans. To this, one might well add: only one of those routes is connected with body-altering, life-changing drugs and surgeries, whose long-term consequences are unknown.,

C. Concerns over false positives and/or over medicalization are bigotry against trans people

Another important point about conversion therapy laws is they reflect the philosophy of strong gender affirmation model advocates who do not view a less medicalized outcome as preferable. To these individuals, supporting a child finding comfort with their natal sex, should not be explored because it would hurt “true trans” children. Furthermore, they claim that it is “cis sexist” and “transphobic” to worry about false positives.

While our goal is the best possible outcome for all, which may include transition, it is simply not logical or ethical to assert both outcomes are equally valid, to the point of disregarding concerns of false positives and the potential harm. Having a non-medicalized outcome is preferable. It is not “transphobia.” Functioning well without health problems brought on by hormones, such as decline in cognitive acumen, bone loss, vaginal atrophy, mitochondrial damage and complications of surgery such as nerve damage, pain from excessive scarring, infection and neovaginal dilation, the expense of medical treatments, as well as the cognitive dissonance around passing undoubtedly is highly likely to impact quality of life. Further, research shows that life expectancy is reduced by gender medical treatments. It’s not devaluing the human being in any way to admit these facts. It’s preferable for trans people to have a less medicalized outcome if they do transition. Good mental function without bottom surgery (which is complicated and has horrific consequences when things go wrong) is preferable (safer, and less expensive) than having bottom surgery. Over-medicalization also falls under medical malpractice.

Here Diane Ehrensaft, the psychologist who is a strong advocate of the affirmative model, chastises the concept of worrying about the effects of early transitions on desistance as transphobic.

Another concern that has been raised is that if a gender-expansive child is allowed to socially transition, then go on a GnRH agonist at Tanner Stage 2 of puberty, thereby never experiencing the puberty associated with their assigned sex, they will never have a full understanding and self-knowledge of their gender because they were denied the opportunity to experience the “correct” puberty. As stated previously, even if they appear happy and well-adjusted, from this transphobic perspective, being a transgender person is considered a poor outcome because of the discrimination they will face and the lifelong course of medical treatments they may require.

Johanne Olson-Kennedy, one of the most pro affirmation model and early medical treatment advocates also believes that not only is encouraging desistance transphobic, but it is transphobic to even discuss the topic.

…the language that you sometimes hear are like, persisters and desisters around childhood. So, there is a body of data that comes out of the seventies and eighties, primarily out of Toronto and Ken Zucker’s clinic that asks the question...how many boys who are wanting to wear dresses in childhood go on to be trans identified. That’s the real question, right?..If you were assigned male at birth and you wanted to play with dolls and act effeminate and then you didn’t want to do that, sort of in adolescence you are considered a desister. And if you have a gender identity of something different than male you are considered to be a persister. It’s not my language I hate it, Ithink it’s horrible…So that data that showed well you know most of the people who are assigned male, they were boys who wanted to wear girl’s cloths, actually anything but male. (audience member they were boys who wanted to wear girls’ cloths). Exactly!

The reason Olson-Kennedy “hates” the word desisters is that she thinks it represent transphobia and concern over it blocks the blanket transition of all children who say they are trans.

Gender Odyssey conference, 2017:

…So, that data though is a meme for the noise about why young people should not go through any medical interventions. Either puberty blocking or hormones
…The issues around this particular body of data is…the question is different, and how you measure gender dysphoria is different, and what the follow up time period is, is different, the nature of the fact that the clinic kind of practiced a reparative model impacts the data. So, there is a lot of stuff that makes it not very useful in many, many ways. Except as a tool against the community.

This point is reiterated below to WPATH colleagues:

Only numbers out about the answer to this question about those who come out in adolescence are from the Dutch – 100% of their cohort had a trans identity at follow up. “Persistence” and “desistance” are another irrelevant binary that do not accurately represent the gender experiences of most trans people. Sadly, I think we are still asking questions that are rooted in easing the discomfort of cisgender people, whether that be parents, or providers.This need for a litmus testing of a “gold star trans person” is derailing to the mission of providing timely, thorough and appropriate patient centered care for trans individuals. (WPATH Facebook June 8)

D. Can childhood gender identity be changed?

Childhood gender identity does change as is shown in desistance statistics, clinical observations, and personal stories. The main questions are…

1) Did those youths outgrow GD because they were not subjected to the affirmation model (early social transition, puberty blockers in Tanner stage 2)?

2) Can therapy and other social support for a body acceptance model in pre-puberty help children align with their natal sex without drugs and surgeries with a likely LGB outcome (especially gay males)?

3) Can a gender non-conforming, supportive, body acceptance model be instituted without doing permanent harm to youth who will have intractable gender dysphoria?

This is what is at the center of the controversy. Some researchers and clinicians, such as Susan Bradley and Ken Zucker believe that transition risks false positives. Below is a quote about the firing of Dr Zucker,

Perhaps even more disturbing to transgender activists was Zucker’s opinion that parents might be permitted to influence orientation of the child towards its natal gender. Declarations by Zucker that “if the parents are clear in their desire to have their child feel more comfortable in their own skin … [and] would like to reduce their child’s desire to be of the other gender, the therapeutic approach is organised around this goal”[48] became nails in his cross.
CAMH therapy included “open-ended play” to explore “underlying mechanisms” for which “surface behaviours” of gender dysphoria are symptoms, and “which can best be helped” if the reasons are understood. Limitations would be set on cross-sex play and dressing. For example, a boy might be permitted to wear at the home but persuaded against wearing them on trips to the mall. Same-sex “peer relationships” would be encouraged because they are “often the site of gender identity consolidation”. If the boy in question did not like “rough and tumble” play, less physical peers might be sought.
Zucker’s management of childhood dysphoria might be summarised as “minimise stress and maximise comfort” in natal sex, in the expectation most will grow out of it. He fears labelling a child is part of “conditioning” to transgender from which return is more difficult. He cautioned parents to: resist too much accommodation from [a child’s] teachers. Don’t let the school make him a poster child … don’t let them parade him around for pink assemblies. This is his personal journey and we don’t know where it is going to end up.[49]

Ken Zucker believed in a body acceptance model that he believes helps dysphoric children adapt to their natal sex. Trans activist claim this approach is harmful to them, understandable because it may delay their wanted transition.

Since there is no study of children raised under the affirmation model with a control group of children raised under a body acceptance model, determining the exact effects of each approach on persistence/desistance is impossible. However, Dutch data that indicates that early social transition grooms some would-be desisters for sex reassignment drugs and surgeries. In (Steensma 2013), children who were socially transitioned were statistically significantly less likely to outgrow gender dysphoria.

There a 3 things to consider:

1) Only the more severely dysphoric were socially transitioned due to the intensity of their symptoms and were the children who would end up being the persisters, regardless of environment.
2) Social transition prevents some youths from outgrowing gender dysphoria and tracts them into a transgender identity and medical treatment.
3) A combination of 1 and 2 are happening. This is very possible and is a worry gender therapists outside of the enthusiastic affirmation model have.

If it is true that denying transition is harmful to trans youth but also true that the affirmation model could groom likely LGB or gender non-conorming heterosexuals for medical gender reassignment, these harms must be weighed against each other. Without a control group study, however, this will not be possible. Affirmation model advocates have already indicated a control study would be unethical. They however, never express that transitioning “would be pre-gay and lesbian” children who would desist if given time is unethical.

E. Some scientists, therapists, and parents think conversion therapy laws are preventing therapists from providing better mental health counselling to young people.

Below are quotes from scientists who are concerned about the ethics of conversion therapy laws.

Dr. Debra Soh (neuroscientist and sex researcher):

After the 2015 passing of Ontario's Bill 77 – the Affirming Sexual Orientation and Gender Identity Act – which incorrectly conflated unethical therapies aiming to change sexual orientation with those exploring gender identity, clinicians are unable to have honest conversations with parents about their children, out of fears of losing their license to practice. This has important implications for a child's well-being, because social and medical transitioning often aren't appropriate solutions.

James Caspian (therapist who has worked with transgender patients):

Psychotherapist James Caspian claimed that many clinicians felt unable to question gender beliefs, due in part to a recent Memorandum of Understanding banning ‘conversion therapy’ by the UK Council for Psychotherapy. ‘I have been contacted by psychotherapists who work with adolescents on the autistic spectrum who have expressed concern over the current climate,’ he added.

Other quote from Caspian:

Already counsellors have contacted me to say they're worried that if a young client — say a 16-year-old — comes to them with a number of mental health issues or a history of sexual abuse and says, 'I want to transition', that it won't be safe for them to say, 'Well, let's look at this sexual abuse you had.
Could that have anything to do with the way you feel about your body?', because that could be construed as conversion therapy.
'One psychotherapist who works with young people called me last night to say she is worried this memorandum could simplify things to a scary degree.
'She said: 'If all I did was affirm my patients were trans without exploring any mental health issues they might have, I don't think I'd be able to help them properly.'
'Equally, people are afraid it might not be safe to work with someone who wants to detransition, i.e. reverse their sex change.
'Let's say a trans female, who is no longer happy in their gender, goes to a counsellor to say they want to go back to living as a man. Could that counsellor be accused of conversion therapy if they help them?
'I kept arguing for specific wording to say, 'We do acknowledge some people do regret their transitions and reverse them, or change their minds.'
But every time I tried to put that wording in it was rejected.

Bob Withers (Jungian analyst who has worked with transgender patients):

‘I think the Tavistock is under pressure because the trans lobby has become so dominant and powerful.’

Sasha Ayad has had some success resolving gender issues in teens who met diagnostic criteria for GD,

Sasha Ayad, founder of Inspired Teen Therapy in Houston, Texas, said she was concerned by trends in the UK. She had referred six cases to the woman in Scotland because her approach was proving so effective.
“I worry for these children in the UK who now won’t have the opportunity to explore gender in any other way than transition,” Ayad said. “That makes me worry about the mental health of these young people.”
She said it was dangerous if professionals merely “rubber-stamped” a child’s passing desire and called for a medical intervention.

Therapists are afraid to provide what they feel is proper mental health counselling to minors,

A therapist who helps teenage girls to question whether they are transgender says she has to keep her work secret because she fears she could be struck off.
The therapist said that official guidelines issued in October made it risky to help patients explore alternative explanations — such as autism and anxiety — rather than simply “affirm” that they must be transgender and assist their transition.
The therapist, who is based in Scotland, said: “You have a young girl who has turned up and said she is trans and at the end of working with you [she] decides maybe she is not.
“I could now get a reputation as someone who was not sticking to the professional body’s ethical framework and that is not a position you want to be in at all . . . potentially struck off.”
She blamed new guidelines issued within a Memorandum of Understanding on Conversion Therapy in the UK for governing the treatment of those uncertain about their gender identity. The memo expects therapists to assist patients wishing to change their gender identity rather than explore alternative treatments.

Anti-conversion therapy laws and the affirmative model are preventing a thorough review of mental health issues that may be contributing to a trans identification. There have been many documented cases of zero gatekeeping for minors and many parents have reported that their children, often who have had no childhood gender dysphoria and often have serious mental health issues, are receiving no mental health counselling. A combination of the implementation of conversion laws, the affirmation model, and informed consent practices have created a situation where in some cases, minors are being medically transitioned without any mental health support or screening. Below are just a few examples,

A parent comment on youth transition skeptic website 4thwavenow: