Another self-promoting “expert” is wholly unqualified to work with trans and gender nonconforming children.

Sasha Ayad
Sasha Ayad | via YouTube

Sasha Ayad is a Licensed Professional Counselor in Texas. Ayad has video’s, most of which require a paid subscription to Patreon. According to Ayad:

I studied Psychology and History in undergrad, received a Master’s of Education, and then earned my Licensure as an LPC (Licensed Professional Counselor) here in Texas. My therapy practice focuses on helping teens who have begun questioning thier [sic] gender identity around the age of puberty.

Noticeably absent from that brief bio is how and from where she obtained her degrees. Suffice it to say, if she received her M.Ed. from Columbia University we would know where she studied.

Ayad tells parents what they want to hear. “Wait six months and see what happens.” People love to procrastinate. I am not a behavioral health specialist but I do know what the most sensible course of action is for parents:

Immediately consult with a board certified psychiatrist whose practice includes adolescent gender dysphoria then get a second opinion.

Before figuring out what to do, or what not to do, a diagnosis is required. Someone who “studies psychology” as an undergraduate student is not even a qualified counselor, let alone a qualified gender specialist who can make a diagnosis of gender dysphoria or its absence. In reading some of her posts, Ayad does not understand what gender nonconforming means.

I became aware of Ayad last November when she authored a piece at an anti-transgender website.

Writing in the third person:

Sasha uses an exploration-based approach which aims to discover underlying issues and help her clients work towards self-awareness, resilience, and long-term well-being. She also conducts occasional consultations for parents of teens with gender concerns.

When people link gender and “underlying issues” that often means that they are wed to the notion of being able to alter someone’s gender identity.

The APA has asserted, in their newest guidelines on working with gender-questioning youth, that the clinician’s role relegated to “affirmative care,” with the sobering reminder that the word affirm means “to say something is true in a confident way.” When a 12-year-old with a history of depression, social anxiety, and self-harm suddenly announces that she is really a boy, the clinician must emphatically and confidently agree with her assertion, and deeper introspective work is made impossible. This approach seems antithetical to the important work of the therapist.…

Clueless! That is not what the article she cites says. Moreover she links to an article in the APA journal which is not a substitute for policy. Quoting in part:

Affirmative care with transgender and gender nonconforming (TGNC) children and adolescents is a new
framework under which many mental health clinicians now practice. It rests on a premise that appreciates
diverse gender expressions and identities within society, and encourages the highest potential for
individuals to follow their own paths to positive emotional well-being.

What Ayad is suggesting is that the depression and anxiety are causing the child to incorrectly assert an incongruent gender identity. It is quite possible (if not probable) that the gender incongruity is causing the depression and anxiety. The clinicians job is to first ascertain what is cause and what is effect. As the article states (which is completely at odds with what Ayad says it says):

When prepubertal TGNC children present in practice, the affirming clinical approach to assessment and treatment often involves complex factors encompassing several domains. As with
any child, one must consider environmental factors (e.g., peer
relationships, family dynamics, school environment) as well as
individual characteristics (e.g., temperament, resiliency, coping
strategies) when determining target areas for intervention, if any.
However, in addition to these routine factors, clinicians are being
sought to assist parents in deciding whether or to what extent a
child should be supported in a social gender transition…

You have to get to the third page of highly condensed text to read the above paragraph. Either Ayad did not get that far or she needs help with reading comprehension.

As long as I have read the damned article, this is part of what it says about puberty blockers:

Numerous benefits of pubertal suppression have been identified, perhaps the most important
being the added time it provides TGNC adolescents to continue
exploring their gender identities without the added stress of pubertal changes that are incongruent with their identities and may
cause psychological distress. The psychological issues that exist
for many adolescents due to gender dysphoria and the social
stigma that accompanies it include depression, anxiety, social
isolation and rejection, self-injury, and suicidal ideation/attempts

By the way, the peer-review process to get this article published required two years to complete. It was submitted in 2014 and published in 2016.

This header at Patreon tells you everything that you need to know about Ms. Ayad:

To prevent the over-medicalization of gender nonconforming youth. To prevent harm resulting from medical treatments on trans-identified minors. And to address confusion and rights conflicts that arise from new ideologies about gender (within and outside of the LGBT community). This will be done through outreach to the mental health and medical community, LGBT orgs, parents, schools, media, and the public.

Gender nonconforming youth neither require nor receive medication. Needless to say, gender is not an ideology. If this woman did any real outreach to mental health and medical professionals she would find another hobby. Many of the posts at Patreon are pay-per-view but there is this from July 1. She is not the author but whoever wrote this is not identified. It seems to be from Helen Joyce whose only qualifications are a Twitter account.

What you need to understand about self-ID

” Even when clinicians try to go slowly, it makes little difference. Most patients will already have learned the innate gender-ID narrative, and see no need for caution. Some parents press for faster treatment, saying they would “rather have a live daughter than a dead son.” (Advocacy groups commonly say that children unsupported to transition are very likely to kill themselves. The data do not support this claim—and indeed, it is highly irresponsible, since hearing that you are at particular risk of suicide is one of the risk factors for killing yourself.) And though puberty blockers are supposed to buy time, in fact they start a child down a path to irreversible changes. Emerging data suggests that they start a cascade of intervention, with almost every child given them proceeding to cross-sex hormones.

None of that paragraph makes any sense. Patients (kids) do not learn a narrative. When they are gender incongruent they are quite certain about their gender. I do not know about these so-called advocacy groups because Ayad’s narrative is without a cite or attribution.

The idea that a child with acute gender dysphoria is at risk for suicide (they are) and telling a child that they are at risk for suicide (no one would do that) are two entirely different things. What Ayad calls “highly irresponsible” is comparable to claiming that allowing your ten-year-old to drive to the store is highly irresponsible.

When it comes to being highly irresponsible it is the claim that there is a causal relationship between puberty blockers and hormones (“a path to irreversible changes.” It is also a misunderstanding of causation and correlation.

In effect, Joyce is claiming that treating gender dysphoria creates gender dysphoria.

What she and Ayad fail to understand is that it is not the puberty blockers which cause persistence. According to a 2013 study: “Intensity of early GD appears to be an important predictor of persistence of GD.” Intensity, the acuteness of the condition, is the determining factor for whether or not the kid will be placed on puberty blockers.

So, yes, many kids who are prescribed puberty blockers will go on to receive hormones. According to Dr. Jack Turban, now at Harvard:

In a Dutch study of 55 transgender people who were given puberty blockers during adolescence, however, none changed their minds and none regretted treatment. All went onto cross-sex hormones around age 16 and later gender-affirming surgery. Psychological functioning improved steadily over the treatment period, and by the end, metrics of happiness and quality of life were on a par with those of the general population.

It should be perfectly obvious that these treatments are successful because they offer relief from a debilitating condition. It continues:

Privately, some experienced clinicians admit they are worried. One says she hears of people leaving the field more often than she used to, and sometimes fears that she is doing more harm than good. She thinks the wave of transitioning teenagers may be followed in a decade or two by another of “de-transitioners” reverting to their natal sex. Their bodies will have been irreversibly marked by cross-sex hormones and perhaps surgery. Some may sue, arguing that the adults around them should have known they could not fully comprehend what they were consenting to.”

Anonymous validators are pointless. Ms. Joyce and Ms. Ayad clearly has an agenda. Based on having taken some courses in psychology as an undergraduate Ayad does not want children to transition. Some of these people are dangerous.

Note: On the surface Ms. Ayad’s credentials do not seem to comply with Texas requirements for a LPC in several ways. I have asked the licensing authority to review the license. It is quite possible that she met the requirements at the time of application and that those requirements have changed. In that event she could very well continue to be qualified.

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By David Cary Hart

Retired CEO. Formerly a W.E. Deming-trained quality-management consultant. Now just a cranky Jewish queer. Gay cis. He/Him/His.