In ‘Free To Be,’ A UCSF Doctor Dispels Myths About Trans Youth

Dr. Jack Turban, one of the nation’s most respected authorities on transgender youth, nearly missed this calling and became a dermatologist. A gay son of a strongly unaccepting father, he took the tried-and-true path of trying to win family love through perfection.

“There’s a lot of pressure to become a dermatologist in medical school,” he tells me via video interview. “People don’t realize that it’s considered a very prestigious thing. I think I also had ‘best little gay boy in the world syndrome’ — like where you grow up thinking this thing is so bad and wrong that you should be perfect in every other way.”

Turban’s ideas about his career prospects began to shift on a trip to Europe, as a part of a piece he was writing for The New York Times on trans kids. “That trip changed everything,” he says. “It was the moment for me when it went from being this intellectualized discussion to the real-life kid in front of you.”

Turban saw the vast difference between the kids who were being affirmed and those who weren’t. After consulting with some colleagues and doing a child psychiatry rotation, he knew his future was working with transgender children and not, as he puts it, rolling mice to their tanning beds.

Much of the work that Turban has done since then as a researcher and an advocate now culminates in the release of his first book, Free to Be: Understanding Kids & Gender Identity (out June 4 via Simon & Schuster). Written specifically for parents — although also a wonderful read for anyone who wants to be more educated about the current political debates around trans people — the book is a readable, engaging and accessible introduction to the basics of what it means to be a transgender child, and the many options open to those who wish to transition. Turban admirably engages a lot of the misinformation circulating about this heavily marginalized demographic, and grounds research in firsthand stories from his own clinical work with kids.

Turban has spent much of his career in the UCSF Gender Clinic, one of the nation’s leading clinics serving transgender minors. During our interview, he noted that some states where he considered setting down roots — including Tennessee — have outlawed such care, meaning that if he had followed that path, his career would have been brought to an untimely halt by Republican legislators.

“It’s scary to think,” he says.

In addition to serving trans kids as a medical provider, Turban has also produced a substantial body of research. One of his frequently cited papers found that when trans youth want puberty blockers and don’t have access to them, it is correlated with a substantial increase in suicidality across their entire lifespan, even if they later are able to get gender-affirming care as an adult. Among other things, this paper demonstrated how letting trans kids go through their natal puberty was not a neutral act, and could in fact have serious consequences.

Another paper of his found that those who realized their gender identity in childhood tended to wait over a decade before disclosing it to anyone. Turban believes that these findings help dispel one of the most widely promulgated myths about trans kids, that of so-called rapid onset gender dysphoria.

“Rapid onset gender dysphoria is just the thing that will not die,” he tells me. “This whole notion that when parents find out is when kids realized for the first time is clearly false. It’s heartbreaking that they have to wait so long before they even feel safe telling the people who are supposed to be the safest to talk to.”

Turban shares his findings in ways that are vivid and easy to digest, which makes Free to Be so valuable. Among other important topics, Turban examines in detail the ill-fated attempts to find a “cause” for being trans (theories include bad mothering, mental illness among mothers and sexual abuse). As Turban notes, these have all been discredited, and he presents strong evidence that transness is likely biological in nature. This would accord with the experience of the vast majority of trans people, and it would also explain why attempts at conversion therapy have been such abject failures. In fact, many studies (including Turban’s own research) have demonstrated that conversion therapy is incredibly harmful, greatly increasing suicidality and depression and failing to have any impact on identity.

In spite of all that, Turban does not argue that the “born this way” narrative is the best way to promote trans equality. What he argues for instead is just getting to know a trans person. “People have all these ideas and opinions about trans people, but when they finally go and meet a trans person, there’s a major ‘oh shit’ moment,” he says.

Turban described a presentation he gave to a group of medical students at Yale, using a pre-test and post-test to determine whether their attitudes shifted. He found that, even though the students left more informed, their beliefs about the ethics of trans medicine stayed the same.

After Turban arranged for a trans young person to speak about her experiences to the class, everything changed. “Major props to this girl, who did not have to do this,” he says. “She just sat down and answered questions, and all the medical students came up afterwards and said things like, ‘Oh my God, I can’t believe I ever considered taking medical care away from this kid, when it’s so clear how important this was.’”

In Free to Be, Turban strikes a parallel between gay equality and trans equality, even discussing his interviews with Evan Wolfson, widely credited as an leading architect of marriage equality in the United States. As Turban notes, Wolfson has long argued that “born this way” might have played some role for the gay rights movement, but that the bigger gains were made when straight Americans interacted with gay ones as the latter became increasingly visible throughout society. Turban believes the same will hold true for trans equality.

Perhaps this is why Turban chooses to take so much space in Free to Be to take us into the lives of the kids themselves, drawing on his own clinical work to compellingly share his clients’ searches for acceptance, bodily autonomy and safety.

In the book, we meet Sam, a seven-year-old nonbinary child. Early on in working with them, Turban explains to Sam what will soon happen when they go through their natal puberty. Turban then asks Sam what they want to do — experience that puberty or try to change it — and Sam says they’ll think about it. Turban ends up following Sam through an adolescence in which they choose not to intervene in their puberty, instead addressing their trans identity simply through things like clothing and haircuts. This episode gives the lie to prevailing myths about trans kids — that they are too young and naive to know what they want for their own bodies, and that maintaining a trans identity and a social transition will inevitably lead to medical interventions.

Although Turban has had a very successful and rewarding career as an advocate for trans kids, it has not been without its share of difficulties. “For the last five, ten years, there’s been this constant stream of death threats,” he shares. “It’s become a lot scarier, especially with the political environment right now. It’s definitely something that I think about.”

Anti-trans hate campaigns also impact the kids he works with, especially when peers at school parrot hate speech. “It just makes me want to cry,” he says. “They hear things like being trans is a mental illness. Or the sports thing comes up, and they all want to quit sports or intentionally lose. Or when dating comes up, they’re really afraid of that.”

As someone who has spent years of my professional life supporting the mental health of trans people, as well as educating other clinicians about best practices for serving this demographic, Turban’s work has been absolutely essential. His research papers are among those that I most often quote and share with colleagues and parents of trans children. They are impactful and eye-opening, and really help those who are not trans better understand the experience.

Free to Be is a wonderful distillation of years of Turban’s research, as well as his advocacy and countless hours of face-to-face work with these kids and their parents. I know it is something I will be reaching for often, and recommending to my clients for some time to come.

Jack Turban will discuss ‘Free to Be’ at Book Passage in Corte Madera on June 2.