Dr. Stephen B. Levine is an expert in gender dysphoria and gender identity. He is a Distinguished Life Fellow of the American Psychiatric Association and a professor with many years of experience in the fields of gender and sexuality.
Levine chaired a committee that crafted a pioneering set of standards of care for individuals suffering from gender dysphoria, and he has been a senior editor for three editions of the Handbook of Clinical Sexuality for Mental Health Professionals. He also founded a gender identity clinic in 1974, which he continues to lead as co-director.
To put it simply, he is a highly respected expert in his field. And he has served as an expert witness in an Alliance Defending Freedom case—Doe v. Madison Metropolitan School District—and another case in which ADF has intervened—B.P.J. v. West Virginia State Board of Education.
As an expert witness, Levine speaks out about the dangers of treatments dictated by gender ideology rather than science. We summarize his five key arguments below, but you can read his full expert affidavit in Doe here and his full expert report in B.P.J. here.
Levine’s research concludes that social transition of children is an experimental therapy that exposes vulnerable children to dangerous lifelong physical, social, and mental health risks.
1. There is no expert consensus regarding therapeutic approaches to child or adolescent gender dysphoria
Experts differ as to how gender dysphoria ought to be treated in children and young adults.
“[T]here is far too little firm clinical evidence in this field to permit any evidence-based standard of care,” Levine writes in his expert report in B.P.J. “Given the lack of scientific evidence, it is neither surprising nor improper that … there is a diversity of views among practitioners as to as to the best therapeutic response for the child, adolescent, or young adult who suffers from gender dysphoria.”
He goes on to write: “[I]t is not responsible to make a single, categorical statement about the proper treatment of children or adolescents presenting with gender dysphoria or other gender-related issues. There is no single pathway to the development of a trans identity and no reasonably uniform short- or long-term outcome of medically treating it.”
2. Transgender identity is not biologically based
“There is no medical consensus that transgender identity has any biological basis,” Levine writes. “Gender dysphoria is defined and diagnosed only as a psychiatric, not a medical, condition.”
He goes on to explain that the concept of a biological basis for transgender identity is merely a hypothesis, not fact. And there is much evidence that such a hypothesis is incorrect.
Reported rates of gender dysphoria and transgender identification have risen dramatically in recent years. While a 2013 estimate placed the incidence of gender dysphoria in adults at .002-.014 percent, a 2019 survey indicated that “between 2-9% of high school students self-identify as transgender or ‘gender non-conforming.’”
Levine points to a handful of other factors that weigh against the hypothesis of a biological basis for transgender identity. One is the significant change in sex ratio among patients presenting with gender dysphoria or transgender identification. He quotes clinical psychologist Dr. Erica Anderson:
“The data are very clear that adolescent girls are coming to gender clinics in greater proportion than adolescent boys. And this is a change in the last couple of years. And it’s an open question: What do we make of that? We don’t really know what’s going on. And we should be concerned about it.”
Levine further points to the documentation of “clustering,” in which instances of gender dysphoria have been observed in particular schools and among friend groups. He also points to the concept of desistance:
“[T]here are very high levels of desistance among children diagnosed with gender dysphoria, as well as increasing (or at least increasingly vocal) numbers of individuals who first asserted a transgender identity during or after adolescence, underwent substantial medical interventions to ‘affirm’ that trans-identity, and then ‘desisted’ and reverted to a gender identity congruent with their sex.”
Finally, therapeutic choices themselves can affect gender identity outcomes. He specifically mentions the “social transition” of adolescents.
3. Transition and affirmation are experimental therapies that can radically alter children’s lives
Contrary to being part of a treatment for gender dysphoria, “social transition has a critical effect on [its] persistence,” Levine writes.
“It is evident from the scientific literature that engaging in therapy that encourages social transition before or during puberty—which would include participation on athletic teams designated for the opposite sex—is a psychotherapeutic intervention that dramatically changes outcomes.”
How so? Levine reports, “studies conducted before the widespread use of social transition for young children reported desistance rates in the range of 80-98%, [while] a more recent study reported that fewer than 20% of boys who engaged in a partial or complete social transition before puberty had desisted when surveyed at age 15 or older.”
What’s more, some practitioners of social transitioning are proud of the extremely low rates of desistance among the children who exhibit gender dysphoria and visit their clinics.
“The fact is that these unproven interventions with the lives of kids and their families have systematically documented outcomes,” Levine writes.
In addition to social transitioning, the administration of puberty blockers is “a powerful medical and psychotherapeutic intervention that radically changes outcomes.”
Levine goes on to review studies regarding puberty blockers, citing one which found that “98% of adolescents who underwent puberty suppression continued on to cross-sex hormones.”
“Rather than a ‘pause,’ puberty blockers appear to act as a psychosocial ‘switch,’ decisively shifting many children to a persistent transgender identity.”
4. Parental involvement is essential for sound care of children who may be suffering from gender dysphoria
When it comes to children who may be suffering from gender dysphoria or claiming a transgender identity, the significance of parental involvement must not be dismissed.
In his expert affidavit in Doe, Levine points out the difference between a parent’s and a teacher’s view of a child: “What can be observed by—for example—a teacher or counselor at school, although important, is only one window into the life and psyche of a child,” he writes.
By contrast, parents “in many cases will have observed the child over his or her entire lifetime, and so will have unique insight into whether the child’s attraction to a transgender identity is longstanding and stable, or whether on the contrary it has been abrupt and associated with intensive online interaction with transgender ‘communities.’”
Levine states his conclusion in no uncertain terms: “For a child to live radically different identities at home and at school, and to conceal what he or she perceives to be his or her true identity from parents, is psychologically unhealthy in itself, and could readily lead to additional psychological problems.”
He goes on to say, in opposition to many gender ideology advocates, that “[m]eaningful and healthy ‘support’ of a child struggling with gender issues must include parents.”
“Extended secrecy and a ‘double life’ concealed from the parents is rarely the path to psychological health. For this reason at least, schools should not support deceit of parents.”
5. There are many risks associated with “affirming” transgender identity in children
Levine first notes that mental health professionals and parents must “consider long term as well as short term implications of life as a transgender individual when deciding whether to permit or encourage a child to socially transition.”
“The multiple studies from different nations that have documented the increased vulnerability of the adult transgender population to substance abuse, mood and anxiety disorders, suicidal ideation, and other health problems warn that assisting the child down the road to becoming a transgender adult is a very serious decision, and stand as a reminder that a casual assumption that transition will improve the child’s life is not justified based on numerous scientific snapshots of cohorts of trans adults and teenagers.”
Health risks include both the obvious and the less tangible. Sex reassignment surgery, of course, is “inevitably sterilizing.” Not every person who claims a transgender identity will undergo such a surgery, but even the administration of cross-sex hormones, which “is now increasingly done to minors, creates at least a risk of irreversible sterility.”
Further, Levine casts doubt on the claim that puberty blockers are completely reversible: “While it is commonly said that the effects of puberty blockers are reversible after cessation, in fact controlled studies have not been done of how completely this is true. However, it is well known that many effects of cross-sex hormones cannot be reversed should the patient later regret his transition.”
Social and mental-health risks must also be taken into account. “Gender transition routinely leads to isolation from at least a significant portion of one’s family in adulthood,” Levine writes. “By adulthood, the friendships of transgender individuals tend to be confined to other transgender individuals (often ‘virtual’ friends known only online) and the generally limited set of others who are comfortable interacting with transgender individuals.”
Romantic relationships may also be affected: “After adolescence, transgender individuals find the pool of individuals willing to develop a romantic and intimate relationship with them to be greatly diminished.”
And even absent surgery, there are social risks associated with delayed puberty. “In my opinion,” Levine writes, “individuals in whom puberty is delayed multiple years are likely to suffer at least subtle negative psychosocial and self-confidence effects as they stand on the sidelines while their peers are developing the social relationships (and attendant painful social learning experiences) that come with adolescence.”
More specifically, citing a long-term study, Levine reports higher risks of depression, anxiety, suicidal ideation, suicide attempts, and self-harm without lethal intent among youth claiming a transgender identity.
Ushering gender-dysphoric children toward social transition to the opposite sex is an experimental therapy that exposes these vulnerable children to more mental health risks, and Levine’s expert affidavit in Doe v. Madison Metropolitan School District and expert report in B.P.J. v. West Virginia State Board of Education only make that reality clearer.