As a therapist who has specialized in helping transgender people for 23 years and who is fully aware of the ever growing need to address the issue of transgender children, I was gratified that you chose to make this topic the cover story [“Transgender Kids,” by Francine Russo]. Although in general I thought the article was very well written, I want to point out a couple of flaws. Most important, it is not the international Endocrine Society that is the primary source for the Standards of Care. Both historically and currently, it is the World Professional Association for Transgender Health (WPATH), formerly known as the Harry Benjamin International Gender Dysphoria Association.

In addition, readers should know that the University of Michigan Health System has one of the nation's longest-existing programs of its kind in the Comprehensive Gender Services Program. It has had a focus on helping transgender adults with a broad array of psychological, medical and surgical services since the early 1990s, before intervening with children was considered acceptable practice. Mention of the role of this major health system would have provided important historical context.

Sandra L. Samons
Ann Arbor, Mich.

THE EDITORS REPLY: Thank you for clarifying that WPATH's Standards of Care are separate guidelines from those of the Endocrine Society. Both documents build on the research described in this story and are widely used in the field. We apologize for the omission and have made a correction in the online version of this story.


I just had the pleasure of reading “Transgender Kids.” As the president of the Southern Comfort Conference, an annual gathering of the trans community, I found the article very informative. It pointed out many of the issues that our community faces on a daily basis. The fact that these issues are finally being taken seriously will help many of the trans youths who have been closeted to get the help and support that they need to lead a better life in their chosen gender.

Alexis Dee
Fort Lauderdale, Fla.


Thank you for “Six Things You Should Know about Concussions,” Karen Schrock Simring's insightful article. I'm pleased that you are giving this problem the recognition it deserves and adding to the growing knowledge that traumatic brain injury is treatable. I have been effectively treating brain injury, particularly concussions, for more than 30 years in my practice as an osteopath. I want to clarify what the article recommends regarding the critical need for rest.

My concern is the directive to gradually return to your regular routine after a couple of days of rest. After a concussion, people do need lots of rest, but that doesn't mean suffering in a dark room, bored and frustrated. The majority of the body's and brain's repair and maintenance occurs during rest and sleep. I tell my patients to sleep as much as the body calls for, which is often 10 to 14 hours a day. It is important that people allow themselves time for naps if their body indicates the need.


After ensuring sleep and rest needs are met, move about gently, go for walks, do tai chi; the body does need to move to help flush debris out of the brain. But shortchanging the body on rest is a critical mistake and can increase the insult to the brain. Listen to your body; it will tell you what it needs.

Maud Nerman
via e-mail


In “Breaking the Cycle,” Sushma Subramanian examines the phenomenon of female victims of sexual trauma in childhood becoming victims in adulthood. She states, “Whether the pattern holds true for men is unclear because of a dearth of studies.”

Studies do exist that demonstrate that abuse in childhood establishes a pattern for men, in some ways similar to and in some ways different from the pattern for women. Prominent among analyses is the 1989 study “The Compulsion to Repeat the Trauma,” by Bessel A. van der Kolk, then at Harvard Medical School. Van der Kolk writes that trauma creates its own psychology, a baffling aspect of which is the tendency for traumatized people to “expose themselves, seemingly compulsively, to situations reminiscent of the original trauma.” He brings the findings of his cited 147 studies to bear on his thesis regarding the effect of childhood sexual abuse on men and women.

In these compulsive trauma reenactments, the abused may play the role of victim or victimizer—but generally women tend to be victims, men victimizers. A recent study by Lorraine E. Cuadra, then at the University of Nebraska–Lincoln, found that criminal outcomes for adults abused as children are “frequent.”

There seems to be something particularly insidious about childhood sexual abuse and how it plagues the child-become-adult. The social, if not personal, consequences of these reenactments tend to be worse for men than for women. Abused girls who become victimized women present a sympathetic tableau. Abused boys who become victimizing men elicit no one's sympathy. Moreover, the abuse itself has come to be seen by some courts as a marker to identify the criminally inclined.

We have a plenitude of studies that speak to, if not analyze, the effects of trauma on men. We don't know conclusively why the effects are as they are, but we know what they are. The bigger question is why, in recognizing these effects and what such abuse does to women and to men, society vindicates the women but incarcerates the men.

Robert E. Byron
Hartford, Conn.


I question the validity of the following statement in “Neuron Transplants May One Day Restore Vision,” by Jessica Schmerler [Head Lines, November/December 2015]. Schmerler writes, “By adulthood, however, the brain has lost much of its plasticity and can no longer readily recover lost function after, say, a stroke.” This sounds to me exactly the opposite of what we now know. Surely plasticity remains deep into old age!

Lechesa Tsenoli
Mangaung, South Africa

THE EDITORS REPLY: Experts used to think the adult brain had almost no plasticity at all. Now we know that is untrue—the brain indeed remains somewhat malleable throughout life—but the capacity of the brain to grow, change and heal in adulthood is significantly less than it is in childhood.


I want to know why lead researcher Brett Laursen, whose work is reported in “Why Preteen Friendships Are Fleeting,” by Meredith Knight [Head Lines], appears to assume that U.S. friendship patterns are universal. The U.K. doesn't have middle school, and friendships here often last until children are parted at grade 11. Our secondary school timetables are less individualized, and kids are likely to be with the same people for five years. As for friendship across genders: the U.S.'s encouragement of preteens to pretend-date is not ubiquitous elsewhere.

I also couldn't help noticing that Laursen assumes racial sorting. That's not a preteen norm. That's racism. Perhaps he would like to try to recapitulate his findings in multicultural North London, where groups of kids of all races hang out together in parks, playgrounds and streets.

Farah Mendlesohn