How Is Youth Gender Transition Different than Quitting the Swim Team? Let Me Count the Ways

But also: Are you freaking serious right now?!

On December 1, The Archives of Sexual Behavior published a new paper, “Detransition and Desistance Among Previously Trans-Identified Young Adults.” The authors are Lisa Littman, the physician and researcher who coined the term “rapid-onset gender dysphoria,” as well as psychologist and sexologist Michael Bailey, therapist and Genspect lead Stella O’Malley, and a detransitioned woman, Helena Kirschner.

In some ways, the paper codifies the little that we already know, and underscores the urgency for more and better research like this. The vast majority of participants were female, and of those, most were same-sex attracted. The opposite was true for the small subset of males, most of whom were straight but “had experienced sexual arousal while cross-dressing.”

Few of the participants felt that they were adequately informed about the risks or benefits of transition. Only one participant “reported that a clinician provided information about treatment alternatives to cross-sex hormones (including the possibility of not taking cross-sex hormones),” Littman wrote. Seventy-five percent “reported that they received inadequate information about these alternatives.” And less than 10 percent were told about the lack of decent research and evidence.

Most of the detransitioners and desisters didn’t meet criteria for gender dysphoria. Rather, they interpreted “the feelings of trauma or a mental health condition as gender dysphoria.” Ninety percent of them had received a prior clinical diagnosis. And most of them reported improvements in mental health and flourishing after desistance or detransition, along with declines in self-harm.

Most of them detransitioned not because of external pressures, but because they came to understand the terms “male” and “female” differently, and they understood the causes of their gender dysphoria differently.

Meanwhile, the detransition researcher Kinnon MacKinnon and others published two papers last week, “A typology of pathways to detransition: Considerations for care practice with transgender and gender diverse people who stop or reverse their gender transition,” and “Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada.”

MacKinnon unearthed similar themes. Participants had lacked “the opportunity to clarify their individual treatment needs prior to undergoing medical/surgical transition.” Regret was a common theme, “alongside dissatisfaction with providers’ ‘informed consent’ procedures.” There wasn’t enough discussion of risks and benefits.

These people did not get good information about gender medical transition. They didn’t get good care. Their providers broke the hippocratic oath. They did harm.

I’ve talked to several detransitioners who have no interest in going public. They don’t want to endure the abuse. They don’t want to be marked by a singular identity. They feel ashamed. They feel traumatized. They are learning to navigate the world and heal. They want to leave it behind.

We don’t know how many more there are. We don’t have any healthcare for them. We don’t yet know how to help. We have to be able to talk about their experiences in order to push forward healthcare reform.

We have to acknowledge their existence. We have to hear their stories.

***

I met The New York Times columnist Lydia Polgreen at the Genspect conference last month. She said she was interested in talking to trans people so I tried to introduce her to as many trans people there as I could—heterodox trans people who feel transition was the right choice for them, but who are deeply concerned about the gender-affirming model for young people.

Then I got on stage and joined a panel to talk about what I’d learned in my years trying to break this story in the mainstream media, and why that media had erected a bulwark against the truth.

Style guides have changed, so that journalists must use phrases like “sex assigned at birth” instead of “biological sex” or, heck, just “sex.” There have been no op-eds by detransitioners in mainstream media. (Please fact check me if I’m wrong.) Trans people who disavow gender identity and its accompanying ideology are almost never quoted in pieces that aim to be “inclusive.” Many young journalists believe it’s their duty to protect marginalized people, rather than tell the truth.

After the panel, I asked Lydia if she’d heard what I’d said. “Yeah, yeah,” she told me. “The failing New York Times.”

She compared me to Donald Trump.

She did not consider a single word I said. She did not seem to consider a single word anyone else there said, either, when, a few weeks later—and a day or two after the publication of those several scholarly articles on detransition—the Times published Polgreen’s 4,500-word Judith Butler-esque ramble. It focused on regret and the “panic” over childhood transition.

In the piece, Polgreen often conflates sex and gender (there are only two sexes, but I personally don’t think there is a thing called “a gender” or that I have one). She accepts the idea of the transgender child, and conflates that with a gender nonconforming child. She brings in race, which we on the left were told never to do—compare Rachel Dolezal to trans people and you’re demonized, but she throws that in, too.

I think of this as a destabilizing tactic from the proponents of youth gender medicine: they throw so many arguments like spaghetti on the wall, incapacitating opponents by the sheer number and inanity of them. Eventually something sticks. Gobbledygook masquerading as coherence kneecaps the vast majority of readers, because of the amount of time and patience it takes to argue back.

Polgreen tried a few of those arguments out on me at the conference, including the comparison to rhinoplasty and the breast augmentations of “cis” girls. Look, we can get into some of those assertions, even though I think they distract us from much more important aspects of this controversy. I’ve met several once-large-nosed women who underwent rhinoplasty in order to conform, to fit in, to feel better about themselves. These were fellow Jewish women who fit the stereotype of the be-schnozed, who did not want to be able to be identified as such. We can argue that little ski-jump noses are indeed marketed to them, as gender identity is to children, because we see so few big-nosed women in the media; a big nose is not associated with beauty in America. We could also call this procedure “gentile-affirming care” and insist that insurance pay for it. But we don’t.

The same with breast augmentation. If a minor wants bigger breasts to conform to a vision of themselves or to a societal standard of beauty (though I’d argue that we don’t have a singular idea of the right size boobs), and later they regret it…I don’t even want to finish this rebuttal. It’s not the same as removing breasts. It’s not the same as taking cross-sex hormones that fundamentally alter your body in permanent ways, far beyond the secondary sex characteristics. It’s not the same as encountering a religious idea of gender identity and changing your body to prove that you’ve properly accepted it into your heart.

Also: lots of people worried about childhood and adolescent “sex” changes don’t okay these interventions for noses and breasts, either, when it comes to kids. A thousand wrongs don’t make anything right.

***

Regrets, I’ve had a few.

What if, in 7th grade, I’d stayed in the library after the bell rang like I was told to, so Chuggie could ask me out? He was so cute. He was from the good neighborhood. So smart. Might the whole trajectory of my life had changed? Would I have become popular? Would I have learned manners, and how to carry myself, and how not to reject people before they could reject me?

I’ll never know because I rejected him first.

I also regret not buying an apartment when I could afford to. Except I could never afford to. Well, maybe there was a brief window 15 years ago when, with some familial assistance, we could have gotten our hands on some real estate, which would be worth nearly three times as much now, and I’d have something to leave my kids in case they wanted to live here when they grew up.

I probably should have gone to UMass. They had a good craft center, and it would have been easier to make friends because the weirdos would have stood out. But it cost more than the school I went to, where I had completely free tuition. There I pretty much only learned about neo-Marxist theory and experimental feminist video and how to critique images of women in the media. Maybe if I’d had a more traditional education I could fill in more days of the New York Times crossword puzzle.

I wish I’d played sports. Tennis. Soccer. Ultimate Frisbee. I wish I’d joined some after school clubs. I wish I’d accepted the theater kids’ offer to allow me into their clique, but they didn’t really do any drugs and I was afraid I was too morally impure for their ranks, and maybe not smart enough.

There are many things I wish I’d done differently. But these decisions, and their repercussions, aren’t etched into my skin, into my psyche, even if they helped shaped me and the trajectory I followed. They aren’t the result of institutionalized and proselytized ideas. They may have altered my path, but they haven’t derailed me.

I wish I hadn’t hired sensitivity readers and compromised my own speech in my book TOMBOY. I wish I hadn’t listened to my friend who told me not to mention detransitioners, that they were so rare as to be inconsequential, and also very dangerous. What kind of writer, when told to look away, doesn’t take that as a cue to peer more closely? I wish I’d expressed more skepticism. I wish I knew then what I know now. And I wish the mainstream press would let me say what I’ve learned.

***

Polgreen regrets giving up the swim team. Other people regret giving up their body parts, their health, their sanity. The lawsuits are beginning. Arguments such as hers surely won’t stand up in court. I assume that the Times’ call for essays on regret was to have pieces prepared to counter or accompany Polgreen’s; I hope some detransitioners and regretters sent pieces in.

There have already been some great critiques of Polgreen’s piece, including Eliza Mondegreen’s and Jamie Reed’s. People have pointed out that the article promotes misinformation when it comes to fertility. I’m not going to litigate the whole thing here, because articles like these put us on the back foot, always having to combat arguments and ideas rather than advance our own. So instead, I’m going to assert an argument of my own: Polgreen misses the point of the controversies around youth gender medicine entirely. Hers is an iceberg argument: focusing on the tip and not the depth of ice beneath it.

One problem is that, if perhaps we have some sense of how to measure the success of these gender medical interventions—improved psychological function, alleviation of gender dysphoria— we don’t know how to measure their failures. Satisfaction versus regret is not really what we’re looking at or for. We’re looking at medical harm. Medical trauma. We’re looking at misdiagnoses, and in some cases, no diagnoses, and then a treatment with no solid evidence base presented to patients for whom it was never intended. The issue isn’t whether they regret; it’s that we don’t even know what we’re treating.

As Christina Buttons pointed out in her Genspect presentation, and as Lisa Marchiano reminded me when I interviewed her recently: if you don’t understand the condition you’re treating, you can’t consent to the treatment. Remember, 90 percent of detransitioners in the Littman study had other mental health conditions. Most had self-diagnosed with gender dysphoria, and didn’t meet the criteria for it. How can we argue that children should be allowed to regret gender transition if those embarking on it aren’t appropriate candidates for it? Polgreen has gotten so far ahead of herself that she’s back at the beginning.

from Christina Button’s Genspect presentation

This is so serious, and yet she employs such a flippant tone:

A handful of [detransitioners] have appeared over and over again in news stories across the world, portrayed as the harbingers of a tsunami of regret that is always about to arrive because countless children are being carelessly affirmed by an ideologically driven activist community in their mistaken beliefs that they are transgender.

Her flighty arguments belie the real harm. I don’t mean harm as in someone using a pronoun that offends a subjective reality. I mean permanent corporeal changes that essentially create intersex conditions in otherwise healthy bodies. It just sounds like gross negligence to me. We have to look beyond the bodily autonomy arguments and talk about how the overlay of an ideology onto medicine, law, education, psychology, and journalism has obscured real and lasting damage.

The New York Times has published many articles arguing these points in favor of gender-affirming care, which range from silly to dangerous. Never have they published an opinion piece from someone actually hurt by gender-affirming care. Excuse my French, but it’s a fucking outrage for the paper of record to continue to skew the narrative this way, when they signal to the rest of world, and to liberals, how to think about this issue. That several papers highlighting the need to study detransition were published in the same week as the NYT piece, which denies the seriousness of detransition—that’s deeply sad.

Please convey your feelings to The New York Times: letters@nytimes.com