One Desister's Tale

On the overlap between autism and gender dysphoria

Maxpixel/Creative Commons

How many trans-identified children “desist”? That is, how many identify as transgender for a time, and then eventually stop doing so, prior to medical intervention (as distinct from detransitioners, who return to identifying with their natal sex after undergoing some form of medical transition)? The answer is that no one knows, in part because few experts are keeping track, and in part because what research does exist is highly politicized.

Some trans activists and advocates, for instance, object to the very idea of measuring “desistance” in the first place, on the argument that this approach may discourage a child from embracing a transgender identity. One Canadian trans activist and researcher insists that research in this area is simply “not relevant when deciding between models of care.” Others claim that the idea of desistance is rooted in transphobic “myth,” though research often shows otherwise.

High-end estimates of desistance tended to arise from longitudinal studies of children who first reported gender dysphoria at an early age. The vast majority of those children resolved their gender dysphoria before, or early in, puberty. In one 2021 study published in Frontiers in Psychiatry, for instance, 88 percent of boys with gender dysphoria were found to have desisted by their teens or adulthood (and more than 63 percent were same-sex attracted). These results are consistent with established research; yet, in the current ideological climate, they often are seen as suspect. That’s because the traditional “watchful waiting” approach used by clinicians to treat children who present with gender dysphoria—which tends to be associated with a high rate of desistance—has largely been supplanted by a policy of encouraging social transition, an approach associated with an increase in observed dysphoria. Indeed, several studies show that nearly all children on puberty blockers go on to cross-sex hormones.

Behind these numbers lie individual stories. Here, I share one—that of a brilliant and insightful young man who struggled with gender issues for several years. His harrowing journey to self-awareness will be instructive for many of those talking and teaching about gender issues to children and young adults.

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It was clear to Ash from an early age that he was different from other boys. Their world seemed to revolve around their bodies, while he was in his mind. They were sporty. He was scientific. They roamed in packs together, while he gravitated toward the girls. They were rowdy. He was gentle. And he had a vague sense that other people could connect emotionally in some way that eluded him.

Puberty was particularly hard on him. He’d had a high, clear tenor voice—unusual and strong and something he’d liked about himself—which descended into an unfamiliar bass. He grew body and facial hair that upset him on some visceral level—the thickness and coarseness of it. The pace of change unnerved him. He came out as bisexual in eighth grade, and his classmates responded by calling him a faggot—though they’d called him that in seventh grade, too, simply because of his not being traditionally masculine.

In ninth grade, he transferred to a new school where, for the first time, he found a group of friends. But something happened—he had no idea what, since it was so hard for him to understand social cues—and soon enough they abandoned him. In the winter, he had what he described as “a psychotic break,” and surrounded himself with imaginary friends.

Ash asked Google why puberty had been so unpleasant for him. Why he had trouble making friends. Why it was so hard for him to befriend boys, in particular, and why he felt different from them. Was it bad if your whole friend group was girls? “Very, very quickly I found different websites talking about being trans and how people had similar experiences to me,” he said. “And then they had transitioned and were happy now. And I thought that, wow, this is an easy way out. I love the idea of this.” He came to the conclusion that perhaps he was a woman.

He went to his therapist, whom he’d been seeing since the psychotic break, and told her that he’d hated puberty and his body hair, he didn’t fit in with other boys, he was mostly friends with girls, he didn’t like being a boy. All true things. She suggested that perhaps he was transgender, confirming his suspicions.

Because of his negative experience coming out as bisexual, Ash didn’t tell many people that he was identifying as trans besides his pediatrician and his therapist. Only they used she/her pronouns when addressing him.

“How did that feel?” I asked him.

He thought about that for a moment. “It felt … exhilarating,” he finally said. But despite the euphoria, his identity was still in flux. When school ended, and he went to summer camp, Ash asked people to use they/them pronouns.

Being science-minded, Ash scoured reputable medical websites for information about transition. He found that they either didn’t talk about the side effects of medical interventions, or that they would be mentioned in passing near the end of the article, without citations, or with citations to articles that he didn’t scrutinize. Later on, he came to wish he had done so.

When Ash finally told his parents that he believed he was trans, they were skeptical—not because they were bigots, but because they didn’t think the treatments Ash wanted were safe, nor that he fit the description of earlier generations of kids with gender dysphoria. Ash had never been particularly feminine or previously expressed any desire to be a girl. Ash wanted to get hormones right away, but his parents were determined to wait.

Rather than confront Ash directly over gender issues, they focused on strengthening their connection with him in other ways, through music, board games, and intellectual pursuits. “When I brought it up, they were happy to talk with me, but they didn’t engage or aggravate me, which was, I think, the best thing to do,” Ash recalls.

Still, their relationship became strained, because many of the websites Ash was reading encouraged trans kids to detach from their parents if they were not affirming. “There was a part of me that started to vilify them,” he told me. “[The sites] said, ‘Oh, if your parents aren’t ‘with it,’ they’re evil people.’”

This, too, was hard on Ash, who’d valued his relationship with his parents. There was also part of his mind that didn’t actually buy into the material he was reading online. Ash describes this period as being one of “cognitive dissonance.”

The next year, Ash got a new therapist, one who diagnosed him as autistic. And this, he says, was like a ray of sunshine: enlightenment.

The therapist “didn’t focus on the issues I was having with gender, but focused on the anxiety, depression, and living as an autistic person in this world, which were much, much more important, and I think [the discussion] relieved a lot of the distress that was fuelling my dysphoria,” Ash said. “I sort of came to a place where I thought, you know, just very internally, that perhaps I am not born in the wrong body … I found [an] identity of non-binaryness.”

Ash’s therapist had been working with him on seeing nuance in the world—something autistic people, prone to black-and-white thinking, sometimes struggle to do. The goal was to be “able to take a step back, to get a bird’s eye view in the stoic tradition and try to see things from other people’s points of view.”

His father, he learned, had been part of an online support group for so-called “gender-critical” parents of kids identifying as trans—i.e., parents who reject the model of instant affirmation and are aware of the uncertain science behind youth medical transition. Ash asked his father for data to back up his position. “I’m very amenable to concrete scientific evidence to an extent which most people are not,” he told me. “I think that the fact that my dad was there to have a conversation with me when I was ready was very important.”

After listening to his father and conducting his own research, Ash concluded that he’d been “misled.” He also learned about desisters and detransitioners from social media and Reddit, and read Keira Bell’s story. Bell had been an unhappy young lesbian with a traumatic childhood. She medically transitioned with a double mastectomy and testosterone, regretted it, and later petitioned the UK gender-identity development service to stop allowing vulnerable under-16s to make such life-altering decisions without adequate counselling. Her court victory was partly overturned, but an evidence review spurred by the case, concerning the effectiveness of puberty blockers and cross-sex hormones, showed that the “quality of evidence for these outcomes was assessed as very low certainty.”

Ash found out about other kids who were certain their struggles were located in their gender identity and who had undergone medical treatments, only to regret them and realize that their problems navigating the world were connected to autism. From there, he dove deeper into the side effects of those medical treatments—the effects on bones, heart health, and fertility, among other things. He came to feel grateful that his parents had drawn a hard line on medicalization.

Ash went to college early, but his social struggles followed him, and he found the woke culture that silenced debate about controversial social issues to be confusing. On several occasions, he was called out or humiliated, forced to apologize when he legitimately didn’t understand that what he had said was wrong. In time, he became afraid to speak.

For a while at college, Ash was still continuing to identify as transgender, even after coming to terms with his autism and the reality of transition. In part, this was because his transgender self-identification gave him entree into his school’s large LGBT social scene.

Yet at the same time that this peer group was providing Ash with a social landing pad, there also were aspects of it that unnerved him. “There were a lot of people talking about trans ideology quite a lot, and they were very adamant about it,” he said. It dawned on him that he needed to start thinking about himself in a holistic way, and not through the lens of a popular ideology.

What helped him finally leave that identity behind, he said, was interacting more with his sexuality: using his body for pleasure, understanding his sexual orientation, and coming to terms with the idea that nothing was wrong with his body or his way of being in the world. “Then I realized, why would I want to get rid of this?” he said. “This [body] is so cool and does interesting things.” (He still does not like his body hair, but now understands this to be a sensory issue related to his autism, one that can be addressed with shaving, not estrogen.)

Ash has become an advocate for autistic children. Around one in 44 kids is diagnosed as being on the autism spectrum these days, and some studies show that as many as five percent of them will identify as transgender (compared to about 0.7 percent of non-neurodiverse children).

“Currently, I do prefer to use they/them pronouns, but I’m not a Nazi about it because it’s a linguistic adaptation that is difficult for many people to make,” he told me. “I’m not responsible for affirming other people’s identities, and they shouldn’t be responsible for affirming my identity … For me, the way I am functioning in this society, the way people treat gender and categories and stuff, I just happen to fit into that [they/them] category.”

These pronouns do a lot of work. They not only signal to people that you’re cool, Ash said, but they signal a desire not to be subject to traditional gender norms. That was one of the things Ash desperately needed in the first place.

But that’s not how he thinks it should be. The boy category should be wide enough to accommodate him. Boys should be allowed to wear dresses—as young boys did in the 19th century. “I think people have gotten more sexist,” he said. “The trans ideology says, if you act and feel this way, then you’re just not in the right body.” It sends a message to effeminate gay men and butch lesbians that there’s something wrong with them as they are.

At the same time, Ash believes that the experience of being transgender is real for many people and that, for some, transitioning is the best way to ease their pain.

“A lot of gender critical people fall into this trap of thinking all trans people are fake, which I don’t believe is proper … I do believe that there are people who are legitimately transitioning and it is the best thing for them.”

“[Yet] I also know that there are people [for whom] that is a terrible thing. But whenever you’re talking to a person who’s identifying as trans, you don’t know which one they are.”

This strikes at the heart of the debates about desistance: There is no surefire way to know who will desist and who won’t. The only way to render evaluations is on a case-by-case basis through good-faith clinical care guided by fact, not ideology.

Children and their families should know about the desistance literature, and that the way they feel now, no matter how intensely, isn’t necessarily a sign of how they’ll feel in the future. By exposing them to a diversity of stories, including Ash’s, we can restore balance to the discussion in a way that may help many distressed young people navigate a difficult and confusing time.

(Published in Quillette)