How Badly Have We Failed Gender-Questioning People?

So Badly That We Need a Detrans Awareness Day

Detrans Awareness Day was March 12. If you’re not already immersed in this topic, here’s a succinct summary to get you up to speed:

That pretty much sums it up. If you’re interested, you can also check out TikTok Tics and Mass Sociogenic Illness to better understand the phenomenon.

A 4000% increase in transgender identification among children and adolescents in less than a decade, followed by a new and exploding group of detransitioners, does not resemble “progress.” It does not resemble a phenomenon of “organic increased acceptance.” It resembles a mass sociogenic illness that we collectively enabled to medically and emotionally harm many thousands of people.

If you’re familiar with detransition Twitter, you already know how similar a lot of the history and experiences of detransitioners are. Here are some of the things I’ve noticed after years of listening:

Not Fitting In

Whether with their peer group, school, family, church, or the general zeitgeist, detransitioners often describe their pre-transition lives as being someone who just didn’t fit in.

Some observers have wondered why, with “increased acceptance,” we’ve had such an explosion in transgender identification among adolescents but not, say, middle-aged or elderly people. I would reply that “not fitting in” used to be a commonly accepted normal feeling for adolescents as they made their way through life, coming to terms with who they are and who they want to be.

Now a kid who wonders about “not fitting in” —especially a kid who really doesn’t fit in — will often encounter a narrative that he or she might be trans.

From there, of course, people are told that questioning your gender at all is proof that you’re not “cis.” It’s very circular. The most casual google search leads to the notion that not fitting in might mean you’re trans, and if you pause to consider that, it’s proof that you are.

But these ideas were simply not floating around 20, 30, 40 years ago. There was a certain amount of “not fitting in” that constituted normal adolescence, and sometimes the kids who struggled more than others were sensitive, intelligent, and quirky. Now our sensitive, intelligent, quirky kids latch on to “being trans.”

Struggling with Their Mental Health

Detransitioners often typically also struggle with their mental health — whether it’s anxiety, depression, trauma, abuse, sexual orientation, family conflict, or something else.

In other words, these folks typically don’t present as otherwise happy, healthy, thriving people who happen to “be in the wrong body.” Another way to frame it: It’s not the case that if you managed to “put them in the right body” they’d become happy because it was the one and only thing wrong with them. And their pre-transition problems remain their post-transition problems. For example, if they were isolated before transition, they will often continue to be isolated — or become more so — after.

Something is often seriously wrong in their lives or circumstances — note the high rate of trans identification among, say, foster kids, bullied kids, kids on the autism spectrum, kids with poor social skills, kids with ADHD or other forms of poor emotional or behavioral regulation.

This one is a bit of a catch-22, just as “not fitting in” is. Of course, we all say; if you’re born in the wrong body, of course you will struggle with your mental health; of course you will be suicidal.

To which I reply:

If we woke up tomorrow, Kafka-like, and discovered we were indeed now in the “wrong body,” we would no doubt be extremely distressed. We would no doubt need to struggle with it and cope with it, just as we struggle and cope with any other tragedy the universe hurls at us. But eventually our happiness would return to the set-point where it was before our “wrong body” tragedy, and we would move on. It’s what humans do. We certainly wouldn’t kill ourselves over it, unless we had another, deeper mental health issue.

Why? There is something called a happiness set point, and this article explains it pretty well, but here’s a snippet:

“…You can win the lottery, and despite the short-term elation you experience, you’ll eventually revert back to your set point. So …the bright skies after a lottery win will turn back to dark clouds. (Multiple studies have consistently proven this is the case.)

“Then there’s the other extreme. You can lose your ability to walk after a terrible car accident. This may plunge you into depression at first. But …you’ll eventually experience happiness again even though you’re wheelchair bound for life.

“…Another example: …. Schools like Harvard and Stanford are the dream universities for young people across the nation. But if a student aspires to enroll in top schools thinking, ‘I’ll be so happy when I receive my I acceptance letter,’ any happiness will be short lived.

“For proof…. Visit any university that has an amazing reputation. Are all the students walking across campus smiling, laughing, and exhibiting happiness? Does their level of happiness exceed that of students attending less prestigious schools?” (No.)

It really comes down to this: If the admittedly horrible event of waking up in the wrong body would cause you life-long misery and suicidality, then something is seriously derailed with your mental health, and it has nothing to do with distress about your gender, no matter how genuine. If something is seriously derailed with your mental health, it will continue even if you transition. That’s what detransitioners seem to discover.

Latching on to Gender as a Simple Solution to Complex Problems

Another common thread is that detransitioners often found it enticing to latch on to gender as a simple solution for their complex problems. They often say, “I was so relieved. It explained so much.”

It’s easy to see why a simple, defined, and concrete solution — transition — seems like such a great idea. It gives you “something to do, and then you’ll be happy.” Your problems will be solved. Especially in America, we’re primed for that quick fix that can usually be alleviated by a product or a self-improving course of action: Buy that car. Lose that weight. Get that job. Then you’ll be happy.

If you didn’t click on the happiness set-point article above, here’s another chance. Understanding the happiness set-point is really important in understanding why transition — or anything else that is supposed to “make you happy” — might work in the short-term but not the long-term: Wherever you go, there you are.

Imagine your adolescent self. Remember how equipped you were (or weren’t) to deal with the world, compared to today. Then think about whether your younger self might have been overwhelmed by any number of serious and complex problems a young person might experience: having no friends, being bullied, changing schools, having conflict or disruption in your family, not being one of the popular kids, having interests that others consider nerdy, being isolated, having depression or anxiety, having an eating disorder, or self-medicating with alcohol or drugs.

The complex problems any young person might have are infinite. Now imagine that you read online — and society tells you, and the media tells you, and the school curriculum tells you — that if you’re unhappy and don’t fit in, you really might have a problem with your gender. And it’s an easy fix.

Would you consider that a relief? A lifeline? A lot of detransitioners did. (And side note: I’m hearing a lot of detransitioned folks saying that they were “on the autism spectrum all along — it explains everything.” While no doubt that’s the case for some people, I wonder if it’s another oversimplification and dead end for many. Time will tell.)

Beware simple solutions to complex problems.

Blind “Affirmation” by the Medical and Mental Health Community, Schools, Media, Peers (and Often, Well-Intentioned Loving Families)

Detransitioners often wonder why no one challenged them — why no one encouraged them to explore their own feelings and motives more deeply — why everyone seemed to shove them on the road to transition, no matter how well-intentioned.

There is no medical or psychiatric diagnosis for “being trans” — there is only “gender dysphoria” and there is no medical test for it, no visible sign of it. All the symptoms rely on beliefs, wishes, and emotional distress, and while that’s not completely surprising considering it’s a psychiatric and not a medical diagnosis, it’s a diagnosis based more on self-report than even other psychiatric diagnoses are.

For example, think about someone with Bipolar I disorder experiencing a manic episode. There are a constellation of symptoms that all the person’s daily contacts can tell you about, and they all point to a manic episode: “She flew to Vegas, didn’t sleep for three days, and spent all our savings.” or “He came to work, wouldn’t stop talking, and went up to the roof and stripped off his clothes.”

When it comes to someone with gender dysphoria, often the people in their lives either have no idea anything is wrong until their loved one makes the announcement, or they know something is wrong (their loved one is suffering) but they aren’t sure what it was. It’s rarely the case that everyone in their lives says, “Yup, I knew it.” There is no equivalent to flying off to Vegas and spending your life savings.

In that sense, gender dysphoria is often “unseen” until the person shares it with you, which makes it similar in people’s minds to being gay and lesbian — and indeed, being gay or lesbian is no longer considered a psychiatric diagnosis for that reason. People who are gay and lesbian don’t have mental health problems; they just need to get on with their lives.

That’s partly why if someone tells you they’re gay or lesbian, you don’t doubt them. It’s just a statement of fact, a way of being. You don’t need to do anything to make them happy. They don’t have a problem that needs to be fixed. They know to whom they’re sexually attracted, and who are you to disagree? So everyone more or less “affirms” them, no questions asked. There’s no debate.

Because “gender dysphoria” is often invisible to outside observers — there are no “outward symptoms”; because people draw the analogy that “it’s just how they feel inside” — then no one wants to doubt people who say they are trans, either. We are told it’s “just how they are.”

This is why the new, enlightened thing is supposed to be affirmation by everyone in society. Affirmation is everywhere — doctors, mental health professionals, schools, employers, families — everyone is supposed to simply believe and support a person’s trans declaration.

But here’s the catch with affirmation. Gay and lesbian people just need affirmation because they don’t have a problem. They aren’t distressed. They don’t need or require anything from anyone else. That’s why they get affirmation instead of a psychiatric diagnosis.

By contrast, trans-identifying people tell us they need a lot of things. New name, new pronouns, hormones that aren’t medically indicated, and cosmetic surgeries. In fact, if they don’t get those things, we’re often told it’s likely they’ll kill themselves. This is hardly the picture of self-actualizing mental health.

It’s impossible to have it both ways. You can’t be so mentally unstable that others fear you’ll suffer harm if you’re misgendered, you can’t be so miserable that you emotionally “need” a host of medically unnecessary hormone and surgical treatments, and then get to be labeled emotionally healthy.

You are either perfectly healthy being trans, and require nothing more from anyone else other than to be yourself, or you are so mentally unwell being trans that you demand all sorts of behavioral changes and cosmetic treatments from society, and that level of extreme distress requires some kind of psychiatric intervention.

The detransitioners often tell us that we’re on the wrong track with blind affirmation of everyone who claims a trans identity. Looking back, they are horrified that mental health providers accepted their narrative of the reasons for their distress, no questions asked. They are angry with doctors that they were offered hormones on a first visit, or that their hesitation about surgery was dismissed or waved away. They are angry sometimes with feeling manipulated or pushed by other trans people or even their own families to stick with the changes after they started to have doubts.

Many detransitioners feel that in their case, blind affirmation put them on a self-destructive path that led to lasting medical and emotional harm that will take a long time to recover from.

A Period of Happiness…at First

All of us know someone who is chronically dissatisfied with life, but they’ll assure you the next big change is going to be what puts it right. I once had a roommate who was often unhappy. She told me she was always happy before she moved to our city, and she missed her hometown. She was chronically miserable, and talked about how happy she could be once she could get out of our city. Once she finally made plans to return to her hometown, she did indeed seem happy. Overjoyed in fact! It was great to be out of our horrible city and back home!

But soon enough, there were problems there too. It wasn’t as she expected. Friends had moved away. Her favorite bar was gone. She had conflict with old friends. She started dreaming of the Southwest. She was miserable in her cold, cloudy hometown with nothing to do. She would only be happy when she moved to the Southwest.

Well, this time I wasn’t as hopeful as she seemed to be. She moved to the Southwest, and the same thing happened. It was amazing there! She was so happy! Until after a while she was as miserable as ever.

Detransitioners often go through a similar experience with transition. They’ve become convinced that transition will solve all their problems, so at first, when they start to make changes, and other people are supportive, they can be extremely happy. For a while. Who wouldn’t be happy when you’re finally taking charge of your happiness and doing something about it?

But after a while, they realize that gender was not the solution to all their problems. In fact, for the detransitioners, it wasn’t the solution to any of their problems.

An Often Gradual but Sometimes Sudden Realization That Transition Was Not Right for Them

This is often the saddest part of detransitioners’ stories — hearing about the discovery that they feel they made a mistake and want to detransition. Not only do they need to reassess their lives, often facing regret, rejection, blame for “making a mistake,” but they have to share that “mistake” very publicly with everyone in their lives.

It’s one thing to share this news with your family, partner, closest friends — and that can be hard enough — but it’s quite another thing to share that with your landlord, your employer, and the people at the DMV.

Many people express the sense that they focused on transition at the expense of all their other problems. Some feel emotionally frozen at the age when they began transitioning. Imagine being a girl of 15, living as a man for 10 years, and then deciding you want to be a woman. Consider something trivial like clothing: The last time you wore women’s clothing was in high school 10 years ago. What do you even want to wear now? Multiply that times every aspect of your life.

It’s a lot. No matter how huge a challenge we imagine it to be, I’m pretty sure it’s more than that.

Don’t Take My Word for It

What do we make of the fact that so many detransitioned people tell similar stories of similar struggles and of the ways we failed them? I’m not sure, but I do know this: these issues have been flaming red flags for years, and we need to address them.

You don’t need to take my word for it. Search online for detrans stories and read the first 10 you can find. Tell me how much these stories resemble each other in trajectory. And now we have a day for these folks: Detrans Awareness Day.

How wonderful it is that we now have a day to recognize and celebrate the people who’ve struggled with these issues — people who have been largely ignored or blamed for their own problems.

But at the same time, the fact we need a Detrans Awareness Day highlights how badly the medical and mental health community has let these people down. “Blind affirmation” and “trans medical care” are not all they were promised to be a decade ago — and what’s more, many countries are finally realizing the evidence for affirmation and transition was never there:

Sweden, Finland, and the UK are all acknowledging the failures of blind affirmation and various interventions. When will we catch up?

Why Is the United States Far Behind?

As usual, we in the States have made this a culture war issue, and not an evidence-based issue. Conservatives rather knee-jerkingly support pulling the plug on what we’ve been doing, but not necessarily for the right (evidence-based) reasons. And liberals rather knee-jerkingly “know” the conservatives are bigoted and wrong, so without evidence, they support transition regardless of the glaring lack of good evidence in support of it. Because liberals are so sure they’re on the side of the angels, they don’t notice the incredible medical and emotional harm they’re inflicting with their ignorant if well-intentioned do-goodery.

Which is worse? No one who participates in this through the culture war perspective is helping gender-questioning people. No one.

I don’t see this winding up any time soon in the US. We’ll have to wait for the rest of the world to figure it out and eventually the overwhelming weight of the accumulated evidence will fall on our American heads like an anvil on Wile E. Coyote.

I’ll let Keira Bell, a detransitioned woman who sued the National Health Service in the UK, have the last word: