Sex-change sorrow The Sunday Times 10.11.19

The original article is here.

I recently met a group of American women in their early twenties who are not supposed to exist. They are women who, in their teens, realised that they were actually men, socially transitioned to the other sex and then underwent hormone therapy to change their bodies, faces and voices to become transgender men. After varying amounts of time, however, they all realised they had made a big mistake, stopped testosterone therapy and “detransitioned” back to being who they were before. They are now embarrassed, they say, but not ashamed. “I don’t identify as anything,” one of them told me. “I just have two X chromosomes in the bag.”

These women are not anti-trans, or religious nuts, or members of the far right. They expressed not a smidgen of transphobia, just a pressing concern that many teenage women, particularly lesbians, struggling with gender dysphoria have been convinced too quickly that the only solution is to change their sex. They worry that any kind of therapy apart from affirmation of transgender identity is now seen as transphobic, and that teens are able to get hormones far too easily.

The widespread consensus today is that detransitioning is so rare that even mentioning it borders on transphobic. But in reality, no one knows how rare detransitioning is — the small set of research studies that detransition sceptics present as evidence to prove that it is very uncommon all come from vastly different contexts, in some cases decades old, and arguably do not capture what’s going on in 2019.

“The online effect is where the transgender boom was born,” one woman arguedBULAT SILVIA
These women live every day with the consequences of their decision: tenacious facial hair (one has to shave every three days) and body hair, deeper voices, permanently enlarged clitorises. They also suffer from the effects of “binding” — wearing a breast corset of sorts, to flatten their chests, so they could pass more easily as men. “I have back issues, lower lung capacity and permanent dents around my shoulders,” one told me.

Another said: “Every now and again, I have to push a rib back in to breathe.” Another, who cannot carry a backpack for long without pain, has “serious back issues”. One joked: “We get ‘sir’-ed at Dunkin’ Donuts every time.”

How could this have happened? We are regularly told that no child or teen is encouraged to take puberty blockers and cross-sex hormones unless they have shown “consistent, insistent and persistent” identification with the opposite sex. And yet all these women became trans quite suddenly after puberty, found affirmation immediately and got testosterone easily.

One says she told her mother that she was having a sleepover with friends, but instead drove hundreds of miles through the night to a centre run by the American sexual-health charity Planned Parenthood to seek help with transitioning. Within a couple of hours, after telling her life story, she says she was diagnosed as trans by a social worker, who was impressed by her tenacity in driving so far, and was started on testosterone therapy before even receiving blood test results. Another was diagnosed online and got testosterone in the post.

By their own accounts, they had been adamantly trans in their teens. One said: “I was the student trying to get a professor fired because he wouldn’t allow ‘they’ and ‘them’ to be used for a singular person in my papers . . . I threatened my parents and friends with suicide. It became part of my identity to be suicidal. I screamed at my parents about this, even though I knew I wasn’t going to kill myself.”

Another went by the pronouns “xe” and “xer” and flew into a rage if she was misgendered. Once they had transitioned, and felt miserable nonetheless, they felt this, too, was just part of being transgender. One talked of “the hunger to suffer”. Another spoke of “using your pain to validate your own destruction”.

How typical are these responses? We can’t tell. In America, it is close to impossible to get an empirical grasp on it. The Reddit group for detransitioners has more than 6,000 members, which might be indicative, but certainly some of that number includes observers and people merely questioning their transition. Clinical research on this topic is scant and tenuous.

In England, where the NHS keeps statistics and where there is only one clinic devoted to treating transgender children, the Tavistock Centre in north London, there is no data on detransitioning. However, the data on transitioning in the past decade is startling. In 2009-10, there were reportedly 32 girls and 40 boys referred to the Tavistock Centre for treatment. In the year from April 2018 to 2019, there were 624 boys and 1,740 girls, overwhelmingly in their teens. One explanation is that, as stigma declined, more transgender children identified themselves as such. But the shift towards girls, compared with boys, suggests that something else may be going on. Why should the female share of transgender patients suddenly shift from 44% to 74% girls in a decade?

The women I spoke to said the internet, particularly the microblogging site Tumblr, was the key change. “The online effect is where the transgender boom was born,” one argued. She and her brother got wrapped up in web subcultures in their teens, as so many now do. Another said: “I went trans online; my brother went alt-right.”

Before the web, many trans teens felt alone and isolated, whereas now they feel collective support and affirmation from peers around the country and the world. Yet those spaces also tend to be dominated by trans people who, for completely understandable reasons, worry about trans people not getting treatment and are eager to help others transition.

Detransitioning is rarely mentioned and usually discounted as a myth or equated with transphobia. When one of the women began to question her decision, she told me: “I thought I was the only trans person who ever doubted it.” (It is worth noting that at least some detransitioners are forced into it because of social pressure, threats of violence, or a lack of access to hormones. Not every detransitioner detransitions because they determine they are not really trans.)

Lisa Littman, a professor at Brown University in Rhode Island, recently published a paper citing parents’ reports on their transgender kids. She discovered a pattern: most (83%) were girls in their teens without any previous history of gender dysphoria, who spent a lot of time online, and more than a third of whom had friendship groups in which 50% or more of the youths began to identify as transgender in a similar timeframe.

Littman was not the first person to use the term, but she described this phenomenon as “rapid onset gender dysphoria”, and worried that it could be caused by social contagion, or connected to other issues such as the rejection of parents, depression, autism or bipolar disease. Littman was concerned that these kids were not getting the full range of mental-health help they needed. (Earlier this year, a governor of the NHS foundation trust overseeing the Tavistock Centre resigned after submitting a report that argued teens were being fast-tracked to transition in the centre without sufficient exploration of other co-morbid factors.)

Littman’s paper was assailed by trans activists and their allies, denounced as transphobic and had to have its wording changed before it was republished. But the research and the findings, while limited in their scope, held up under peer review and were the same in the republished version as in the original. This is a real enough phenomenon to merit much more research to confirm it. But the pressure to stop this research remains enormous: Littman lost her consulting job over the paper after a campaign to get her fired for transphobia.

The pressure on parents to give puberty-blocking drugs or cross-sex hormones to gender-dysphoric kids or teens is also intense. “Do you want a happy son or a dead daughter?” is the usual formula, deploying statistics on suicide among transgender people. And those stats are sobering. According to a study last year in Pediatrics, the journal of the American Academy of Pediatrics: “Fifty-one per cent of transgender male adolescents reported at least one suicide attempt — the highest rate in the study. The second highest was among young people who are nonbinary — those who do not identify exclusively as male or female — at 42%, while 30% of transgender female adolescents reported attempting suicide.”

This is horrifying. But it’s also horrifying that, in a 2015 survey of transgender people of all ages, “39% of respondents experienced serious psychological distress in the month prior to completing the survey”, and 40% had attempted suicide in their lifetime. A combination of discrimination and bias hurts trans people, as well as the inherent psychological struggles of feeling that you were “born in the wrong body”. It only takes a modicum of empathy to see what a lifelong struggle this can be. But transition is quite clearly not a panacea, even as it definitely helps many children and teens.

“Fast-track” transitioning — some children are brought by their parents to socially transition as early as two years old — has also unnerved some gay men and lesbians. The vast majority (studies range from 63% to 94%) of gender dysphoric kids turn out to be gay after puberty. So how can you tell which gender-dysphoric child is gay and just needs to be left alone, and which is trans and needs urgent treatment? Since the brain doesn’t fully develop until you’re 25, how do we truly know who is really trans and who is gay before then?

With those who are gay, mercifully, you don’t have to make any early, irreversible decisions. They need no medical intervention. They can simply figure it out for themselves over time. With trans children, it’s a whole different story. Social transition is one thing. Puberty blockers and irreversible hormones and surgery are quite another.

All the women I spoke to who detransitioned now date women or don’t date at all. Their transition was based entirely on how they felt at that moment, which they now regard as a false signal about their long-term identity. Which prompts the question: how much of the extraordinary surge in transgender girls is related to their discomfort with being a lesbian? What role does homophobia play in enabling transition?

I don’t know how we solve this problem. Every child is unique. His or her gender dysphoria may be due to sexual orientation or transgender identity, or it could be part of countless co-morbid other factors. This has to be a decision based on each case, with parents and therapists involved. Some children need to be fast-tracked; many don’t. All I know for sure is that too many of these irreversible calls have been wrong ones.

I know that gender dysphoria throughout childhood is one thing; sudden gender dysphoria among teenage girls is another. I also know that the ideological campaign to affirm transgender children and teens, while admirable and, in many cases, essential and well-intentioned, risks overreach. When the number of girls seeking to transition increases by more than 5,000% in less than a decade, there are bound to be false positives. (Some good news is that thoughtful clinicians are aware of these questions and are beginning to generate considered responses.)

What we need is an open debate about what’s best for gender-dysphoric kids and teens. Questioning the orthodoxy is not transphobic, as so many reflexively charge. No one, including trans people, wants to transition children who might turn out to be cis (people whose gender identity matches their birth sex) — and often gay and lesbian. Equally, we don’t want to prevent genuinely trans children from having treatment and care.

This balance is hard. But because of that, waiting and seeing if a gender dysphoric child or teen really is trans before making irreversible decisions seems to me to be the right call. Ditto requiring several broad-ranging therapy sessions for teens before they make the jump — as opposed to swift affirmation and handing out testosterone-like candy. And setting up studies that can tell us definitively how rare or common detransitioning is, and whether puberty blockers and cross-sex hormones damage children and teens in the long term, is essential. Right now, we are effectively experimenting on minors who cannot give meaningful consent. And that alone should give us pause.

Andrew Sullivan is contributing editor at New York magazine