Detransition, Desistance, and Disinformation: A Guide for Understanding Transgender Children Debates

photo by FreeImages.com/Andrew Beierle

I have participated in transgender communities since 1994. Between those experiences, and my many years of work as a trans writer, activist, performer, and presenter — speaking at community events, conferences, and colleges all over North America — I have had intimate and in depth conversations about trans experiences and issues with well over a thousand transgender people (likely more). I’ve extensively researched both the medical literature, and the history of psychiatric/medical “gatekeepers” who provided trans-related care, for my 2007 book Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity, and that work continued in my writings and activism related to trans-related diagnoses in the recently published DSM-V.

Over the course of those two-plus decades, I have witnessed the slow evolution from the old gatekeeper system — which engaged in pathological science and often harbored antagonistic attitudes towards its trans clients/research subjects — toward what is gradually becoming our contemporary trans healthcare system — one that works in partnership with trans communities, and which increasingly has trans people’s best interests at heart.

This evolution was not merely the result of trans activists “fucking shit up” (although admittedly things were contentious at times, and there were plenty of protests along the way). Rather, this change was facilitated by a more general trend within research and medicine — away from the paternalistic “Doctor Knows Best” attitudes of the mid-twentieth century, towards today’s recognition that practitioners and researchers need to actually be concerned about, and seek feedback from, the communities that they serve. This transition has not been perfect, nor is it complete (as many old-guard gatekeepers still adhere to the old ways). But the changes that have occurred in my lifetime have been immensely promising.

But lately, as transgender people have become more visible and have garnered increasing media scrutiny, trans-unaware politicians, pundits, and journalists have suddenly swooped in to weigh in on these important issues — issues that (conveniently) they themselves are not personally invested in. Some of these people have very clear anti-trans agendas. Others are (perhaps well-meaning) interlopers who believe that by simply reading a few research papers and interviewing a few people here and there, they can acquire an “objective understanding” about this complex subject that spans a half-century of history. And sadly, they often center their op-eds and think-pieces on an especially vulnerable segment of our community: transgender children.

You’ve probably seen some of these articles. They raise concerns about “80% desistance,” and offer examples of trans people who have since “detransitioned,” and they will leave you with the impression that trans health practitioners are engaging in some kind of reckless sociological experiment. Whenever transgender people object to these misrepresentations or the old gatekeeper ideologies, these pundits and journalists will decry “transgender activists are attacking science!” without ever acknowledging the countless trans advocates, researchers, and health providers who actually agree with us on many of these matters.

Rather than write a short pithy critique or rebuttal of the latest “children are at risk!” or “activists are out of hand!” article-du-jour, I decided to write this lengthy nuanced piece. It is intended to be a step-by-step guide for anyone interested, one that fills in all the holes, reads between the lines, and unpacks the many assumptions that riddle the typical op-ed or think-piece about transgender children.

Many of the aforementioned problems begin with an over-simplification of either trans terminology and/or the breadth of transgender experiences, so that is where this guide will begin. I will also provide necessary background regarding gender transition in adults before addressing the more controversial topic of transgender children.

1. The distinction (and lack thereof) between transgender and transsexual

The word transgender historically (as well as within the context of this essay) refers to people who defy societal expectations regarding gender. Trans activists of the 1990s who championed the term left it purposely open-ended — it may refer to transsexuals (i.e., people who transition, who I’ll get to in a minute), people who identify outside of the gender binary, crossdressers (i.e., people who identify with their birth-assigned gender, but sometimes dress and/or express themselves as the other gender), people whose gender expression is non-conforming (e.g., feminine men, masculine women, people who are androgynous, etc.), and possibly others. Not everyone who falls under this umbrella will self-identify as “transgender,” but are all viewed by society as defying gender norms in some significant way.

Unfortunately, in mainstream discussions (as well as within certain segments of the trans community), the word “transgender” is increasingly (mis)used to specifically refer to people who identify and live as members of the gender other than the one they were assigned at birth — that is, people who have historically been described as transsexual. Some people who fall under this category don’t like the label “transsexual” (just as some don’t like “transgender”), but I will be using it here because the distinction between people who socially and/or physically transition (i.e., transsexuals), and those transgender-spectrum individuals who don’t transition, is germane to this conversation.

2. There are many transsexual trajectories

People are used to hearing the canonical transsexual story of the person who knew ever since they were a child that they should have been the other gender, who subsequently struggled with those feelings for many years, until at some point they were finally able to transition to their identified gender, and then they lived happily ever after. Many transsexuals’ experiences fit this general template, but others differ. Some people don’t experience gender dysphoria and/or a desire to be the other gender until significantly later in their lives. Some happily live as members of a non-transsexual identity (e.g., crossdresser, genderqueer, gay or lesbian) for many years before coming to the understanding that they might be happier if they transition. Finally, transsexuals may differ in their social and physical transitions. Many (such as myself) both socially and physically transition, while others may be happy socially transitioning sans physical interventions. And others may physically transition but not fully socially transition (e.g., in cases where it is not safe for them to live full-time in their identified gender).

Finally, just as trans individuals’ identities and personal understandings of gender may shift over time prior to transitioning, they may do so afterwards as well. I know people who followed the canonical transsexual pathway to initially become trans men or trans women, but over time found they were happier identifying as genderqueer and/or presenting more androgynously. A relatively small fraction (less than 4 percent, perhaps even smaller, according to most studies) ultimately decide to detransition — that is, return to living as a member of their birth-assigned gender.

The reasons why people detransition are varied. Some find that, on a visceral level, the changes in their body and life didn’t really make them happy, or didn’t feel right. Others are happy with the changes, but make the decision to detransition for pragmatic or logistical reasons. For instance, some people detransition because it’s too difficult for them to obtain hormones or other gender-affirming procedures they may want. Some detransition for their partner’s or spouse’s sake, in order to keep their relationship intact. Some detransition because they had problems finding a job or housing, and/or they were tired of being harassed on a regular basis simply for being a visibly trans person walking down the street. Some permanently detransition, while others may decide to re-transition back later in their lives.

This is the messy backdrop of trans realities necessary for us to honestly discuss this subject.

3. What Is Transphobia?

So when I just mentioned trans people being harassed on the streets, or denied jobs or housing, most reasonable people would agree that those are examples of transphobia. But transphobia isn’t merely the “fear” or “hatred” of transgender people. No, it is best thought of as a double standard that is pervasive in our society, and which presumes that cisgender (that is, non-transgender) bodies, identities, and experiences are valid and the unspoken norm, whereas their transgender counterparts are deemed illegitimate, inauthentic, defective, and suspect in comparison.

This is important to stress, because often the authors of these op-eds and think-pieces will stress how they are “pro-trans” or “trans-friendly,” yet they will nevertheless make a statement or express an opinion that clearly reveals that they view trans people’s genders to be less valuable or valid than their cis counterparts. In the same way that expressions of sexism, racism, ableism, or homophobia can be subtle and unconscious, the same holds true for expressions of transphobia.

4. Trans and cis are useful shorthand, but do not represent immutable, essentialist categories

In trans activism, we often use the word cisgender to refer to people who are not transgender, and cissexual for people who are not transsexual (as explained in my cisgender/cissexual terminology FAQ). These words serve a useful purpose when talking about transphobic double standards — e.g., how trans people are perceived, interpreted, or treated differently than cis people. However, in discussions about trans identities and trajectories, these terms often give the false impression that “cis” and “trans” are immutable and mutually exclusive categories, when in fact they are not.

For example, there are many people out there who (at this particular moment) would describe themselves as cisgender or cissexual, but who in the future will identify as transgender or transsexual. And (in the case of those who detransition) some people who self-identify as trans today may not in the future.

In fact, when discussing matters of identity and gender transition, people are by default presumed to be “cis” until they say or do something (e.g., voice a trans identity, express gender non-conforming behavior) to denote otherwise. This point is crucial, and I shall be returning to it shortly.

Furthermore, there is no test (medical, psychological, or otherwise) to determine whether or not a person is “really trans.” The terms transgender and transsexual are experiential — individuals have an internal experience of gender that they can either try to repress, or outwardly express via being gender non-conforming, or transitioning to their identified gender, respectively.

5. Who should transition?

A subset of transgender people experience discomfort or distress with their birth-assigned gender and/or a strong desire to be the other gender — in the medical literature, this experience is referred to as gender dysphoria. It is not some “invented condition” or mere “gender confusion” — it is very real, intensely felt, and can become all-consuming and even debilitating over time.

While low-level gender dysphoria may be mitigated in various ways (perhaps through crossdressing, gender experimentation and exploration, etc.), the only remedy known to effectively reduce or eliminate intense gender dysphoria is gender transition. There is a large body of clinical evidence demonstrating this — this is why transitioning is medically sanctioned.

Once again, there are no tests to determine for sure whether any given transgender person should (or should not) transition. What happens in practice is that, if a person’s gender dysphoria and/or desire to live in their identified gender is intense enough, they will seek out the means to transition — either through the healthcare system, or if that’s not available, through other means. As I chronicle in chapter 7 of Whipping Girl, gatekeepers used to have extremely stringent criteria for approving gender transition (largely based upon childhood history, sexual orientation, and “passability”), and this ultimately forced many trans people who strongly felt the need to transition to either lie to gatekeepers about their history and/or transition DIY outside of the healthcare system.

I (like many transsexuals) struggled with the question of whether or not I should transition. I remember being on trans-focused online discussion groups back then, and posing the question: “How can I possibly know for sure if I’ll be happier transitioning to female and living as a woman?” On more than one occasion, I received unsatisfying (yet, in retrospect, profound) responses along the following lines:

You won’t know for sure unless or until you try. If you take those first steps and you like the results — the changes in your body or life, if you feel more happy or whole — then transitioning was probably the right decision for you. If you don’t like the changes — either right away, or a year or more down the road — you can always change your mind.

For me, a couple weeks into transitioning, I knew that I had made the right decision. But other people start, but then stop for some reason or another (e.g., out of fear, or it didn’t feel right for them). Some transsexuals who started-then-stopped in the past, may successfully transition years later, under different life circumstances. I should also add that, when I say “start transitioning” here, I’m talking about hormone therapy — the effects of which are largely reversible if you only do them for a few weeks or a couple months (which is generally when people who don’t like the effects tend to stop).

So basically, that’s transitioning. None of this is cut-and-dried. Transness is not something that can be easily or objectively measured — it is inherently subjective and experiential. Transitioning is a matter of personal exploration, of finding what works for you on the individual level. By necessity, it is often a process of trial and error.

6. The “cisgender-people-turned-transgender” trope

The decision to transition does not happen in a vacuum. It occurs in the presence of systemic societal transphobia. Every transgender person is highly aware of how pervasive this double standard is (as we face it every day). And every transsexual who transitions does so in spite of systemic transphobia. This is a testament to how intense gender dysphoria can be, or (to put it in less pathologizing language) how deeply rooted our gender identities are: We’d rather live with the stigma of transphobia than be forced to live in our birth-assigned gender.

Because cisgender people cannot relate to gender dysphoria (having not experienced it personally), and often refuse to take trans people’s gendered experiences seriously (because they view us as illegitimate and suspect as a result of transphobia), they will sometimes invent ulterior motives or condescending theories to explain our desire to transition — e.g., that we transition to try to “fit in” (as straight, as gender-normative), or to obtain male privilege, or because we’re sexual deviants, or because we are confused/clueless/gullible and thus easily swayed by nefarious ideologies (e.g., patriarchy, medical institutions, transgender agendas). I’ve heard many other concocted reasons (and I debunk many of them in Whipping Girl), but what they all share in common is that they 1) dismiss the legitimacy of our gender identities and experiences with dysphoria, and 2) discount the severity of the transphobia we face (which allows them to depict us as making frivolous/reckless/thoughtless life choices rather than serious well-considered ones).

It is here — at the intersection of all these assumptions — that the “cisgender-people-turned-transgender” trope is born. This trope drives nearly all mainstream op-eds and think-pieces that engage in hand-wringing over trans people and gender transition. This trope usually plays out in one of two ways:

The trans-antagonistic position: This is forwarded by people who do not believe that trans is an authentic experience or identity. If you don’t believe that gender dysphoria is real, or that trans people’s gender identities are legitimate, then in your mind, trans people must be delusional, wayward, and/or misled people who deserve to be scrutinized and critiqued for their life choices. According to this view, transphobia is not a form of discrimination, but rather legitimate public criticism. And if “trans” is not an actual thing in your mind, then you will likely see the world as being made up of people born into one of two natural sexes, some of whom frivolously/recklessly engage in physically altering their bodies. This mindset helps explains why people so frequently misuse the adjective “transgender” as a verb (e.g., “transgendering,” or implying that we have been “transgendered”), which makes transgender seem less like a legitimate identity or experience, and more like a mere process that some people undergo.

The trans-suspicious position: Even if you accept that gender dysphoria and trans gender identities are real (albeit rare), you may become suspicious about how increasingly visible trans people are now compared to ten years ago. After all, you are likely oblivious to the shifts (that I mentioned in my introduction) from the old gatekeeper system (which made it extremely difficult for trans people to access the means of transitioning) to today’s trans healthcare system (which takes trans people’s experiences and concerns seriously). Being unaware of all this, you may become worried that this rise in transgender people is actually due to people who are not “really trans” (i.e., cisgender people) being inappropriately swayed or recruited into trans identities and gender transition.

I want to take a moment to examine this “trans-suspicious” position, as it is the one most commonly espoused by pundits who present themselves as “trans-friendly,” and the one most likely to come off as “reasonable” to the average trans-unaware reader. From my perspective (as outlined in the previous steps of this guide), here is why the trans-suspicious position is rife with anti-trans bias:

• As I outlined at the start of this section, the argument that some people are easily swayed or misled into transitioning can only be made if one intentionally denies, discounts, or downplays the existence of societal transphobia, gender dysphoria, and the legitimacy of trans people’s gender identities. In other words, this line of reasoning is condescending and steeped in transphobia.
• The notion that some people who transition are not “really trans” presumes that cisgender and transgender are immutable, essentialist categories — this is absolutely not the case (see step #4). In fact, by definition, anyone who spends serious thought considering, and takes actual steps toward achieving, gender transition is on the transgender spectrum (at least during the time period in which they are doing these things). Even if transitioning doesn’t pan out for these individuals for some reason, it does not mean that they were “really cisgender” all along; it simply means that transitioning was not the right path for them personally. (note: some who ignore step #4 have misinterpreted this passage — I address these misconceptions in a follow up post.)
• If the trans-suspicious position were true (i.e., that cis people are needlessly being pushed toward trans identities and transitioning), then the clear implication of these op-eds and think-pieces is that access to gender transition (and possibly even the acceptance of, or information about, transgender identities) should be restricted to some degree. That is the clear logic at work here, even if the authors who forward such arguments (who want to come off as “trans-friendly” as possible) often go to great lengths to not explicitly state this. In other words, what is being implicitly proposed is rolling back trans rights and/or trans people’s access to healthcare (e.g., by returning to the more stringent gatekeeper system that failed so many trans people in the past).
• I can’t help but notice that these op-eds and think-pieces are invariably written by cisgender authors who (as outsiders to all this) look upon this situation and reflexively come to the conclusion: “Oh no, some cisgender people are choosing or being misled into a transgender lifestyle!” But I would as ask: Why is this even a problem? I mean, so long as these supposed “cisgender-people-turned-transgender” are happy with their life choices and their post-transition lives, why should anyone even care? Frankly, I believe that this concern stems directly from the transphobic assumption that cisgender bodies are valid and valuable, whereas trans people’s are invalid and defective. It is this assumption that leads these authors to view these supposed “cisgender-people-turned-transgender” as an inherently undesirable outcome, even if these individuals wind up being happy in the end. After all, they have taken their precious and perfect cisgender bodies, and transformed them into defective transsexual ones. This helps to explain why the implicit premise of these pieces (i.e., that gender transition should be restricted in order to protect cis people) resonates with so many readers: Denying trans people access to healthcare and living happy lives seems like a small price to pay if it saves even a few cisgender people from making such a horrible mistake with their bodies.

Of course, both the trans-antagonistic and trans-suspicious positions that I have outlined in this section would be strengthened if there were some evidence (however credible) to suggest that cisgender people are indeed being “turned” transgender. For instance, what if some of these people who transition decide to revert back to being cisgender? This, of course, leads us to the next issue . . .

7. Using people who detransition as pawns

I discussed people who detransition briefly in step #2. There are numerous reasons why a person might detransition: some of them visceral and personal (e.g., perhaps transitioning didn’t feel right for them), and others directly related to societal transphobia (e.g., the loss of jobs, housing, family, support system, safety). It could also be some combination thereof.

In a perfect world, we would be able to have open and honest discussions about detransitioning, viewing it in terms of a personal decision based on the individual’s well being. But unfortunately, purveyors of the cisgender-people-turned-transgender trope insist on citing the existence of such people (and occasionally exploiting their personal stories) to forward trans-antagonistic or trans-suspicious agendas. They turn these individuals into anecdotes that seem (to people who are largely trans-unaware) to prove their thesis that “cisgender people are being turned transgender.”

The dynamic here is quite similar to the “ex-gay” phenomenon. Conservative forces who insist that homosexuality is a “treatable disease” or merely an “alternative lifestyle” love to tout the existence of “ex-gays” (some of whom may identify that way and regret their earlier homosexual ways). This stance understandably makes gay communities even more entrenched in their positions, and increases the likelihood that they will distance themselves from anyone who professes a shift in sexual orientation from gay to either bisexual or heterosexual. As a bisexual person myself, I am disappointed by gay and lesbian community tendencies to demonize those who experience shifts in orientation, just like I am opposed to trans people who want to throw people who detransition under the proverbial bus.

I don’t like what I see, but I can understand why these community dynamics occur. And it doesn’t originate with us. It starts with transphobia — with people outside of trans communities making trans-antagonistic and trans-suspicious arguments.

I would love to see more support from trans communities (and from health providers) for people who choose to detransition. But this isn’t going to be easy so long as people who adhere to the cisgender-people-turned-transgender trope continue to use such individuals as political pawns.

8. Spotting bias in debates about transgender children

We finally have sufficient background to engage in a thoughtful conversation about transgender children! Of course, most op-ed and think-piece authors who wish to convey consternation and concern about this highly sensitive subject usually begin their pieces right here, at step #8. I maintain that, without any of the background that I have provided here, most trans-unaware readers will be unable to reach any informed conclusion.

Also, at this point, I will no longer concern myself with the trans-antagonistic position. After all, if you believe that “trans is not a real thing,” then obviously the very idea of “doctors and parents turning children transgender” will seem like an atrocity worthy of inciting moral panic. Instead, I will focus on the trans-suspicious position, particularly as it has been forwarded by reasonable-sounding science-minded writers such as Alice Dreger (in this article) and Jesse Singal (in this essay). (Interested parties can find my initial responses to those articles here and here, respectively.)

First, I will describe two different approaches to handling transgender and gender non-conforming children, then I will critique the manner in which these approaches are depicted in trans-suspicious renditions of the subject.

For many decades (e.g., back when I was a child), if a parent brought their cross-gender-identified or gender non-conforming child into the medical/psychiatric system, the predominant form of treatment was (what is now typically called) “gender-reparative therapy” — that link takes you to a blog-post in which I describe such therapies in more detail and offer additional links for further reading. This approach is based on the presumption that young children’s gender identities and preferences are still fairly flexible, and it utilizes positive and negative reinforcement strategies — specifically, encouraging or restricting certain types of play, or play partners — in an attempt to make the child behave and identify in a more gender-conforming manner. (Note: some people object to the use the term “reparative” here, presumably because in their minds, these children’s genders are not yet “fixed,” and therefore, are not being “repaired.” However, I will stick with “gender reparative” here because that is the term most commonly associated with these positive/negative gender reinforcement methods.)

However, the assertion that these children’s genders remain malleable isn’t necessarily true. According to the UCSF Center of Excellence for Transgender Health, “Children as young as 18 months old have articulated information about their gender identity and gender expression preferences.” By the ages of three and four, children are already displaying preferences in gender expression and identity. Indeed, this is the age that many transsexuals report first knowing that they should be the other gender. As children, many of these transsexuals were forced into accepting and conforming to their birth-assigned genders (due to transphobic attitudes in their parents and society), only to transition later in adulthood to their identified genders. In other words, gender-reparative therapies merely reinforce these same transphobic attitudes, albeit in a more invasive clinical setting. Most of the people who I have met over the years who had been subjected to gender-reparative therapies are now adult transsexuals who resented the treatment: they felt coerced into it, and found it stigmatizing or traumatic. This is why WPATH (the World Professional Association for Transgender Health, the professional organization that publishes the “Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People”) clearly state (in “Standards of Care” version 7): “Treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth has been attempted in the past without success (Gelder & Marks, 1969; Greenson, 1964), particularly in the long term (Cohen-Kettenis & Kuiper, 1984; Pauly, 1965). Such treatment is no longer considered ethical.”

In growing recognition of these problems (and as part of the more general evolution away from gatekeepers who held transgender people to transphobic standards), contemporary trans health providers are increasingly adopting a “gender-affirming” model for transgender and gender non-conforming children. Rather than being shamed by their families and coerced into gender conformity, these children are given the space to explore their genders. If they consistently, persistently, and insistently identify as a gender other than the one they were assigned at birth, then their identity is respected, and they are given the opportunity to live as a member of that gender. If they remain happy in their identified gender, then they may later be placed on puberty blockers to stave off unwanted bodily changes until they are old enough (often at age sixteen) to make an informed decision about whether or not to hormonally transition. If they change their minds at any point along the way, then they are free to make the appropriate life changes and/or seek out other identities.

Most trans activists and advocates prefer the gender-affirming approach, not only because it challenges societal transphobia (rather than reinforcing it, as the gender-reparative therapy approach does), but also because it favors an individual approach for each child, rather than pushing all children toward the same end goal (e.g., gender conformity). A child who, for their entire life, has strongly insisted that she was a girl, or he was a boy, will receive different counseling and treatment than a child who is merely gender non-conforming, or who is just starting to question their gender identity. This approach is far more consistent with the diversity that exists under the transgender umbrella (see step #1).

However, trans-suspicious writers remain leery of the gender-affirming model. And in the process of critiquing it, whether intentionally or out of naivety, they tend to make a series of omissions and misleading claims (most of which stem from ignoring steps #1–7) that practically strong-arm uninformed readers into viewing gender-affirming approaches as reckless, if not constituting medical malpractice. Here are some of the most common biases in these pieces:

• They are primarily concerned about children socially transitioning, being placed on puberty blockers, and ultimately hormones. As a result, they often fail to mention that only a subset of trans kids follow that path (i.e., those who identify as that gender consistently, persistently, and insistently), and that the gender-affirming model also provides support for gender non-conforming and questioning children who do not transition as children.
• They often talk generically about “transgender children” without ever elaborating on the diversity of transgender identities and trajectories, or the fact that some transgender people transition while others do not (see steps #1 & 2). Instead, they create a false dichotomy between “transgender children” (i.e., those who maybe should/will ultimately transition) and “gender non-conforming cisgender children” (who they fear are being misled into gender transition, and who they believe would lead happier lives not transitioning). This ignores step #4 (that trans and cis are not immutable essentialist categories): Some gender non-conforming kids who are not cross-gender-identified during childhood may eventually cross-gender-identify and transition later in adulthood. More importantly, this framing leads to step #6 — the “cisgender-people-turned-transgender” trope — which favors cis bodies, lives, and concerns, over trans ones, as evident in the next few bullet-points.
• If/when people are interviewed or given voice in these articles, they will likely be those who regret their decision to transition (i.e., detransitioners), gender non-conforming adults who are glad they did not transition (e.g., Debra Soh, and “Jess” in Dreger’s article), and parents who are pleased with the results of their child’s gender-reparative therapy (e.g., in Singal’s piece). Early gender transitioners who are happy with the decision, adult transsexuals who wish they had the opportunity to transition earlier, and people who felt stigmatized/traumatized by the gender-reparative therapies they were subjected to — all of whom certainly exist! — are never heard from in these pieces (a point Casey Plett makes in this piece).
• As discussed in step #6, the theme of these pieces is that something must be done to stop these cisgender-kids-being-turned-transgender, and the implicit solution is to curtail/limit/end childhood gender transition. Yet, in these pieces there is absolutely no consideration of how this might impact trans children who might benefit from gender transition. In fact, such oversights can lead to obvious hypocrisy. For example, authors often raise fears that some children (i.e., ones who are “really cisgender” in their minds) may be pushed into the “wrong” puberty, and thus may have to undergo expensive medical procedures to correct those bodily changes. But this precisely describes what a trans child would face if they were not allowed to transition until adulthood. If the former example concerns you, but the latter one doesn’t, then that’s a clear sign that you value cis bodies and lives over trans ones.
• Along similar lines, these articles invariably raise fears about children being placed on puberty blockers and hormones, and question whether someone so young can make such an important and potentially irreversible decision about their own body. But consider a cisgender girl who has always been happy with her assigned gender. Then suddenly, at the age of nine or ten (as she is entering puberty), her body shows signs of masculinization, and doctors confirm that this is due to her body producing testosterone (for the record, this is not a hypothetical situation for some intersex children). If this child was horrified about these potential unwanted changes, and asked for hormonal intervention (which the doctor confirmed would be safe and effective), would you respect her decision and allow her to proceed with it? Or would you dismiss her wishes on account of her lack of maturity, and insist that she just deal with the testosterone until she is eighteen and capable of making an adult decision? As with the last example, if this scenario concerns you, but the idea of transgender children being forced to experience unwanted puberties does not, then you clearly value cis bodies and lives over trans ones.
• Hormones aside, sometimes these writers express fears over completely reversible gender-affirming steps, such as social transition. For example, Singal forwards the idea that social transition might put pressure on those children to stay in that identity (even if they later want to opt out) in order to appease their parents (who have, according to this scenario, become invested in their child’s transness) — see Parker Molloy’s dissection of this claim. I cannot completely rule out that such pressure could exist to some degree. But much like the “community pressure” claims in discussions about people who detransition (see step #7), focusing only on that potential pressure ignores the far greater social pressure that pushes in the opposite direction: transphobia. In these pieces, where is the concern for socially transitioned children who often experience transphobic pressure to revert back to their birth-assigned gender? Or how about the transphobic pressure that is most certainly preventing many transgender children from voicing their identities and desires in the first place? (E.g., out of fear of disappointing their parents — which for me, was a major reason why I never came out to my parents as a child.) In fact, trans-suspicious writers almost never consider transphobia at all, at any point in their analyses (i.e., they completely ignore steps 3 and 6).
• The fact that transphobia isn’t even considered by these authors explains why they are able to play down the unethical and potentially traumatic nature of gender-reparative therapies. Neither Dreger nor Singal even mentions WPATH’s stance against these methods, even though it is the world’s largest and most longstanding professional transgender health organization. Dreger wrote an entire article about why gender-reparative therapies shouldn’t be banned without ever describing what they involve, or the negative consequences they can have. Singal discusses these methods, but questions whether they are “gender reparative,” and gives the impression that they are merely “nudging” kids in the right direction, akin to forcing children to eat their vegetables. In reality, gender-reparative therapies involve taking children who already face societal transphobia, and subjecting them to an even more intense and directly targeted form of transphobia under a clinical microscope.

These are some of the ways in which anti-trans biases manifest in these trans-suspicious op-eds and think-pieces. Trans-unaware readers — who have not been introduced to steps #1–7, and who (due to systemic transphobia) are already primed to view “transgender” as a bad outcome and “well-adjusted trans kids” as an oxymoron — will not likely see through the “truthiness” of these articles.

9. Why does “80% desistance” even matter?

I’ve considered writing this essay for a while now. But the article that finally drove me to it is Singal’s most recent piece: “What’s Missing From the Conversation About Transgender Kids.” In it, he tries to defend the “80% desistance” statistic, which purports that 80 percent of children who experience gender dysphoria (or “gender identity disorder,” as it was called in previous versions of the DSM) eventually grow up to be comfortable in their birth assigned gender (often identifying as lesbian, gay, or bisexual). There are numerous reasons to be suspicious of how that number is derived, as explained by Brynn Tannehill, Kelley Winters, and Kristina Olson and Lily Durwood, plus my thoughts here. (More recent peer-reviewed articles to this effect can be found in my 2018 essay Reframing “Transgender Desistance” Debates.)

I also think that the popular interpretation of these “80% desistance” results — that gender dysphoria simply “resolves” in these children — is rather naive, and brought into question by many transsexuals’ life experiences. For instance, I experienced intense gender dysphoria as a child. But living in a transphobic world with no gender-affirming options whatsoever, I learned to deeply repress those feelings in order to survive. If some researcher were to have carried out a follow up exam on me when I was eighteen, or twenty-one, or twenty-four, I probably would have described myself as a “happy cisgender male” (except for the fact that nobody was using the word “cisgender” back then). But repression only holds for so long, and I eventually had to come to terms with my gender dysphoria. I transitioned in my early thirties. Other transsexuals do so in their forties, or fifties, or even later. So I cannot help but think that at least some of these instances of “gender dysphoria resolving” may actually be “repressing gender dysphoria” in response to societal transphobia — especially given that many of these research subjects were subjected to gender-reparative therapies.

I am a scientist myself. So I can understand why Singal might want to hold up “80% desistance” as a scientifically derived finding. But when it comes to marginalized populations, we should be very suspicious of who is generating these statistics, and how they are being used. I could easily cite statistics showing that people of color perform worse on IQ tests, or that women are less proficient at math and other technical fields, but that would be an utterly irresponsible thing to do unless I was also willing to discuss how racism and sexism, respectively, likely play a role in creating those disparities. Not to mention how nefarious forces may be using those very statistics to reinforce societal racism and sexism.

“80% desistance” isn’t merely some objective and empirically derived statistic. It is a political stance. Virtually every politician, pundit, journalist, and layperson who cites “80% desistance” does so to convey a particular message: The needs of the many outweigh the needs of the few. We should restrict or abandon gender-affirming approaches, and perhaps even reinstate gender-reparative therapies (transgender children be damned), in order to protect the cisgender majority from the threat of being “turned transgender.”

10. In conclusion

I am for the gender-affirming model. But not because I believe that every single gender non-conforming or gender questioning child is a burgeoning soon-to-be-transsexual like me — I certainly do not believe that (as I’ve discussed throughout this guide). Rather, I am for the gender-affirming model because 1) it allows children to explore their genders without the constant pressure and threat of transphobia, and 2) because it treats every child as an individual who may have different desires and needs, and who may follow one of many different life paths.

We can continue to debate the efficacy of gender transition, or of gender-reparative versus gender-affirming approaches, and each side will be able to find statistics to support their side of the argument. But what is really driving this debate is a difference of opinion with regards to what constitutes a “good outcome.” Trans activists and advocates like myself generally think that a good outcome is a happy child, regardless of whether they transition or not, or whether they grow up to be transsexual, non-binary, gender non-conforming, lesbian, gay, bisexual, etcetera. Trans-antagonistic and trans-suspicious people (who constantly cite “80% desistance”) seem to think that a good outcome is a cisgender child, and they seem to be willing to make transphobic arguments and subject transgender and gender non-conforming children to clinically ordained transphobia (i.e., gender-reparative therapies) in order to achieve that end goal.

Trans-suspicious pundits who believe that “cisgender child” represents the best possible outcome will often point to the difficulties associated with being transgender. As a trans person (and a happy one at that!), I will admit that being transgender can be quite difficult at times. But these difficulties have little to do with me physically being or becoming a trans person (as these articles seem to suggest). Sure, I did have that one surgery years ago. But then again, lots of people undergo surgeries for all sorts of reasons, and it by no means ruins their lives. Oh, and I also have to change my estrogen patch every few days. Although that only takes about a minute — no big deal.

Being a transgender person is not especially difficult in and of itself. But the one thing that does make transgender and gender non-conforming lives difficult and harrowing is transphobia. Systemic transphobia, expressed at both the individual and institutional level. Period.

And if you are actually concerned about transgender and gender non-conforming people — whether they be children or adults — then I suggest that you stop fretting over the “cisgender-people-turned-transgender” trope, and instead work to help end transphobia once and for all.

postscript added 8–11–16: for those interested, I wrote a follow up post addressing some of the responses to this piece that I received.

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