interesting times

The Hard Questions About Young People and Gender Transitions

Photo: Jonathan Kirn/Getty Images

Earlier this week, I met a group of women in their early 20s who are not supposed to exist.

They’re women who, in their teens, realized 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 realized 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 even mentioning it borders on transphobic. But in reality, absolutely no one knows how rare detransitions are currently — the small set of research studies detransition skeptics present as evidence that it is very uncommon all come from vastly different contexts, in some cases decades-old, and arguably don’t capture what’s going on in 2019. 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,” i.e. wearing a breast corset of sorts, to flatten their chests, so they can pass more easily as men. “I have back issues, lower lung capacity, and permanent dents around my shoulders,” one told me. “Every now and again, I have to push a rib back in to breathe,” another recounts. “I have permanent bruising,” another explains. “Serious back issues,” says another, who cannot carry a backpack for long without pain. “We get ‘sir’ed at Dunkin’ Donuts every time,” one joked.

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 mom one evening that she was having a sleepover with friends, but instead drove hundreds of miles to a Planned Parenthood through the night in search for 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 getting any results from blood work. Another got diagnosed online, and got testosterone in the mail.

By their own accounts, they had been adamantly trans in their teens. “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.” One 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 that 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, because in the U.S., it’s close to impossible to get an empirical grasp on it. The Reddit group for detransitioners has over 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. Even in Britain, where the NHS keeps statistics, and where there is only one center devoted to treatment of transgender kids (the Tavistock Centre), there’s no data on detransitioning.

But the data on transitioning in the past decade is startling. In 2009–2010, there were reportedly 32 girls and 40 boys referred to the center for treatment. Since 2018, there have been 624 boys and 1,740 girls, overwhelmingly in their teens. One explanation is that, as stigma declined, more transgender kids identified themselves as such. But the shift toward girls, compared with boys, suggests that something else may be going on. Why should the female share of transgender patients suddenly shift from 44 percent to 74 percent girls in a decade?

The women I spoke to said the internet, particularly Tumblr, was the key change. “The online effect is where the transgender boom was born,” one argues. She and her brother got wrapped up in web subcultures in their teens, as so many now do. “I went trans online; my brother went alt-right,” says one. Online support for trans teens is wonderful. 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. But those spaces also tend to be dominated by trans people who, for completely understandable reasons, worry about trans people not getting treatment and 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 tells me, “I thought I was the only trans person who ever doubted it.” (It’s also worth noting that at least some detransitioners are forced into it because of social pressure, threats of violence, or a lack of ongoing access to hormones — not every detransitioner detransitions because they determine they aren’t really trans.)

A Brown University professor, Lisa Littman, published a paper earlier this year citing parents’ reports on their transgender kids. She discovered a pattern: Most (83 percent) were girls in their teens with no previous history of gender dysphoria, who spent a lot of time online, and “more than one-third [of whom] had friendship groups in which 50 percent or more of the youths began to identify as transgender in a similar time frame.” Littman was not the first person to use this 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, and 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 Tavistock Centre resigned after submitting a report that argued that teens were being fast-tracked to transition in the center, without sufficient exploration of other comorbid factors. He felt the place had so lost its way in a thicket of ideology that he had to quit.)

The Littman paper was assailed by trans activists and their allies, denounced as transphobic, and had to have its framing language changed before it was republished. But the research and the findings, while very 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 herself 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: “Fifty-one percent 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 percent, while 30 percent of transgender female adolescents reported attempting suicide.” This is horrifying. But it’s also horrifying that, in a 2015 study of transgender people of all ages, “39 percent of respondents experienced serious psychological distress in the month prior to completing the survey,” and 40 percent 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 kids and teens.

“Fast-track” transitioning — some kids are brought by their parents to socially transition as early as 2 years old — has also unnerved some gay men and lesbians. The vast majority (studies range from 63 to 94 percent) of gender dysphoric kids turn out to be gay after puberty. So how can you tell which gender-dysphoric kid is gay and just needs to be left alone, and which one is trans and needs urgent treatment? Since the brain doesn’t fully develop until you’re 25, how do we ever truly know who’s really trans and who’s gay before then?

With gays, 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 kids, it’s a whole different story. Social transition is one thing. Off-label puberty blockers and irreversible hormones and surgeries are quite another. And this is zero-sum. All the women I spoke with who detransitioned now date women or don’t date at all. Their transition was based entirely on how they felt at the 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?

To be honest, I don’t know how we solve this problem. Every child is different and unique. His or her gender dysphoria may be due to sexual orientation or transgender identity, or it could be part of countless comorbid other factors. This has to be a decision based on each case, with parents and therapists involved. Some kids 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 kids and teens, while admirable and, in many cases, essential and well-intentioned, also risks overreach. When the number of girls seeking to transition increases by more than 5,000 percent 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, like this one.)

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

The Weak Case Against the Case Against Trump

Now that we’re in a formal House impeachment inquiry, it’s worth noting the emerging arguments against the whole idea. There seems to be no defense on the substance. Trump is guilty as hell. So the move now is to admit the offense but say it doesn’t merit impeachment. In the words of Peter J. Wallison, of the conservative American Enterprise Institute:

First, the Constitution is clear … that an impeachable offense must be a serious crime. Second, if Congress chooses to act without finding such a crime, it will have created a precedent for removal of a president on a purely partisan basis, weakening the stability of the presidency and changing the nature of the U.S. government in the future. And third, Congress will have to overcome the fact that President Trump actually delivered the requested weapons to Ukraine without any of the actions by Ukraine’s government that he purportedly sought. In other words, he did not carry through the act for which he is being charged.

Let’s unpack this by comparing it to the last impeachment. Bill Clinton was impeached after a years-long hunt for malfeasance on the charge of lying under oath about an extramarital affair. No hearings were held in the House at all, because the Starr Report was so detailed and comprehensive. (The investigation was also secret — a precedent that surely undermines the ridiculous argument that this impeachment procedure is illegitimate because its early hearings were not public.) And lying about an extramarital affair, even under oath, is a trivial offense that does not involve affairs of state, or abuse of power, is not treasonous, or a bribe. It does not amount to a fear that the president would continue to abuse his public office, and needs to be reined in.

Because of that, neither a majority in the country nor a majority in the Senate supported his removal from office. Before the trial, only a third of Americans thought impeachment and removal was the right response. Surely, if any impeachment were to be found to have created “a precedent for removal of a president on a purely partisan basis, weakening the stability of the presidency and changing the nature of the U.S. government in the future,” it would be this one. It’s a little much for Republicans to have insisted on the Clinton impeachment and yet declare this one unworthy to be considered because the offense, while bad, did not rise to the “high crimes and misdemeanors” standard.

After all, Trump has been charged with blatant abuse of his presidential authority — asking Ukraine to intervene in U.S. politics by investigating a hard-right conspiracy theory and digging up potential dirt on Hunter Biden, and thereby, Joe Biden. The quid for this quo was urgently needed military aid, which the Congress had passed, and which Trump initially refused to provide, seeking a clear and public announcement by the Ukrainians that the Bidens were corrupt.

The White House instantly knew this was a serious problem, because after complaints, the recording of the call was placed in a top-secret file, and the reconstructed transcript of the call edited to remove specific references to Joe Biden and Burisma, the Ukranian energy company that hired Hunter Biden. This is an admission of guilt, and an attempt to mislead Congress and the public. The ellipses in that “rough transcript” are the equivalent of the missing minutes from the Nixon tapes. As to the argument that because Ukraine eventually got the missiles without pursuing the investigation Trump wanted, and that therefore there was no crime at all: What matters is the conspiracy, even if it isn’t successful.

Conspiracy with a foreign government to intervene in an American election is clearly a high crime. The Founders were fixated on foreign influence when they came up with impeachment. More to the point, the president refuses to admit any wrongdoing at all, and is now almost certainly repeating the Ukraine gambit with China, in trade talks. In other words, this is part of this president’s modus operandi, and he insists he has an “absolute right” to do it in the future.

Nixon’s crime was hardly high. Burglary is not treason. Yet he resigned rather than face conviction in the Senate. Now imagine if Nixon had asked the Soviet Union to help him break into the DNC. He’d have been toast long before he quit. His high crimes were entirely about the cover-up: obstructing justice, abuse of power, and contempt of Congress. Trump has done all of that in this case, abusing his foreign-policy power, forbidding anyone in his administration to testify, hiding and then editing evidence, and declaring the constitutional process as a “witch hunt” with no legitimacy. And he has declared all of this as “perfect” and completely without fault. He will never admit his misdeeds or apologize for them because his sick psyche prevents him from ever doing that in any situation.

And that’s the real purpose of impeachment: to prevent future abuse of power. Exonerating Trump, who has admitted nothing wrong, is a carte blanche for him to commit the same crimes again. He initiated the Ukraine business immediately after the Russian question had been resolved. He has openly said that Article 2 gives him the right “to do whatever I want.” He is a corrupt liar who loves flirting with treason. He’s gotten worse with every passing day. And yet the Republican Party seems intent not only on letting him off the hook, but enabling him to a second term.

Impeachment exists because the Founders feared a president like Trump — corrupt, contemptuous of the Constitution, obstructing justice, dishonest in everything, abusive of his power, and infecting domestic politics with the influence of foreign powers. If we do not use it in this case, we will be betraying them.

The Sanest Man in America?

It tells you something about our times that the following statement by Barack Obama is in any way controversial:

Among young people, particularly on college campuses … There is this sense sometimes of, ‘The way of me making change is to be as judgmental as possible about other people,’ and that’s enough … If I tweet or hashtag about how you didn’t do something right or used the wrong verb, then I can sit back and feel pretty good about myself, because, man, you see how woke I was? I called you out … This is not activism. That’s not bringing about change. If all you’re doing is casting stones, you’re probably not going to get that far. That’s easy to do.

This is not new for Obama. He was skeptical of “social justice” ideology throughout his term in office. In 2017, he said:

One of the dangers of the internet is that people can have entirely different realities. They can be cocooned in information that reinforces their current biases. The truth is, on the internet everything is simplified, and when you meet people face to face, it turns out they’re complicated. It is harder to be as obnoxious and cruel in person as people can be anonymously on the internet.

Take the biggest actual social change, hailed by liberals, of the last couple of decades: marriage equality. We did not spend our time calling out homophobia, attacking the churches, or describing our opponents as “deplorable.” We made our case carefully; we engaged the other side respectfully; we lobbied state legislatures; more and more gay people told their stories; brilliant lawyers fought various cases, beginning with failure until achieving success at the Supreme Court. I can’t tell you how many times I debated religious fundamentalists, while never disparaging them. I produced an anthology of the best arguments on both sides. You do this kind of hard work for a couple of decades, with civility, and you’ll be surprised how many people you can persuade to change their minds. It seems to me that if your argument is better and you make it relentlessly, you’ll win. But if you avoid actual argument and resort to slurs, cancel culture, and ever more polarizing rhetoric, you’ll lose.

Yes, it’s harder with the internet which rewards the opposite of respectful debate. You can feel less of a need to talk to your opponents face-to-face. You can too easily dehumanize the other side. But Obama is right about the complexity of people. Attack people for their “whiteness,” accuse people of sexual crimes without any proof or certainty, disparage all criticism of Israel as anti-Semitic, cast every point against gay marriage as bigotry — and you’ll definitely make waves, and be cheered on by your own tribe. But bringing about change? Sometimes I think this kind of activism — damning them while not talking to them — actually prevents change.

One little example of human complexity: Pat Buchanan was  (and still is) one of the most virulently anti-gay voices in America. I debated him a few times. And I appealed to him to see the humanity of gay people, rather than what he believed was the iniquity of gay sex. I kept communications open. I couldn’t help but like him as a person. He is, in fact, kind. And when I came out as HIV-positive, one of the very few Washingtonians who wrote me a hand-written letter was Buchanan. He said how sorry he was about the news, but he was sure we’d still have many years in which to fight and argue and debate. It really bucked me up at the time.

People are complicated. The key to persuading them is to embrace all of them good and bad, while making your case. We did that in the marriage-equality movement, which is why that big change happened, and just as important, why it has lasted.

See you next Friday.

Andrew Sullivan: Questions About Youth Gender Transitions