The woes of “detransitioners” are a warning: treating children with gender dysphoria is riskier than zealots admit
It is a freezing day in late November, and I am trudging to a church hall in Manchester. As has become usual when women in Britain meet to talk about issues that affect them as a sex, the location has been kept secret until an email shortly beforehand. Such meetings routinely attract protests; harassment sometimes leads to a change of venue.
Today, thankfully, there is no trouble. “Get the L Out”, a group of lesbians who argue for the “L” to leave “LGBT” organisations such as Stonewall (see Kathleen Stock, “Sticks, Stones and Lawsuits”), which they see as consumed with trans issues to the detriment of same-sex-oriented people, are running security. No-nonsense women in hi-viz jackets stand at the back of the hall. “If you interrupt a speaker, you will have to leave,” one booms. Nobody doubts it.
The occasion is the launch of the Detransition Advocacy Network, a support group for people who are not supposed to exist. People who were once “transgender”: so sure that they had been born in the wrong body that they “transitioned”, changing clothing, names and pronouns, and perhaps taking hormones and having surgery to live as members of the opposite sex, only later to realise they had made a terrible mistake.
In recent years a new ideology has upended the way people think about what it means to be a man or woman. Developed by academics in gender studies and “queer theory”, a hard-to-define offshoot of postmodernism that sees almost everything as discursively constructed, it regards these categories as based not on biology but on “gender identity”—the supposedly innate sense of which sex you are. In “trans women” (natal males who identify as women), and their female-to-male counterparts, it is the identity that is understood to be the true self. The body is something to be moulded accordingly. Many adherents of this ideology treat detransitioners as apostates.
The event starts with expert testimony on the treatment of children and adolescents with gender dysphoria—the medical term for severe discomfort with one’s sex. The Tavistock Centre is an NHS mental-health and wellbeing clinic which, among other things, treats young people with gender dysphoria. A decade ago it saw fewer than 100 under-18s annually. Last year it saw nearly 2,600. Its work has become a battleground. On one side are activists and clinicians who press for “affirmation”: an immediate change of name, dress and pronouns, with the expectation of proceeding to medical treatment. On the other are feminists who dismiss gender as sex stereotypes and object to the medicalisation of nonconformity, and parents who fear that children who are merely confused will be turned into lifelong medical patients.
‘Pre-pubescent children who have been “affirmed” in their cross-sex identity unsurprisingly regard the onset of puberty with dread’
Every study of pre-pubescent children with gender dysphoria has found that the great majority become comfortable with their birth sex before reaching adulthood. Many turn out to be gay. Now, however, clinicians regard their condition as signalling a cross-sex identity. Transition stories in parents’ blogs and newspaper articles tell of little boys who demand long tresses, dolls and tutus, and little girls who demand buzzcuts, trucks and dungarees—and parents and doctors who conclude that such children are “really” of the opposite sex and must have their bodies fixed to match.
Most paediatric gender clinics now follow a protocol developed at the Centre of Expertise on Gender Dysphoria in Amsterdam since 2000. Pre-pubescent children who have been “affirmed” in their cross-sex identity unsurprisingly regard the onset of puberty, during which their bodies would develop along the “wrong” lines, with dread. Why not, adventurous clinicians thought, prescribe them drugs previously used to delay puberty only when it arrives early? Taking these to halt normal adolescence would offer time to reflect before irreversible physical changes happened, the thinking went, and make it easier for children to alter their bodies to mimic the opposite sex in adulthood.
As activists pressed for such treatment, clinics elsewhere took it up with enthusiasm. Emerging evidence, however, suggests that this supposedly cautious treatment is anything but. Almost every child who has ever taken such “puberty blockers” has progressed to cross-sex hormones, with lifelong consequences. Even if a child grows up into a contented transgender adult, skipping natal puberty may permanently harm brain development, and probably causes brittle bones. Worst, it means certain sterility.
The Tavistock’s move towards the Dutch protocol prompted alarm. 35 clinicians left. One of them, Kirsty
Entwistle, who worked at a satellite clinic in Leeds, was in the audience in Manchester: “I knew there would be detransitioners,” she says, “but I thought it would be in 10 years’ time when the reality of infertility set in.” Last July she wrote an open letter, strenuously disputed by the Tavistock, describing a culture of fear, with clinicians staying silent about the lack of evidence underpinning the approach for fear of being labelled “transphobic”. Standard medical practice has been abandoned under pressure from trans activists, the Manchester panellists said. No one is tracking children who have transitioned to see if they grow up healthy and happy—or if they end up regretting what they have done.
“I regret it all,” says a slight 23-year-old in a lumberjack shirt, hunched behind a microphone. She is one of eight young detransitioners from several European countries here in Manchester. All are lesbian. They, and many in the audience, see the doctors and clinicians who supported their transitions as the post-modernist version of those who sought to turn gay people straight—only now they are seeking to fix bodies rather than sexual desires. “Transition has been presented as so progressive, but the only thing I see is it reinforcing gender stereotypes,” says one.
“If there is a ‘gay conversion therapy’ of our times, it’s this,” says Charlie Evans, the network’s founder, who identified as trans for a decade before switching back last year, aged 28. Of the 300 or so detransitioners who responded to her social-media call some months ago, most were young and female. That chimes with the changing caseload at paediatric gender clinics around the world, which used to see mostly prepubescent boys but now mostly see teenage girls.
These young women have been indelibly marked by their quest for manhood. Five took cross-sex hormones: their voices are deep and some have receding hairlines. Five had their breasts removed, and two their ovaries and wombs as well. Those who underwent hormone treatment will not know whether it harmed their fertility until they try to have children. Those without reproductive organs know they never will.
The eloquence of a 23-year-old German who goes by “Satan Herself” (@sathananas on Twitter) prompts tears among many. She talks about the difficulty of living as a young lesbian without cultural role models or social networks, in a world that values women only insofar as men find them attractive. Meeting other detransitioners was a revelation, she says. “Where have these women been all my life? . . . It was just so normal to be a lesbian and a masculine woman and I’ve never felt that, ever.”
Between 14 and 16 she was repeatedly hospitalised with anorexia.She started breast-binding at 18, seeing a gender therapist at 19, taking testosterone a month after her 20th birthday, and had a mastectomy, hysterectomy, and oophorectomy (removal of ovaries). “I’m really glad my parents forced me into treatment for my eating disorder and didn’t let me die,” she says. “I wish someone had been there to tell me not to get castrated at 21.”
One young woman after another describes eating disorders, discomfort with her same-sex orientation and alienation from “compulsory femininity”: pink, glitter and princesses—and body-shaming and ubiquitous porn. In gender therapists’ telling, they say, transition was their salvation. “There’s a very strong narrative that if you don’t transition you are going to kill yourself,” says Satan Herself. “I genuinely thought it was the only option.”
As the event ends, a woman in the audience says in a curiously expressionless voice: “Those surgeons should be in prison.”
‘No clinic is researching what distinguishes children who persist in cross-sex identities from those who desist’
Across the rich world gender medicine is booming, particularly for children. A decade ago the USA had only a handful of paediatric gender clinics; now it has at least 65, and scores, maybe hundreds, of adult ones that dish out cross-sex hormones to over-18s practically on demand. In 2016 Johanna Olson-Kennedy, the director of the Centre for Transyouth Health and Development at the Children’s Hospital Los Angeles, told Reuters that she had supported the social transition of over 1,000 children, with only one eventually deciding to desist. A paper in 2018 by Dr Olson-Kennedy and others discussed mastectomies carried out on trans-identifying females as young as 13. “If you want breasts at a later point in your life, you can go and get them,” she has said. Contacted for comment, Olson-Kennedy said that “a lot of drummed up fear and poor information” was being circulated.
No clinic is researching what distinguishes children who persist in cross-sex identities from those who desist. None are seeking other reasons why they might feel uncomfortable in their sexed bodies. Detransitioners’ testimony suggests plenty of possibilities: eating disorders; past sexual abuse; rejection of same-sex orientation; or autistic spectrum disorders, which cause rigid categorical thinking. No clinic is researching less drastic treatment protocols. Anyone who ventures onto such forbidden territory risks being accused of transphobia; their reputation, even their livelihood, can be on the line.
In 2015 Kenneth Zucker, a Canadian psychologist who ran a gender-identity service for young people in Toronto’s largest mental-health clinic, was fired after a campaign by trans activists. In 2018 the clinic accepted that the allegations were false, apologised, and paid Professor Zucker more than CA$500,000 (£300,000) in damages. But in the meantime his service had been shut down, and he now practises privately.
In 2018 Lisa Littman, a social scientist at Brown University in Rhode Island, surveyed parents of trans-identified teenagers whom she found on websites critical of the affirmative approach. Many said their children had shown no signs of dysphoria before puberty, and had friends who had asserted trans identities at around the same time. Littman hypothesised a type of social contagion, with groups of teenagers finding and sharing a “maladaptive” solution for adolescent angst in online transition narratives. Her work gained widespread attention. But, after lobbying by trans activists, it was withdrawn by the journal where it appeared and was sent for a highly unusual post-publication review. It reappeared six months later with some language altered, but the core findings unchanged.
About five years ago, Michele Moore, an expert in inclusive education, started to get a new and surprising sort of letter from parents who had found her name online. Previously, she would receive pleas for help from parents who were fighting councils to get educational support for their special-needs children; now she started to hear about children who were being “gender-affirmed” at school—referred to by opposite-sex names and pronouns—without their parents’ knowledge. When she went public with her concerns, a petition claiming that she was biased against trans people sought to get her removed from her position as editor of Disability and Society, the leading journal in her field. It gained 7,500 signatures and led to a review by the publishers.
That review exonerated Moore from any bias or wrongdoing. But the strain has been immense, she says. Still, she feels she cannot give up. “Every time I meet with detransitioners, I feel I can’t desert them even though I would love not to be doing this work. The threats to my job and my livelihood are all very difficult, but when I’m with people who have been harmed I feel I have to have the courage to keep the conversation open.”
Even children’s literature is not immune from harassment by trans activists. My Body is Me!, a picture book for small children, came out in December, published by Transgender Trend, a parents’ group that lobbies against paediatric transitioning. The author, Rachel Rooney, said her aim was to counter an “explosion” of books promoting gender ideology to small children—books like Who Are You? The Kid’s Guide to Gender Identity, which is aimed at children aged three and up, and explains that gender is your “personal expression—what you like, how you dress and act”. Rooney’s gentle message of self-acceptance and body positivity was likened to “Nazi propaganda” on Twitter; Clara Vulliamy, another children’s author, said it presented an “extreme ideology that explicitly targets children” and unsuccessfully called on Authors Aloud, an organisation that arranges school visits, to drop Rooney from its roster.
Before the rise of gender ideology, the surpassingly rare men who sought a “sex change” were understood to have widely varying motives. (Women almost never sought to transition, and nobody would have dreamed of a child doing so.) In the 1980s and 1990s, Ray Blanchard, a sexologist at Toronto University, classified these men into two broad groups, according to their sexual orientation. The homosexual ones had generally been feminine in behaviour and appearance from a young age, and transitioned in their 20s to fit in better—and perhaps to have better luck finding sexual partners.
The heterosexual ones were far more numerous. They had generally been conventionally masculine, often married with children, and transitioned in middle age. Most had cross-dressed in private since puberty, while fantasising about mundane or stereotypical aspects of being female: menstruating; riding a girl’s bicycle; knitting in a group of women; helping a maid clean the house. Blanchard hypothesised that they experienced an “erotic target location error” that he dubbed “autogynephilia”: sexual desire for themselves in the form of a woman.
Blanchard neither intended his theory to be used to shame anyone, nor saw autogynephilia as meaning the desire to transition was insincere or should be denied. Indeed, he argued that carefully screened members of both groups of males could do very well living as women. Now semi-retired, he still receives emails from trans women—and men who have decided not to transition—who say that they fit the description. Anne Lawrence, an American trans woman and author of Men Trapped in Men’s Bodies: Narratives of Autogynephilic Transsexualism, embraces the term.
Yet Blanchard’s work is anathema to modern trans activists and rarely mentioned any more by gender clinicians. In Galileo’s Middle Finger, a book about activists who seek to discredit evidence-based research, Alice Dreger, an American medical historian who had been active in the 1990s movement to stop doctors tidying up the genitals of babies with disorders of sexual development, rather than waiting till they were old enough to give their consent, considers why. She points out that even to refer to autogynephilia risks bringing the fantasy crashing down. “The ultimate eroticism of autogynephilia lies in the idea of really becoming or being a woman, not in being a natal male who desires to be a woman,” she writes. She describes the condition as “a love that would really rather we didn’t speak its name”.
‘Helping dysphoric children to become comfortable in their bodies makes no one much money; turning them into lifelong patients has become big business’
This determination to deny any sexual motive for transitioning is central to understanding why activists are so wedded to the gender-identity narrative. It is also, a new book argues, why gender-dysphoric children are being transitioned, despite strong evidence that they are far more likely to grow up gay than transgender. The thesis of Inventing Transgender Children and Young People, a collection of essays co-edited by Moore and Heather Brunskell-Evans, a sociologist and philosopher, is that gender-dysphoric children are interpreted as trans in order to prop up the insistence of trans adults that they are motivated by an innate gender identity that does not match their body. For there to be trans adults in this sense, there must be trans children. In Brunskell-Evans’s words, they are gender ideology’s “necessary victims”.
Another factor propelling gender ideology’s spread is the search for profit. Helping dysphoric children to become comfortable in their bodies makes no one much money; turning them into lifelong patients has become big business. In America, puberty blockers cost as much as $20,000 a year per patient. Cross-sex hormones are cheaper, but are taken for decades. Breast augmentation for trans women, or removal for trans men, costs around $10,000. Inverting the skin of a penis to make a neo-vagina costs $10,000-$30,000; constructing a neo-phallus out of a roll of flesh stripped from a forearm, $20,000-$150,000. “Facial feminisation” surgery, which disguises some of the changes caused by male puberty, costs around $100,000.
The benefits of this rest on flimsy evidence. A study in 2011 that tracked all 324 “sex-reassigned” people between 1973 and 2003 in Sweden found that though their gender dysphoria had been alleviated, they were much more likely than people of similar ages and backgrounds to have subsequent criminal convictions or psychiatric problems, and 20 times more likely to have killed themselves. International research reviews in 2004, 2014 and 2016 found that the available studies were too poor to draw conclusions. Surgery was not compared with less drastic alternatives; follow-up periods were short; many patients had been lost to follow-up; and important health outcomes, such as thrombosis caused by cross-sex hormones, had been ignored. A more positive review in 2018 found that overall gender dysphoria was reduced and mental health improved—though these results referred to a time when medical gatekeeping was stricter and probably underestimated the frequency of regret.
This controversy alone should cast serious doubt on the mantras of the trans lobby. But the issue stretches far wider: to the effects of admitting trans-identified males to what were previously female-only spaces and activities. Increasingly “no” is not an acceptable answer. Take for example Michfest, an annual music festival in Michigan for “womyn-born womyn” (spelt thus to exclude even the word “men”) that ran from 1976. Starting in 1995 trans women denied entry held a protest nearby. By 2014 human-rights groups such as GLAAD (formerly the Gay and Lesbian Alliance Against Defamation) and the American Civil Liberties Union (ACLU) had rallied behind them. Faced with petitions and boycotts, in 2015 Michfest finally closed.
Or take Vancouver Rape Relief, a women-only rape-crisis centre, which in 1995 turned down an application from a trans woman to become a counsellor. It was dragged through 12 years of legal hearings, all the way to the Canadian supreme court, before its female-only policy was ruled lawful. Though it was awarded costs, they were never paid. Earlier this year it was stripped of public funding, after a long campaign. It has been repeatedly vandalised; in August staff arrived to find graffitied death threats, and a dead rat nailed to the door.
The main institutional force behind trans activism is the big, established civil- and gay-rights groups such as Stonewall in Britain, and the ACLU, GLAAD and the Human Rights Campaign (HRC) in America. Once same-sex marriage became law, they needed a new cause—and a new reason why donors should continue to be open-handed. They found it in “gender self-identification”, lobbying to replacing biological sex in law and practice with gender identity as the basis for inclusion in spaces and activities that are traditionally sex-segregated, such as public toilets, changing rooms, rape-crisis centres, sports and so on.
A recent report published by Dentons, a big law firm, and written in partnership with trans-rights groups across Europe, reveals just how effective this lobby has been. Entitled “Only Adults? Good Practices in Legal Gender Recognition for Youth”, it argues for children of any age to be allowed to change the sex on their birth certificates without parental consent. This would not be popular, it acknowledges. But other unpopular trans-rights policies have become law before, it explains, such as gender self-ID in Ireland in 2015. It recommends linking trans-rights laws with unrelated proposals that command broad support—in Ireland, self-ID was bundled in with same-sex marriage. And it advises staying out of the news as much as possible. Irish trans activists, it explains, “directly lobbied individual politicians and tried to keep press coverage to a minimum”. Dentons said it prepared the report on a pro bono basis for IGLYO, an LGBT+ youth organisation. “The recommendations on advocacy were based on interviews with IGLYO’s members, who shared their personal experience. The firm is proud of its work for this and other pro bono clients.”
This lack of scrutiny means that, when it comes to gender ideology, public policy is very far from public opinion. In the popular imagination, trans people are a tiny minority who suffer great mental anguish and have invariably undergone a “sex change”—genital-reconstruction surgery—as a last resort.
Few understand the far-reaching implications of gender-identity doctrine: that anyone who says they are a woman, or man, must be believed. It is backed up by a strange, scavenging ideology, with fragments from various civil-rights movements woven into an incoherent but superficially compelling narrative. From feminism came the idea that women were “more than” their biology—true, but quite different from the claim that there is nothing more than biology to being a woman. From gay rights came a suspicion of arguments based on what is “normal”. Queer theory provided the convenient argument that trans people are oppressed by “cis” ones (non-trans; cis is the Latin prefix for “on the same side as”). In a clever reversal, males excluded from women-only spaces were described as oppressed by females.
In the USA, it is common to see false parallels with racial segregation. When trans women claim the right to use female changing rooms they are compared with black Southerners fighting Jim Crow laws. In this analogy a male demanding the right to enter women’s changing rooms is a civil-rights hero—like Ruby Bridges, perhaps, in the famous picture of her arriving, aged six, at a whites-only school in Louisiana in 1960 escorted by federal marshals. The women who do not want to get naked in the company of strange males are thus cast as the screaming mob of white supremacists trying to hang on to their unjust privileges.
For centuries, women were at the sharp end of sex segregation: excluded from education, the professions and many jobs. But even as the women’s liberation movement tore down those barriers, it fought for and won a quite different sort of sex segregation—that which was necessary for women to play a full part in public life. Women’s public toilets and changing rooms meant freedom to use public facilities, from shops to pubs to swimming pools. Domestic-violence refuges and rape-crisis centres provided female-only spaces to recover from male violence. Women’s sporting competitions meant the achievements of exceptional female bodies were recognised as on a par with those of male ones.
All this is now falling to trans activism. According to Stonewall’s glossary of terms, the term “trans” refers to anyone whose “gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth”—within which are included part-time cross-dressers. Estimates for the share of people who might self-identify as trans according to such a broad and woolly definition range from 0.5 per cent to as high as 4 per cent, all of whom would be entitled under self-ID laws to use facilities intended for the opposite sex.
Few of those people will ever undergo any sort of gender surgery. Many neither suffer from gender dysphoria nor make any effort to “pass” as members of the opposite sex. Alex Drummond, a bearded, middle-aged male who wears lipstick and sometimes a skirt, advises Stonewall on lesbian issues. “Pips” Bunce, a senior male Credit Suisse executive, dresses as Pippa on some days (in a blonde wig, pink dress and fishnets) and Philip (no makeup, standard-issue man’s suit) on others. In 2018 Bunce, who self-describes as “gender-fluid” rather than as a trans woman, accepted a Financial Times award for “female champions” of women in business.
Gender self-ID is becoming the norm in all formerly sex-segregated spaces, not just public toilets. That includes prisons—even though almost all violent or sexual offenders are male; and despite significant disparities between the sexes in strength and aggression. Ireland already has two male rapists held in women’s prisons, both escorted at all times by prison guards for the protection of female inmates. Among the sizeable number of males incarcerated in women’s prisons in Canada, where self-ID is federal law, are two paedophiles, one who assaulted three girls aged under eight and another who assaulted a three-month-old baby. They are being held in prisons with mother-and-child facilities. In Sweden a man who murdered and dismembered his ex-girlfriend in 2013, and decided to transition while held in a top-security men’s prison, was transferred to the women’s estate in October. In Britain, where activists have managed to push self-ID in practice despite failing (so far) to make it law, Karen White, formerly Stephen, a multiple rapist, was moved to a women’s prison in 2018—before being moved back again after sexually assaulting several other inmates.
As I have written in a previous issue of Standpoint, sport is rapidly going self-ID. Rachel McKinnon (pictured) holds a women’s world record in cycling. Hannah Mouncey, an Australian who played for the national men’s handball side before transitioning, recently wrote about turning down a spot on the women’s side because of the other players’ “frankly ludicrous” objections to having a male in their communal changing rooms and showers.
Males were first permitted to compete in women’s Olympic events in 2004, provided they had transitioned surgically. That rule never made much sense: most of the male sporting advantage is due not to the testosterone produced every day by the testicles, but to the legacy of male puberty. This includes a larger heart and lungs, stronger bones, a narrower, more ergonomically efficient pelvis and more high-twitch muscle fibre. But the small number of people who undergo transition surgery, and the fact that until recently it was usually sought in middle age, meant that male athletes did not enter women’s elite sports in noticeable numbers.
That is starting to change. Since 2015 male athletes have needed merely to take medication that lowers their testosterone levels for 12 months (to a level still far higher than seen in women) in order to compete in the Olympics as women. Tokyo 2020 may see some quite mediocre male athletes swipe women’s golds. One to watch is Laurel Hubbard, a 41-year-old New Zealander who won gold medals in women’s weightlifting at the 2019 Pacific Games, knocking two female Samoan teenagers down to silver and bronze.
Tokyo 2020 will put the consequences of gender ideology in front of a global audience of billions. The sight of larger, stronger males on podiums flanked by the females they have defeated will highlight the reality of sexual dimorphism in a way that revolts intuitions about fair play. Small countries that excel in just one or two events will see their hopes dashed. Women who complain about males in their sporting events are often criticised for being “unkind”—or worse; last year Martina Navratilová was dropped by her sponsors when she said males should not be allowed to compete in women’s events. But sponsors are also unlikely to find much benefit in being associated with events that are widely regarded as a farce. Samoa’s prime minister described Hubbard’s victory in the Pacific Games as “shocking” and “unfair”.
This year will also see an escalating legal fightback against the campaign to push gender self-ID onto the statute book in Britain. The most salient issue is that of children. As growing numbers of detransitioners speak out—and some perhaps seek to sue their doctors—it will become harder to overlook the malign consequences of replacing objective sex categories with subjective gender identity in law, society and medicine. The real question is how much more damage will be done before public opinion finally turns.