Andrew Sullivan is a writer and a gay activist who played an enormous role in mainstreaming the idea of same-sex marriage in both the LGBT movement and in the culture at large, has just placed a very large target directly on his back. New York Magazine just published an extensive essay written by Sullivan titled “The Hard Questions about Young People and Gender Transition,” and Sullivan asks some hard and heretical questions of the movement he has long been a part of, and dares to ask whether we might be destroying some of these children and teens. I’ve excerpted some relevant passages from the essay below—take a few minutes and give it a read:
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…Right now, we are effectively experimenting on minors who cannot give meaningful consent. And that alone should give us pause.