This article and this post are surefire attractants for pushback, for they describe how two experienced therapists dealt wth two cases of “desisters”, or people who have started the route to transsexuality but then either reversed or renounced their decisions. While I gather these people are rare compared to those who begin puberty blockers and then continue transexual changes with hormones and sometimes surgery, the two cases described in this Quillette article (click on screenshot) give us some insight into why young girls decide to transition, how they do so, the kind of obstacles they face, the “support” they get from compliant therapists and doctors, and, in particular, the rah-rah don’t-introspect encouragement they get to continue transitioning from the online community.
Their cases may not be typical, but according to Abigail Shrier’s book Irreversible Damage: The Transgender Craze Seducing our Daughters, they’re not uncommon, either. I suggest you read the piece even though it’s long, as it reveals a number of things that concerned Shrier in her book. In particular, while attacking Shrier’s book on the Science-Based Medicine site (and removing a favorable review of it by their colleague Harriet Hall), David Gorski and Steve Novella emphasized the high standards of care that professional organizations mandate for young people wishing to change gender. What this article shows is the damage done when those standards are violated. (That is Shrier’s point—not that standards are always violated, but that it’s easily done, and can cause that “irreversible damage” when things aren’t done properly. Shrier is not a transphobe, but has been painted as one because she urges caution.)
For full disclosure, here are the bona fides of the authors:
Susan Evans tweets at @sueevansprotect. She is a psychoanalytic psychotherapist, a former registered nurse and psychiatric nurse, and a former staff member of Britain’s public-health Gender Identity Development Service. Marcus Evans tweets at @marcusevanspsyc. He is a psychoanalyst in private practice, and formerly served as Consultant Psychotherapist and Associate Clinical Director of Adult and Adolescent Service at the Tavistock and Portman NHS Trust. This essay has been adapted, with the authors’ permission, from the recently published book, Gender Dysphoria: A Therapeutic Model for Working with Children, Adolescents and Young Adults, by Susan Evans and Marcus Evans, published by Phoenix Publishing House Ltd. Copyright © 2021 by Susan Evans and Marcus Evans.
Click on the screenshot to read. It is not a tendentious article, but rather two case studies written up fairly neutrally, as psychologists and psychiatrists often do. You can draw your own conclusions, but for sure the piece will be deemed transphobic, for it describes two desisters, individuals the transgender activist community would prefer to ignore.
So we have two transgender men, born as women, going into therapy, “Bianca” (details and names changed, of course) was a 25 year old who began taking puberty blockers at 16 and went on to testosterone therapy and then a mastectomy and hysterectomy at 20, while “Emily” was a 22 year old who had become a transgender man and then detransitioned.
I won’t go into the details of each case, but there are similarities between them.
First, both women had difficult or traumatic childhoods, and hoped that changing sex might help resolve some of their psychological difficulties. When this didn’t happen, it threw them into depression, and eventually they sought therapy from the authors.
In both cases, after transitioning they realized that their desire to really “change sex” was an illusion. For one reason or another, they didn’t feel like men or had others consider them as men. Some of this was connected with the inability of hormonal or surgical treatment to turn them into their own images of “men.” Nor did the transitions resolve their underlying psychological difficulties, which remained. This caused yet further trauma on top of their unresolved childhood issues. (It’s been observed that many people who want to change genders have psychological problems, which may help explain both the high pre- and post-transition suicide rates of transgender people.)
Here’s what the authors say:
Detransitioners and desisters often report being aware of doubts in their minds, but then ignoring them and pushing on. This involves a form of mental double bookkeeping as, on the one hand they push for transition, while on the other hand they question the direction of travel.
We have observed that the desire to transition is often connected to an attempt to distance the person from the psychic pain related to internal and/or external traumatic experiences. These traumas and their effects can be reawakened by more recent developmental conflicts or events in the young person’s life. The child tries to control their underlying vulnerability by projecting unwanted aspects of the self into their natal body, which is then regarded as the problem that needs to be changed or eradicated. At this point in their gender-identity history, most young people will strongly resist any attempts to explore the psychological aspects of their presentation because they will feel any adult who questions their resolution is undermining their solution to their psychological well-being.
In our clinical experience, we often find that the vulnerable part of the self, which is hated, has been captured by a part of the self that believes psychic pain can be eradicated through a transition. Ordinary doubts and anxieties about the belief system are dismissed and attacked as they undermine the concrete solution. However, once the excitement of transition wears off, the individual can find themselves disillusioned, facing the social, physical, and psychological damage done. This can lead to a re-emergence of underlying feelings of despair, sadness, and anger, now often compounded by a sense of guilt or shame for their own part in the process.
It’s no surprise, after hearing about the shock that Bianca and Emily experienced when realizing that their actions didn’t turn them into the “real” men they wanted to be, that the transgender-activist community is so insistent that trans men are men in every respect, and that trans women are women in every respect. It is a form of verbal confirmation that the rest of us must adhere to, but at least in some cases is surely a strategy to quash doubts.
The authors seem highly empathic, and the accounts of therapy they give show them as sensitive and delicate with the desisters. They do not pass judgment on their subjects, but instead try to get them to understand themselves, which is what good therapists do. Bad therapists—and both subjects describe some—immediately diagnose adolescents like Bianca and Emily as being of the wrong sex, and set them immediately on the path to treatment, beginning with puberty blockers or hormone treatment. Compliant and nonquestioning physicians—and these are also described—push ahead with the surgery. These cases exemplify the lack of proper care from some doctors and therapists dealing with an irreversible decision, and I, for one, am convinced that a fairly intensive period of therapy with objective and empathic therapists must precede any actual medical treatment with hormones.
But the most disturbing bit of the article is the “support” these girls (I use their natal sex) got from the Internet community. This is “support” that was not really supportive, for it was highly tendentious. Over and over again, we hear how Bianca and Emily used the ideas they got from the Internet to keep on with their transition, even when they had doubts. Puberty blockers? Take them, says the Internet! Hormones—yes, of course. What to say to doctors and therapists to ensure that they approve your transition? The Internet is full of advice about how to gull doctors and therapists. And if you have doubts, there’s nobody to listen sympathetically, for these are not therapists, but activists. They don’t do doubting. Here are a few quotes from the subjects:
Bianca: After an initial feeling of excitement about starting on the blockers, I felt flat, as if all the life had been taken out of me. I spoke to the trans support group, and they said that it was normal and that I would feel better when I progressed onto the cross-sex hormones. Again, the group was incredibly supportive and encouraged me. I also started to experiment with living as a boy, and this gave me a feeling of excitement and pleasure. I began to drift away from all my friends, spending more and more time online in my chat group.
Therapist: You were being given an idea that everything would be okay if only you could stop your development as a girl and transition to be a boy.
Bianca: [Angrily] That was the message throughout the whole process, including some of the professionals who seemed to encourage the idea that transitioning was a solution to my problems. [After a pause] Looking back, I can see that the online group was always critical of my previous friends and family, encouraging me to feel that they did not understand me or that they were responsible for my feelings of rejection.
. . . (from Bianca) However, I was still looking like a girl and felt very self-conscious.
This was when I started to think I needed surgery. I began talking about this in my online group. I became convinced that I had to go through the whole thing—having my breasts removed then having the bottom surgery. I started researching and looking into the next steps. I met up with the trans community at organized events, and they were all so supportive and encouraging. I thought I had finally found somewhere I belonged. Once again, I was advised what to say in the interviews [with therapists and doctors]. It was like an exciting game.
. . .I had to wait several months for the first operation, during which time I started to get doubts about what I was doing. I mentioned my doubts to the [online] group, and they said that doubts were normal, [but] they would disappear when I had the mastectomy. They said that I had been unhappy as a girl for many years and that I probably wouldn’t be happy until I fully transitioned.
They were suspicious of newer members of the group, who expressed serious doubts about the process of transition. In many ways, the group got quite nasty, saying that the ones expressing doubts were weak and were selling out on their true selves. I remember feeling anxious about discussing my doubts anymore because I didn’t want to get that criticism from the group. By this time, I had left home and I was living on my own in a bedsit [one-room apartment], completely separated from my parents and everyone in my family, except for the odd phone conversation with my brother.
Therapist: Very difficult for you to stop to face all these critical thoughts and feelings. I imagine you were worried you would be rejected by the group and you already felt you had lost connection with your family.
Bianca: Yes, but also, I feel angry now. Why didn’t anyone stop me or question me? Why didn’t anyone ask me, “Look, what are you doing?” Instead, they all endorsed it, encouraged it even. They all said that it would sort things out … The doctors should have asked more questions, delved a bit deeper.
And a bit from the case discussion of Emily, which is much shorter than that of Bianca:
Emily said that she started to tell herself that she did not really like her body, in order to fit in more with the other online friends and their descriptions of “being trans.” Despite not feeling particularly dysphoric, Emily started to wear a binder for her breasts and eventually reached the stage where she would not leave the house without the binder on. She found it extremely uncomfortable, but said that she could remember feeling there was almost something good about being able to withstand the pain, as if it were an achievement of some sort.
Over time, she spent more and more hours on Internet chat rooms, where she felt persuaded to go on to transition, and at 16 she asked her local doctor to refer her to the gender-identity clinic. Once referred, she persuaded clinic staff that she wanted to transition. She commenced on cross-sex hormones aged 17.
Emily explained that she did not really engage with thoughts about why she wanted to transition, or what the long-term implications would be. She explained to the clinic that she hated herself and hated her love of women, which she felt was unacceptable. She described living in a dream-like state, supported by her trans friends online, who encouraged her to believe that she would feel so much better when she had transitioned. At no stage did anyone explain that she could not biologically transition to be a male. . .
It goes on, and what I like about the article is that it simply describes the cases and the words of the two desisters. The first quote in this article gives the tenor of their analysis, and doesn’t go nearly as far as Shrier does in her book describing a tsunami of ill-considered attempts to transition—attempts facilitated by people whose personal interest is getting other people to change gender.
Yet when I read articles like this one, I think Shrier was really on to something. At least in the two cases above, which Shrier’s experience says can be multiplied many-fold, one cannot describe these episodes as “transphobic”. They are simply the attempts of psychologically confused and distressed young people to get help.