“Desistance” in two cases of transgender men

August 6, 2021 • 1:15 pm

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.

50 thoughts on ““Desistance” in two cases of transgender men

  1. “internet chat room” seems to come up a lot more than is healthy. I like you guys, but if I’m making any sort of major life decision, you aren’t the folks I’m going to for counsel. Which when I think about it, makes the troubled childhood/family life background of these cases a bit of a double whammy – it not only messes with your head, it removes what for most people is a key support network.

    The case study approach is excellent and makes me want to facepalm for not having thought of it earlier. Very much in the style of Oliver Sacks, done well they can make for both engaging reading for a wide audience, and provide compelling insights. “More of them please” might be a good way to approach the subject.

  2. While I gather these people are rare compared to [non-desistors]

    I’m not sure we know that. Desistance is rare among those who start transition as settled adults (over age 25 or so), but (as far as I’m aware) no-one has reliable statistics for those who start transition as teenagers.

      1. They are activists. It is not their mission to be objective. I don’t think there is reliable data on the issue, if only because the issue, in it’s current scale, is still fairly new.
        Some percentage of trans folks go through the process of detransitioning. Others, when they realize that their expectations will never be met, live lives of despair, or take a lot of depression meds. And there are a lot of suicides.
        We just can’t know those numbers and percentages right now, because there is a cohort of people actively trying to suppress any such comprehensive research.

    1. This is why we need more research, really more surveys, on trans histories. When did you start to feel different? Did you always feel you had a trans orientation? Was this feeling constant or did it come and go over months or years? I’ve had the impression (based on some anecdotal conversations with trans and gay people) that some go thru phases where they feel like they are batting for one team, and later they swing back to be on the other team. And many settle into somewhere in the middle, or on neither.

      1. Research is difficult partly because of psychopathic trans activists like Andrea James who stalk and threaten not just researchers but their families. Read Galileo’s Middle Finger by Alice Dreger.

    2. As Shrier points out, desisters are not rare at all among the SOGD’s (sudden onset gender dysphoria): between 70 and 88%!

  3. In the general case we, society, have decided that when a person is in severe mental distress that they shouldn’t make decisions about serious matters and that they should be held less responsible for decisions or actions while in that state. We have all sorts of laws and rules to protect people in such conditions.

    I agree with that, that the kind of society I want to live in is one that will try to protect me from myself when my ability to do so myself is compromised. I’m hard pressed to think of examples with more serious consequences than using hormones and surgery to make drastic changes to your body that you will never be able to recover from, nor examples of more serious mental distress than a young person who hates themselves so much that they are willing to take that risk.

    I absolutely agree with Jerry. Mental health treatment should absolutely come first. Such a serious decision should not be made while in such serious mental distress.

    A good point from the quoted material, that seems obvious once brought to your notice, is that with today’s medical technology it is not possible to change people fully from one sex to another. Buyer’s remorse seems entirely plausible to me. Especially given that you can never fully go back to what you were, if your transition does not meet the image you had of what you wanted to be, that would be crushing.

    1. (Bianca) was seen by Britain’s specialist service for two assessment consultations in which she persuaded the worker that she had been gender dysphoric for many years and that she was feeling suicidal. Following this, she was placed on puberty blockers.

      Normally, people who are suicidal (or report being suicidal) would be at the top of the “severe mental distress” list, and psychologists would agree that no major decisions should be made till this unstable state of mind is resolved. Instead, the narrative is that wanting to kill yourself is a perfectly reasonable reaction to feeling as if you’re in the wrong body and/or are the wrong sex, and the medical solution is permanent cosmetic changes through drugs and surgery.

      I find this astonishing. And I’m also astonished by ‘science-based’ opinions that sex is either mutable, or replaced by “gender.”

      1. In fairness, I’m not sure there’s a whole lot we can do about doctors who are essentially hoodwinked into a diagnoses because a group can train you on exactly what to say to them. Train the doctors on what sort of catchphrases to look for, I guess. But I suspect the trust implicit in the doctor-patient relationship means it’s always going to be somewhat vulnerable to fraud. The industry has trouble just managing addictive drug use, and that’s an area where they’re actively on the lookout for deception. I can’t imagine they’re going to be anywhere near as good at detecting deception in a medical area like this.

      2. “And I’m also astonished by ‘science based’ opinions that sex is either mutable, or replaced by “gender””. As you already indicated by your hyphens, rest assured, these opinions are positively not science based.
        They are pomo and activist inspired drivel.

  4. To be frank, the woke sanctification of transgenderist delusions is much worse than the dismissal of “bourgeois Mendelism-Morganism” in that fabled utopia of yesteryear. The idea that sex is merely something “assigned at birth”, like citizenship, is nonsense. So is the concept, apparently accepted in Connecticut and Ireland, that sex can be changed by simply asserting the change. Finally, the
    idea that one can be “born in the wrong body” is worse than nonsense; it is, to be blunt, crazy.

    That such hooey has become a conventional part of woke doctrine confirms Geoffrey Wheatcroft’s observation, 20 years ago, that the Left was no longer intellectually serious. After the collapse of Communism, a pop zombie-Left remained with the authoritarian impulses and leaden rhetoric, but without any of the intellectual substratum of Marxist-style class analysis. A sociological study of how the Left lobotomized itself in this way would be useful. My own view is that this self-lobotomy is entirely due to post-modernism and grievance studies in the groves of academe, from which our current pop-Left draws all its shibboleths. So, academia is influential after all.

    1. I don’t think this situation is “entirely” due to academics. I see elements from a pre-occupation with therapy and self-actualization, gaming culture and identifying with avatars, guilt over discrimination against homosexuality and a desire to make amends, anti-bullying and “being kind,” and more. I suspect it may be a perfect storm.

    2. There are people who really are trans gendered. It is not hooey or crazy or delusional. It is literally the experience that your body is the wrong sex. I’ve known a couple trans people who were (last I checked) quite sure they made the best decision for themselves to transition. Complicating matters, though, is that there are a range of orientations between cis and trans, and I understand some report that they oscillate around in self-orientation. This is why this issue is so tricky.

      1. It is literally the experience that your body is the wrong sex.

        How can “literally experiencing that your body is the wrong sex” be differentiated from “experiencing a strong feeling that your body is the wrong sex?”

        It sounds like the distinction between “literally experiencing the presence of God” and “experiencing a strong conviction that one is in the presence of God.” In both cases, the sincerity of the believer and the subjectivity of the experience doesn’t entail the truth of the first interpretation.

        1. I can happily rephrase it to be what you say: ““experiencing a strong feeling that your body is the wrong sex”. In any case, of course what is intended here is the subjective conviction that ones body should be a certain way.

      2. The thing is that there are no tests or ways to know for sure which patients will benefit from transition. I’m sure some do (albeit very few to no SOGD’s), but the unknowns are very large In such cases reticense is indicated.
        Stronger, I think that medics and surgeons that proceed with hormones and surgery without an extensive medico-psychiatric work-up should be stricken from the roll.

    3. The idea that sex is merely something “assigned at birth”, like citizenship, is nonsense.

      Just to report that an editorial in the latest issue of Nature uses the phrase: “assigned female at birth”. Woke capture proceeds.

      1. Assigned at birth is only a hornets’ nest in < 0.1% of the population .
        XY pseudohermafroditism is a (rare) reality. Generally not much of a problem besides infertility. But a huge problem in sports, ie. women's sports.
        I think the simplest way to determine if somebody is male or female is to check for the SRYgene , overwhelmingly found on the Y chromosome. So much so it would suffice to check for a Y chromosome. Easily done.
        I'm talking here about 'women' that don't know they are men. Victims of biology.
        I'm not talking about male athletes suddenly identifying as women. Those are just cheats.

  5. Considering how traumatic growing up is for many kids, that some come to believe they were born with the wrong gender is not at all surprising. A lot of the pressure comes from the in-built desire to succeed in the battle for mates. When that doesn’t go well, for whatever reason, the idea that one might do better as a member of the “other side” is going to occur. Of course, they may be victims of the “grass is greener” effect. Even worse, as transgender, they are unlikely to win the battle for mates on the other side either. While I acknowledge that gender transformation might be a solution for some small part of the population, it seems like it should be discouraged and only taken as a last resort. Of course, that’s my gut feel. I await the science.

  6. … two case studies written up fairly neutrally, as psychologists and psychiatrists often do.

    You mean like “Anna O.” in Herr Doktor’s Studies on Hysteria? (I kid!) 🙂

    1. Indeed. The case studies are carefully and sympathetically written up. But I note that both the authors describe themselves as ‘psychoanalysts’. A bit of a red flag for me.

      1. What does “a bit of a red flag” mean, then? You think they made up the women’s words? If they described themselves as “cognitive behavioral therapists” would you find the article more palatable. I don’t like psychoanalysis much, and certainly not the Freudiian variety, but there are all brands of psychoanalysis these days and I prefer just to read the article rather than judge its veracity (which comes mostly from the women’s own words) by professional descriptions of therapists.

  7. I find the risks of transitions problematic, but this source throws up a lot of warning flags:
    – Anecdotal
    – Psychoanalysis
    – Pop terminology.

  8. “…She explained to the clinic that she hated herself and hated her love of women, which she felt was unacceptable.”

    Possible responses from the internet activists …

    a) “Don’t worry, when you get further along and the testosterone kicks in, you will still love women like mad, but with no shame or guilt or self-hate, because you will be a red-blooded randy boy.”

    b) “Don’t worry, once you become a real boy, we will help you learn to express your inner homosexuality, and you’ll go boy crazy for boys.”

    Reality: please consider that your love of women is simply honest lesbian attraction.

  9. Whatever happened to “which of your bits of skin do you rub against which bits of other people’s skin, and precisely what is it’s relevance to me, or my goldfish?”
    Is my skin involved at some point? No? Then it really is precisely (not approximately) NONE of my business. Zero, nada, nil, none.

    1. The question of parental rights and self-determination for kids is very much of relevance to me, and my business, because I live in this country and have a kid.

      This does not mean I’m against any transitions. It doesn’t mean I’m for them. It does mean, however, that tales of doctors giving underage kids drugs after the kid was coached in an internet chat room on what to say to get the drugs is pretty alarming and something I’d think a whole lotta people, me included, have an interest in stopping.

      1. And you thought all this through before you stopped using contraception and started trying to have a child. Of course you did – you’ve reproduced.

    2. @gravelispector

      When coercive government initiates coercion to force results due to a claim that involves what should have been, indeed, no business of anyone, the claimants private matters and parts must become public.

      1. Where is the government involvement here? It’s the NHS, not a CIA black-op under Black Mesa.

        1. @ fravelinspector

          Government can coerce its own agencies, and public accommodation, and schools, and … etc forever … to treat a natal man who simply claims to be a woman the same as if a actual woman.

          What if I have a woman-only clothing optional health spa “open to the public” , and a natal man – a fully natal man – claims to be a woman and demands service. I refuse service. “She” sues me.

          Use your imagination to continue this story.

  10. Two other points – in F to M transitions they use a lot of testosterone which is an anti-depressant. Consequently the patient can mistake the thrill of transitioning with the anti-depressant effects of the testosterone.

    AND…. one thing we never hear about is how a transition narrows one’s future dating options. Patients are immediately deleting a large % of both straight and gay potential partners with the transition. That’s never a good move.
    D.A.
    NYC

    1. Patients are immediately deleting a large % of both straight and gay potential partners with the transition.

      They are?
      Why? I don’t see the connection.

  11. For anyone interested in a balanced, nuanced view of the issues surrounding trans people, i recommend ‘Trans – when ideology meets reality’ a recently published book by Helen Joyce.

      1. I’ve just started reading it on Kindle. She writes with a nice clarity:

        Most people are in the dark about what is being demanded by transactivists. They understand the call for ‘trans rights’ to mean compassionate concessions that enable a suffering minority to live full lives, in safety and dignity. I, alongside every critic of gender-identity ideology I have spoken to for this book, am right behind this. Most, including me, also favour bodily autonomy for adults. A liberal, secular society can accommodate many subjective belief systems, even mutually contradictory ones. What it must never do is impose one group’s beliefs on everyone else.

        The other belief systems accommodated in modern democracies are, by and large, held privately. You can subscribe to the doctrine of reincarnation or resurrection alongside fellow believers, or on your own. Gender self-identification, however, is a demand for validation by others. The label is a misnomer. It is actually about requiring others to identify you as a member of the sex you proclaim. Since evolution has equipped humans with the ability to recognise other people’s sex, almost instantaneously and with exquisite accuracy, very few trans people ‘pass’ as their desired sex. And so to see them as that sex, everyone else must discount what their senses are telling them.

      2. There is a very good article in the (London) Times today by Lionel Shriver (female) who castigates the cowardice of publishers, booksellers and the BBC who have spurned that book. Waterstones ( the biggest UK bookseller) are actively suppressing sales. “Customers are obliged to special-order or told that the print run was puny (a lie; warehouses have never run short of a book already in its third printing).” despite the book being in the bestseller lists. The book has been described as “radioactive” and, so far, no US publisher has touched it and it took an especially brave UK publisher (OneWorld) to run with it after a number of high profile ones refused .

        What is inspiring is that pretty well all of the comments associated with the article are pro-Shriver and Joyce.

  12. I thought puberty blockers were only relevant to people who hadn’t started puberty, so isn’t 16yo several years too late?

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