No One Is Denying That “Desistance Occurs,” Jesse Singal

The desistance myth is the belief that “about 80 percent of kids with gender dysphoria end up feeling okay, in the long run, with the bodies they were born into.” This is not true. It is a pernicious and damaging myth, because it encourages parents to disbelieve their kids and even to refuse to allow their kids to get appropriate care and treatment.

This blog post is about a relatively minor claim in Jesse Singal’s latest article about trans issues, concerning what critics of the desistance myth say.

Singal’s article has many second-person-removed claims. For example:

Many of these so-called detransitioners… say they were nudged toward the physical interventions of hormones or surgery by peer pressure or by clinicians who overlooked other potential explanations for their distress.

Which clinicians pushed them? Is there any verification of this?

Similarly:

The concerns of the detransitioners are echoed by a number of clinicians who work in this field, most of whom are psychologists and psychiatrists. They very much support so-called affirming care, which entails accepting and exploring a child’s statements about their gender identity in a compassionate manner. But they worry that, in an otherwise laudable effort to get TGNC young people the care they need, some members of their field are ignoring the complexity, and fluidity, of gender-identity development in young people. These colleagues are approving teenagers for hormone therapy, or even top surgery, without fully examining their mental health or the social and family influences that could be shaping their nascent sense of their gender identity.

Note that Singal isn’t making any of those claims himself; he’s just reporting that others are saying that, without confirming if what they’re saying is true or not.

This seems, frankly, like shoddy reporting for a front-cover feature in The Atlantic.

Who are the clinicians who echo these concerns?

Which professionals are approving teens for top surgery without “fully examining” first? (What does “fully” examining mean, anyhow?) If these professionals are acting unethically, why not say who they are?

Did Singal fact-check at all before publishing these claims? If he did fact-check, what did he find out?

By putting all these claims in the anonymous second person, Singal inoculates himself from having to say if these claims are false or true (while strongly implying they are true). He’s made himself immune to fact-checking.

Which is why this relatively minor claim, about what critics of the desistance myth say, caught my eye. It’s one of the few places in this article where Singal makes a claim that I can actually check. Here’s Singal:

Within a subset of trans advocacy, however, desistance isn’t viewed as a phenomenon we’ve yet to fully understand and quantify but rather as a myth to be dispelled. Those who raise the subject of desistance are often believed to have nefarious motives—the liberal outlet ThinkProgress, for example, referred to desistance research as “the pernicious junk science stalking trans kids,” and a subgenre of articles and blog posts attempts to debunk “the desistance myth.” But the evidence that desistance occurs is overwhelming. The American Psychological Association, the Substance Abuse and Mental Health Services Administration, the Endocrine Society, and Wpath all recognize that desistance occurs. I didn’t speak with a single clinician who believes otherwise. “I’ve seen it clinically happen,” Nate Sharon said. “It’s not a myth.”

(Incidentally, many, possibly most, current critics of the desistance myth, are criticizing Jesse Singal’s own articles. Singal should have disclosed this to his readers.)

“Desistance,” depending on the writer, can refer to different things. In this article, Singal defines it like this: “desisters are people who stop experiencing gender dysphoria without having fully transitioned socially or physically.” The term has also been used to refer to people who are diagnosed as trans, but eventually identify with the sex they were assigned at birth.

Singal explicitly claims a “subset of trans advocacy” debunks “the desistance myth” by arguing that desistance never occurs.

That would be an incredibly unreasonable thing to argue. Which explains why no one of any note argues it.1 Rather, when debunkers refer to the desistance myth, in virtually every case they are referring to something like this claim:

While the actual percentages vary from study to study, overall, it appears that about 80 percent of kids with gender dysphoria end up feeling okay, in the long run, with the bodies they were born into.

That’s the actual desistance myth trans advocates are debunking. But Singal misreports their argument, replacing it with a much weaker argument.

It’s possible that Singal is not purposely deceiving, but is simply not objective enough to correctly parse the argument against the desistance myth. But it doesn’t actually matter. Singal is being purposely deceptive about what critics of the desistance myth argue, or he’s so biased that he can’t correctly discern what they are arguing. Either way, he’s not a reliable reporter.

I think this is typical of the (possibly unintentional) dishonesty practiced by Singal and many of his defenders. They refuse to address the arguments against their views in good faith, preferring to attack strawman and marginal arguments, while diminishing or ignoring more substantial arguments. Another example is Singal’s colleague Katie Herzog, who – in the pages of The Stranger – claimed critics pegged her and Singal as transphobic, not because of what they wrote, but because they are cis.2 This claim is utterly false, as anyone could tell with a google search – but how many Stranger readers will check? Like Singal, her tone seems so reasonable and trustworthy.

The fact that this claim of Singal’s is false, does not prove that Singal’s unverifiable claims are false.

But I don’t think they can be presumed to be truthful, either.

This is the end of this blog post; what follows is a description of the ten google results I examined.


P.S. Just to be clear – the claim that 80% of gender dysphoric children “desist” is nonsense – especially when used to imply that a large portion of people who transition will eventually detransition. Several of the links below refute the desistance myth in detail.


I did a google search for “the desistance myth.”3 I then went through the results to find the first ten webpages criticizing the desistance myth. This involved going deeper than just the top ten results, since I eliminated duplicate results and webpages refuting the idea that there is a “desistance myth” (including one written by Jesse Singal himself). The ten pages I wound up with are listed at the bottom of this post.

My working assumption is that if the argument Segal debunks is so common among “a subset of trans advocacy” as to be worth addressing in The Atlantic, then it would be easy to find with a google search.

One of the top ten results was the ThinkProgress article Singal cites.

Not a single one of these articles denies that desistance ever happens. In every single case, “the desistance myth” refers to the idea that research shows that a large majority of kids diagnosed with GID “desisted”; I did not find one example of the argument Singal claims to be criticizing.

For example, this is what the ThinkProgress article Singal cited says:

Dating back decades, there are about a dozen studies that prop up the desistance myth. Each claims to have studied a cohort of kids with GID and found that a significant percentage (around 60 to 90 percent) of those kids ended up “desisting” in their gender dysphoria and embracing the gender that they were assigned at birth.

There is no good-faith reading of this as the author denying that “desistance occurs” at all. Singal attributes a claim to this article that is not anywhere in the article.

What follows is a list of the top ten google results I located.

The End of the Desistance Myth – Huffington Post

It’s time for the 80 percent desistance figure to be relegated to the same junk science bin as the utterly discredited link between vaccines and autism.

The Desistance Myth – Transfigurations
The author, Julia Serano – possibly the most prominent critic of the desistance myth – explicitly acknowledges that desisters exist.

There are numerous reasons why a person might detransition: some of them visceral and personal (e.g., perhaps transitioning didn’t feel right for them), and others directly related to societal transphobia (e.g., the loss of jobs, housing, family, support system, safety). It could also be some combination thereof.

The article critiques, not the idea that desistance ever happens, but the idea “that 80 percent of children who experience gender dysphoria (or “gender identity disorder,” as it was called in previous versions of the DSM) eventually grow up to be comfortable in their birth assigned gender.”

Dispelling the “desistance” myth of youth gender non-conformity

Those of us familiar with this debate have heard the critics use discredited research which claims an 80% (or more) rate of “desistance” in gender non-conforming (GNC) youth, sometime during puberty.

The article goes on to cite more recent, not yet published research which found a desistance rate of about 4%. Several of the articles on this list approvingly cited this 4% research. Whether or not this research holds up and is replicated over time, however, clearly no one approvingly citing the 4% figure is denying that desistance ever happens. 4% is not 0%.

The pernicious junk science stalking trans kids – ThinkProgress

Dating back decades, there are about a dozen studies that prop up the desistance myth. Each claims to have studied a cohort of kids with GID and found that a significant percentage (around 60 to 90 percent) of those kids ended up “desisting” in their gender dysphoria and embracing the gender that they were assigned at birth.

The end of the ‘desistance’ myth? | Growing Up Transgender

Anyone with even a cursory awareness of issues relating to transgender children will have heard the 85% ‘desistance’ myth.

This article includes a more detailed discussion of the 4% figure.

Trans Britain: Our Journey from the Shadows – Google Books

Flawed research statistics and the voices of disqualified doctors claim that about 80 percent of all trans kids desist being trans. This idea of the ‘desistance myth’ has been debunked by many already.

Everything you need to know about trans children, gender affirmative therapy and hormone blockers

A recent landmark court case in Australia showed that up to 96% of trans kids who sought services from the gender clinic at the Royal Children’s Hospital of Melbourne between 2003-2017 continued to see themselves as transgender as they got older.

Emily G kmii on Twitter: “The desistance myth is an example of a failure to reconcile what could be considered Lagrangian vs Eulerian frames.”

In context, Emily is talking about the myth that “90% of trans kids desist.”

Fox Fisher on Twitter: “Detransition is 4% not 85%! The end of the desistance myth via this excellent blog https://t.co/wQxlLa3G1t #transgender”

(Note: The link goes to the “growing up transgender” blog post which is included earlier on this list.)

Media Misinformation About Trans Youth: The Persistent 80% Desistance Myth | GID Reform Weblog by Kelley Winters

  1. I have seen people argue that the definition of “desister” is too unspecific to be meaningful, and therefore they won’t say if desistance happens or not. But that’s a different argument than Singal’s strawman. []
  2. Here’s the exact quote from Herzog: “I was quickly pegged as transphobic, not because of the content of my piece but because I, a cis woman, had the audacity to write it. This, apparently, was many people’s problem with Singal, and they took to Twitter to argue that this article should have been written by a trans person instead.” []
  3. I first took steps to avoid google’s personalized search results, since I wanted google’s unfiltered results. []
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17 Responses to No One Is Denying That “Desistance Occurs,” Jesse Singal

  1. 1
    Grace Annam says:

    Thanks for posting this, Amp. Someone brought the topic of desistence up and mentioned that it was the topic of a piece in The Atlantic, and before I even looked at it, my response was, “I’m so tired of my legitimacy being a fit topic of discussion.” Then someone mentioned that they saw that the author was Jesse Singal and stopped right there.

    I was inclined to do the same. However, I was about to be presenting at a conference, and running a question-and-answer-and-discussion workshop, and so I knew I had to be informed about it. So I read it, but it ended up being quickly and under distracting circumstances, and I did not read it as closely as you did, and needed time to process. You noticed things which I did not, and helped me to articulate some of my discomfort with the piece. So, thank you.

    Also, on Jesse Signal’s credibility on trans topics (I have nothing to say about him generally), it’s important to get further info from Julia Serano, and Julia Serano again, and Parker Molloy.

    Grace

  2. 2
    Grace Annam says:

    Also from Serano:

    2) I live-tweeted Singal’s latest Atlantic article, highlighting its many biases & disingenuous/distorted framing: https://twitter.com/JuliaSerano/status/1008818007814967296

    In the wake of this article being published, two other trans women shared their negative experiences with Singal:

    1) Here is Katherine Cross sharing her story:
    https://twitter.com/Quinnae_Moon/status/1008839472891531264

    2) Cat Fitzpatrick mentions Signal threatened to sue her for politely disagreeing with him:
    https://twitter.com/intermittentcat/status/1008885871310004224

    Grace

  3. 3
    lurker says:

    80 percent of kids with gender dysphoria end up feeling okay, in the long run, with the bodies they were born into

    i think that depends on what “gender dysphoria” is?

    a lot of teenagers can feel wierd and confused about gender, and a lot of those wierd and confused people are not trans, i think. teenagers can be confusing to find out what they really want. so if those are ‘gender dysphoria’ then a lot of them will not be trans so the number will be high.

    if you look at very bad ‘gender dysphoria’ and it stays bad over a long time then those people are less confused and a lot of those people will be trans, i think. so if those are gender dysphoria then the number will be low.

    this makes math sense, i think.

    i think a lot of this is fighting about testing? if what i just said is true then you need a test to make a line between first group and second group. if first group is too big then we will think some kids are cis when they are not. if second group is too big we will think some kids are trans when they are not. both of those are bad, I think. So i think only way to know where to draw line is to do a lot of tests.

  4. 4
    Sebastian H says:

    Lurker, the statistics of the situation makes things tricky because trans people are much rarer than cis people with some gender dysphoria. This also makes a number of Amp’s links problematic because they want to limit the discussion to the desistance levels of people who make it all the way into the trans category (diagnosis seems too clinical and not quite accurate?, trans description, maybe?). But I think the more honest desistance questioners (as opposed the ones who are just using the issue to be anti-trans) are saying something like: of the group of people who will come under the ambit of trans/gender dysphoria psychological intervention an enormous percentage of them will turn out not to be trans, but rather cis with gender dysphoria (i.e. they will ‘desist’ if we treat them under a trans oriented treatment protocol).

    This is a genuinely difficult problem because

    a) genuinely anti-trans people use adjacent discussions or similar arguments, so trans people feel attacked with these discussions;

    b) (relatively) cis people with gender dysphoria may need different treatment protocols compared to trans people.;

    c) since cis people are an enormous majority compared to trans people, starting to focus on those different protocols may cause the (in my opinion more dire) needs of trans people to be sidelined.

  5. 5
    Ampersand says:

    One thing that makes this confusing is that GID (“gender identity disorder”) was eliminated as of the DSM-5. Instead the DSM-5 has “gender dysphoria.” And the two terms do not have the same meaning.

    Just feeling “weird and confused about gender,” on its own, does not meet the diagnostic criteria for GD:

    In adults and adolescents –

    A A definite mismatch between the assigned gender and experienced/expressed gender for at least 6 months duration as characterized by at least two or more of the following features –
    1 Mismatch between experienced or expressed gender and gender manifested by primary and/or secondary sex characteristics at puberty
    2 Persistent desire to rid oneself of the primary or secondary sexual characteristics of the biological sex at puberty.
    3 Strong desire to possess the primary and/or secondary sex characteristics of the other gender
    4 Desire to belong to the other gender
    5 Desire to be treated as the other gender
    6 Strong feeling or conviction that he or she is reacting or feeling in accordance with the identified gender.

    B The gender dysphoria leads to clinically significant distress and/or social, occupational and other functioning impairment. There may be an increased risk of suffering distress or disability.

    So older studies (which are most of the studies) refer to GID, not GD. GID diagnosis did not require “A definite mismatch between the assigned gender and experienced/expressed gender.” Furthermore, if you look at these studies, many of them include “borderline” cases of GID in their samples.

    In those studies, many of the young people diagnosed with GID never were trans and never identified as trans. But in the popular discourse, those studies were used to suggest that trans teens are, in 80% of cases, just going through a phase.

    This also makes a number of Amp’s links problematic because they want to limit the discussion to the desistance levels of people who make it all the way into the trans category…

    When discussing if young trans people are likely to “desist,” it is appropriate to limit the discussion to people who fit the DSM-5’s defnition of GD.

    If people want to discuss a broader group of young people, of course that’s fine – but they should make it clear, in that case, that most of their subjects would never have been considered trans, by themselves, by clinicians, or by society in general. To use the results of a study of people who may or may not be trans, to generalize about trans people, is a problem.

  6. 6
    lurker says:

    i think that makes sense. but there is still a problem of whether people should be treated as trans if they say they are trans but they do not pass the test that amp posted. if no, you will treat some trans people as cis, that is bad. if yes, you will treat some cis people as trans, that is bad too.

    when amp says

    When discussing if young trans people are likely to “desist,” it is appropriate to limit the discussion to people who fit the DSM-5’s defnition of GD.

    it depends on definition?

    if ‘people who say they are trans’ are trans, you need to use that same group when you talk about this stuff. i do not think it makes good sense to use a different definition in different places. and if you think only ‘people who pass trans test’ are trans then you should use that definition everywhere too. otherwise this is too confusing.

    you can say that almost all teen trans people are real, because they pass test, or you can say that every teen who says they are trans is trans, without test. but i do not think you can say both at the same time.

    when i read your blog i think you think ‘people who say they are trans’ are trans? if so i do not think your quote is right?

    for most people i think it is like this: a kid says they are trans, you want to know what to do and what treatment to give and so you need to know whether they are trans or just confused.

    singal says that unless they take test you should not think they are trans, because most teens who say they are trans are not. i do not know if that is true so i do not know if i agree.

    singal also says you should give good test to make sure they are trans. i agree that a really good test is good, because the better test that you give, you will not have so much error on either side. treating trans people as cis people is bad, treating cis people as trans people is also bad. i do not understand why people do not like the test.

  7. 7
    Ampersand says:

    “Trans,” like most English words, means different things in different contexts.

    In the context of a panic about clinicians and parents rushing kids into surgeries when those kids aren’t actually trans, we should look to the diagnostic criteria, because that’s what clinicians and doctors do. That is the relevant definition in this context.

    In the context of someone saying to me “I’m trans,” of course I’m not going to quiz them on if they’ve taken a test; that would be unreasonable. I’ll just take people’s word for it.

  8. 8
    lurker says:

    In the context of a panic about clinicians and parents rushing kids into surgeries when those kids aren’t actually trans, we should look to the diagnostic criteria, because that’s what clinicians and doctors do. That is the relevant definition in this context.

    is that the context?

    if you are a doctor then you apply the test, yes, but maybe different test for different doctor though? that is what singal says, so different doctors have different context.

    and if you are a parent you need to decide whether to go to doctor at all. and you need to decide whether to believe all the trans people who say ‘listen to your kid’ or all the people like singal who say ‘listen to doctor.’ and you also need to decide whether to believe the doctor who says kids don’t change their mind or the doctor who says kids do change their mind.

    so among parents and doctors, very different context. all of them. how can they talk to each other if words do not mean the same thing for any person who is talking?

    In the context of someone saying to me “I’m trans,” of course I’m not going to quiz them on if they’ve taken a test; that would be unreasonable. I’ll just take people’s word for it.

    i agree, that is what i do too!

    but we are talking about this here, so why use only doctor definition? are we not talking about how some kids say they are trans and maybe they are wrong? i am not a doctor, you are not a doctor too i think? i cannot say it very well but i think maybe you are choosing one definition one place and another definition somewhere else in a way that does not make good sense?

    its math: if you have two groups nearby then as you draw bigger circle around one group you get some of other group by mistake, no way around it. and if you draw circle smaller not to have that problem, you leave out some of your group by mistake, no way around it. cis circle and trans circle work the same way.

    but if you want to solve problem using circles you cannot keep changing size and place of circles! it is too confusing and we will spend all the time arguing about where circles should be. that is why i find these discussions so hard.

    if people say they are trans, i act like they are trans, that is polite. but without test, more likely that more of them are wrong. that is just math, if you use same word to mean same thing. the whole point is trans is a thing that is true, which makes it a thing where word has real meaning. people are trans or not trans, that word has meaning when you use it.

    i will use whatever circle you want to draw but i do not think you should change circles.

  9. 9
    desipis says:

    The 4% figure is puzzling in the context of definitions of “Gender Dysphoria”. From the case judgement:

    The fifth intervenor, the Royal Children’s Hospital Gender Service in Victoria is a specialist unit comprising of a team from multiple disciplines including Paediatrics, Psychiatry, Psychology, Endocrinology, Gynaecology, Nursing and Speech Pathology. Since its commencement in 2003, the Gender Service has received 710 patient referrals including 126 between 1 January 2017 and 7 August 2017. 56.

    96 per cent of all patients who were assessed and received a diagnosis of Gender Dysphoria by the 5th intervenor from 2003 to 2017 continued to identify as transgender or gender diverse into late adolescence. No patient who had commenced stage 2 treatment had sought to transition back to their birth assigned sex. No longitudinal study is yet available.

    The DSM-V was published in 2013, and this is where the term “Gender Dysphoria” was defined. How did patents from 2003 to 2013 receive a diagnosis of “Gender Dysphoria” prior to the publication of the DSM-V? If not diagnosed under the same criteria, how does the criteria they were diagnosed under compare?

    It seems like there’s no good data on the desistance rates and the answer is “nobody knows”. In such circumstances any treatment should be considered experimental until such data can be collected and analysis published.

    Who are the clinicians who echo these concerns?

    One possible motive for anonymity would be to avoid the harassment and smear campaign that people like Dr Kenneth Zucker experienced.

  10. 10
    Harlequin says:

    The DSM is an American manual. The case you linked is from Australia and wouldn’t use it.

  11. 11
    Ampersand says:

    There’s really very little we can say about the 4% figure, in my opinion, until an actual report on the Royal Children’s Hospital research is released.

    However, it’s possible that the research, conducted after 2013, involved diagnosing patients based on the symptoms recorded in their records.

    If Singal personally spoke to clinicians who supported that claim, but asked to be kept anonymous to avoid harassment, that’s something he should have reported.

    Harassment is a problem, from either side. (And it does come from multiple sides – Phyllis Burke reported receiving death threats after she published a book criticizing gender reparative therapy). But the major claim against Zucker – that he advocated for and practiced reparative therapy – seems to be true. Zucker (aided by Singal) has walked this back this in the past few years, but if we look before that Zucker’s pretty clear about it.

    In his case studies and descriptions of patients, Zucker usually explains gender dysphoria in terms of what he calls “family noise”: neglectful parents who caused a boy to over­identify with his domineering older sisters; a mother who expected a daughter and delayed naming her newborn son for eight weeks. Zucker’s belief is that with enough therapy, such children can be made to feel comfortable in their birth sex. Zucker has compared young children who believe they are meant to live as the other sex to people who want to amputate healthy limbs, or who believe they are cats, or those with something called ethnic-identity disorder. “If a 5-year-old black kid came into the clinic and said he wanted to be white, would we endorse that?” he told me. “I don’t think so.”

    From a 2007 report by NARTH (pdf link) (emphasis added by me):

    [Zucker and a co-author] base their case on several points, claiming treatment affords the following benefits:

    1. A reduction of social ostracism by peers.
    2. An opportunity to relieve the psychopathology which has been documented to be associated with GID, both in the child and within the family;
    3. The prevention of later transsexualism;
    4. The prevention of homosexuality in adulthood. On this controversial point, Zucker believes that treatment is justified for social reasons — but he is doubtful about their being justification to prevent homosexuality for religious reasons.

    And if a secure gender identity prevents the development of later homosexuality, as Zucker acknowledges as a possibility, parents should be informed of the research on the relationship between the two. Zucker’s priority is “helping these kids be happily male or female,” but he also acknowledges that the treatment process does, in some cases, apparently avert homosexual development. And in support of parents’ rights to avert a homosexual outcome for their children, Zucker cites a persuasive quote from Richard Green: “The right of parents to oversee the development of children is a long-established principle. Who is to dictate that parents may not try to raise their children in a manner that maximizes the possibility of a heterosexual outcome?”

  12. 12
    Grace Annam says:

    desipis:

    It seems like there’s no good data on the desistance rates and the answer is “nobody knows”.

    If your answer must be two words long, then yes, that’s the answer. Slightly longer version: “There’s little data, and what there is is flawed, but what we have suggests that the rate of desistance depends strongly on how you define your terms, and also suggests that there is a strong correlation between length, consistency, and forcefulness of the expressed gender identity and an eventual successful transition.”

    By the way, every study of desistance I’ve seen to date —including all those mentioned by Singal in his latest piece— has a very short longitudinal component. A given case is taken as an instance of desistance the instant someone decides not to transition. But a sizeable percentage of the trans people I’ve met and/or talked to only succeeded in transitioning socially (if the did succeed; some are still closeted) on their second attempt, and sometimes their third. Many trans people find that they can’t climb that hill on the first try, especially when the first try is as a child, but that by the time they’re in their mid-twenties or mid-thirties, if they survive that long, they’ve gotten strong and/or desperate enough to risk everything by trying. So if you want to find out whether someone has actually desisted, you need to follow them into their thirties.

    I help facilitate a support group for trans and GNC adults. People are constantly trying to figure out what their best path is, and what they need to do, and how best to do it. Some choose not to transition. Some start transition and step back in an effort to save relationships with loved ones, or for fear of losing their employment and housing. It’s beyond hard work. Cis people, unless they are very close friends or intimate partners (and sometimes not even then) see very little of this work. They just see the visible result, and it comes as a surprise. It’s very common for people to say, “Woah, woah, not so fast!” But what they don’t realize is that the trans person isn’t running a slow mile; they’re in the middle of a marathon which has been invisible.

    I’m reminded of a local resident whom my wife ran into awhile back. He misgendered me, and she corrected him, “Grace, my wife, yes?” And he said, “Well, you have to give us time, [Lioness]!” And she said, “It’s been three years since she transitioned.” And he looked shocked, because in those three years apparently he’d given it very little thought, and then he asked, slowly, as though the possibility had never dawned on him before, “…is Grace… happy?” And Lioness told him that I was.

    Cis people seem to have a hard time envisioning happy trans people. This is probably because the most common trans narrative, for decades, has been the Tragic Trans Narrative. It’s why the Trans Documentary Drinking Game has a drink for “sad piano music” (you know, at the part where the narrator says portentiously, “But Steve had a secret…”). It’s why the “We Happy Trans” project (now defunct) seemed necessary.

    This assumption of tragedy does a lot of damage by prompting cis people to want to make really, really, really sure that we know what we’re doing. As part of my transition, I researched and had done a small cosmetic procedure, of the sort that any adult can get done if they have the coin, and which thousands of people get done every year. One surgeon told me that he would do it, but he wanted a letter from my therapist first. This for a procedure which any cis person could have by walking in, filling out a medical history, and plunking down a pile of cash.

    This is the environment in which trans people are seeking medical services, and it’s well to be mindful of it, because it explains a lot of our reaction to pieces like Singal’s. Many of us are beyond tired of having to justify ourselves to ease the anxieties of people who know very little about us.

    In such circumstances any treatment should be considered experimental until such data can be collected and analysis published.

    Embedded in that framing is the notion that not intervening is not experimental, that it’s the safe road. But, of course, for children who are definitely trans, transition is the safer road, and no intervention at all is the more hazardous road. For a pubertal child, it’s not a choice between nothing and cross-hormone therapy. It’s a choice between puberty with testosterone and puberty with estrogens. That’s why puberty blockers are such a useful tool; they buy time, so that the team can determine if the child is consistent, persistent, and insistent, and only then stop blockers and administer hormone therapy or stop blockers and let the endogenous hormones do their thing.

    I get why cis people tend to frame it this way. Because from their perspective, what if we administer hormones inappropriately and that cis kid has to go through life with cross-sex physical characteristics? And sure, that’s a real concern. But it’s very often expressed in the absence of the complementary concern. What if that trans kid doesn’t get hormone therapy and has to go through life with cross-sex physical characteristics. Most living trans people have gone that route, and it’s awful. We would spare the trans children coming along behind us that trauma. And we get frustrated when people who’ve not given the topic a lot of thought stop at “but what if the kid isn’t trans?” and don’t also ask “but what if the kid isn’t cis?”

    Grace

  13. 13
    Sebastian H says:

    “Because from their perspective, what if we administer hormones inappropriately and that cis kid has to go through life with cross-sex physical characteristics? And sure, that’s a real concern. But it’s very often expressed in the absence of the complementary concern. What if that trans kid doesn’t get hormone therapy and has to go through life with cross-sex physical characteristics. Most living trans people have gone that route, and it’s awful. We would spare the trans children coming along behind us that trauma. And we get frustrated when people who’ve not given the topic a lot of thought stop at “but what if the kid isn’t trans?” and don’t also ask “but what if the kid isn’t cis?””

    This is definitely true.

    The problem is further complicated in my mind by noticing that it is probably quite a bit worse for a trans kid, but also that it is pretty bad and much more frequent (by a factor of 10x or more) for a cis kid. That suggests to me that we want to get really good at telling who is whom, and/or we want to stick to reversible things as long as we can get away with it.

  14. 14
    Sebastian H says:

    “By the way, every study of desistance I’ve seen to date —including all those mentioned by Singal in his latest piece— has a very short longitudinal component. A given case is taken as an instance of desistance the instant someone decides not to transition. But a sizeable percentage of the trans people I’ve met and/or talked to only succeeded in transitioning socially (if the did succeed; some are still closeted) on their second attempt, and sometimes their third. ”

    This is also a good point. At some point in the future we will have a much better handle on how many desistance cases are just delayed expressions of trans identity and how many aren’t.

  15. 15
    desipis says:

    Harlequin: The DSM has significant influence outside of the US.

    In Australia, [the DSM-V] is one of two diagnostic manuals currently used; the other, published by the World Health Organisation, is the [ICD-10].

    Grace:

    But a sizeable percentage of the trans people I’ve met and/or talked to only succeeded in transitioning socially (if the did succeed; some are still closeted) on their second attempt, and sometimes their third.

    Social transition isn’t part of the diagnosis, so I don’t think reverting a social transition would be classified as desistance.

    Embedded in that framing is the notion that not intervening is not experimental, that it’s the safe road.

    The cornerstone of modern medicine is evidence. If you allow treatments without supporting evidence then you allow all sorts of quackery. Obviously there needs to be room for experimental treatments in order to be able to collect such evidence. However, I don’t see how a general concern that doing nothing might be worse can be used to justify a treatment. You could use the same argument to justify treating cancer with homeopathy.

  16. 16
    Ampersand says:

    If you allow treatments without supporting evidence then you allow all sorts of quackery.

    The idea that modern trans care is “treatments without supporting evidence” is obviously false. There is a significant body of peer-reviewed literature showing that, for most people with GD (or, in the old terminology, severe GID), transitioning (in various ways) is an effective way of relieving GD-related distress.

    Essentially, the “80% desistence” claim is an attempt to push back against that already existing literature. But it becomes increasingly clear that it doesn’t hold water. Earlier today (or maybe yesterday? Time zones are confusing), the author of a study that Singal and others have relied on, said that his study should not be used to generalize about desistence rates.

    Social transition isn’t part of the diagnosis, so I don’t think reverting a social transition would be classified as desistance.

    Social transition is part of a common path for treatment of gender dysphoria. Two of the traits that indicate gender dysphoria – “desire to belong to the other gender” and “desire to be treated as the other gender” – would obviously motivate people with GD to pursue social transitioning.

    I can’t say that no one socially transitions without having gender dysphoria… with billions of people, everything possible has possibly happened at least once. But it if happens at all, it must be very rare. Why do you think someone without gender dysphoria would socially transition?

  17. 17
    Grace Annam says:

    desipis:

    Social transition isn’t part of the diagnosis, so I don’t think reverting a social transition would be classified as desistance.

    You’re thinking about diagnosis in too binary a manner. This is not a fire-and-forget situation. It’s a situation where you make a tentative diagnosis, proceed with the least permanent treatments first, and assess as you go along, to either progressively confirm the diagnosis or to differentiate what you’re looking at from the initial diagnosis.

    From https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria:

    The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides for one overarching diagnosis of gender dysphoria with separate specific criteria for children and for adolescents and adults.

    In adolescents and adults gender dysphoria diagnosis involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning. It lasts at least six months and is shown by at least two of the following:

    1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics
    2. A strong desire to be rid of one’s primary and/or secondary sex characteristics
    3. A strong desire for the primary and/or secondary sex characteristics of the other gender
    4. A strong desire to be of the other gender
    5. A strong desire to be treated as the other gender
    6. A strong conviction that one has the typical feelings and reactions of the other gender

    In children, gender dysphoria diagnosis involves at least six of the following and an associated significant distress or impairment in function, lasting at least six months.

    1. A strong desire to be of the other gender or an insistence that one is the other gender
    2. A strong preference for wearing clothes typical of the opposite gender
    3. A strong preference for cross-gender roles in make-believe play or fantasy play
    4. A strong preference for the toys, games or activities stereotypically used or engaged in by the other gender
    5. A strong preference for playmates of the other gender
    6. A strong rejection of toys, games and activities typical of one’s assigned gender
    7. A strong dislike of one’s sexual anatomy
    8. A strong desire for the physical sex characteristics that match one’s experienced gender

    For children, cross-gender behaviors may start between ages 2 and 4, the same age at which most typically developing children begin showing gendered behaviors and interests. Gender atypical behavior is common among young children and may be part of normal development. Children who meet the criteria for gender dysphoria may or may not continue to experience it into adolescence and adulthood. Some research shows that children who had more intense symptoms and distress, who were more persistent, insistent and consistent in their cross-gender statements and behaviors, and who used more declarative statements (“I am a boy (or girl)” rather than “I want to be a boy (or girl)”) were more likely to become transgender adults.

    Social transition isn’t a required part of the initial diagnosis, but it can be (see adult criterion 5 and child criteria 2, 3, 4, 5, and 6). It can also be part of the process of assessing whether a child is “persistent, insistent, and consistent”. But even in adults, it’s useful. Many trans people, as an initial step, do their best to present socially as their gender of identification… in a location two or three hours’ drive from where they might be recognized. If their internal experience of being regarded as a member of their gender of identification is possible, then that’s a confirmatory piece of evidence that they are trans or GNC. If not, then that’s a piece of evidence that whatever they’re grappling with lies elsewhere.

    desipis:

    The cornerstone of modern medicine is evidence.

    Of course. And for things which are new or poorly understood, in the absence of evidence, we use reasoning. And when the evidence is slight or conflicting, we do our best to tease out which is the best evidence and reason from that. You’re making medicine sound like a precise science. Parts of it are. Many, many parts of it aren’t.

    desipis:

    However, I don’t see how a general concern that doing nothing might be worse can be used to justify a treatment.

    Which is not what I said, as you should be well aware. Children who are definitely trans are actually harmed by going through the puberty of their assigned sex. Many, many trans people will tell you this from their own experience. We have been saying this for decades. It causes chronic experiential trauma in the moment, it sets us up for lifelong chronic trauma to the extent that it prevents us from passing as cis when we transition, and in many cases (including mine) it creates a necessity for surgical correction where none need have existed.

    This is not “a general concern that doing nothing might be worse”. This is a certain knowledge that, for a child who is actually trans, doing nothing will be worse.

    There is no question that for someone who is actually trans, transitioning improves their life across the board, and often completely relieves the underlying dysphoria (though it can never erase the trauma of growing up and living as trans in a profoundly rejecting society). The only question is how to determine that someone is trans. For competent adults, in the modern day, we take them at their word and provide support so that they can suss out what they need. It’s conceptually very simple, though the details require expertise. As recently as a decade ago, some programs were still demanding that trans women go through a two-year real-life experience before permitting them hormones, let alone surgery. Most programs still require that a therapist sign off that they have assessed the client and reasonably ruled out complicating diagnoses.

    For children, it is typical and developmentally appropriate of all children —trans, cis, and in between— that they play, imagine, and try ideas and roles on for fit. So it’s perfectly appropriate, before any permanent modification, to allow some time to assess whether they are “persistent, insistent, and consistent”. Social transition can be, and often is, part of that multi-year assessment. And that’s what puberty blockers permit — a multi-year assessment of exactly the sort experts agree is best, and fearful-but-open parents want. And that very basic fact is what most anxious cis people I talk to don’t know; they think that doctors are prescribing hormones to twelve-year-olds. In other words, they are letting their anxieties push them to make value judgements about a course of treatment which they fundamentally misunderstand. And, people and organizations hostile to trans people consciously and deliberately foster that misunderstanding.

    I know a woman who showed up to a therapy session in jeans and was told by her therapist that she better show up in a dress or a skirt or the therapist would not believe that she was a woman, because “women wear dresses and skirts”. During the session when the therapist uttered those words, the therapist, a woman, was wearing pants.

    I know a woman with a history of testicular cancer and one testicle gone as a result, who had transitioned hormonally and socially years before, who presented to an oncologist with ideopathic pain in the remaining testicle. The oncologist referred her to a psychiatrist. It was an odd situation, for which the actuarial tables which govern modern oncology had no entry, which required a doctor to make an informed judgement, in a situation where the woman might have recurrent cancer, for whom removal of that tissue would be a benefit, because it would enable her to lower her hormonal dose. It took that woman months more to find a urological surgeon who would remove the remaining testicle.

    I know a woman, who, as a girl seeking puberty blockers, in Massachusetts, with parental approval, was told by a child psychologist that they would not write a letter to her endocrinologist because she was not suicidal. For puberty blockers, mind you, not for cross-hormone therapy. And this child was 17 years old at the time, visibly masculinizing month-by-month, had already transitioned socially years before and had been consistent, insistent and persistent in her gender expression since her early teens. But in this psychologist’s understanding, apparently you can’t be trans if you’re not suicidal, and not only can’t you be trans, you can’t even be possibly trans. The woman I’m speaking of transitioned hormonally on her eighteenth birthday and never looked back. There is no doubt that she’s trans, and there was no doubt at the time.

    People worry that cis people might get inappropriate treatment. But cis people make up 99% of the population, and trans people who received inappropriate treatment seem to hugely outnumber cis people, in raw numbers. You have to work hard to put together ten “ex-trans” people, but you can find ten trans people who have received inappropriate medical care just by getting eleven trans people in a room and asking them to tell their stories.

    That’s the environment this society is discussing this issue in. The average evaluation is not even-handed; it is tilted significantly against trans people. And that’s why Singal, who says that he wants to have a nice, neutral, even-handed discussion is getting push-back from people who have a lifetime of experience surviving in an environment which has been weaponized against us. It comes across a lot like a white US American telling a black US American how to deal with racism. And Singal doesn’t like it when people tell him he’s wrong and that they know better. Well, welcome to a small taste of our daily, weekly, monthly, annual meal.

    Grace

    edited to fix typo(s)

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