Something odd is happening in gender clinics. In 2017, the number of males receiving transgender surgery in the United States increased by 41 percent over the year before, while the number of females seeking such surgery increased by 289 percent.
At the Tavistock Clinic, Britain’s sole pediatric gender clinic, the number of boys referred over the past decade has increased by 1,150 percent, the number of girls by 4,400 percent. Why is the number of females seeking transgender treatments rising much more quickly than the number of males?
You can get some clues by looking at blogs and videos posted by detransitioned and desisted women. Detransitioners and desisters are people who thought they were transgender for a time and changed their minds. In their posts, some common themes regarding these women’s reasons for transitioning emerge, reasons that have nothing to do with being transgender.
- Some young women say they transitioned because of same-sex attraction. They had internalized so much homophobia, they became boys rather than accept themselves as lesbians. In Britain, five clinicians have resigned from the Tavistock clinic on principle in the last three years. One of their major concerns is the large numbers of gay children being transitioned because of homophobia. The children were facing either bullying at school or parents who did not accept them. One clinician said, “A lot of the girls would come in and say, ‘I’m not a lesbian. I fell in love with my best girl friend but then I went online and realized I’m not a lesbian, I’m a boy. Phew.’” Staff at the clinic joked ruefully that due to transition “there would be no gay people left.”
- Other women say they transitioned as a reaction to trauma, often the trauma of a sexual assault. One detransitioned woman said (minute 1:55) a sexual assault “absolutely contributed to just this feeling that I wanted to take my body off.” Women using transition as camouflage is not progressive. Progress occurs when women no longer feel a need to hide.
- One of the reasons my daughter gave for wanting to transition was because people listen to boys, and she wanted to be heard. Notice she did not say she had a deep internal sense that she was a boy. She wanted the kind of respect she believes only boys attain. Girls shouldn’t have to medically transition to get respect. The culture needs to change, not the girls.
- Some women felt they didn’t fit in with other girls and had no examples of gender-nonconforming women. One young woman said (3:47-4:38) “I was never … raised to believe that there was more than one way to be a girl…. I thought femininity and womanhood was like, being thin, being white, wearing skirts and wearing dresses and you know, playing dress up, playing with dolls … and liking boys…. And that was never my experience.… I thought, well then I must be a boy.”
- Due to internalized misogyny, women have often been convinced they need to modify their bodies. “Teen girls are taught to hate everything about themselves. None of us can win. Even the thinnest, most clear-skinned, prettiest of girls find an enemy in the mirror,” a desisted woman said. In response to culture telling them their bodies are not good enough, women from many generations and places have bound their feet; mutilated their genitals; wore corsets, girdles, and high heels; endured cosmetic surgeries; and starved themselves. What feminists see in gender-dysphoric girls binding their breasts, taking testosterone, and seeking mastectomies, hysterectomies, metoidioplasties, and phalloplasties is a new and more virulent form of internalized misogyny.
When my daughter came out as transgender, I wanted to find a therapist who could help her sort out what her gender dysphoria meant. Was she transgender, or was she ashamed of same-sex attraction, reacting to trauma, wanting respect, uncomfortable with feminine stereotypes, or had she internalized hate for women’s bodies?
I quickly discovered that it is nearly impossible to find therapists who do this kind of work. If a girl presents as transgender today, the vast majority of therapists will immediately affirm the girl’s declared gender identity and ask her what steps she would like to take toward transition.
I interviewed at least a dozen therapists in search of one who could help my daughter examine her feelings and motivations. I finally resorted to paying out-of-pocket for my daughter to talk online to a therapist who lives in another state. I know I am not alone. I belong to an online support group of nearly 1,500 parents of gender dysphoric youth. Finding therapists who provide standard mental health therapy rather than automatic affirmation is a frustration for most of us.
Twenty states are considering well-intentioned anti-conversion therapy bills in 2019, including my own state of Minnesota. The term conversion therapy used to apply only to attempts to change a person’s sexual orientation. Now the term is applied to attempts to change either a person’s sexual orientation or a person’s gender identity.
The goal of anti-conversion therapy bills is to ban mental health therapists from using conversion therapy with minors. I am afraid these bills will have a chilling effect on therapists’ ability to help girls who say they are transgender. Let me be very clear: I am discussing only the impact of anti-conversion therapy bills on youth who are identifying as transgender only. My arguments don’t apply to sexual orientation.
What the general public does not understand is that standard mental health therapy is now considered conversion therapy when practiced with gender-dysphoric youth.
This is how my daughter’s therapist describes her work: “The type of therapy I’m doing is … pretty standard….You’re doing a thorough assessment of a client long-term…You’re looking at their history back many years. You’re thinking about comorbidities, other types of psychological or mental health issues that might be … contributing to their discomfort, and you’re looking at the symptomology and trying to really thoroughly assess where this is coming from….For example, people who have a body image disorder or an eating disorder, the symptomology is going to look very, very similar.to what we describe as gender dysphoria. So the work I’m doing is really just a careful analysis of a person’s … presenting concerns” (7:45-8:45). Does this sound harmful? Does it sound like an attempt to change someone’s gender identity?
My daughter has appreciated the opportunity to think deeply about what her feelings mean and whether transition would be a helpful thing for her. Yet activists who believe in an affirmation-only approach are filing complaints to her therapist’s licensing board, claiming the therapist is practicing conversion therapy.
Why are transactivists so determined to prevent youth from receiving therapy that in any other context would be considered good and ethical practice? I think it is because transactivists believe they should be exempt from the rules the rest of us follow when we seek medical care.
I accept that I must get a diagnosis from a doctor before the doctor will give me a prescription or a referral. There are some elective treatments a doctor will give me without a diagnosis, such as cosmetic surgery. I accept that I must pay for elective procedures; my insurer will not.
By contrast, transwoman Andrea Long Chu wrote in a New York Times opinion article that a trans person should be able to get surgery based on “a simple demonstration of want” even if it will make the person feel worse. Long Chu asserts that when doctors use the alleviation of pain as the criteria for treatment, they are acting like “dictators” and “kings.”
In an essay for Jezebel.com, transactivist Harron Walker was enraged because a journalist dared to feature several detransitioners in a story about adolescent transition for The Atlantic. Walker fears that stories focusing on people who feel their transitions were a mistake might lead medical providers to reinstitute gatekeeping for hormone therapy, the same kind of gatekeeping the rest of us take for granted when we seek medical treatment.
I suspect Walker’s outrage is fueled by the fact that The Atlantic is a mainstream media outlet with a large circulation, a national readership, and a left-center bias. Coverage of detransitioners in mainstream media poses a threat to transactivists who want their treatments available on demand and covered by insurance.
To transactivists, girls who transition by mistake are expendable collateral damage whose existence must not be allowed to hinder trans people’s access to hormone therapy and surgeries. Thus, standard mental health therapy must be called conversion therapy, and it must be banned through legislation.
If standard mental health therapy is allowed, someone might notice that gatekeeping serves an important purpose. Someone might figure out that trans people are no better than the rest of us at diagnosing and treating their own illnesses. Many transgender people will say they are not ill and should not be treated as such. If they are not ill, then they are seeking elective treatments, and they should pay the full cost just like the rest of us.
In his Jezebel rant, Walker says a journalist writing about children who transitioned by mistake is using the kids “as a smokescreen” to hide anti-trans sentiment. My daughter is not a smokescreen. Neither are the thousands of young women like her struggling in a culture that does not value them. They are harmed, not helped, by immediate affirmation of gender identities that may have been adopted as a way to cope with other issues.
If you want to help girls, talk to your legislators. Tell them to require therapists to provide thorough assessments for gender-dysphoric minors and to identify and treat any comorbidities.
Ironically, one of the clinicians who resigned from the Tavistock clinic said of the clinic’s practices, “It feels like conversion therapy for gay children.” If you really want to ban efforts to convert young lesbians into straight people — that is, into straight transmen — tell legislators to remove gender identity from anti-conversion therapy bills. Girls need all of us to take a stand.
States currently considering conversion therapy bans include: Arizona, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Maine, Massachusetts, Minnesota, Missouri, Nebraska, Oklahoma, Pennsylvania, Texas, Utah, Virginia, and West Virginia.
States that have already banned conversion therapy include: California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, and Washington.
The writer is using a pseudonym to protect the privacy of her daughter. She is a feminist and a life-long liberal Democrat with a master’s degree in public affairs from the University of Minnesota’s Humphrey Institute. She submitted this essay to The Federalist because liberal media will rarely touch this topic even though it is a women’s rights issue.