The problem of real vs. fake

The distinction between “real” and “fake” comes up a lot when discussing transgender issues. This is also sometimes framed as “valid” vs. “invalid”. I think this distinction is a false one in most cases, and serves to obscure thinking on these issues. People are very invested in whether their identities or conditions are “real” or“fake” and therefore have a strong stake in proving points that makes their identities “more real’. Likewise, opponents of transgenderism attempt to prove (or just assert) that transgender identities are “really fake”.

This whole discussion is a category error. Identities are not real or fake, because they are narratives. Narratives are stories and are constructed and culturally-specific. This does not make them “fake” though. It is an unfortunate assumption of Western culture that things that have material existences such as rocks or hormones, or body parts are “more real” than things that are concepts or narratives or stories. When it comes to the question of how to be more happy or how to best live our lives, this is not true. Concepts and narratives have as much, or even more to do with this question. They are very powerful. Dark thoughts can lead to suicide itself. People live and die by the millions over narratives. Would you say that religion has had less impact on human action and happiness than the spleen? or molybdenum? Constructed things are neither less real nor less powerful than physical things.

It is important to note that I am definitely not saying that everything is constructed. The postmodernists, having discovered that narratives are constructed sometimes go too far when they decide that everything is constructed. Bodies are not constructed (though the meanings placed on them sometimes are). Instincts aren’t constructed,impulses aren’t constructed, hormones aren’t constructed, chairs aren’t constructed. This does not make them “more real” though, and certainly doesn’t make them “more important” which the next leap in the chainfrom “more real”.

Another error that the postmodernists make is taking the idea that narratives are constructed and neither true nor false to mean that they are all equal. They are not equal. Narratives can be more useful than others, narratives can be more healthy than others. Some narratives are life-affirming and lead to flourishing, and others lead to destruction. An extreme case of a destructive narrative can be found in something like the “Jim Jones cult” which led to mass suicide. This also illustrates just how powerful narratives are, as they can override even survival instincts.

There may be low-level biological instincts and imprinting that lead people to develop transgender identities. However, the story that arises to explain these instincts is distinct from the instincts themselves. Neither is more real than the other, but it might be possible to decouple them.

Certain conditions like PCOS and autism correlate with transgender identity, both of which are known to not be caused by childhood experience. (That doesn’t make them more real than things that caused by childhood experience though!) It very well might be the case that some people benefit from cross-gender hormone therapy. Many trans people report the find hormone therapy improves their mood and functioning and they should be allowed to make that choice. However, this question is distinct from the narrative that is told to explain it. People with thyroid hormone deficiency function better when given thyroid hormone, but do not have a story that their “true thyroid is functional and they must take thyroid hormone to affirm their healthy thyroid identity.” This is partially because they don’t need to construct such a story, because thyroid deficiency is not stigmatized. Gender is such a polarizing topic that people who want hormones because they feel it makes them function better is seen as not a sufficient reason. They somehow have to prove that they are really a member of the other gender in order to get that medicine.

This distinction between “real” and fake” leads to endless discussion on whether trans women have “female brains”,which contain the assumption that if this question is true transgender identities are “real” and if this question is false transgender identities are “false”. There are several studies which show brain differences between trans folk and controls. In some cases these studies are confounded for the effects of cross-gender hormones in other cases not. A few of them do show a couple of brain structures that look similar between trans women and cis women This study is often quoted.

However, other show intermediate structures and others show trans women having structures in common with cis men. Here is a great article about a study showing that trans women’s brains show differences from controls, but not that they are like cis women’s brains.

There is a related idea that if there are such brain structures, then the condition is physical and therefore real. However, nearly all mental health conditions show up in the brain. Autism, schizophrenia, bipolar, and depression all show up in the brain. The real truth is that mental health conditions are no less real than physical health conditions and should not be stigmatized. People who suffer from things like depression or bipolar are stigmatized while those that suffer from heart disease or cancer usually aren’t. This whole discussion is a red herring really, but becomes important when we decide physical conditions are “more real’ than mental conditions. This distinction is doubly false because mental conditions are physical conditions also.

In summary I recommend experimenting with banishing the idea of “real vs. fake” from thinking about gender issues, it might reduce the emotional charge and help to promote clear thinking, and answer the real question which is what response to gender dysphoria will lead to the most happiness and well-being.


  1. Another brilliant one.

    You are right that it doesn’t seem to work to just say “I feel better on these hormones”, even though this is an objectively measurable idea that should theoretically cause fewer fights than the endless tug-of-war of gender definitions (I have seen some people who define themselves in these terms but they are few and far between at this point). And of course the only way to avoid such a fight is to have the definitions mean nothing.

    There’s also the possibility that the definitions themselves are causing the majority of the problems with real vs. fake, thus having people arguing past each other when aside from what labels they’ve used to describe the world, they agree.

    I do think it would be interesting to compare the various sampling methods of the brain studies in order to see what lurking variables may exist. Obviously the structure of the brain is neither a necessary nor sufficient cause, but if there is a strong correlation in some of the studies, that might be worth looking into.

    I know I’ve discussed this with you via email but it does all seem to come back to the false idea that mental illness is less real than physical illness even when, as they appear in the brain, they are a special kind of physical illness.

    1. Yes, it is clearly not as simple of a matter of as preferring some hormone or another.

      I do think the definitions and languaging is a huge source of the issue and how people are talking past each other. It also has a lot to do with how people are or are not invested in being associated with certain terms. I hope to explore that more in a couple of future posts.

      Thanks for the continued support!


    There is a likely genetic component to transsexualism, and genes involved in sex steroidogenesis are good candidates. We explored the specific hypothesis that male-to-female transsexualism is associated with gene variants responsible for undermasculinization and/or feminization. Specifically, we assessed the role of disease-associated repeat length polymorphisms in the androgen receptor (AR), estrogen receptor beta (ERbeta), and aromatase (CYP19) genes.


    Subject-control analysis included 112 male-to-female transsexuals and 258 non-transsexual males. Associations and interactions were investigated between CAG repeat length in the AR gene, CA repeat length in the ERbeta gene, and TTTA repeat length in the CYP19 gene and male-to-female transsexualism.


    A significant association was identified between transsexualism and the AR allele, with transsexuals having longer AR repeat lengths than non-transsexual male control subjects (p=.04). No associations for transsexualism were evident in repeat lengths for CYP19 or ERbeta genes. Individuals were then classified as short or long for each gene polymorphism on the basis of control median polymorphism lengths in order to further elucidate possible combined effects. No interaction associations between the three genes and transsexualism were identified.

    This study provides evidence that male gender identity might be partly mediated through the androgen receptor

    Gender identity has a biological component.

    1. I believe the differences bound in transgender brains are related to behavior only, because identities are social constructs, there are no inborn identities. How come the transgender community is so keen on believing this outrageous idea?
      Isn’t it so sad the modern world believes social constructs are invalid just because they are not material objects? To all the people who say identities are invalid ebcause they are social constructs, you don’t know what you’re missing, keep living on your materalistic world.

    2. This particular study shows a barely significant result around one allele, but it wouldn’t be surprising at all if there were genetic, or epigenetic differences that lead to a greater likelihood of transgender identity. I think the confusion comes in that we use the word “gender identity” to refer to both the high-level narratives and any low-level subcortical structures. I prefer to use “gender identity” to mean the high-level construct because it corresponds to how we generally use the term identity, like if someone identifies as Goth, or Republican or some other identity. I don’t think the construct is quite correct, but Julia Serano has used the term “subconscious sex” to describe this subcortical construct.

      When I compare gender identity to identifying as Republican I don’t mean to trivialize it. Indeed, conservative and liberal political stances are correlated with biological differences in the amygdala. People tend to adopt the political stance that intuitively makes sense with their biology. I think it is much the same in the relationship with transgender narratives, and any underlying subcortical imprinting.

    3. An example of how major parts of the scientific community are oblivious to essentialism, or rather oblivious to the fact that they are unaware that they don’t even understand what they mean by gender. Identity is a narrative, whereby there is no given way in which varying biological conditions will figure within it (whether at all), whether it is the imprinting of narratives or the intensity in forms of stimulus.

  3. “It is important to note that I am definitely not saying that everything is constructed. The postmodernists, having discovered that narratives are constructed sometimes go too far when they decide that everything is constructed. Bodies are not constructed (though the meanings placed on them sometimes are). Instincts aren’t constructed,impulses aren’t constructed, hormones aren’t constructed, chairs aren’t constructed.”

    This may cause some confusion. At one point you acknowledge that narratives are constructed, yet you then say that “instincts” & “impulses” are not constructed. If the property is phenomenological, then it is constructed (whether in one’s life or an evolutionary construct), which goes also for terms such as “instincts” & “impulses”, for which their uses in contexts such as this, usually work to mislead people and give the impression that construction is contradicted. Not only will the subject of this impression not tend to be familiar with the principles of construction, but they will have to understand “instinct” in terms of how biology utilizes construction, for example by way of imprinting and so forth.

  4. Hello! Recently discovered your writing and have been quite enjoying it. This is an insightful post. I am a transsexual man, and I absolutely loathe both the “real vs fake” and “trapped in the wrong body” narratives. When used by trans people, both are attempts to legitimize us to the system on the system’s terms–ultimately a game we will always lose, which only recapitulates the deeply flawed assumptions of the gender system.

  5. “It very well might be the case that some people benefit from cross-gender hormone therapy. Many trans people report the find hormone therapy improves their mood and functioning and they should be allowed to make that choice. However, this question is distinct from the narrative that is told to explain it. … Gender is such a polarizing topic that people who want hormones because they feel it makes them function better is seen as not a sufficient reason. They somehow have to prove that they are really a member of the other gender in order to get that medicine.”

    Spot on! That’s a very libertarian sentiment. From raw meat and milk, to heroin and meth… people need to be free to make their own choices as to what they put into their bodies. Can’t stop anyone, anyway. (Witness the states legalizing cannabis. People are starting to realize this.)

    It’s better if they’re *informed* choices, of course. So if I wanted to try synthetic estrogen, I should be able to obtain a prescription after nothing more than a checkup and a stern lecture on the health risks, or perhaps signing a waiver of liability. I should not have to make up a line of bullshit about gender this, that, or the other thing.

    (Take for example, the moves by Colorado and Washington to allow cannabis for purely recreational use. Prior, you had to have a medical excuse — chronic pain, glaucoma, etc. But the fact is, lots of people just like to get high, and should not need an excuse. They give you the warnings, like don’t drive or operate machinery while stoned… ring up the sale, and off you go.)

    And truly, it’s all bullshit anyway… everyone just tells their gender therapist what they expect to hear, because we can all find that out on the internet. Even the so-called tests (COGIATI, etc) are so transparent as to be easily skewed by a child.

    The gatekeeping itself is responsible for much of the harm, methinks.

    1. If someone uses hormones because it “improves their mood and functioning”, then it is basically a drug. So why are they giving it to kids? I agree with the marijuana analogy- adults should be allowed to use it responsibly, but not kids. Same with transitioning. A trans person should be at least 18 before they start on any treatment of this nature. They are too young to decide before that. Many of these people, including adults, have emotional problems. Hormone treatment will only make it worse, as it causes wild mood swings. In the long run, it is better to let time do the healing. Your birth gender is who you are, like it or not. Life is a journey of discovery. That is true for trans people, too. – aps

      1. Oh, come on — hormones ‘improve their mood and functioning’ so therefore they are ‘like marijuana’? You all are stretching the analogy too far! We also give anxiolytics and antidepressants to kids as well, to ‘improve their mood and functioning’, and while those are certainly medical drugs (but drugs nonetheless), they’re being administered under close supervision of doctors. So what you’re suggesting is to tell to these kids is: ‘life sucks — get used to it!’. Well, of course life sucks. But in the middle of all that sucking there are good things as well, and if we can use medical science to improve our mood and functioning — assuming it’s done under medical supervision, of course — then why should we prevent kids from leading happy, functional lives? In other words: what makes kids so different from adults in the sense that we should only allow adults to stop their suffering, but kids — just because they’re kids — should bear the suffering in silence and get used to it?

        Now I have no idea what kind of parents you had, but mine were rather of the compassive sort: if they felt that there was a medical treatment that could help me to relieve suffering, then they would get me to a doctor and do whatever they could to help me out. It didn’t matter what exactly I was suffering from — allergies, the common cold, or a more serious case of herpes zoster… — they would get me to the doctor and get some adequate treatment for me. I couldn’t care less about what I was taking, I didn’t philosophise on the rational or irrational, reprehensible or commendable nature of the ‘medical drugs’ and prescribed regimen I was given: I would just gobble up the drugs and do what the doctors told me to do, to stop suffering as quickly as I could. Imagine that we would only wait until kids reach 18 or 21 in order to give them antivirals or antibiotics… or even vaccines! How humane would that be?

        While many activists hate to see transgenderity to be labeled ‘a disease’ or a ‘body malfunction’ but rather put the stress on the variety and diversity of the human species, I think that, for the practical purposes of non-activist, non-politicised treatment of gender dysphoria, we as a human and humane society should simply stop pretending that we should not do something to alleviate suffering for ideological reasons. Arguing that ‘kids are too young to know what’s good for them’ is like saying that Jehova’s Witnesses are morally right to forbid their kids from getting surgery and blood transfers (because it’s forbidden by their religion) since, as kids, they cannot know what is good for them or not (in this case, in a religious sense), and, of course, non-Witness doctors are ‘biased’ in their assessment of the needs of their kids — so doctors shouldn’t be allowed to ‘persuade’ or ‘influence’ kids by saying things like: ‘look, we can do a heart surgery to heal you so that you can run around and play with your friends again; or we can listen to your parents and let your heart stop and you’ll die’.

        When it comes to the point where we have to use ideology to refuse to prevent kids from suffering, using the argument that kids are too young to know what’s good for them, then we’re pushing ideology too far. Kids are perfectly aware of their suffering. It’s up to their parents to give them choices to alleviate their suffering — unless they happen to be sadists, blinded by ideology and religion, and prefer to see them suffering in order to make a point.

        Has half the world gone mad?

        Now, of course we are more than able to criticise medical advances, or the lack thereof; we should even be very careful about listening to a doctor’s liberal Kool Aid and get second, third, fourth opinions, when it comes to making a radical, life-changing (and probably not reversible) decision regarding our kids. That’s not the point. I can wholeheartedly agree that in far too many cases, overly liberal doctors are way too ready to push the gender confirmation surgery button, just to make their point. Obviously parents should question what their doctors tell them, and carefully scrutinise their opinions to see if they’re based on medical fact or on liberal propaganda. That’s more than clear to me! Last but not least, it’s only fair to check first if any other alternative methods of dealing with the situation exists: if those kids are really suffering from gender dysphoria, then there is a sort of differential diagnosis that can be made. Actually, putting them on puberty blockers is a rather good method; their action is reversible,

        But once all that has been removed from the table, then we ought to take a good look at what’s left: here is a kid suffering from a ‘condition’ or ‘issue’ or whatever you wish to call it; there is a doctor who is offering a medical solution which is scientifically proven, within a reasonable margin of error, to give very good results. Once that is established, then the answer is clear: transgenderity is not much different than any other ‘medical condition’ for which there are radical methods to deal with. It’s just in people’s minds that such differences exist.

        Read that article about the myths around ‘kids being too young to know what they want’. Puberty blockers (yes, they are hormones!) will essentially allow kids to delay their puberty until they are older — theoretically until, say, they’re legal adults — so that they have more time to decide what they want to do. It doesn’t mean that they get the hormones and start chopping bits off their anatomy (or adding bits) immediately afterwards; it means that, instead of going through the horrors of a puberty for the ‘wrong’ gender, which will be much harder to reverse later on, they can delay that ‘horror’ for several years, during which they can do many more evaluations, get observed by many more doctors and psychologists, figure out exactly what they want to do, without being put through the anxiety and stress of having to make a ‘rushed’ decision before puberty kicks in. Obviously, such a course will ‘improve their mood and functioning’ — because it removes the stress and anxiety of having to go through puberty without being sure about their gender identity.

        I conclude with the last paragraph of that article:

        Both historically and today, the idea that there exists some cultural norm of blindly pushing children toward transition – that adults would actually want a cisgender child to “become” transgender – is absurd. Transgender teenagers experience catastrophic rates of homelessness, precisely because they’ve been failed by their families, their schools, and other cultural institutions that should be protecting them (NHCHC, 2014). This fact-averse tabloid fearmongering over safe and effective medical treatment is a disservice to these already vulnerable youth.

        1. “When it comes to the point where we have to use ideology to refuse to prevent kids from suffering, using the argument that kids are too young to know what’s good for them, then we’re pushing ideology too far. Kids are perfectly aware of their suffering. It’s up to their parents to give them choices to alleviate their suffering — unless they happen to be sadists, blinded by ideology and religion, and prefer to see them suffering in order to make a point.”

          Your position is itself ideological. Extremely so. Not simply at the level of what to do to alleviate suffering, but at the level of the very presuppositions for which you construct the problems. Perhaps the most stupid thing in the common view of gender, is the idea that there is an essential male of female (or somewhere between) inside every individual, especially as people tend to become very attached to their perceived identities.

          When it comes to the seemingly substantial crossover of fetishism and dysphoric psychology, where there is already much confusion for adults, it will especially be the case that kids won’t know what is good for them.

          1. Just another opinion on when to give kids hormones. In reality a more balanced approach between both your points. What I mean is it would be wise to let the child struggle some to a degree with guidance. Be that guidance be from parent and or therapist of some sort. If the adults come to a conclusion on a case by case basis that child really does need help then use what is appropriate. What I mean by appropriate could be just psychotherapy or maybe hormones blockers/hormones that sex hormone more in teenage years. Really it boils down to judging what the child is feeling is it want or is it need and acting with appropriate level of aid. Sometimes it will mean to not give into childs wants but if they are really in need who is to say no to that either. The hard part of all of that is of course finding that middle road and yes in a way that applies to adults. That is the problem I have seen with all of this gender stuff to be honest. Most are looking for the black and white side and not some middle ground of where the truth may be. I would also hope that the medical community would be wise enough to find the best solution not the easiest or most extreme to fit their ideology but I also realize they are human and will have a bias. There for the best thing I can think of is experiment on things to find the best solution for each individual be that child or adult. Starting with the least altering first then progress to more altering methods as required.

  6. Piping in late on this article, but two thoughts occurred to me…

    The first is that I agree that something like ‘gender identity’ is a high-level narrative (and, by contrast, ‘sexual preference’ might be much deeper), and, like all things related to ‘identity’ and ‘self’, they are mental constructs. However, and borrowing from the title, just because they are high-level narratives, it doesn’t make them ‘less real’ or ‘fake’. In fact, because we still live in gender-polarized societies, assigning ourselves an identity to fit in one or the other half of humanity’s main groupings is simply a survival strategy (anyone who refuses that is ostracised). Now this does not necessarily mean that ‘gender identity’ is purely biological and genetically determined. Rather, there is a complex interplay between the individual and the society it lives in. Since we are a gregarious species, we have definitely evolved identification mechanisms with groups of humans (e.g. family, tribe, clan, and so forth), and this prompted our system to reward us by ‘fitting in’ while fearing ostracism. In other words: we ‘feel good’ if we identify with a group, we ‘feel down’ if we’re rejected by a group. It would be hard to imagine that homo sapiens could become a gregarious, social species if such biological mechanisms were not in place.

    So, yes, ‘gender identity’ is just one narrative that makes us ‘feel good’ if we are identified with one of the genders, and makes us ‘feel bad/down/depressed’ if we’re not. But even if such a narrative is a high-level mental construct, and artificial (since it changes over the ages and according to location; gender roles are in perpetual motion in time and space), it nevertheless is rooted on simple, low-level mechanisms of pleasure/pain that have been biologically evolved as part of our genetic makeup as a gregarious species.

    Because gender roles are established based on physical attributes — and this is true for at least 90% of all humans, in all societies and in all epochs — there is a necessary correlation between both. Here is the slight disagreement I have with your assumption: while I agree that things like ‘masculinity’ and ‘femininity’ are mental constructs artificially developed based on archetypes related to a particular society, at a point in time and a location, they nevertheless differ from things like ‘being a Goth’ or ‘being an American’, for the simple reason that our species bipolar sexuality (as represented by the two biological sexes) is, for at least 90% of all cases, a permanent fixture deeply rooted in our genetics. In other words, it’s not likely that the evolutionary branch we belong to will evolve a ‘sexless’ (or single-sex) human being in a million generations from now (unless we do that artificially, of course!). We carry with us the genes for sexual dimorphism across an uncountable number of generations, since sexual reproduction became so successful with multicellular organisms that it practically wiped out all alternatives, at least on planet Earth. It’s such an optimal reproduction strategy that evolution did not bother to explore alternatives, at least in our branch (one could argue that other reproduction strategies exist, and could have been explored as alternatives, even for complex multicellular organisms like human beings, so that sexual reproduction is merely a local optimum and not a global one, but such argumentation is just speculative: we’re stuck with this local optimum and it’s not going to change for homo sapiens).

    As a consequence of this, and as a sentient species with highly developed cognitive abilities, plus with the evolution as a gregarious species, ‘gender roles’ were introduced as narratives to form societies, all of which have to deal with the sexual dimorphism. Because the sexual dimorphism is not so high in human beings than on other species (i.e. we’re more like cats — who have almost zero sexual dimorphism — than chicken — where both sexes considerably differ from each other), the actual narratives that establish gender roles can vary a lot, overlap, and even cross over. However, it’s unlikely that homo sapiens ever had a ‘genderless’ society (if it had, we have not retrieved any artefacts proving that hypothesis). It’s safe to assume that all societies at all times always had different gender roles, with bigger or smaller differences between them, but still significantly different to be able to distinguish between both.

    I argue that this is the reason why the narrative that establishes ‘gender identity’ — a narrative that each individual adopts and manifests in society as a ‘gender role’, which, in turn, also includes sexual preferences — is different from similar high-level narratives like ‘being an American’ or ‘being a Goth’. The latter are very specific narratives in the context of a certain society at a specific time, and are not physically tied to any evolutionary trait, biologically or not. Put in other words: while for this time and period we might argue that ‘being American’ or ‘being female’ are equivalent narratives at the highest level of our cognitive abilities, ‘being American’ just makes sense in the context of a few centuries and is not directly biologically conditioned (except for the simple fact that ‘Americans’ have a habitat, a physical location, and that they reproduce inside a society that tags the ‘American’ narrative to them), while ‘being female’, whatever meaning is attributed to it, is a narrative that persists since homo sapiens exists, and will continue to persist thousands of generations after ‘being American’ loses its meaning.

    To summarise: yes, we might be employing the expression ‘gender identity’ at two completely different levels. The higher level you refer to, which is a mental construct, is also often mixed up with the concept of ‘gender expression’, which is mostly a mental construct as a response to a social construct (society defines roles, conformity to those roles is expressed in behaviour and attire, and this varies according to location and epoch, therefore ‘gender expression’ is definitely a construct…). The lowest level, which you link to ‘low-level subcortical structures’, is what others usually label as ‘gender identity’, in the same sense that the low-level brain structures stores memories with a self-representation (see the work of António Damásio and others on the representation of memories), and we tend to call this self-representation at the lowest levels ‘identity’ or ‘self’.

    But I totally agree that the usage of ‘identity’ for those two levels is misleading and confusing.

    1. There is a misunderstanding here is the supposition that construction is artificial.

      Your disagreement is that because of the existence of all but universal evolutionary imprinted heterosexual desire, that this will tend to reinforce socialization through two generalized kinds of constructed bodies (“male” & “female”) and two ways in which the bodies are to be (“gender roles”)? This doesn’t appear to be a point of disagreement.

      Yes in a cultural shift “America” may loose it’s meaning and may disappear, yet because of the existence of two general polarized kinds of bodies, it will tend to also be a point of reinforcing existing ways in which bodies and roles are meaningful (two kinds of bodies, two ways in which the bodies are to be).

  7. I know this is going to come off as overly simplistic but if you think about it is not that simple.

    Anyway I feel the problem with instinct is essentially like quantifying which comes first the chicken or the egg. Yet of course the question here is a lot more complicated. Or simply for some is it that simple? I do believe that instinct is a valid aspect yet it is also influenced with time and learning Hence the chicken or egg debate.

    Just a thought.

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