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.