detransition

The identity trap and alt. ways to work with gender dysphoria

In this video I talk about ways to work with gender dysphoria for those that want to work with gender dysphoria in ways other than transition and medical intervention, and also for those who still have some gender dysphoria after transition and medical intervention.

Transcript:

So, hello, this is my second video and I am going to talk about ways to work on dysphoria other than medical interventions or transition. So, the reason for this is that first of all not all gender dysphoria requires transition or leads to transition. I think this idea kind of become pervasive and it’s not really true. However, there are people who do benefit from transition medical treatment. There’s evidence that shows that at least many people do experience reduction in their gender dysphoria but not everyone. Also, even among those who do undergo gender transition often still have dysphoria. I’ve known many trans people over the years and many of them may have felt like their transition was a success or beneficial but still suffer from these issues.So, the ideas that I’m going to describe here could be beneficial either if you are looking for ways to work on gender dysphoria without going through this process or maybe you might feel good about transition but want also to have better ways to work on stuff. So, we describe a number of ideas. Not all these apply to everyone. So, just sort of choose the ones that apply to you.

So, the first thing i want to talk about is the identity trap. For whatever reason in the last
20 or 50 or 30 years in Western thought we really got into this idea of identities, particularly in academic circles. This idea that we have identities and multiple identities and that identity is really important and that we need to find an identity and form an identity and discover our identity. In general, I think this is not a very good idea at all. I think it is a pretty toxic idea for several reasons. One of the first things to understand about it is that it is not a human universal.  It is a particular cultural point of view of this particular time. If you look at Western philosophy you don’t see people talking about identity very much at all. You don’t really see that until very recently that people were thinking of things in that context.

If you look at Eastern philosophy, you do sometimes see some talk about identity. In Buddhism and maybe Hinduism as well, but it is in a negative context. It is about the traps of identity and about how identification actually gets you away from your true self. We say that these identities are your true self, which is exactly backwards in my view. So, we can talk about this in a few ways.

So, one of the issues of identities is that they really connect to tribalism. Any time you have an identity which is also a group identity, such as identifying as white, or identifying as male, or female or gay or straight or black or any of these things, it creates a sense of us and them. So, there’s people that are in our identity group and people that are outside it and then this leads to tribalism. I think identities originated based in tribalism and evolution where we were part of a tribe and there was an us and a them. We kind of needed an intuition to know who were our people and who were not. So, this creates a lot of divisiveness, and makes it hard to hear things that are outside our tribal view.

Once we identify with a tribe, for example if we identify as trans we are now in that tribe, and so we take this worldview as being true, and other worldviews are rejected. This creates a lack of flexibility and a lack of ability to take in outside information. Once one identifies with something it becomes very difficult to change that. This happens in other contexts too, like in psychology and psychotherapy for things other than gender issues. For example, if you are working with someone who is depressed, sometimes they identify with their depression. They will say being depressed is who they are and that they are that kind of person. In this case it is much more difficult to work with them, and in fact they’re very unlikely to even come to therapy in the first place because they see their depression as who they are.

So, the first thing you have to do is convince them that the depression is not what they are and to try to externalize it which is very difficult. There’s a real difference between identifying a trans vs. saying “I am somebody who has gender dysphoria”.  I think it is a useful exercise to think of yourself as someone who has gender dysphoria vs. a person who is trans because that can lead to more options.

The problem is that adopting identities can increase distress and this is sort of what you see in some of the Eastern philosophy such as Buddhism.  One of the things that we want to do with mindfulness is to loosen the sense of identity – to see that for any identity we are more that that, or that we are outside of that, no matter what it is. There’s actually an exercise I think comes from Hinduism where you say “I’m not this, I’m not that” to take off these identities.  Who would I be if I was not trans? Who would I be if I was not cis? We go through the process of taking off these identities to see what’s underneath.

This idea is in some of the newer Western psychotherapies as well. For example, ACT, where we have this idea of “self as context” which is a being state, vs. “self as content” which is a concept. Identities are essentially concepts, so not authentic being. With identities we are involved with concepts, and acting from rules in our head. So, we’ve been acting from rules in our head, and this is different from acting from our authentic self, which is more like a being state. It is something that is more organic and not rule-based.  It is what we feel in the moment. Once we are in the rules, we’re dissociated from what is in the moment. The rules are a kind of shortcut, they might describe us in some way, but they aren’t what we are in each moment which is ever changing.

You actually see this when people do adopt a trans identity. People read a transgender internet group, and then come to a point where they accept this identity, and the their distress actually increases. If their distress increases when they take on the identity, then the reverse of that is to disidentify and see if that lowers distress. It can be just an experiment to take on that identity and then take it off. If identifying increases your stress and disidentifying decreases your distress then maybe that is the right way to go, but it is something that you have to experiment with yourself.

The second thing that I want to talk abut is “cognitive traps”.  So there are a lot of these going on in the community where you adopt a belief system that leads you in a kind of spiral towards greater and greater identifying. This is encouraged in various ways. For example, the idea that “if you have dysphoria it means you’re trans”.  If you say you feel some discomfort about your gender and you aren’t sure; they will say that means you are trans because cis people don’t feel discomfort about their gender. So any discomfort you feel confirms the trans identity. Especially if you are someone who by the process of identifying increases your dysphoria. Then you are going to be in a spiral, so now you have more distress and confirms you are trans even more. So, these things activate a spiral.

That’s what I mean by cognitive trap, it is this feedback loop that makes things worse and worse. So then the antidote is the reverse process, like saying this story doesn’t necessarily mean that you are trans, and I am just a person with gender dysphoria. So then, you can see if maybe that will reduce your distress and you can begin to reverse the loop.

Another kind of distortion is found in one of the tests the community will frequently put out.  They ask “If you would prefer to be the other gender, then that means you are trans and must transition.”  That is not true, because that is not the actually choice you are making by transitioning. These interventions are only partial and so the real choice you are making is between having a more normative body of your natal sex, or undergoing a kind of partial gender reassignment and being in a trans body. You can make that choice, and for many people that might be right choice, but you can’t make the choice of changing your body fully and becoming fully the opposite gender because that is not possible with today’s technology. So that is one thing to really consider. You have to be in touch with the reality of the real choice you are making.

One reason to let go of the identification is that if you don’t identify with the gender dysphoria it can be placed in context with rest of your life, and you can consider whether you will cause other problems that are worse.  So then the question of the choices that you make is based on a holistic view of yourself. It is not just gender, but is based on everything.

Another trap that exists is for people who experience erotic fantasies of feminization of some kind. Not everyone with dysphoria experiences this but some people do. Then the community will say “that fantasy is proof that you have this essential identity of trans” which also leads you into the identity trap I talked about.  You don’t choose what your fantasies are like.  You have a certain sexuality generally which doesn’t change, but you do choose how you identify. For example, you can choose the meaning you place on your sexuality, but not the fantasy itself.  You can choose the meaning you place on it. You can say “well, I just have this fantasy”, and maybe you can enact that fantasy with a consenting adult or maybe you can not enact it all.  It’s a question of what choice is best for you.

The danger of these fantasies is they can lead you away from the ability to form healthy romantic relationships.There’s nothing wrong with the sexuality per say, but it is a question of whether it can lead you to connect to another person or if it leads to a kind of self-absorption. If it prevents you from connecting to others, then that is a problem.

Sometimes people have a kind of dual sexuality where they have both erotic feminization fantasies and a more heterosexual male sexuality as well. In that case it really depends. You might find somebody you can enjoy both these things with but in some cases only one of them will lead to successful relationship, so I think it is better to choose what will lead to relationships and love and all those kinds of things.  The problem is not about what is normal at all, it’s not about heterosexuality being normal, that doesn’t matter. It is about whether it is functional and can lead to connection.

Sometimes,there can be obsessions and compulsions around these things and if that is the case then the idea of obsessions and compulsions are something that is generally understood in psychology so it can be something you can work with somebody about. Seeing someone who knows about those issues could be helpful. When I talk about choice the goal is to empower you to have as much choice as you can in this process. Some things we don’t choose. We don’t choose our feelings. We don’t choose our erotic fantasies but we do choose our responses to them. This is true in theory, but in practice people don’t always have choice. Maybe because there is something really distressful interfering.

Some people have trauma issues. I’m not say all gender issues are caused by trauma at all. That is not what I’m saying, but if you do have trauma that can interfere with the choice process. So again, that is something to work on with someone who specializes in trauma potentially or you can read books about it. So, another thing I want to talk about is what I call gender schemas, where you have some ideas about gender that are distorted in various ways.  Distorted may not be the right word, more like rigid. The idea that one sex is good and one sex is bad. Like men are really good and women are really bad or women are really good and men are really bad.  Or maybe that it is unsafe to be a man in the world and safe to be a woman in the world or vice versa.  That is something that you might have to work though and it might not be conscious. In my case it wasn’t something conscious at al but a visceral sense that it was unsafe to be myself and man rooted in all the bullying I suffered.  It was really unsafe to be male and be myself, even though I was completely surrounded by many feminine men and never had a problem with them. It was just for myself it felt unsafe. One remedy to this kind of rigid view is to really recognize the within-group diversity of men and women. For example, to see how men and women are both very diverse groups. There are all kinds of men and all kinds of women. Maybe to look to role-models who are more atypical members of their gender and are similar to you.

Another idea to look at is the universality of suffering. One of the views of the trans community is that gender dysphoria is a very unique kind of suffering. That is an isolating view and contributes to making your world smaller and also contributes to being more attached to identity and the identity trap and increasing suffering. One thing that reduces suffering is to see the universality of it. Even though our suffering is unique in various ways it also universal. We all in some ways want to be something different than what we are. Envy or a sense that other people have the thing I need to be who I want to be in the world. In the Eastern practices, such as the Buddhist practices, we generate compassion by acknowledging the universality of suffering and we start with easier people like our friends because we want good for them because they are suffering, and then we go to neutral people, then we get to our enemies and we see they are also suffering, so they are the same as us in a way.

By seeing ourselves as being part of a universal human experience it reduces the loneliness and reduces that sort of special character of the gender dysphoria which makes it feel like no one else suffers the way I do.  So this gender dysphoria is really unfair and feels really lonely.  It reduces that.  I’ve said this once before and some people said it was trivializing gender dysphoria which is definitely not what I am trying to do, because it is not trivial. It can be very severe and intense even leading some people to suicide because it is so intense. However other kinds of suffering are like that too, they can also be so intense as well.  Seeing the universality of it can help to reduce it. We’re all humans in this boat together.

Finally, the last thing is living according to values. Really discovering what your values really are.  This is known to be helpful because if we are focused on living our values we are focused on expanding ourselves, expanding the world and expanding who we’re helping. This helps us get out of the kind of self-absorption that can be really toxic and also helps us to endure suffering.  I think one of the ideas that comes with the ideology around gender dysphoria is that we are not supposed to have pain and not suffer. This is not true, we all have pain. The question is how do we live despite that and how do we face this pain. How do we say despite our anxiety or fear or pain or anger we are going to live according to our values. This makes life more fulfilling and rewarding.

The Greeks had this distinction between hedonia and eudaemonia. Hedonia was simple pleasures such as having a drink or playing games or dancing and all of these things. They are important in moderation, but in excess can lead to this over filled feeling. There is point where they are good and then as you get more of them they become less satisfying. Then there is the idea of eudaemonia which is the meaningful kind of life. It represents living according to virtues and living according to values. It is always good and does not lead to burnout. That’s a question to ask about transition. Is it living according to your values or not. Is it creating a greater good? If it enables you to live according to your values it is a positive step. If it is shrinking your world, like a couple of other people have said then it is negative. If it shrinking your world and making it harder to live according to your values, then it might not be the best path and that is something to sort out. Again I’m not saying all these medical interventions are bad, they can be good or harmful. So, that is all I have for today and hopefully I will do more videos in the future. Thank you.

 

TWT – Now on video!

I haven’t written much recently. A lot of that has to do with being in grad school, the last thing I want to do is even more writing. 🙂 So I’ve decided to start creating some videos. This is the intro video where I tell my story and I eventually hope to make more videos about detransition and alternative ways to deal with gender dysphoria.

Transcript:


Hello, my name is TW. I am the author of the blog Third Way Trans and I thought I would make a video about detransition and also about different ways to deal with gender dysphoria. This is inspired by several of the detransitioned women that have been recently making videos and so I decided that there should be videos from the detransitioned men as well.There’s already a few and there should be more. This is going to be the first in a series.

This is just an introduction. One of the reasons is to help other people who are transitioning so they feel like they’re not alone and they can have someone to talk to. So if you are ready to detransitioning or considering detransitioning you can definitely email me at the address that is given by the video and you know i would be happy to chat with you. A second reason is also to help people deal with their dysphoria. One of the things that I discovered in this journey is that there were other ways to deal with my dysphoria that would work better and also would have been less harmful. I had to go through this whole transition first in order to figure all that out and I had to spend 20 years being transitioned. I transitioned when I was 19 and detransitioned when i was 39. I’m 42 now. I spent all this time transitioned and modified my body in many ways which is still causing problems to this day and I want to help people be able to deal with these issues without having to go through that. To be clear, I don’t oppose transition and I really understand how debilitating gender dysphoria can be.  So I don’t propose to ban transition or eliminate it, or to eliminate treatments like hormones and medical treatments.

I don’t think these treatments should be eliminated but at the same time we should help as many people as possible to work through these issues without having to go through that because it’s a horrible thing to go through, and it’s imperfect and leads to social problems and potential medical problems including sterility. The last is very important. Having children is very important to many people and may not seem so important when you are young.

Transition has become much more visible as many more people are identifying as trans than there used to be. I remember when I first looking at these issues back 20-25 years ago the reported incidence was about somewhere between 1 in 10,000-100,000. 10 years later the incidence numbers look more like 1 in 1200 – 3,000. Recent numbers used at this point are 0.3% or about 1 in 300, and a recent survey shows something like 0.6% which is about 1 in 150 or 1 in 125 or so. The question is what is this? Is this because of greater social acceptance as some people say? Some people say, oh it’s great people can be themselves. Or is there an element of social contagion which is leading more and more people to jump on the bandwagon of trans. I think it can be both.

I definitely think that there are benefits to having more social acceptance because a lot of the issues to do with being trans have to do with lack of social acceptance and all of the
stigma. That will help trans people to live better lives but at the same time I think there’s also some elements of social contagion. People who would have not transitioned in other times but in this time consider it, are probably the ones who maybe have better ways to deal with their issues and so I think there’s definitely a problem going on. I think it’s a problem with therapists that rubber-stamp people’s transitions. For example, seeing them once and approving them for hormones which I think is pretty bad practice. Especially because I have training as a therapist. I have a master’s degree in psychology and I am now in a PhD program in clinical psychology. I worked in three different clinics seeing a lot of clients including trans clients.

One of the things I learned in my clinical training is just in general how little you know about someone when you see them once or twice or three times. There’s so much we don’t know.  They don’t really trust you as much in the beginning.  If you’ve been a client in therapy you probably know  what it is like to work with a new therapist or psychologist.  You don’t really know them and it takes time to be comfortable with them and to be able to tell them things. As the therapist it also takes time to figure out what is going on. It takes time. I mean, the places I work we don’t even make a treatment plan until three or four sessions because we don’t really know you, like we have to figure it out. If you are writing a letter to somebody after one session you don’t know them. You don’t know enough There’s no way even really great therapists can know enough. Again, I do think people benefit from this practice, and I do think it should exist, but I also think there needs to be a lot more exploration beforehand.

Particularly, people who transition often talk about issues of trauma. They talk about abuse, sometimes there is sexual abuse. Sometimes there is kind of aversion to being their sex because they hate their sex. For example if you’re a woman that hates being a woman because they don’t like dealing with men or things like that. These are things that can be worked with psychologically sometimes.  OCD can be there sometimes too. I think there needs to be a lot more of this kind of exploring beforehand and definitely more than just 1-2 sessions. I don’t know how someone can have the clinical training I have and think that is good practice. Especially someone who has been with clients and known how much complexity they have and how much depth they have and how much you don’t know about them.

I guess I’ll also talk about my own story. When I was a child I experienced trauma issues with bullying. When I was young I was physically the slowest boy but also very intellectually advanced like a child prodigy. By fourth grade I was going to the high school to take high school math, and on the other hand I was the weakest. So I was singled out for being a kind of super nerd. This didn’t make me popular at all. It made me popular with the adults actually but not my peers. So I suffered a lot of bullying and violence. It peaked in middle school where every day I would have some sort of violence directed at me.

When I was a child I started to have this fantasy of being a girl, because it meant I could be safe and not suffer from this violence due to being at the bottom of the male hierarchy. I could also be more soft. I used to cry a lot and that was also something that was not seen as good for a boy. I could be free of all of that and also still be intellectual because everyone was saying that girls can be smart too.  Of course I did’t understand the complexity of society then and all the prior sexism behind that message because I was six. It became a fantasy that kept me comfortable, not something that could really happen, more like a fantasy I had.

Then when I got to adolescence it continued and became tied to sexuality. I was also attracted to women so it was confusing, and my dating life didn’t got well when I was a young teenager. I was a late bloomer but eventually once I got to be a junior in high school I did have some success in dating and had several different girlfriends. After that my gender dysphoria declined.

When I got to college, in the first few months I didn’t meet any women and it felt like a real step back and my gender feelings resurfaced again.  Now I understand that one of the reasons I was successful in dating as a high school senior was because I was at the top of the heap and then when I became a freshman in college I was at the bottom of the heap. This was in 1993, so I was on the early pre-WWW internet and at the same a trans newsgroup was created on Usenet, and I heard people who had similar feelings to mine and it was like a revelation! Other people had these feelings too and I could relate to them. It meant you could really do this. It could really happen!

One of the first things I did was go to my university counseling enter and talk to the intern there. He seemed freaked out. Then I went back a second time and he said this was beyond the scope of the counseling center but we have these referrals to give and they gave me a referral to a gender clinic. I was kind of mad at that because I had to pay for it. The counseling was free at school, I didn’t have much money as I was a student. Ok, I went to the clinic and told the psychologist my story and that I wanted to be female. I didn’t talk about bullying and I was unaware that it was related in any way. This is something I sorted out later when I was in real therapy.

So, I was just like this is who I am and this who I want to be and they were like that’s great. There was no kind of anything, just two session and I was given hormones. One thing I’d like to point out that is kind of ironic is that at the time this was not considered good practice and a violation of the standards of care. At that time they said you had to have at least 12 sessions of therapy for hormones. That’s not true any more. Lots of people are doing it after just one, two or three sessions. This thing that was harmful in my life has now become standard practice in the clinical community.

This really became my identity, and I was young and there were very few young transitioners then, so it wasn’t actually that hard to become seen as a woman, and I started to get a lot of positive attention. That felt really good, I felt like things were going well, but objectively that wasn’t the case. I always got really good grades, but I was put on these really high doses of hormones which were crazy. We don’t do stuff like this any more but I was on the equivalent of 17 birth control pills/day at some point. Just unbelievable! It seemed like the medical community was like okay we are just going to do weird stuff with you people and not follow any good practices. That has actually gotten a lot better over the years.  I think there is a lot more understanding now of hormone practices.

This caused me a lot of problems like my brain wasn’t working right. I was not able to do my work in school. It was also hard because my transition was very visible at a small school and this wasn’t common then. Also there were still things that were wrong. This was supposed to cure my dysphoria, however what I found is that it didn’t actually do that.  It just made me uncomfortable with different parts of my body that weren’t feminine. I had really big hands and a big jaw and so I still had the same problem of hating parts of my body.

Now, I had additionally the problems of being trans in the world, like a lot of social problems. Sometimes people would be aware I was trans and sometimes they wouldn’t and all of those were problems. If they weren’t aware there was a sense of I can’t tell them about it, and that really closes off intimacy because you can’t share this really important part of your life. If they did know about it there would be lots of different reactions. Some people were fine. A lot of people were fine on the surface, but they would really act differently towards me. It almost felt like having no gender at all and being outside of humanity. It was a really awful feeling.

I really thought this was was my identity and what I had to do. Even though there problems I thought it was something I had to do because it was my truth. There were other problems too. My body was really tense all the time and I was disconnected from my body a lot and had a lot of dissociation. I wasn’t even aware it was dissociation, it was just kind of the way I was. It is only now that I am in my body that I understand the difference. So yes, there was a lot of problems.

I had difficulty romantically too. There were actually a lot of people interested in my but I was not able to bond with people. This was really frustrating and eventually I started to go to therapy. I wasn’t working on my gender, but on why I couldn’t have relationships and why my body was so tense.  I started to do therapy and all of these embodied practices. I got involved in meditation. I got involved in doing dance practice. I got involved in doing a practice called Biodanza which is a sort of practice where you learn to connect to yourself and other people. I eventually became aware I was really disconnected to my body. I eventually came to the realization that a lot of this had to do with my attempt to present myself female which was unnatural for my body. I was holding my shoulders in and holding my butt out, and doing all sorts of things that were outside the natural movement of my body. This was causing strain and stress on my body.

I came gradually to the realization that this was actually a problem. That this whole transition was actually a problem. It was still difficult because I still had this feeling like maybe I should be a man, but it was totally unsafe emotionally and I couldn’t do it. I did a lot more therapy and eventually came to understand the roots of this with the bullying and feelings unsafe about being myself and a man in the world. I didn’t see things this way in an intellectual sense, but in a visceral. So, it was a long process and eventually I worked through. It was also a big revelation because I thought my gender identity of being female was fundamental. It seemed like an absolute truth and an absolute axiom, and then it turned out not be that at all. It turned out to be something that could be change.

This was very surprising to me because there is all this thought around gender identity being something that can’t be changed and that it is permanent. Although now it is getting kind of confused because it’s permanent but it also can be fluid and it can also change but it doesn’t change and there is no real kind of consistency in the whole ideology behind it.  Having learned that it could be changed, its really something I would not have wanted to do through because it’d be much better have dealt with my issues without changing my body so that I wouldn’t have the difficulties I have now.

I can’t really get my hormones right. I take testosterone but it doesn’t work right, its always a problem because I can’t find the right balance of it and never get it right. I know I can’t recover my body all the way. For example I look way younger than I am which people think is positive. I don’t like it because it reminds me it isn’t right. I want to look like a 42 year old man because that is where I am and not being seen as that is frustrating sometimes. There is also breast growth and stuff like that. I could get rid of it but it also feels like that is just changing my body more so it brings issues.

If you’re interested in the clinical implications I experienced this and other people have experienced this and they are talking about they have dealt with dysphoria A lot of women have gone back, and there are some men as well that found ways to deal with dysphoria. They found ways to work with it, and it is very important for the clinical community to be aware there are ways to work with it. We should be working on this a lot more even if we support transition. I do support it for some people. We should still simultaneously be working on how we can help people deal with these issues without doing that because it would save people a lot of trouble and a lot of expensive imperfect medical interventions.

One of the reasons I went on to a PhD program because I want to research those ideas and also ways to work with dysphoria. In this series I am going to start making some videos and focus on the ways I’ve seen other deal with dysphoria as well as just some general psychological principles. Sometimes it seems like we just throw out the basic principles of psychology, and we need to put back some of these ideas. It takes a while to know someone and human nature is complex. I think things would be better if we kept that in mind. That’s all I have for today. It is just an intro to tell you about myself and I’ll be making more videos. Also feel free to read my blog which is listed in the comments and email me if you have any questions. Either questions about dealing with dysphoria, or maybe you don’t want to transition or have questions about detransition and want support about that. Thank you.

Social Justice and Gender Therapy

This post is an expansion of this discussion I had in the comments on the 4thWaveNow blog. I am hoping to get back to focusing on working with dysphoria rather than political issues, but after spending the last three months in grad school surrounded by these ideas I thought this post was important.

A lot of what is currently going on with gender therapy is currently related to “social justice” ideology. The goal of social justice ideology is an admirable one. Its goal is to correct injustices that occur when groups are marginalized in various ways. This is a noble pursuit. Being part of a marginalized group and being subject to discrimination and prejudice is pretty awful, which is something I certainly learned after 20 years of living as a trans women.It is not the goals of social justice ideology that are problematic, but its methods. In fact, its methods sometimes cause harm to the very marginalized groups it purports to protect.

I have seen several stories from parents who take their children to see therapists for gender issues and the therapist sees the person only once and immediately recommends transition, dismissing any parental concerns as prejudice and bigotry. Likewise, people who see therapists of their own accord find their cross-gender identities are enthusiastically supported and exploration is dismissed as unnecessary. They are reassured that their gender feelings cannot relate to other causes. Some critics have suggest that therapists are just going along with trans people because they are money-grubbing and afraid of losing business if they don’t just go along with things. I don’t think this is actually true, for one I have known many therapists and none of them seem like money-grubbers, for another seeing people only once is a poor money-grubbing strategy. Rather, it is misplaced idealism that leads to this practice, which is harmful to very minorities it purports to support.

I have written in more detail about this particular ideology here. In particular there are two features that are relevant here. One is the idea of oppression. Social justice ideology sees people as members of “marginalized” or “privileged” classes. People in marginalized classes are seen as suffering from oppression and discrimination. This is true to some extent, but social justice ideology tends to see all of their problems as coming from that source.

Secondly, narratives are primary. What I mean by that is personal narratives and stories are the most important thing. The subjective triumphs over the objective. This also intersects with the idea of oppression, where members of a dominant class are seen as unable to understand the experiences of people of the marginalized class and therefore they must always take those experiences at face value.

This means that if therapist who has a strong orientation towards social justice and works with trans people they will tend to see their problems as due to oppression, and additionally feel they should not question the client’s narrative which must be taken at face value as they are oppressed people. At first I found it perplexing this practice of engaging in minimal assessment for something as serious as hormonal treatment and surgery. This seemed irresponsible especially given as I am trained as a therapist and understand how much focus is generally placed on assessment for other conditions. Now, I understand it is not so much irresponsibility, as morality. It is not that they consider it unnecessary to do assessment; it is that they actually consider it immoral to do assessment!

This is intended to help trans people and other marginalized people, but it actually can cause harm. What it means in essence is that if someone is a member of a dominant class they receive regular psychotherapy but if they aren’t they receive a special kind of social justice psychotherapy. I do think it is important that the legitimate issues that arise from social justice thinking be considered, but not at the expense of regular therapy. I feel I have been profoundly harmed by my original therapist’s failure to encourage deep exploration of my issues, versus simply “affirming my identity”.

Because of this, gender therapy is reduced to just a few steps, specifically:

1. Eliminate sources of oppression (internal and external). If the person does not accept their trans identity then that is internalized oppression, if someone else in their life questions their trans identity, than that is just due to their prejudice and privilege that makes them not understand the gender-questioning person in question.
2. Affirm and validate their identity. In particular don’t question their identity, or assume the possibility of other underlying causes, a privileged person should never question the narrative of a marginalized person.
3. Make them aware of their options and make sure they have adequate resources and support to get through transition.

A few months ago, I attended a conference about trans health. At this conference, there was a presentation titled something like “assessments for mental health” and I was excited to attend this presentation because I thought I might finally come across some good information on this topic, which every training and conference I attend never seems to have. Unfortunately, I was rather disappointed. The presenters presented a case study of a client who had psychotic symptoms, and issues with dissociation. Surely some caution would be indicated in this case. Of course, the answer was “we found a way to get them enough resources and support to have that surgery” and there was nothing about any kind of evaluation of whether they should do this or not.

I have attended four separate trainings on working with trans clients and they all were more or less like this. Everything in the training was about cultural competency and better understanding trans people. There might also be something about the nuts and bolts of transition as well. However there was never anything about how to help people deal with their issues without transition, or how to differentiate between those who will do well with transition and those who won’t.

Here is an example of a syllabus for a class for therapists to learn about trans issues. Notice that everything in the syllabus is about learning about the experiences of trans people and how to affirm them. Again, nothing about the dynamics that might lead to transition, what factors should lead to extra caution, or how to help someone figure out if they can deal with their issues without transition.

Again, it is very appropriate to consider social justice factors when working with trans people, but it should not be considered the sole factor and overshadow regular clinical judgment. Paradoxically, serving social justice requires making sure that social justice ideas don’t result in substandard therapy for sexual minorities like trans people.

Where did I go?

Where did I go?   I fell into a grad school hole.   I started a PhD program in clinical psychology this fall, and our workload for the first quarter was very demanding. I ended up regularly working 60-70 hour weeks and the last thing I wanted to do was more writing. Now the quarter is over, and I am back.

I am questioning whether school is something I want to continue with or not.   I was hoping to get more involved in the scientific/research end of psychology in addition to the clinical end which I really can’t do with counseling degree.   However, I am wondering if this is interfering with my work rather than aiding it. This path greatly delays the amount of time it will take until I will be able to be in independent practice, something I could do in about 1.5 – 2 years at the Master’s level, but will take more like 5-6 years on this path.   Also it will be several years before I can actually do any kind of research on my own interests. I do feel it is very complimentary to my previous training, my master’s program was in holistic counseling, and this program is very much in the academic/scientific tradition which has a totally different culture to it.   So, that is something for me to figure out.

It has been good to take a break from writing the blog, I find it very difficult to avoid getting sucked into all of the toxic politics around these issues. My primary goal for this blog is to help people dealing with dysphoria, and finding better ways to deal with their dysphoria than transition.   I don’t expect those ways to work for everyone, but even if they work for some people that is a good thing.   I don’t have any moral or philosophical objection to transition, hormones or surgery. I just think they are awful experiences that people should not have to undergo unless necessary. I feel that I lost a lot of opportunities as a result of this, from not being able to have a family, to dealing with social stigma, to relationship difficulties, and various mental health issues stemming from untreated trauma and taking too high dosages of estrogen.   On the other hand I recognize that some of the challenges of transition arise directly from stigma, and I don’t want to contribute to the stigma faced by trans people either.

Although, I do have a secondary goal of bringing awareness of these issues to mental health professionals, both the issues of detransitioners, and even more importantly working to find ways to prevent unnecessary transitioning.   Increasingly, at least in the USA, there is no exploration happening at all, and some therapists even find it offensive to explore or question with their clients. I think a lot of this ties into “social justice” ideology, which I wrote about a little bit here. and guest poster Lane on the blog also wrote about.   I will write some more on this, as I am finding this ideology very prevalent in my psychology program, I don’t know if many people realize the extent to which it has taken over many parts of the field. It is important to note that one can oppose social justice ideology, without being against its goals of equality or ending oppression which are admirable.   Indeed one important reason to oppose it is the harm that it can cause to minorities and particularly vulnerable people dealing with gender issues.   Jonathan Haidt and others write about the issues of political monocultures leading to groupthink and blind spots and the people at Heterodox Academy write about these issues well.

Also, I have been taking some time to reflect upon detransition.   It has been over 2 years since my detransition, and over 3 years since I started on T. There have been things that are good about detransition, but there have been some losses as well. It is not possible to fully restore things to the way things were.   In some ways things are better. It is so great to let go of having to speak with a voice that was not my own, and to just be able to be myself without worrying about how my gender is perceived. I also find much to my surprise that I really enjoy hanging out in groups of guys as a guy, I feel like I fit in there. None of the guys I hang out with are “dudebros”, some of them are gay/bi, a lot of them are nerdy or psychology people, but it feels really good to hang out with them. Also being on testosterone has granted me more vitality and energy, greater emotional stability and generally sharper thinking.

However there are still problems that remain. For one it is impossible to get my hormone levels right. I have experimented with a wide variety of different levels and gotten it the best I can. If my levels are too low I suffer from low energy and fatigue, if they are too high I end up with too many angry thoughts and too much sex drive. I find the best middle I can but it doesn’t quite work right.   I even experimented briefly with not having it, which leads to feeling calm and peaceful but not quite alive. Also going without sex hormones is bad for long-term health. But, who knows what the long-term health consequences are. I have no idea if I am helping or harming my health by taking T, compared to nothing at all or E.

Another problem is I keenly feel a loss of community.   I was an active part of various queer communities for the past 20 years.   When I was younger I was largely focused on the bi community but also spent time in general alternative sexual minority communities.   I once co-hosted a radio show on bi issues, went to conferenes of various kinds, and worked in a queer counseling center.   The queer community was my people, and now I feel alienated from those communities due to my detransition and critical views around gender.   It is hard to go against what I considered to be my people, but I think it is very important to speak truth.

It is especially strange to be doing this right in the middle of time where there are more out trans people than ever and in many ways trans people are celebrated. I don’t at all mean to say that trans people don’t suffer a lot of stigma and problems, but there are certain subcultures where this is well accepted.   They happen to be the subcultures that I mostly live in, and I feel like I will get in far more trouble for being critical around gender issues than for being trans.   Letting go of my trans identity right at the moment when more acceptance is happening feels especially strange. I still struggle with shame around transitioning in the first place and ending up in this place. I haven’t shared about my transition/detransition with my grad school colleagues or many of my newer acquaintances/friends.

Another area that is especially challenging is dating. Even though dating as a trans woman was definitely a challenge, there were actually quite a lot of people that were attracted to me. Some of these people also didn’t have any problem with my being trans. The irony is that the real problem was me. A lot of people that were attracted to me were attracted to aspects of my androgyny or even appreciated that I was trans. However, that was unacceptable to me, as I was so wrapped up in my “gender identity” that I was very closed off about talking about being trans, and wanted to people to validate my identity, so if they were attracted to my being trans or masculine qualities that was very uncomfortable and unacceptable. I became very difficult to get close to, and that closed offness was a bigger barrier to relationships than being trans was actually.

Now, I just feel invisible. I do get read as male, but still have quite a bit of breast growth and barely grow any facial hair. I am pretty sure I will do something about my breast growth, and I think it will feel better not to feel the need to wear baggy clothes and conceal things all the time. Part of me feels good about doing that, but part of me procrastinates because it feels like it is doing the same thing again, changing my body so I can be myself.   I did briefly date a woman who was a friend that I knew before detranstion, but since then haven’t met anyone. I think I am reluctant to approach people because I don’t know how to explain my body to them, I know that is something I need to get over. I just really wanted to share the good of detransition as well as the bad, I think that is important.

That is where I am now, I am hoping to get a few more posts out over my break, and catch up with people.

“regret rates” are not the sole measure of outcomes

I’ve seen the statement made many times that “the rate of regret for gender transition is very low”, generally quoted between 1 -3 % or so. This is used as evidence that we should not be so concerned with the problem of detransition. People identifying with a certain gender and wanting to transition is enough proof that transition is right for them, and therefore there is no need for any in-depth screening.If someone identifies with a certain gender and wants to transition then clearly that is the right thing, as evidenced by low regret rates. Also, there is no reason to look at different ways to deal with dysphoria, because we have this great treatment that already works.

However, there are several problems with this which are:

  • The reported measures of regret rates don’t actually measure regret rates.
  • Regret rates are not the sole measure of good / bad outcomes.
  • The demographics of transitioners today are not the same as those in the past.
  • Gender transition improving people’s quality of life, doesn’t mean there aren’t less invasive ways to get the same improvement.

The reported measures of regret rates don’t actually measure regret rates

An example of a study that shows transgender regret rates is here. This study shows a “regret rate” of 2.2%. However what are they actually measuring? What they are actually measuring is the rate of “legal detransition”. They measure what percentage of people who undergo a legal name and gender change then undergo a second legal name and gender change. They don’t measure people who have regrets but don’t detransition legally, or don’t detransition at all. It is also possible to detransition and not regret the original transition.

Regret rates are not the sole measure of good / bad outcomes

Indeed, regret is an important component of good outcomes. Regret is part of a poor outcome, and satisfaction is part of a good outcome. However, it is not the totality of good outcomes. Good outcomes include social adjustment, economic well-being, mental health, and other measures of health. There hasn’t been any research that I know of on long-term outcomes of gender transition (20+ years), partly because most long-term transitioners are lost to follow up.

Because I transitioned 20 years ago, I know many MTF transitioners that were in my cohort or even 5-10 years before. What I see is concerning. I am the only one out of them that has detransitioned, and most of them would not say that they regret their transition and continue to go by feminine pronouns and feminine names. In terms of life outcomes, I would say economically they are mostly doing well. However, socially they are struggling. Most of them are alone. I see a lot of social anxiety, people being unwilling to leave the house. In addition, they still continue to deal with dysphoria and have emotional difficulties.

This is not a good thing, some people would say these difficulties are due to oppression and by reducing this oppression it would reduce or eliminate these difficulties. I definitely believe that oppression is a large factor in some of the things that are awful about being transgender. I oppose those that intend to make the world worse for trans people. However, I do not think it is the sole source of these difficulties.

The demographics of transitioners today are not the same as in the past

These studies of regret rates are often used as reasons that we don’t need to be too concerned about people with cross-gender identities regretting transition. This is combined with the idea that people have a fixed and essential gender identity and aren’t wrong about it. So, if someone identifies as transgender, then they are transgender, and that can’t be changed.

In particular we should be concerned about two groups, adolescent / young adult FTM transitioners and transitioning children. Historically, the ratio of MTF : FTM transitioners was around 3:1. A recent study showed that FTM transitioners are now exceeding MTF transitioners, a large change. Also, there is a recent
study
showing that many of these are young women dealing with typical adolescent identity issues as seen here. I wrote about this in more detail here There are already more and more female detransitioners and people who take testosterone for a while and then stop. The trouble is we don’t know how to distinguish between the people that are going to be happy with their transitions in the long term and those who won’t. This is a topic that is in great need of further study, and we should proceed with caution until we have it, to make sure we aren’t giving a permanent solution to a temporary problem.

We should also be concerned about transitioning children, as historically 75-90% of children with gender identity issues desisted at puberty. I believe that children that have gender dysphoria that persists into adolescence should be given access to transgender services. I don’t think this point is particularly controversial in the field. However, desistance rates have been declining. This has been celebrated as vindication for the use of puberty blockers, but it seems to me that this is evidence that the experience of puberty itself leads to desistance, and therefore it is important to have these children experience at least some of their natal puberty in order to determine whether they will desist or not.

The wrinkle in all of this is that if someone is to undergo gender transition it is better for them to experience as little of their natal puberty as possible, both for the emotional effects of their puberty, and better physical results from transition. This is one of the things that makes it tricky. I think it would be best to try to figure out how much of the natal puberty they need to experience to determine if they would desist or persist, I don’t know what the answer to this question is.

Also there are those that claim desistance is equivalent to persistence as long as they are well-adjusted. I disagree with this strongly, even if they become well-adjusted trans people. If they could have been well adjusted without this treatment as well that is still a loss. Infertility and a lifetime of dependence on hormone treatment should not be treated lightly. Of course if the choice is between being a well-adjusted trans person and non well-adjusted cis person, we should prefer the well-adjusted trans person.

Gender transition improving people’s quality of life, doesn’t mean there aren’t less invasive ways to get the same improvement.

The research shows that gender transition improves the quality of life of some transitioners, and I do not advocate for eliminating it, or denying access to those who need it. However, this does not mean we shouldn’t continue to look for better ways to work on these issues at the same time. Even though transition does indeed improve people’s quality of life, this is still a community under significant distress. Attempts to help people work on these issues without transition should not be denounced as “conversion therapy”. It is not evil to want people to find better ways to deal with their issues.

The problem of extrapolating the idea of “innate gender identity” from MTF folk to FTM folk.

In earlier posts I have been critical of the construct of “innate gender identity”. One problem I have talked about is the problem that low-level instincts and imprinting that may lead to transgender identity are called “gender identity” and the high-level narratives that transgender people use to explain themselves to themselves and others are also called “gender identity”. I use the term identity to describe the high-level narratives, because that is what we generally mean when we use the term identity, say when someone identifies as Irish or a Goth or Republican or something. Even those identities have low-level biological correlates. We know for example that conservatives tend to have a stronger threat response and a stronger disgust response than liberals. The important point is that the high-level narratives are culturally specific and do not necessarily arise from the low level instincts. People with the same low-level instincts can arrive at different identities depending on their circumstances and their environment.

The classic transgender narrative holds that people have an innate gender identity and if their bodies are different than this identity they will undergo tremendous suffering and the only way to end this suffering is to attempt to change your body as much as possible to one of the opposite sex and socially convince people that you are a member of that sex. Only then can you be your true self, and be free of the suffering of gender dysphoria.

There are some good reasons that the idea of innate gender identity came into fashion. The most classic is the tragic story of David Reimer. In short, psychologist John Money had the idea that gender identity was established around age 2 or 3, and established in response to socialization. Therefore, if you raised a natal male as a girl, he would adopt a female identity. John Money found the perfect subject to test his theory on in David Reimer. David Reimer lost his penis in a circumcision accident as an infant. John Money believed that if he was raised as a girl, he would develop a female identity and could be given estrogen at puberty and become a well-adjusted woman, albeit without reproductive organs. Money reported this case as a success, and indeed my undergraduate psychology textbook of 20 years ago referenced this case as support for Money’s theory.

However, in the late 90s, this story was exposed as false. David Reimer did not adjust to life as a girl, hated taking estrogen, and demanded to be put on testosterone and ended up living as a man, eventually marrying a woman. Sadly, his story ends tragically, as he committed suicide in his 30s.

A later study was done on 16 male children that were raised as girls because they were born with the genital abnormality known as cloachal extemony Of these children, 8 out of the 16 identified as male and transitioned, and all 16 had “interests more typical of males” This is half, a very large number, but also illustrates how even though these children were male except for their genital abnormalities they had different outcomes of identity. This is because the identity is a response to these low-level instincts and not the low level instincts themselves. These 16 people with identical histories developed different identities. Much the same way as people with cross-gender feelings or instincts can develop different identities depending on their cultural circumstances and even their own choices.

That is where the idea of “innate gender identity” originated, from studying male children that were raised as girls due to lacking a penis for one reason or another. Then this idea was extrapolated further. If there is some innate gender identity, then natal females must also possess a similar identity, and if they have an innate male gender identity that will cause the same problems. This idea is also being extrapolated onto children, but that is a subject for another post.

There are two assumptions here that aren’t necessarily true. One is that the cross-gender feelings of trans people are from the same cause as the feelings of natal males raised as girls, the second is that natal females with some degree of male identity will have the same dynamics as natal males with some degree of female identity.

I tend to focus more on MTF issues and male detransitioners because that is what my experience is, but I think there will be (and already are) many more female detransitioners, in part due to the way this gender identity idea is even less of a fit for what is actually happening there.

People are identifying as non-binary, outside of gender entirely, identifying as one gender at one time, being dual gender, identifying as a different gender a different time. Taking T for a while and then stopping, inventing new pronouns, etc. So, now the idea as the gender identity is innate, yet sometimes it is fluid, and sometimes it changes and sometimes it doesn’t, but it is still innate and if you try to change it that is wrong, but sometimes it changes on its own. Huh? There are also those with a strong persistent male identity as well. These dynamics exist among MTF-spectrum folk as well, but are more common among FTM-spectrum folk.

Historically, there has been approximately a 3:1 ratio between MTF transitions and FTM transitions. However, a recent study has shown in recent years that the amount of people presenting with FTM issues has grown to even exceed the number of MTFs presenting at gender clinics. Something which suggests social causes are at play.

So, the question is, why is this happening? Why is there a huge increase in the number of FTM transitions (even more than 3x because the number of MTF transitions is increasing as well). Some people say this is because of greater awareness. I think it is because of a shift in the cultural milieu.

There are biological factors correlated with FTM transition. We know that both interest conditions such as CAH and endocrine conditions such as PCOS are correlated with FTM identity. These lead to masculinization of behavior and in some cases physical masculinization and likewise in some cases male identity. Again the presence or absence of these factors don’t make anyone’s transition more or less “real”.

I am believer in behavioral functionalism, which is to say in order to make sense of why a behavior is happening it useful to look at what functions it serves for the person that is engaging in it. So, the question becomes what functions does this process of identifying in these ways serve. First, an important part of identity is being part of a group and creating a sense of affiliation with the group.

So then the question is what is the function of these identities and this community. It is my belief that it is fundamentally a reaction to a conflict between being who they are and the cultural expectations placed on females. A reaction to societal stereotypes of women, objectification, misogyny, and in some cases particular traumatic experiences particularly around men. The particular themes vary but these are common ones.

The reason why behavioral functionalism is so great, is by understanding the function of the behavior it can make things that seem really strange on the surface become clear. For example, it can be puzzling on the surface why there are so many FTM-spectrum folks coming out of women’s colleges, but if you understand the function of safety from men, it makes sense because both transitioning FTM and going to a women’s college both can serve the same function of safety from men and getting away from misogynist expectations.

In fact as I had said once before, a lot of this looks like “lesbian until graduation” of 20 years ago which also served the same function of getting away from misogyny. The difference is that this trend involves testosterone and permanent body changes that can’t be reversed. So that is a disaster. Lesbian until graduation might leave behind a few broken hearts and might be an interesting youthful adventure. Any woman who takes T and returns to female identity will be dealing with the permanent effects of testosterone.

Again just as the existence of “lesbian until graduation” does not deny the existence of those who retain a long-term lesbian identity that is healthy for them, neither does the existence of “trans until graduation” deny the existence of those for who testosterone use and male presentation is right. The difference is that it is important to find better ways to distinguish between the two before people take T if possible. How to do this? I don’t know, but I suspect looking at misogyny, gender schemas, dissociation and trauma is a good place to start.

Also, if we do end up with a lot of female detransitioners, it will eventually lead to a backlash that will also effect those that seek these treatments to improve their quality of life, so everyone should be concerned with this, no matter what your political stance on trans issues.