trans

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.

 

Trans or just a fetish?

The question “Am I trans or is it just a fetish?” has to be one of the most common questions that is asked by people considering MTF transition. This question shows up over and over again on reddit’s r/asktransgender and other transgender forums. They almost always answer “yes, you are trans” and there is even this handy website to determine whether you are transgender or not. (Always yes!)

I think it is very important to deconstruct this question and analyze it as I think it explains some of what is going on around this issue. First, there is an implied hierarchy. One can either be trans or “just” have a fetish. The word “just” implies that this is a lesser state. Also you “are” trans but “have” a fetish. One of these things is an identity, and the other is a stigmatized mental illness. I know I would prefer to be something than to have a mental illness! There is also an implied either/or to the question. One is either trans or just has a fetish, not both. I’m not saying that having a fetish is a mental illness, just that is what is implied by the word.

People with trans identities are definitely stigmatized in many contexts, that is true. However, there are certain subcultures where being trans can be considered positively, perhaps in some queer, academic or liberal contexts. In nearly all contexts being viewed as a woman with an unfortunate issue with a wrongly sexed body, is much less stigmatizing that being viewed as a man with a fetish. This adds to the view that being trans is a more desirable state than “having a fetish”. Even in the fetish/kink community itself cross-dressing is considered one of the lower status kinks to have.

This hierarchy has existed in the trans community in a long time. Kate Bornstein wrote about it the 90s. Post-op transsexuals were at the top of the the hierarchy, followed by pre-op transsexuals, and then transgenderists (which at the time was not an umbrella category but instead was a state intermediate between transsexual and transvestite), followed by transvestites, and then fetishistic cross dressers at the bottom. This hierarchy creates a bias towards identifying as trans vs. “having a fetish”.

A larger problem is that emotionally charged words like “fetish” leads one into the realm of moral reasoning. In moral reasoning, things are good or bad, as opposed to analytical reasoning where things are true or false. Moral reasoning activates tribalism and divides us to moral tribes. When two opposing moral tribes discuss an issue it can be difficult to impossible to find compromise. The discussion of trans issues in an objective way becomes very difficult because there are factors on all sides that throw the discussion into the realm of moral reasoning. On one side there is the use of stigmatizing terms such as “autogynephilia” and “fetish” which are sometimes used by enemies of trans people to shame them. On the other side there is the use of social justice ideology which also throws things into the realm of moral reasoning. Once one side uses moral reasoning, the other side than also veers into moral reasoning and communication stops. Moral reasoning also trumps analytical reasoning which means that analytical reasoning tends to stop when moral reasoning is invoked. A good sign that you are in the realm of moral reasoning is when you believe that the “other side” is 100% wrong about everything, whether this be liberals, conservatives, men, women, trans activists, radical feminists, or who ever else. I recommend reading my favorite social psychologist,  Jonathan Haidt if you want to learn more about this issue.

My general view is that you don’t choose to have these thoughts and feelings but do have some ability to choose what to do with them. Some people have more ability to choose than others depending on their particular circumstance, this depends on the intensity of their feelings, the psychological circumstances that surround things, as well as their personal temperament. In many cases the “fetish” will be far less disruptive and be manageable. Transition creates many difficulties as well, and does not cure dysphoria, it only manages it. I think it is better thought of as a chronic condition that can be managed in a variety of ways, and the task is to figure out the best way according to your own circumstances. Also not only is term “fetish” stigmatizing it is incomplete, as there are often deeply meaningful psychological components attached as well and it is not usually just a sex thing.

This phenomena can itself be divided into several different parts some of which have the potential to cause problems others of which do not. Part of it all is simple fantasy. Fantasy itself is not harmful, and also cannot be controlled. We fantasize about what we fantasize about, and lots of people have all kinds of strange and wonderful sexual fantasies. This is just what happens when our modern brains intersect with our primitive sexual instincts. Fantasy itself is never a problem, it is only when it becomes combined with something else that it is a problem. Even for those with particularly unfortunate sexual fantasies that would cause tremendous harm to enact, the fantasy itself doesn’t harm anyone. Also, trying to prevent thoughts doesn’t usually work, and only strengthens them.

One example of when it becomes a problem is if it develops obsessive qualities or becomes compulsive. Another is if impedes the ability to form relationships. Yet another is if it causes one to violate the boundaries of others in some way.

If it is used as a coping mechanism, this can be okay in moderation. However, like most coping mechanisms there is a tendency to escalation and requiring more and more of the “drug” for the same effect.

Also, it can be tied into psychological needs. Sometimes it is tied into an experience of an “inner woman” which some people who experience this phenomena have. Jack Molay writes about this here and here.

I think Jung’s writings on the anima are very relevant here. Jung described working with the anima as important to the psychological growth as those qualities can be integrated and produce growth. The anima can be an important guide. However, Jung simultaneously warns about the phenomena of “anima possession” where a man can become taken over by the inner woman. It was actually reading Jung and his phenomena of anima possession which first knocked loose my transgender identification.

In summary, a “fetish” or cross-dreaming are not lesser states to transgender identity. This idea can lead to preferring transgender identity which could potentially be far more disruptive to one’s life. Also, shame over sexual motivations can specifically lead to the preference for a transgender identity over other possible outcomes. This is a place where trans critics sometimes go wrong, by specifically shaming the sexual aspects of trans identity, they may be creating more of the very phenomena they oppose.

For some more related reading I recommend this essay by Ozy “Trans as Choice” and this essay by Angus Grieve-Smith “On the Slippery Slope”

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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.

The obstacles presented by ideology in discussing trans issues

One thing that makes discussion of trans issues very difficult is that it that it lies at the intersection of ideology and truth. Science strives to seek truth and to be ideology-free. It can never meet this goal because it is done by humans who are incapable of being ideology-free. Still, it is the best method we have for minimizing the effects of bias and trying to get at an accurate picture of the world.

Jonathan Hadit, who is one of my favorite psychological writers, studies moral reasoning. He wrote an excellent book about it called The Righteous Mind. One of the things he talks about is that people have certain values that they hold sacred. He talks about the ideological differences between liberals and conservatives as being largely due to the fact that they hold different values sacred. When the tribal values are threatened people are far more concerned with neutralizing the threat then what is true or not. These sacred beliefs essentially become religious beliefs and anything that challenges them feels like heresy.

This is just part of the natural condition of humanity, and the same people that can be very capable of reason and nuance about questions that do not concern their sacred values suddenly become incapable of it when they do. I remember having a co-worker who was a decent programmer. He was also a Scientologist, and would occasionally talk about how “L. Ron Hubbard was an incarnation of the Buddha, and a messiah” or other Scientology related topics. I found it perplexing that he could have the logical chops necessary to be a good programmer and simultaneously be a Scientologist, but once beliefs acquire a religious character they are immune to logic. It is much the same with political ideologies.

One of the other things Hadit talks about is the importance of diversity of ideologies in creating good science. Scientists, like all people have ideologies and sacred beliefs. Scientists are often quite passionate about their theories. They are far from neutral, disinterested observers. So, any one scientist runs the risk of having their bias interfere with their observations. Science has tools for neutralizing bias from double-blind studies to peer review. Peer review relies on other scientists looking over the science, but they too have biases. If you have an ideologically diverse set of scientists then the effect of their biases are minimized. However, to the degree that they are not ideological diverse, groupthink and other phenomena can prevail. This effect is increased if the scientific study in question contradicts the sacred tribal values of that particular group of scientists.

In the therapy world we are also concerned with the biases of therapist interfering with the therapy and making it hard to see the client clearly. This phenomenon is called countertransference, which is where the therapist projects their own stuff onto the client and does not see the client clearly. Being aware of this is a start, but therapists are people too and are often blind to their own biases and personal hooks. One way to counteract this is through consultation groups, to get the opinions of others who do not have the same biases that you do, and therefore can see things clearly that you can’t see. However, if the therapists in the group share the same ideological beliefs and biases, then this does not help, and can even make things worse as phenomena such as groupthink take over.

Having a strong conviction that the “other side” is absolutely wrong about everything is a sure sign of being engaged in tribal thinking. The truth is messy and cuts across ideologies. It can be very difficult to let go of tribal thinking as it gives a sense of belonging, which is a primal need. If one does commit to the truth wherever it leads you, you are likely to be denounced by all ideological tribes. That can be a very lonely path. Speaking out for truth that goes against your tribal values is very difficult. I recently read Alice Dreger’s excellent book Galileo’s Middle Finger where she talks about the conflict between truth and activism. Indeed, Dreger, as someone committed to truth over ideology, is often denounced for both being a “crazy liberal” and “neo-reactionary conservative”. I once read two articles denouncing her in these opposite ways within 10 minutes of each other.

The community of psychologists and therapists is far from ideologically diverse. Hadit, who is a social psychologist, gave a talk to a group of around one thousand social psychologists and asked them how many identified themselves as conservative or moderate. As described in this article in the New Yorker,
only 20 or so identified as centrist and only 3 identified as conservative. There might have been more conservatives that feared the career ramifications of openly identifying themselves as conservative. Further research in the article confirms that 37.5% of those social psychologists surveyed would be less likely to hire a conservative colleague, so their feelings would be entirely justified. This article describes social psychologists specifically, but similar phenomena exist with clinical psychologists, social workers and other mental health professionals.

I have come to the reluctant conclusion that it is progressive ideology itself that is the one of the things that gets makes it difficult to work on these issues. As a life-long liberal, and former card-carrying member of the ACLU back when that was a thing, it has been tough to come to that realization. I have long considered liberals to be my tribe and to see this ideology as itself being a problem makes me feel like I am without a tribe. However, since tribalism itself is the issue, perhaps that is a good thing. I want to emphasize that all ideologies get in the way of seeing the world clearly, it is just that the particular ideology that dominates the psychological profession is on the left. In particular, the following aspects of progressive ideology, particularly the specific progressive ideology of the psychological profession come in to play:

Privilege / Power Dynamics

Progressive ideology views the world in terms of privilege and power dynamics. People are divided into privileged and marginalized people across various axes. Why this is relevant is that is trans people are seen as a marginalized class while cis people are seen as a privileged class. This brings in to play various aspects of progressive ideology which is concerned with equalizing power dynamics. Indeed, helping marginalized people have a voice is a noble goal, however sometimes this ideology can cause harm to the very people it is trying to support.

One for the related ideas is that a marginalized class has been silenced and it is important that their voices be heard, particularly about their own experience. The privileged class is deemed to not understand the experience of the marginalized class and should listen to them. This is indeed true, and there is a long history of medicine centering men and treating women as afterthoughts and other examples of only paying attention to the dominant class. So it is indeed good and important for trans voices to be heard about their own experience.

However, this ideology leads to trans narratives being taken at face value by clinicians, and digging underneath them to be seen as being against the tribal values of the clinicians working on these issues. This is a well-meaning attempt to bring social justice to the marginalized people.

However, digging underneath things can be very important. Psychology is full of ideas about how people have defenses, self-serving rationalizations and all kinds of ways in which they don’t necessarily understand their own motivations. This is just as true whether someone is privileged or marginalized, and to ignore this when working with marginalized people is to do them a disservice. Indeed it is giving them lesser care, than you give to privileged people.

Primacy of narrative / lived experience

Another part of this ideology is the primacy of narrative and lived experience. This means the subjective is more important than the objective, and that lived experience trumps scientific research. This goes triple when it intersects with the ideas of privilege/oppresion referenced above. This is another idea that has good roots but can be taken too far. Narratives and lived experience are indeed important. As a therapist it is important to bracket aside theory and make sure that you are not treating a client as an object, or a theoretical construct and seeing the person as an individual. People are messy and do not fit cleanly into boxes.

However, the theoretical constructs and scientific research matter also. There is a vast deal of difference in degree of scientific orientation among psychologists and therapists. One problem in psychology is that the academic community of research psychologists and the community of clinicians and therapists often don’t talk to each other. Some sections of the the clinical community are even actively anti-science. Some professors in my master’s program would use the term “evidence-based practice” almost as a swear word, like it meant un-evolved. The narrative is not the only thing that matters.

Nothing is pathological

Progressives are absolutely allergic to the idea of pathology and tend towards the idea that calling anything pathology is “stigmatizing”. So there are movements to talk about how everything from bipolar to schizophrenia is a healthy variation of human experience. Many even question the very idea of mental illness. They are quite correct that stigmazing causes harm. I think it is harmful to stigmatize people based on their conditions, however we should never lose track that some things are healthier than others. For me the question of whether something is healthy is not whether it is normal but rather whether it is functional. Even being functional in some environments is sufficient, that is just a matter of getting to the right environment.

I recently read the excellent book Buddha and the Borderline by Kiera Van Gelder. This book tells of a woman’s journey in healing from borderline personality disorder. She describes how much of her community as well as many of those therapists and psychologists that treated her did not want to give her the borderline label for the reason that it would be stigmatizing. She acknowledges that it can indeed be stigmatizing when she is labeled borderline by others, but it it is also helpful to acknowledge it as an illness and that helps her in working with it.

I think refusing to understand that there is a such thing as health and a such thing as pathology causes problems, especially if you are in a profession where you are supposed to be an agent of health. Pathology should not be mistaken for diversity.

The insider experience is the only one that matters

Progressive ideology centers the insider experience, and holds that the words of a member of a group are those that are valid about a group. For example, only trans people should speak about trans experience, only women should speak about women’s experience, only black people should speak about black experience etc. It is indeed quite true that people that don’t have a certain experience are likely to get things wrong about that experience. Women are likely to see things about their experience that men don’t see, etc. Problems arise when the people studying something are all of one group and they are studying a different group. This idea also intersects with the idea of priviledge/power, and so applies in a much larger way when it is a privileged class studying a marginalized class.

This is an important idea, and tremendous harm has been caused by the lack of representation of minority groups in health. It is a very good thing that their voices are being heard in respect to their own health. However, while it is true that the insider can see what the outsider cannot see, it is also true that the outsider can see what the insider cannot see. Fish can’t see water. How many times have you encountered someone who had some false idea about themselves that everyone but they could see? This is precisely why the outsider perspective is important also. It is best to see something from as many perspectives as possible. All groups whether marginalized or privileged are prone to cultural blind spots and groupthink. Particularly in the case of groupthink, an outsider perspective is precisely what is needed.

Identitarianism

I have written quite a bit about my views on identity here, and here The identity politics wing of progressivism strongly encourages a focus on identity, both the importance of personal identity and an identification with particular groups and classes. In addition to the critiques I made earlier, one problem with identiarianism is that it exacerbates the kind of tribal thinking that clouds truth. Once people feel their group is threatened they focus on defending their group rather than truth. This is just hard-wired into human psychology.

Conclusion

The nature of tribalism, identity and ideology increase the difficultly of find scientific truth on trans issues. The tense nature of these discussions drive away many people who might be interested in working on these issues, and also causes harm to trans people, as they are deprived of scientific advances and the best possible care. Understanding these effects and working towards minimizing them can help to reduce the tension in the ongoing discussion and help us work towards a future where all those who are dealign with these issues receive the best possible care.

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.