transgender

New Survey of Detransitioners – Participants Wanted

*Survey closes on April 30*

Hi,

I’d like to announce recruitment for a new research study designed to better understand the experiences of people who have undergone gender de-transition. For the purpose of this study, gender de-transition is defined as having undergone gender transition related medical procedures (hormones and/or surgeries) and then subsequently de-transitioned. The study is an anonymous online survey. Take a look at the recruitment information and if you are interested, follow the link to the study. Please share the recruitment information and link with anyone you think might be interested and eligible.

Thanks,

Recruitment Information

Study Title: Individuals who received medications and/or surgery for sex reassignment and then de-transitioned: a descriptive study

Gender dysphoria, discomfort about one’s biological sex or assigned gender, is often treated with medications and/or surgery (also called transition). Some individuals choose to “de-transition” by stopping medications and/or having survey to reverse the effects of transition. The purpose of the study is to describe a population of individuals who experienced gender dysphoria, chose to transition by taking medications and/or having surgery, and then de-transitioned (by stopping the medications or having surgery). We are interested in individuals who have de-transitioned, whether they feel positively, negatively, or neutrally about their decision to transition and the time they spent transitioned before de-transitioning. This research study is being conducted by Lisa Littman, MD, MPH, Adjunct Assistant Professor, Icahn School of Medicine at Mount Sinai.

Previous research shows that the satisfaction rates for transgender individuals who transition is generally high and the regret rates are low, though little is known of those who describe unsatisfactory experiences with transition or de-transition beyond accounts available on social media. An informal survey on social media yielded over 100 surveys from de-transitioned individuals in only two weeks of recruitment. Given that this population exists and has not yet been described in the medical literature, this research is needed to describe this outcome, to generate hypotheses, and to assess the psychological and social needs of persons who have taken, or are considering, this decision.

This survey is completely anonymous and confidential and conducted through Survey monkey, an independent third- party. There is no way to connect your name with your responses. We do not track email or IP addresses. Please do not write in any identifying information about yourself in the open text boxes. The survey should take 30-60 minutes. Participation in this research study is voluntary, and you may refuse or quit at any time before completing the survey. If you know of any individuals with a similar experience who might be eligible for this survey, or any communities where there might be eligible participants, please copy and paste this recruitment information and survey link to share.
Survey Link: https://www.surveymonkey.com/r/VZLBVJ3

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.

Identity is not the same as authenticity

I have been again thinking about identity, because it seems to lie at the heart of all the recent discussion of transgender issues. I have also been thinking about how the way we treat identity with respect to gender dysphoria is very different from that with other conditions. In fact, the way we treat identity with respect to gender dysphoria is the polar opposite of the way we look at most other conditions. In many different contexts, I was taught the importance of not making an identity out of someone’s condition.

For example, we try not to say “schizophrenic” instead we say “person with schizophrenia”. We try not to say “a depressive” and instead say “person with depression”. However, with gender issues it is the reverse, we are encouraged to say “trans person” rather than “person with gender dysphoria” and also to affirm those identities.

The reasons for this disidentification process are several. One is to avoid distorting our perception of the person so we do not see them as just their condition. We must remember that they are so much more than that. Another reason for this practice is to avoid stigmatizing them, so they are not seen as being just that particular condition, they are a full dynamic human being with many different parts

Another reason for this, relates to the person seeking to work with their condition themselves. When someone identifies with something it becomes frozen. It is much harder to treat someone for depression if they identify with it. If they say “being depressed is just who I am, it cannot change.” that is much harder to work with that than someone who says that they “have depression”. One technique for those who are too identified with their depression is to externalize the depression. We try to get them to see the depression as not their whole self, and to perhaps say “that is the depression talking”. This tries to bring their whole self into the picture, rather than just the depression, as the rest of the self can get lost when an identity is formed.

I have talked about identities as self-concept in the past. However, another important aspect of identity which I neglected is group identity. A lot of identities involve identification with a group. When people talk about identities they are often talking about things like race, class, national identity, political identities and certainly gender. Group identities divide us into groups. They say who is “us” and who is “not us”. The desire to be part of a group is a very basic human desire. We are tribal creatures. However, when group identities come into play, they tend to override objective reasoning. There is a sense that our group is right and the other group is wrong. Reason is no longer used to explore the truth, but is instead used to support our moral position. Arguments become moral, rather than rational, and moral reasoning trumps objective reasoning. This is part of what makes discussion of trans issues so difficult. Identity comes into play, and discussion becomes very difficult.

Another problem with group identities is that they can result in a loss of individuality. Connecting with a group and being a part of a group can be such a good feeling, especially if it is a group of people that reflects parts of oneself that have not been reflected before. A lot of my own impulse to transition 20 years ago arose in part from my encounter with the community. It felt so good to encounter people that shared the same feelings about gender that I did, as my gender feelings felt like a deep secret that I would never share with anyone and did not share with anyone “real”. Talking to people who had the same feelings and could relate to my experience was so great. I do think it played a role in my adopting the transgender identity. I am not saying that I adopted this identity due to peer pressure, as the reason I adopted this identity also related to the deeply held feelings that I had. It is rather the intersection between my deep feelings ,and the group that led to my development of this identity. I think this is true of most identities, they are the intersection between biological factors, temprament, and social identity. Cross-gender feelings exists in all cultures but how they are expressed is different depending on cultures. In one culture one might be considered a shaman, in another an abomination, in another a transsexual. Cultures and subcultures say these feelings mean certain cultural identities and the ultimate expression lies at the intersection between the cultural ideas and the internal feelings.

In a way, there is something strange about talking about people “discovering their authentic identities”, because I actually see authenticity as something that opposes identity. I see it as something that lies beyond identities. Identities freeze things into place, and are almost like heuristics. They are shortcuts for who we are, that help explain who we are to others, but are always partial. So, affirming someones identities, is in a way taking them away from authenticity. It is not surprising that many of the people who write of detransition cite mindfulness as an important factor, because mindfulness is precisely a method for loosening identities and the holds they place on us.

I am not trying to say identities are all bad, indeed they are important. They are important because they allow us to feel a part of a group. They are important precisely because they act as heuristics. If we had to feel authentically into each moment of every day that would be a very slow, inefficient process, and probably quite difficult to pull off. Also there are problems associated with lack of stable identity, such as borderline personality disorder for example. Like Jack Engler said “you have to be someone before you can be no one”. Sometimes being authentic can be very difficult or impossible due to the pain associated with it, that can be a reason to live in identities. There is nothing wrong with that, it can be what is right for that time and it can serve an important protective function. Exploring identity is generally seen as part of normal adolescent development, because it relates to being in the world and playing roles in society. However, it seems like we have taken to reifying identities and mistaking them for the person themselves, when they can only be an approximation.

Can transition be the best solution? Yes, but I believe the answer lies under identity and not in identity, because that is where the creativity lies. So, I think it would be much better when looking at these issues to see someone as a person with gender dysphoria, rather than a trans person or a potential trans person. The same applies when exploring one’s own issues. This means the whole person doesn’t get lost and many solutions are possible. It also changes the question from “determining if someone ‘is’ transgender” to determining what the best way to move them towards wholeness.

taking dysphoria literally vs. symbolically

This article by Dr. Schwartz posted on the 4thWaveNow blog discusses the need for caution when working with transgender children. In particular, one thing he talks about is looking at the things that children are saying about their gender symbolically rather than literally. He says that differences in treatment philosophies arise from which lens the clinician views the child’s gendered self, as a literal truth or a symbolical one. In particular he says the following:

“It is possible to respond to children in a manner that is either organized around their literal narratives, or around psychological interpretations of those narratives, which themselves take into account such inner contradictions and perplexities as described above. Toward which path the clinician leans may be strongly influenced by the degree to which he or she shares the child’s apparent view of gender, that is, holds the assumptions of essential gender, or not. Simply put, if you believe gender is an internal reality, you will likely be guided or motivated to accept a literal hearing of the child’s narrative, since it matches that view. The child’s self-presentation may then seem straightforwardly comprehensible enough to guide you in clinical decision making. On the other hand, if your prejudice is to hear any claims about real, inner gender as necessarily—necessarily because you do not believe gender is real in the sense described above— composed of symbolic or metaphoric representations, then the child’s story instigates an active interpretive process, and clinical decision making proceeds differently”

Later on he goes on to say:

“There is much more to children than what they say. We owe to them a deeper listening than a literal one.”

This article is talking about children, but much of what he is saying applies to adults as well, who also have symbolic psychological processes, which just might be a little more buried. Giving this kind of deep listening and taking the time to do so is something that is not happening much with therapeutic work with gender issue currently. There is a sense of “well that is just your identity, and it shouldn’t be questioned.” This kind of deep listening also takes time, and is not something that can be done in a couple of sessions of therapy.

Indeed, I think this focus on taking gender thoughts literally is precisely what makes cross-gender roles in modern Western culture different from those of other cultures. Lots of cultures have cross-gender roles of some kind, but only in the West do we have the idea that one literally becomes the other sex, and that indeed the whole point of transition is to do just that. This also brings with it the idea of “passing”, proving your membership in the identified sex by becoming indistinguishable from natal members of that sex. This is also something that is not considered part of the gender-variant roles of other cultures.

If taking gender dysphoric thoughts and feelings symbolically, seems strange or a form of denial, it is helpful to see that this is something that we do all the time, and in fact it is quite important that we do so.

Consider being angry at someone for wronging you in some way. You might feel anger, and have the associated thought “I am going to kill that person”. Taking that thought literally would cause a great deal of trouble. There are lots of responses that you can have to the feeling of anger, and the thought “I am going to kill that person”, some of them healthy and some of them are not.

One possible response to the anger is to feel shame, that you are a “bad person” for having such angry thoughts, and a good person wouldn’t be angry and have the thought about killing someone. This would just add to the emotional pain and would not do anything to assuage the anger.

Another possible response is distraction, to pretend that it isn’t happening and distract yourself. This sometimes is a healthy response, as the emotion might be too overwhelming to deal with right now, or be related to some temporary chemical issue like meds or hormone levels. However, it does nothing to meet the underlying need of the anger, and even if something is heightened by brain chemistry issues, there still might be a real need underneath that. Anger is an important signal and shouldn’t be ignored. Distraction shouldn’t be an always thing, and many mechanisms of distracting from feelings escalate over time, such as numbing behaviors like drug use.

Another possible response is to try to repress it, saying “I’m not really angry”. This tends to only strengthen it.

It is also possible to construct an identity around it. “I’m an angry person, that is just how I am” This will make it a lot harder to work with as you take it as an essential part of your identity rather than as an emotion. This will also strengthen it.

Another response is to accept it, this doesn’t mean you literally do what it says, but that you acknowledge and accept it. The function of anger is to provide energy to deal with an obstacle. There is likely a real obstacle that needs to be dealt with in some way. Once you have acknowledged and accepted the anger you might get some insight into what that is, and sometimes it is obvious. Once you know you can act appropriately to meet that need, perhaps there is different way to meet the need, or perhaps you have to negotiate with that person, or perhaps you do need to engage in appropriate consequences for them. This can be hard in the moment of course. The important thing is that the anger is a real signal of your real needs and is not always unhealthy.

To take dysphoria symbolically is similar. There is a feeling of dysphoria, which is distress and dissatisfaction combined with thoughts such as “I should be a woman”, or “I am a woman” or “I hate being a man” “Being a man is disgusting”, etc. Like anger, this distress is on a spectrum and can go from mild to quite overwhelming. To take it literally, is to go through transition / hormones / surgery. This may be the right thing, but it is not the only thing. There are other responses besides taking it literally.

Shame and repression have similar effects here that they do with anger, and denying it by saying “I’m really a manly man” or something like that and attempting to live that will also make things worse. Dyphoria points to the fact that something is wrong and needs to change, it is an emotional response that says something is wrong. The associated thoughts give a proposed solution, but like the “I want to kill this person” thought, it is not necessarily the case that they be taken literally. Constructing an identity around it also strengthens it like with the anger.

The question is what are the underlying needs? They may be sexual, but they may not be, and I think it is ultimately the psychological needs that drive one to transition (vs. just having a fetish) Ironically, one of those needs might be to avoid the shame of having a fetish. In any case, there are real and valid needs that are underneath the dysphoria and it is important to meet them. It is only important that they be met somewhere in your life, it is impossible to meet all of our needs in all aspects of our lives, and indeed we must make compromises in order to have relationships and connection with people, and that is the single largest determiner of happiness.

Sorting this stuff out is something that can take time, and indeed something I think there needs to be more of. Yes, adults at least should have the right to transition, and transitioning does improve some people’s lives. However I think there is the need for more exploration, I sure wish I had that. I was approved for hormones after just 2 sessions of therapy, working out everything took 150 sessions.

Here is a story of someone who worked through things symbolically. Here is a
story
from a man who work on integrating his own feminine side but wasn’t transgender. I also recommend the site Transcend Movement in which he talks about a similar process of working through things symbolically. I am not saying that everyone can deal with their gender issues through such a process, but I am saying that more people can than currently are.

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.

“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.