When Will Transgender Clinical Activists Acknowledge Detransitioners?
In the United Kingdom, there has been increased media attention on “detransitioners” — people who identify with their natal sex after a period of being “transgender” through social, medical, or surgical “transition.”
A recent BBC documentary opens with the story of Debbie, who was “born a girl, assigned female at birth, and lived most of her life this way.” (Of course, she wasn’t “assigned” female, she was observed female, but never mind.)
At age 44, Debbie transitioned medically, taking testosterone, which gave her a beard and made her go bald. She then transitioned surgically, having flesh from her arm grafted to construct a pseudo-penis. Debbie told the BBC that she got the idea about being transgender after watching TV coverage of trans people: “It was like a Eureka. I thought, This is me. This is what I’ve got to do.” Debbie had struggled with many issues and had been sexually abused as a child.
She hoped that changing gender would help her “become a different person” as well as “accepted in the world.” However, after 17 years on testosterone and changing her name to Lee, and after having had “multiple procedures,” she realized she had made a mistake:
I remember breaking down. It was like this was a mistake. It should never have happened. But what the hell do you do about it? How do you go through yet another harrowing transition? What do you do? I’ve got no hair. I’ve got a beard. I’ve had all my body mutilated. How the hell do I go back to being the Debbie that I was?
Another British woman, Charlie Evans, who formerly identified as a man, has set up a charity to help people who are detranistioning. Evans told the BBC she has been overwhelmed by the number of people coming forward. “There are thousands of us,” Evans says. “A lot of these women feel that they were not in a position to give informed consent because they were so unwell.”
There has been next to no research into the phenomenon of detransition. Despite this, clinicians are proceeding with high-risk and irreversible treatment for gender-confused patients. This is particularly distressing in relation to children. The gender youth clinic at Britain’s National Health Service has seen 10,000 young people in the last three decades. A consultant psychiatrist there, Elizabeth Van Horn, discussed the problems with BBC presenter Emily Maitlis:
Van Horn: [Detransitioners are] a very tiny proportion of our patient population, and by saying that I don’t wish in any way to sort of limit the impact that it has on those particular individuals, but what we know from our population is that actually well less than 1 per cent of our population choose to detransition.
Maitlis: Isn’t that the point? . . . We don’t know that number is small because we don’t know the number. Many that we just spoke to said that they can’t return to the Tavistock [the main NHS gender service] for whatever reason that is. And your duty of care presumably should be to find out how people are feeling, to find out what has happened afterwards where there isn’t the extensive medical research or evidence to take care of those people.
Van Horn: I wouldn’t disagree with you at all, and I would actually encourage anybody who is in that situation to go and see their GP and to seek to get a referral back to the Gender Identity. . . .
Maitlis: But it’s not just about going back, is it? It’s a concern that you’re putting people on these pathways without enough evidence of the treatment or of the long-term consequences of what that treatment is doing. This can be life-changing treatment in many situations and circumstances, and that pathway is something that you’re putting people on without the requisite evidence.
In America, the same concerns apply. I recently spoke to a 41-year-old man from the Midwest. He told me how he was “feminine growing up” and was badly teased. From a young age, he became “fearful, self-hating about the way that I walk, speak, stand — the way that I move and the way that I dress.” He told me that “in college I heard about transgenderism and I seized on it as the solution.”
He moved then to the West Coast, where a free clinic “immediately affirmed” his female gender identity. He was then given “a rather incomplete informed consent document to sign. . . . Then at every appointment that followed, [he was] given information that contradicted the informed-consent documents.”
After a period of homelessness, he managed to get a job, at which point his doctor told him that he “should really get surgery.” He was given an orchiectomy, having been told that it would help him and remove the need for cross-sex hormones. But that isn’t what happened.
“I went into shock because I wasn’t told that [orchiectomy] was castration. I was told it was some gender bullshit.” After this he “developed a drug habit” and began “ejaculating blood.” He said that “the gender clinic kept telling me, ‘Oh, it gets better.’” But it didn’t. He told me:
You’re supposed to get an independent psychological evaluation to determine co-morbidities before you begin hormone-replacement therapy. And I had none. And you’re supposed to have two more before any surgery. And I had none. I confronted the doctor about this, and the doctor said that the lying was done to grant me greater access to care.
After surgery, a different therapist found him to be on the autistic spectrum.
Another detransitioner I spoke to recently was 21-year-old Helena from Chicago. She and three other young women have started a network, called the Pique Resilience Project, to help other detransitioners. Helena told me she is worried that voices like hers are being “silenced” and shut out of the transgender debate. She also worries that there is a lack of therapeutic and medical support for detransitioners. “Nobody seems educated,” she says. “A lot of practitioners don’t want to touch this with a ten-foot pole. . . . They’ll just refer you to a gender-affirmative practice.”
Helena has struggled with an eating disorder, depression, anxiety, and ADHD symptoms since her early teens. At 18, she decided she wanted to socially transition and begin cross-sex hormones. She decided that after spending a lot of time online, especially on Tumblr. She believed that being transgender would help boost her social status, since previously she had struggled to make friends and be accepted by her peers.
“I saw that [you] were listened to more if [you] had an opinion and you said you were trans,” she says. “It incentivized me to want to identify as trans because it was hard to just be like a cis girl.” After talking for 20 to 30 minutes to an LGBT social worker, who asked about ten questions, she was granted testosterone.
From her social worker’s initial notes:
Patient states that since he has been able to make this appointment, his depression has already started to improve. Patient expects that his whole life will be quite different and he will be very happy when he starts to change.
Patient states that he is 100% confident that he will get top surgery [full double mastectomy] in the future.
Patient states that he would consider bottom surgery [genital modification] if the options that he would like for a penis became available, but he is not interested with the current options.
“It’s actually pretty ridiculous, the answers that I gave, and she like accepted those answers without questioning them,” Helena tells me. As well as making her more aggressive and permanently lowering her voice, she endured unwanted clitoral growth. Which, she notes, was “the one thing that I really didn’t want,” but she spoke of “having to sacrifice in order to get other changes.” Incidentally, this was not listed as a potential side effect on her informed-consent form.
About four months in she told her therapist she was confused and having doubts. However, the therapist, who worked at an LGBT resource center, was concerned that she might be experiencing “internalized transphobia” or familial pressure.
The therapist “was pretty adamant that there was something else causing me subconsciously to doubt being trans,” Helena says. “I always got the vibe that she was just like skeptical that anyone could decide they weren’t trans like that. She was just confused about what I was saying. Like she had never expected to hear this before. She was really caught off guard.”
At every therapy session, the therapist would discuss the possibility of “top surgery” (the surgical removal of her healthy breast tissue). They did not discuss Helena’s other problems — her eating disorder, anxiety, or depression — even once.
Helena tells me:
A lot of the people who are transitioning are doing it because they have very serious psychological problems, and like very serious family problems, and very serious emotional difficulties in their lives. And so, when you transition, it kind of gives you a distraction, but the entire time all of those problems are still brewing beneath the surface.
So when you detransition, yeah, maybe you’re not taking the testosterone anymore and, yeah, maybe you understand that you’re not this fake identity anymore, but all those problems that you still started out with are still there. Those problems that were so painful that they led you to transition, they’re still there, so you have to deal with those.
