My testimony for Quebec's Comité de sages sur l'identité de genre

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[You can learn more about Quebec’s Comité de sages sur l'identité de genre here.]

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I am a graduate student here in Quebec studying the subject of gender identity, and I would like to extend my gratitude to the committee for the opportunity to submit my testimony.*

At the turn of the 21st century, girls and young women were rarely if ever seen at gender clinics. But starting in the mid-2010s, everything changed. Now female patients seeking transition outnumber male patients two-to-one across the Western world. This new patient demographic is not well understood on any level. We don’t understand the etiology of gender dysphoria in this population. We don’t yet know the efficacy and safety of transition-related interventions. And we don’t know how many of these patients may change their minds in the future and come to regret the decision to transition. 

When I began my studies, I was interested in building upon the work of Lisa Littman, who identified the potential role of social influence in the development of gender dysphoria, trans identification, and the desire to transition among adolescent and young-adult females. My research focuses on the online communities where so many girls and young women have explored and adopted transgender identities in recent years. I have been particularly interested in the attitudes, beliefs, and experiences that contribute to trans identification among adolescent and young adult females. I wanted to understand what girls and young women were looking for—and finding—in the process of coming to identify as transgender. I wish to briefly summarize what I’ve learned for the consideration of the Comité. 

Until recently, researchers, clinicians, and parents understood something a lot like gender dysphoria to be a normal stage of adolescent development for teenage girls. Simply put, it is hard to grow up female. It can be hard to accept the changes to one’s body—like menstruation and breast development—and the way society responds to those changes. There have always been girls and young women who sought a way out of the developmental challenges puberty posed. They took off-ramps like anorexia or cutting. Today, trans identity is a super highway promising an escape from the discomfort of female adolescence. My research suggests that adolescent and young adult females are responding to common developmental pressures and seeking to fulfill basic developmental tasks through trans identification. This is not the same thing as being in any sense ‘born in the wrong body.’ 

Many of the young females I see in online trans communities are seeking an explanation for the distress they feel over their changing bodies. They often struggle with questions of identity. They may not know how to fit in with their peers. They are looking for a place to belong, a sense of direction in life, a purpose or cause to devote themselves to, and recognition for their uniqueness and for the changes they undergo as they move from childhood toward adulthood. They are also often looking for a scapegoat for difficulties in life. The belief that one is transgender offers a clear scapegoat: the female body itself, which can be disciplined into compliance with the new identity regime, much the way the anorexic disciplines her body through starvation. A transgender identity can be especially appealing when healthier developmental pathways are blocked, for whatever reason: because the whole world locked down during a pandemic, because a young person has too few friends and opportunities in real life, or a too-compliant personality, or because mental health difficulties and neurocognitive differences interfere with her ability to build a compelling life offline.

As you can see, there are a mix of healthy and unhealthy impulses and needs that drive girls and young women to embrace gender. Once they do, they embark on a trajectory that has become familiar to me after reading thousands of such accounts online. This trajectory begins with exposure, being prompted to identify oneself with a gender. Young people are constantly prompted to make these kinds of self-identifications online and offline, and they quickly learn that what you choose says a lot about who you are. 

Being prompted to identify yourself with a gender is often the first time a young person gets the idea that your gender is a choice—and that selecting a gender is not a straightforward statement about whether you’re male or female but rather a loaded question about who you are, deep down, and what ‘side’ you’re on in the conflict over social justice. And if you’re questioning your gender, then you’re—by definition—not “cisgender”: you are some flavor of trans. To put it simply, having a personality means having a gender. And having a gender means being trans. 

If you have the misfortune to question your gender online, you will be encouraged to experiment in all kinds of ways, large and small, some of which can be binding on future choices, and all of which attach a great deal of attention and importance to gender, which can create distress where none existed before or make ordinary adolescent discomfort worse. Sometimes, the distress comes first and the trans identity comes second. Sometimes, the idea of being trans comes first and the distress comes second. 

So young people move from exploration and experimentation to adopting a new identity. This is a stage that is torn between two processes—one constructive and the other destructive. Embracing a new identity and a new set of beliefs about gender provides opportunities for learning, growth, belonging, and mastery of new concepts—all of which can be exciting for young people. But tearing down your old identity and beliefs and attachments is painful.

Distress increases via attentional focus, cognitive dissonance, negative co-rumination, and phobia indoctrination at this stage. So, if you started out somewhat uncomfortable in your developing body, now you’re being drip-fed new sources of negative rumination around the clock. You’re learning that everything you ever thought you knew about yourself is wrong. That nobody sees the ‘real’ you. That if you don’t transition right away, nobody will ever see the ‘real’ you. That time is running out. That your body is being poisoned by the wrong hormones, the wrong puberty. That if you don’t transition now, you’ll regret it and that you’ll just end up transitioning later when it will be harder to pass and you’ll have poured years of your life down the drain in the meantime. That people will reject you for your identity and stand in the way of the changes you’ve come to believe you need so that your life will be worth living. 

Entrenchment of a new trans identity often happens online and in the privacy of a young person’s mind, long before they come out to loved ones. Love-bombing in online settings increases the friction young people experience in their offline lives. Things that didn’t used to matter to someone start to chafe. This reminds me of cult inductions that whisk prospective members away for a high-energy, passionate, love-filled weekend—before dumping them back on the street on Monday morning—in a world that all of a sudden feels raw and uncaring by comparison.

If a young person wasn’t distressed before, they are now, as they internalize the trans script that prescribes distress as a sign of being truly trans. In a perverse way, experiencing distress legitimates a trans identity. The more distressed you feel, the more ‘valid’ your identity is.

At long last, we see the often belated disclosure of a trans identity to loved ones, friends, teachers, and classmates. The identity has a tight hold by this point and young people often respond to curiosity from loved ones with defensiveness. They may say they know they’re trans, even though they can’t explain it. Questions and challenges cause dissonance and lead a young person to feel distressed, even to shut down entirely. Direct challenges to her new identity tend to further entrench that identity. Think of Aesop’s fable about the sun and the wind, competing to remove a traveler’s coat. The harder the wind blows, the tighter the traveler wraps his coat around him. That’s what happens with a trans identity.

But because transition cannot possibly live up to the expectations young people attach to it, the process is full of disappointments. Often, girls and young women respond to disappointed hopes by doubling down. The next step, they tell themselves, will finally deliver. If testosterone hasn’t helped, surely top surgery will. There can be a reckless escalation of interventions. 

Eventually, some young people end up disillusioned—but stuck. They feel bound by past choices. Maybe they think they’ve gone too far to turn back. Maybe they worry the changes they’ve undergone cannot be undone. Detransition takes place when a young person gets unstuck and moves beyond disillusionment to action. 

All along the way, from the first days of identifying as trans to years after having undergone mastectomies and hysterectomies, adolescent and young adult females express serious doubts about their fragile new identities and the decision to transition. In the online spaces I study, they offer up alternative explanations for why they feel the way they do and why they want to transition, like comorbid mental health issues, traumatic experiences, social isolation and the need for belonging, social influence from friends or online trans content, the desire for a special identity, the need for purpose or direction in life, and discomfort with just about anything to do with sexual development, whether you feel uncomfortable with changes to your body or have trouble accepting your sexual orientation. 

Trans identification and transition often appear to be motivated by rejection of femaleness. This often seems like a much stronger motivator than any positive embrace of masculinity or whatever it means to be nonbinary today. Girls and young women express discomfort with sex-role stereotypes and expectations (e.g., expectations around expressing femininity), hate being treated like or seen as women, and report being uncomfortable with female body parts and functions. Girls in particular will often say they once believed that other girls felt the same way but then they learned about trans identities and realized their feelings made them not ordinary girls but ‘trans boys.’ 

We have no way of knowing now how many of the girls and young women currently identifying as transgender and pursuing transition will flourish as a result of being ‘affirmed’ in their new identities. But we have good reasons—and mounting evidence—to think that many will be harmed. 

The recent documentary, Trans Express, which aired on Radio Canada, showed that a 14-year-old girl can be prescribed testosterone after just nine minutes of consultation with a gender clinician. Whatever else may be going on in her life and her psyche is pushed aside in the process of ‘affirming’ her new transgender identity. Factors like sexual trauma, autism, homophobic bullying, eating disorders, and much more are overshadowed in the rush to facilitate young patients’ ‘embodiment goals.’ 

This documentary also shared the stories of three young women who transitioned only to change their minds months or years down the road, after taking testosterone and undergoing double mastectomies. These young women are not alone in experiencing medical harm at the hands of gender clinicians who perhaps meant well but did not truly understand the issues and conflicts that their patients faced. 

I must end on a personal note. I was a troubled adolescent girl once, too. I didn’t know how to cope with the changes happening to my body. Because I hit my teens during the early 2000s, I simply stopped eating. If I were a teenager today, the promise from medical providers to stop the periods that burdened my life with pain and shame and to cut off the breasts that I hated would have held tremendous appeal for me. I am grateful, every day, that I grew up back then and not today. A difference of just 10 years meant that I got the chance to accept myself and my body, without undergoing life-altering procedures that I could never take back. 

I would ask the Comité to consider the rights of girls and young women to grow up with their bodies intact, so that they have the same chance to accept themselves as they are, rather than be ‘affirmed’ as they are not.

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*I also want to thank Women’s Declaration International-Quebec for reaching out to me and inviting me to be part of their testimony on the impacts of gender identity on the rights of women and girls.