Trans identity and doubt: My talk at Genspect's The Bigger Picture

Two weeks ago, I had the pleasure to attend and speak at Genspect’s The Bigger Picture conference in Killarney, Ireland. It was truly an amazing three days. This is the rough text of the talk I gave about trans identity and doubt.

In many ways, trans and the Internet have grown up together. From the 1980s on, the Internet has been a prime site for gender exploration and it’s easy to understand why. The Internet connects us across great distances, links us with strangers who share our unusual interests, and allows us a level of information control that doesn’t exist offline. Online, you really are who you say you are, in the way you never can be in what some of us still think of as ‘the real world.’

But over the last 30-some years, both the Internet and what it means to be trans have undergone huge shifts. Back then, you had to seek out transsexual content in dark corners of Usenet. Now, you log on and trans is everywhere. 

Most research on these online communities focuses on older males who identify as transsexual or transgender and researchers tend to take it for granted that online communities provide positive sources of social support and valuable information. 

But what if the role of online communities isn’t quite so straightforward? What if online communities cut both ways, mixing positive and negative experiences? What if research done on earlier populations doesn’t transfer to the explosion of young people—especially girls and young women—identifying as transgender since the 2010s? What about the possibility of social influence over trans identity? 

These kinds of questions are why I set out to explore the attitudes, beliefs, and knowledge about gender that young women encounter online and the intentions and expectations they express regarding transition and/or detransition. My research draws on an online content analysis of five Reddit communities,* with a focus on female members who are questioning their gender, identifying as transgender, or who have desisted or detransitioned.  

I’ve tried to approach my research the way an anthropologist would approach an unfamiliar culture. When someone joins any community, they undergo a process of socialization into the ‘local culture.’ In online communities that are primarily text-based, the most visible form of socialization is into what you say and don’t say and how you say or don’t say it. 

There’s a lot we could talk about today when it comes to socialization into trans identity in online communities.* This is my list of codes from my online content analysis. But since we don’t have all day, I want to zero in on the subject of doubt and the strategies that members of online trans communities use to deal with doubt. 

I also want to say a quick word about clinical relevance. From the beginning, online transsexual communities provided advice on navigating clinical encounters and presenting the right ‘profile’ to clinicians: you know yourself, you know what you want. In practice, this often means subverting clinical gatekeeping. The advice from online trans communities today is no different: Don’t bring doubts into the exam room. Doubts risk derailing access to pharmaceutical and surgical interventions that patients come to believe are essential. 

So if you’re a clinician and you don’t know what to listen for, you’re not going to hear it. You’ll meet with your young patients and walk out sounding like Johanna Olson-Kennedy. Her patients know who they are and she borrows their certainty when she says she doesn’t send patients to therapy when she starts them on insulin, so why would she send her gender-dysphoric patients to therapy before starting them on puberty blockers or hormones? Or, as Helen Webberley put it: “Diagnosis is very straightforward. It’s self-diagnosis. I can’t know their identity.” 

I’ve been down the road at EPATH this week. The clinicians gathered there don’t want to talk about doubt any more than they want to talk about regret and medical harm and detransition. That’s because the presence and persistence of serious doubts threatens the basis of gender-affirming care. Affirmative care is based on the premise that patients know who they are and that it’s not the role of clinicians to scrutinize identity claims. The affirmative approach in fact discourages meaningful clinical inquiry. Clinicians narrow their curiosity to questions about where their patients locate themselves in the Gender Universe and what their embodiment goals are. This is putting curiosity and clinical inquiry on an awful tight leash. 

But the exam room isn’t the only place where it’s hard to talk about doubt. Doubts are also taboo in online trans communities. Taboos must be handled with great care.

Doubting other people’s gender self-identity is strictly forbidden. Questioning the concept of gender identity won’t fly either. But you’re allowed to express reservations about your own identity and decision to transition as long as you couch these doubts in the right terms. 

In online trans communities, you’ll hear the most serious doubts expressed: Am I really trans? Should I do this? Could this be related to sexual abuse I experienced? What if I’m just a lesbian? What if getting help for other issues makes my dysphoria go away? What if I’m wrong? Is transition actually helping? Is my life better or worse since I came out as trans or started transitioning? What if I regret it and end up detransitioning? These conversations make it clear just how fragile transgender identity can be. 

There are also many ways to talk about doubt. 

• I’m struggling with internalized transphobia

• I need to get over my imposter syndrome

• I need to stop having these Intrusive thoughts

• I’m having a hard time accepting myself as trans

• I feel like I’m pretending 

• I feel like I’m deceiving people

• I’ve got brainworms

• I think I’m in denial

• I’ve got all this “TERF rhetoric” stuck in my head

• I need to unlearn my internalized cissexism

• I’ve got trans OCD

• I feel like a fraud

Most of these are variations on three basic themes: internalized transphobia (“I can’t accept myself as trans because I haven’t overcome a lifetime of socialization into anti-transgender attitudes and beliefs”), imposter syndrome (“I feel like I’m faking it”), and intrusive thoughts (“I have disordered cognitions that pathological undermine my sense of self”). 

Let’s start with internalized transphobia. 

This is sometimes referred to as internalized cissexism, when someone who identifies as trans feels ashamed of their gender identity or expression, or doubts or tries to deny their transgender identity. 

One poster on the verge of getting a double mastectomy wrote: “My dad always stews up my internalized transphobia when I’m finally happy. I’m doing my best to see this as a medical treatment for dysphoria but there’s always a lingering fear in the back of my head. Anybody else have this happen? What have you done to ease the anxiety?”

Another poster demonstrates the conflict that can arise when a sense of self forged online meets offline interactions: “Right now whenever people who know me in real life use masculine terms and pronouns for me I feel like it's forced or they're somehow lying to me to make me feel better… It's unhealthy, it's self-destructive, and I know it all comes back to this awful internalized bullshit, but has anyone experienced something similar? Did it get better when you were further along in your transition? It makes me worry that the reason I feel uncomfortable socially transitioning is that I'm somehow not trans and that I'm just confused, but that \*can't\* be right because online and in my own head, I'm very happy with they/he pronouns and being treated like a guy.”

Another wrote: “I feel like a faker… I'm afraid that once I get the surgeries, I'll be hit with regret because I was actually cis the whole time. Is this internalized transphobia and dysphoria? No matter what I do I still feel female and it's driving me insane.”

Think of overcoming internalized transphobia—self-doubt—as Doing the Work. Gender-questioning youth are called upon to dismantle the entire structure of transphobia they’ve supposedly internalized, which mirrors the work society as a whole is supposed to undertake on behalf of trans acceptance. 

I want to be clear about what this means. When you doubt and ‘invalidate’ yourself, you doubt and invalidate other trans people. You harm other trans people whenever you don’t perceive or think about them in the way they want others to see them. So you’re seen as self-victimized by internalized transphobia but also as a perpetrator of transphobia, even if you never open your mouth. 

This effectively abolishes the privacy of the mind as a space where you’re free to explore ideas. Not only must you express yourself publicly in approved ways, you must think only approved thoughts. Operating under these expectations, questions and doubts—which are already threatening to a fragile sense of self—produce added anxiety and fear: that you are causing harm, that your treachery will be discovered, and that you’ll lose the community you rely on for emotional support if you cannot bring your questions and doubts—your internalized transphobia—under control.

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Next up: Imposter syndrome. Imposter syndrome can be characterized as feelings of self-doubt and incompetence that persist in spite of one’s qualifications. In other words, imposter syndrome describes the uncomfortable feeling that you are not what you appear to be. You feel like an imposter, even though you’re not an imposter. That’s why it’s called Imposter Syndrome and not ‘self-awareness’ or ‘Being An Imposter.’ 

When it comes to trans, the question of whether one is an imposter or not is trickier, subject to fluctuating personal understandings of gender and sex. The question of what it means to feel like an imposter  and whether that sense of self-doubt provides an accurate or false picture of the situation is an open one. 

Here’s what the Trans Guide to Mental Health and Well-Being says: “One thing that I think is worth remembering is that imposters don’t get imposter syndrome. If you were really a ‘gender fraud,’ you would be revelling in your purposeful deceit; instead, you’re anxious about whether you’re a good person. Likewise, worrying about whether you’re trans enough is a pretty universally trans experience, and it’s actually an excellent sign that you are who you say you are!”

The Gender Dysphoria Bible—a resource that’s frequently shared and cited in online trans communities—rushes in with reassurance: “But here’s the thing… only trans people are worried about if they are actually transgender!” Only trans people doubt whether they’re actually transgender.

So doubt equals trans. 

Resources like these suggest that not only is feeling like an imposter normal and not a cause for concern: but feeling like an imposter is a sign that your transgender identity is authentic. 

Here’s what that can sound like: 

• “It seems like every night I have the same crippling doubts. What if I’m faking it? What if I’m deluding myself? What if I’ve obsessed so thoroughly over this that I’ve convinced myself I have dysphoria when it’s really a symptom of my depression/anxiety? What if I’m just a confused girl?”

• “the more i think about my dysphoria and really start to sit down and unpack it i feel like i'm faking it ?? even though i'll literally shake from unpacking dysphoria, something will tell me i'm actually faking it and i'm trying to *feel* trans when i'm not or something.”

• “I don't think that anyone will ever see me as a man. I mean, I barely see myself as one. I want to work on that but I don't know how. I just feel like I'm wearing a mask, covering the fact that I was born female. None of it feels authentic.”

• “7 years into my transition, 5 years on T, 3 years top surgery. I’ve never felt so unhappy with who I am NOT PHYSICALLY, just as a person, I’m completely stealth which I feel is a massive problem but I don’t know how to not be ? I feel like a fraud, I don’t know how to relate to people anymore…”

A poster who shared a history of severe sexual trauma expressed the worry that: "But deep down, I know that I'm just a trans person who just happened to be abused... But that voice in the back of my head always tells me I'm a fraud who's just riddled with trauma from a young age."

Here’s a poster who is worried about starting antidepressants, in case antidepressants alleviate her gender dysphoria and the basis for her transgender identification: “I also can't help but be afraid that if it does help, I'll just end up thinking ‘damn I wasn't trans, I was just mentally ill.’ Not that dysphoria is a requirement of being trans but I'm just wondering so I can hopefully tackle that imposter syndrome before it tries to start up.”

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‘Intrusive thoughts’ is another borrowed term, this time from the realm of obsessive-compulsive disorder and other anxiety disorders, where intrusive thoughts refers to “unwelcome, involuntary thought[s], image[s], or unpleasant idea[s] that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate.”

In online trans communities, intrusive thoughts usually refer to recurring doubts and unwanted negative thoughts about trans identity or transition. These are also sometimes referred to as “brainworms” or “terf thoughts.” 

• “I’m OCD so I constantly go through cycles of doubt in my identity. At the end of the day I know exactly who I am, but I can’t stop the intrusive thoughts from questioning it.”

Another poster breaks down the “basic train of the thought of “the vibe”: 

“Basic train of thought of ‘the vibe’

• Bout of persistent dysphoria about remaining sex characteristics I cant change (hand size, wide hips, no access to having natal male genitals etc)

• Whether its "truth", TERF brainworms or internalised transphobia: thoughts of I cannot escape being female, I will never stop being trans

• Belief my transition will never be complete because I will never be not-female entirely and can never live as a male without additional context

• "I must accept my biology as I cant ever change it"

• Believing I must accept being female and go through some form of detransition, despite being the most at home and at peace with my body I ever have been

• Because im comfortable in my body now, the thought of "being female" is more acceptable. Still very dysphoria inducing and it fucks my entire sense of self up, but almost bearable to think about if I could keep my body as it is (which ironically, is vastly NOT female anymore) 

• Nothing but mental pain and self hatred from every angle of the argument because i'm stuck in a middle ground and feel I always will be” 

“The vibe” is the poster’s word for “intrusive thoughts,” which includes the persistent thought that she “cannot escape being female,” that her “transition will never be complete,” that she “must accept her biology…” The end result? “Nothing but mental pain and self hatred from every angle of the argument because i'm stuck in a middle ground and feel I always will be.”

•  “I feel like my life since I was twelve has been a lie, or some trick of my own brain. Some sick obsession I was too consumed by to see. Is it possible my dysphoria and perception of my gender was created entirely by a hyperfixation?”

I want to break one post down in detail. The poster titled it: “Struggling with imposter syndrome?” 

I'm confronting some weird things since I started medically transitioning and people have started actually referring to me as a boy way more than when I was just out socially. I always have this intrusive feeling when someone correctly genders me that like 'Ah, I see, this person is either humoring me or making fun of me, for I am not a real boy and they know it' even though I have obviously never ever felt that way about anyone else and I do know that everyone who does this just genuinely sees me as a man. It's a pretty transphobic thing to keep directing at myself and it kind of feels like an extension of imposter syndrome. Did anyone else struggle with this when you first came out/started transitioning? What did you do to train yourself out of it, if anything? Might just take some getting used to to believe that other people DO see me the way I see me.

See how this works? First, the poster applies the ‘imposter syndrome’ frame. Then the poster contains the doubts. Doubts become “intrusive feelings” and irrational responses to being “correctly gender[ed].” The poster sets up defusing threats to community beliefs and norms by reassuring other community members that the poster has “obviously never felt that way about anyone else” and that “everyone who does this just genuinely sees me as a man.” Then the poster expresses contrition and seeks empathy, writing “It’s a pretty transphobic thing to keep directing at myself,” before finally asking for advice on how to “train yourself out of it.”

The poster gets to share a troubling experience of persistent, severe self-doubt (“this person is either humoring me or making fun of me, for I am not a real boy”) but only in way that includes no actual exploration of whether this doubt has any basis in reality or whether such persistent misgivings should tell the poster anything about the advisability of transition.

Doubt tends to surface as transition milestones approach: coming out to family or at school, starting testosterone, scheduling a double mastectomy, changing legal documents. And the advice is almost always: If you’re not sure, take the next step and see how it feels. Fill that prescription and see how it feels to hold that vial of testosterone in your hand or inject it into your thigh. You can always change your mind. Never mind that the more costs you sink, the harder it can be to pull back. 

Internalized transphobia, imposter syndrome, and intrusive thoughts let members of online trans communities express and then disown their doubts. 

So you can say: I can’t let go of the fear that I’m faking it and that this is all a huge mistake. But the conclusion is predetermined: your fears are irrational. Your doubts are misplaced. You must say so yourself, and then the community reinforces your refusal to take your questions and doubts as serious challenges to your self-identity and decision to transition. Not only that: your doubts are a sign you’re really trans. 

Resistance, doubts and scruples become part of the heroic story arc that leads to accepting your trans identity and embarking on transition. The ways in which the decision to identify as trans and transition mirrors an authentic journey of self-discovery makes it harder to question, too. You’re overcoming difficulties—including your internal hangups. You’re undergoing often painful procedures. You’re making hard decisions about who to keep in your life and who to cut out. These are the kinds of things people do when they’re overhauling their lives—whether that’s for the better or whether they’ve joined something many of us have come to think of as a cult. 

* * * * * 

I wanted to wrap up with some quotes from women who desisted or detransitioned, just to show how their self-reflections provide a kind of symmetry to the stories we’ve been looking at. Detransitioners talk about the discomfort of pretending to be something you’re not, feeling like an imposter, and worrying that everyone else is just playing along. 

Or as one poster put it: “I stopped my transition because it started consuming all of my thoughts… I just can't live the rest of my life sometimes feeling like my ‘true self’ is an imposter. I decided that I need to accept that I will never be completely happy with myself, and feeding these thoughts will only make them more worse.”

They talk about how transition often exacerbated their sense of gender dysphoria and feeling of wrongness in their bodies, even going so far as to say that “Thinking I may be trans gave me dysphoria.”

Another wrote: “Once you start to hate your body you can become fixated on it… I was constantly thinking about the idea, and the more I thought about it the more I hated my body the way it was. Now I'm starting to understand why the idea resonated with me so much. Transition for me was sort of an escape route.”

They talk about realizing that what transition offered would never be enough. “‘I am going to be some aspect of female no matter what I do. I was born female, whether I like it or not. I have a genetically and physiologically female body, female chromosomes, a female-pattern bone and organ development. Is that ok?’ And it was over. That was the center of my thoughts on transitioning, and it was never going to be ok with me. I wanted to be a biological male so bad, and it would never happen…”

They stop believing that the next step will finally deliver on the impossible promises of transition. They reflect on the factors that made trans so appealing: “I was in an intense need to find myself and diagnose me with anything to explain why I was suffering. It was my attempt to search for meaning, because suffering for no reason is preposterous.” 

They talk about what online trans communities might call ‘intrusive thoughts’: the knowledge that they will always be female, no matter how much they might wish they’d been born male, and how they learned to live with that reality, rather than disown it. 

They show that there’s a way out. 

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You can read Steven’s response to my talk here:

Eliza talked about the way doubt is discussed in online trans communities, particularly how it’s dismissed: by labeling it “internalized transphobia” or “intrusive thoughts” and providing reassurances that doubt is actually evidence one is trans: cis people, after all, don’t worry about their gender. It reminded me of an informal ritual I’d sometimes see in trans circles, where if one person brought up feelings of doubt, everyone else would echo it by talking about their own experiences with doubt, making them feel like they weren’t alone. The message was “we’re all in this together, we’re all just like you, having doubts is just what being trans is like—so you don’t need to take them seriously.” I even had conversations with other trans people where we’d talk about the role autism, or bullying, or sexual abuse played in our transitions, sometimes even going so far as to admit we wished we’d never transitioned in the first place—but somehow always maintaining the doublethink we needed to go on believing that we were trans, that being trans was good, and that we should keep on taking the meds and getting the surgeries.