What do you do when the story you’ve been telling yourself falls apart?
Detransitioners and gender clinicians face a similar challenge: confront reality or look away?
The ways gender clinicians talk about detransition are so illuminating. They'll stick "detransition" in scare quotes, they'll say detransitioners are "transitioning to" their “assigned gender at birth.” They talk about gender journeys where patients transition and transition back, on a quest to discover their true selves—never mind that those “journeys” may include sterilizing pharmaceutical regimens and surgeries. In short, gender clinicians will do and say anything to avoid confronting the reality of harm and regret that it was their responsibility to prevent.
To avoid this reckoning, clinicians must trap detransitioners in the ideological framework that legitimizes transition. Sometimes, this trap is quite a literal one: requiring patients to demonstrate gender dysphoria and live in as their “desired gender” (read: actual sex) before they can change their legal documents and access medical procedures to reverse the effects of transition. Mostly, clinicians do this rhetorically, refusing to recognize detransition for what it is: a rejection of the belief system that justified transition. Clinicians tell detransitioners that they might just be genderfluid or nonbinary, or warn them that they need to work on their “internalized transphobia.” The patient isn’t allowed to say "I'm just female,” and that means the patient isn’t allowed to break up with gender identity and a way of thinking about gender and sex that harmed the patient in the first place.
So to detransition medically, legally, and (in many settings) socially, detransitioners are forced to keep playing the same mind game. Is it any wonder many detransitioners don't go back to the medical providers who harmed them in the first place and who refuse to open their eyes to the reality of what they’re doing?
This shows up in this week's episode of Gender: A Wider Lens, where two Dutch clinicians who developed the protocol for child medical transition fail again and again to openly and seriously evaluate their beliefs, actions, and the consequences. Rather than take on detransition and regret with the seriousness these topics deserve, Thomas Steensma and Annelou de Vries repeatedly attempt to “queer” negative outcomes instead. (Maybe we just need to 'queer' our ideas of what a good medical outcome is?) Gender clinicians like Steensma and de Vries hate talking about regret (the question of regretting or not regretting is too "binary"). They’d rather talk about fluidity, gender journeys, 'transitioning' to your assigned gender at birth.
When a teenager says she's trans, it's all very simple: believe [her], affirm [her]. When she says transition was a mistake, it's suddenly more complicated. Is she sure? Was she unduly influenced? Has she considered she might just be non-binary?
When a patient declares a trans identity, the social context in which that identity developed couldn't matter less to gender-affirmative clinicians. The patient's experience is valid. The mere suggestion of social influence—whether in the form of encouragement to transition or discouragement for gender-nonconformity and same-sex orientation—is taboo. Gender clinicians are clear: they’re treating a medical problem (often conceptualized as a congenital birth defect or a misguided endocrine system) with medical interventions.
But when transition fails, we see the selective readmission of social context to explain those bad outcomes that can't be “queered” away. The society that didn't influence the decision to transition in any way is now to blame for the failure of serious medical interventions. When transition fails—and only when transition fails—transgender identity conveniently morphs from a birth defect or an endocrine condition to be treated with pharmaceutical and medical solutions to a strictly individual mental health issue or a social problem. The patients who “know who they are” back when they identified as transgender now were misguided all along. In other words: gender dysphoria is a medical condition right up until medical treatment fails. Patients are indisputably trans right up until the moment they were never trans.
Presented with the reality of regret and harm, gender clinicians protest that they couldn't possibly have acted any differently. They tell patients: You wanted it. You asked for it. You were so sure. What else could we have done?
There's a terrifying disconnect between what gender clinicians see and say and what they do. These clinicians cannot see the patients in front of them. The language they use scrambles the complex clinical presentations they need to parse. Girls become “boys,” not in reality, but in the way gender clinicians talk about reality. Elective mastectomies on girls become “reconstructive chest surgery” on “boys.” Exploratory therapy to understand where distress over sex and gender originates becomes “conversion therapy.” Drastic, life-altering medical interventions—like “pausing” puberty and all the cognitive, physical, and emotional development that goes along with it—become conceptualized as non-interventions. Hysterectomies, oophorectomies, and phalloplasties become “gender-affirming care.”
There's a transfer of loyalty that takes place when doctors are confronted with "trans" kids. Doctors' sense of responsibility shifts from the actual patient in front of them to the patient's transgender alter. That is, the doctor falls under the same spell as the patient. Doctor and patient then collude, mining the patient's one and only body for resources the trans alter requires, and drugging and slicing that body into compliance with the new identity regime.
But what happens when the new identity regime collapses? When patients detransition, they must face the realities they sought to escape by transitioning. A similarly daunting challenge faces gender clinicians when patients detransition: they must accept that they did not know what they were doing—that instead of doing good, they caused harm.
For gender clinicians like Steensma and de Vries, gender dysphoria and the children and young people who suffer from it must be exceptional, as though nothing we know about child and adolescent development, identity formation, managing distress, reconciling with what we can’t change about ourselves applies. If it turns out that gender dysphoria and the young people who suffer from it aren’t exceptional, then we threw everything we knew out the window. We didn’t ‘help’ exceptional children but harmed ordinary ones, struggling with ordinary challenges of development, sexual orientation, identity, meaning, and direction.
What do you have to believe to transition? What do you have to believe, as a clinician, to facilitate the transition of children and young people? That you've asked the right questions. That transition is the answer.
For detransitioners and gender clinicians alike, there comes a moment when the story they’ve been telling themselves with hope and pride falls apart. For gender clinicians who saw themselves practicing “life-saving” medicine, it's painful to be confronted with detransitioners who provide a different perspective of medical providers' actions and the consequences.
What do you do when the story you've been telling yourself falls apart? Ask detransitioners. They’ve been there.
Per usual, beautifully expressed and important insights Eliza. This story of gender is falling apart like a cheap suit because it cannot withstand contact with the reality expressed by detransitioners. As humans, we cannot escape needing stories, frames of context, to make sense of reality. Our human languages are the bones of our stories, and sometimes even the words we have to work with fail us in telling stories that are helpful and moving away from stories that are harmful. Stories are always at best approximations of reality that we tell ourselves and each other. Even science must be told in stories that are approximations of reality. When our stories fall apart, we are destabilized, because we actually need stories. They are essential to moving in the world as a human being. All we can do is try to create better stories that are 1. closer reflections of reality and 2. are helpful to humans wishing to be healthy, happy, and whole.
I think there's a profound disconnect taking place in our culture and it's being manifested in many different ways (disconnect from our bodies, each other, the earth). No one is immune -- not professionals, not anyone. Objectification has been popularized as "empowering" with the "choice" to alter one's appearance as the ultimate expression of the "true self". But subjugation is often repackaged and sold back to us as an "empowering choice".
Automation and mechanization of the world and humans gives us the illusion of ultimate control. I think the reality we need to reckon with is a much bigger than just transition/detransition--it's that the patriarchal worldview of power and control is harmful and unsustainable, that the view of women and the earth as nothing but exploitable resources has spread like a virus and infected everyone and everything.
It takes courage to face ourselves and we need to make room in our hearts for ourselves and others to be able to identify problems and mistakes before we attempt to make repairs.