The meaning of detransition ought to be made by those who have experienced it but is instead most significantly shaped by the anxieties and priorities of those who have not.
I think the primary anxiety among trans people is that your research will be cherry-picked and attract the predictable anti-trans disapproval and condescension that is characteristic of Substack commenting sections. You already know where I stand. Meaningful discourse on transgender lives and experience should be welcomed. Including de-transition. Your writing is good and is offered in a serious tone that comes out of research without a specific agenda. Most do not appreciate or want this. They have no use for it. And they will not grapple with it or process it. They are on the periphery of the transgender experience and world, believing they understand it sufficiently. In the spirit of Neil Postman, they want a quick reconciliation and resolution of the "trans problem." They will use what you put out as they see fit. I expressed this concern last time. I won't pester you on this in the future. Your research is meaningful and with value, but its timing and presence has little appeal for many trans people in this oppressive environment. So we frown on it, or outright hate it.
Actually, I was attracted to the Neil Postman reference, as I had read that book as a journalism student way back when I was a young "man," and not a trans-lesbian. The child-like quality of much of the electorate coupled with an election process wrapped in slogans and advertising is, at least in part, why Donald Trump is in the White House a second time. And if you are trans, that reality stings whenever we choose to engage. As a country we "amused ourselves to death" and were complacent, while the Fox settled back into the hen house. Detransition will mean harm or death for some in this environment (and as a de/re-transitioner, I am not touching that one). Carry on.
Hi Kenzie, thank you for your thoughtful comment, you raise some interesting points and I agree that 'Most do not appreciate or want (research without a specific agenda). They have no use for it. And they will not grapple with it or process it.... its timing and presence has little appeal for many trans people in this oppressive environment.' This is something I would like to explore in a future article.
I also agree that the current political climate vindicates many of Postman's conclusions, and not in a positive way. Much of his writing feels unfortunately prophetic.
I’ve been reading your comments on this blog’s posts and I really appreciate that you’ve been sharing your thoughts. It’s been helping me challenge and refine my thoughts.
I’m a detransitioner who never really felt understood or represented like the way you have in this piece and it’s a breath of fresh air. There’s very few spaces to have discussion about detransition and all its implications, it’s claustrophobic. Sometimes I give up on any meaningful true discussion happening cause it’s bond to be a hot potato moving from one side to the next without anyone ever slowing down enough to examine it.
I’m in a weird state between support for gender affirming care for trans people and also overwhelming caution about medical transition, not so much because of I blame the doctors per say but more so the motivating factors that might lead some to medically transition when they really shouldn’t. It’s hard to want to add an extra layer of protective wrap because it will be annoying to trans folks but it might save a potential detransitioner a great deal of pain and regret. It’s complicated as you already know, but the simple act of having another person actually say it that isn’t on a reddit board is a hopeful start.
I think your approach is the most honest one and I appreciate it.
Thank you for sharing this with us. Please feel free to engage with some of our other previous posts. We also have a few written by detransitioners. It's always nice to hear from detransitioned people to get feedback.
"If a detransitioned person understands their experience as one of medical malpractice, the onus is on you to accept that." I think this phrase is doing a lot of heavy-lifting about what I think is the crux of the friction between the two groups you've described. Assessment of malpractice is not a feeling or a "definition of detransition," it's an opinion about policy and an assertion about what doctors should and should not do. If a narrative of detransition is one of malpractice, that is a political opinion, one that affects people other than detrans people, and it isn't wrong for people to weigh in on a policy proposal that affects them.
If doctors are effectively presenting transition as, like you say, an advertisement-- like, "do this, it'll fix you! you'll feel good about your body and gender and never be depressed again!"-- I would agree that this is uninformed-if-not-wholly-unethical and a total betrayal of informed consent. If someone asks for guidance on what to do about their gender feelings, and either receives bad advice (like "just do it and figure out how you feel later, it'll be fine") or none at all, I would agree that is a deep injustice. These are situations where it would be reasonable to feel betrayed, or like a doctor has failed their duty of care.
But I don't think that caring for someone who feels regretful is equivalent to agreeing with whatever they think should have happened instead. If someone considers it malpractice that doctors did not withhold care when they were insistent it was what they wanted, when they fit the WPATH standards of care (which imo are fairly reasonable, though I have my gripes), then no, I am not obligated to agree that malpractice has occurred. Empathy does not oblige me to lend a listening ear to people whose opinion is that *the only way* to deal with their feelings of regret is to create policy which would simply make others feel regretful instead.
This kind of conflation between narrative self-determination/empathy and policy agreement is exactly what leads trans people to think that any empathy for detransitioners-as-a-group requires agreement with the specific detransitioners who have made anti-trans political grandstanding their entire personality/career. I can feel very sad for what those people have been through, I can consider their situations & feelings when thinking about what I support policy-wise, and still consider them monstrously immoral, ignorant, and manipulative people who should not be given a megaphone.
I think the primary anxiety among trans people when it comes to engaging sympathetically with detransitioners is that we will always be posed as groups who need conflicting accommodations, that we are playing a game of tug-of-war which must always have a loser. I think this framing is completely unethical-- it begs the question of whether its even possible to provide compassionate care for *everyone at once*, which is what I actually want to see happen-- and I disagree that compassion obligates me to agree with or listen to people who propose it.
Hi Jesse. Thank you for your comments. Just a couple of points,
First, at no point in this article do I make the argument that transition is presented by doctors as an advertisement. The argument I make here is about representations of detransition, specifically, about partial ones that present detransition as, for example, exclusively defined by medical regret and extreme complications, at the negation of other forms of detransition, and why this might be the case. This piece is a theoretical exploration of representations and constructions of detransition, and the philosophical reasoning underpinning certain reactions to detransition. The legitimacy of these reactions as accurate or objective understandings of reality is not the point.
Second, '"If a detransitioned person understands their experience as one of medical malpractice, the onus is on you to accept that." This line was an illustration of something I had written in a previous, unpublished piece. It was not meant to be a central argument in this one, and in hindsight I would clarify that I am primarily referring to positionality in a research context.
We are in agreement that a solution in which compassionate care is provided for all is the best one.
Rereading it, I can see how that was your intent. I would much rather believe that The One Percent has made an error in communication than an error in baseline ethical philosophy. But I followed y'all for months and a series of "its sooo hard to talk about this we must be very careful" followed by "the hidden cost of overzealous activism in media" is such a hypocrisy it makes all of your careful phrasing up to that point seem like a manipulative ploy. Considering the efforts The One Percent has put into trying to demonstrate self-awareness, I'm unsure how that piece-- or any of these immediate follow-up pieces, including the one that was ostensibly a response to my complaints about it-- managed to slip through whatever editing process y'all follow.
Again it seems that y'all are not actually very good at addressing a potentially-hostile audience-- a problem that I personally navigate every time I write about gender/politics/culture, so I'm well aware of what is easy and what is extremely hard when it comes to communicating. Considering your institutional credentials, published credits, and access to actual policy-makers (such as WPATH), the weight of responsibility (and the level of expected rigor) on you is much higher than mine, and you either learn how to shoulder that or you simply name problems only to make them worse.
Whether you address that or not from here on I suppose is none of my business since I've already unfollowed. Substack is not sending me notifications of new replies to my comments here, so the only way I see them is if I keep going out of my way to check, and at this point I don't trust y'all enough to think this is worth my time. Feel free to reach out directly if you end up posting something that honestly addresses literally anything I've brought up in my replies.
First, I want to thank all of you for the responses. It's great to have a dialogue on Substack. Your publication and discussion here is showing me where my thinking is probably too constrained by my own personal experience. So you are broadening my horizons which is appreciated, although sometimes uncomfortable.
In examining my own feelings and motivations I will admit that the detransitioners that make it their political career for the consumption of the anti-trans establishment out there has a way of overtaking my thinking on the subject. But the potential for serious long-lasting harm to transgender people is great. And this is probably why I offer up a contentious response with my Substack writings. Healthcare access is already being limited for trans gender people and I'm one of those that believes there should be easy access after a reasonable approval process. With transitioning regarded as just another medical condition (and yes we really have to separate medical transition from non-medical). With available care for the patient to achieve a level of comfort, not perfection. This is what I want for myself. And my girlfriend, who's coming home from Canada soon completed a full medical transition years ago with great success. She presents as a cisgender woman 100% When I first met her I didn't know she was transgender (and no, that gold standard outcome should not rule our lives; I myself am trans binary, complete with lipstick nail polish and makeup. And I don't apologize for it). What the medical community can offer a transitioning person is quite amazing. And if somebody wants that it should be available to them. Without having their psychological and financial well-being under tremendous pressure and great threat in the process. And I will admit that I wasn't one of those trans persons that was carefully managed or gatekeeped. My access to hormones was remarkably easy (although providers did know I had a lengthy history of self-care). There wasn't such a system back when I was age 30 and wanting hormones and transgender care and management. Wanting it badly. But having therapists shrug it off along with more than one psychiatrist. Looking back, it's truly heartbreaking. And now at age 60 it's gotten better (which is why my anti-transgender people, you are seeing so many transitioners out there "overnight." They're not hidden anymore). My personal story is sorely lacking in any comprehensive support, and includes the all too typical alcoholism and suicide attempts. I'm bipolar, and it's a complicated story, but I presented in a state of near psychosis wanting to cut my genitals and bleed to death only to be given an untrained therapist for 12 weeks which got me nowhere (except still alive instead of dead). That particular day almost got me sent to inpatient psych. But I believe that psychiatrist did not want to hospitalize me for my severe life-threatening gender dysphoria because it would have been stigmatizing (back in the DSM 3-R days). In hindsight I believe that's what her (political) motivations were because I surely needed to be treated (and psychiatry is politics not only medicine). I was a danger to myself. Instead I was left to limp along. Now with the diagnosis of Gender Identity Disorder-NOS. Any diagnosis should go along with meaningful treatment options, but back then that didn't happen for me. So I accessed hormones from overseas pharmacies when the internet was beginning to be a reliable source of information and products. The advent of the internet is what saved me, not what caused me to be transgender. I saved myself because of the internet, and not because of the sorely lacking medical system which simply did not accommodate people with gender dysphoria in any reliable way. We've come a long way from that. Slowly, and later with rapid establishment of transgender care. And that's why a lot of this discussion has a way of paining me and reminding me of the trauma that I experienced throughout my life regarding my transgender condition. It's sad and completely unnecessary for a person to go through all that. And now here we are. Complete transgender healthcare was beginning to be part of the larger medical establishment. Only to be placed under serious threat with the current Trump administration. And of course the anti-transgender government officials do not want that care to continue. As feisty Greta Thunberg would say "how dare you!"
Thank you, I appreciate your candor, genuinely. I think it's very hard to be self-aware about how much experiences/loyalties/feelings affect our beliefs-- it's definitely a constant & effortful thing for me, anyway, and the high stakes of the issue make it wayyy harder than it should be.
"Easy after a reasonable approval process." Again, this is limiting access to healthcare for people like me who would not pass whatever approval process you can cook up, and who cannot afford (with time or money) to pursue assessments and would not willingly consent to them even if I could. That's wholly the crux of the beef here, is what constitutes "a reasonable approval process" and how much doctors should be obligated to *withhold* care by conflating that deprivation with *providing* care. I am not the one with credentials and status and the authority to decide on someone else's behalf what "reasonable" looks like.
Again, as I stated in a below comment, it seems the guys behind The One Percent have agreed that the current provision of care is incompetent and totally inadequate, while reserving the right to gatekeep it anyway. This is not for the sake of *all patients* so much as for the sake of a specific category of patients-- detransitioners-- and comes at the expense of people like me. Like you, I have a long list of mental health contraindications to just "letting me do what I want" that even a very very good and well-informed doctor or therapist would struggle to understand or advise on.
I would love to see that change such that doctors *can and do* give competent advice, with solid backing in both empirical data and coherent philosophy-- but I would also like to reserve the right to get what I need even if I decide that I don't want or need their advice. I feel like this "more, not less" approach to healthcare-- preserving the agency that patients currently have while educating doctors to give better advice to those that want it-- is an extremely obvious solution (even though there are still a million questions about how to pragmatically enact it!), one which The One Percent has repeatedly refused to name. The implication is that people like me are simply the cost of doing business if it means protecting detrans people from regret, which I find irresponsible and unconscionable. They can change that any time, but this recent series of pieces has left me extremely distrustful that they are capable of talking about this with the level of responsibility required for either advising WPATH standards or explaining a fraught issue to the general public on substack.
"Again, as I stated in a below comment, it seems the guys behind The One Percent have agreed that the current provision of care is incompetent and totally inadequate, while reserving the right to gatekeep it anyway."
We have stated this no where in any of our posts. We agree with much of what you've laid out here, Jesse. Where we differ is that we believe in academic freedom and that within the context of research ethics and care delivery, everyone has the right to have their experiences researched and considered. This is also fundamental to a healthy democratic society and within the LGBTQ+ community.
While we understand than many trans people can find learning about detransition unsettling, this does not mean researching or discussing these experiences is not valuable or important to do.
I was referencing a published research paper by Exposito-Campos, referenced there, which I only looked up because you have *implied it repeatedly* with the way you talk about transition. You certainly haven't stated that you feel anything else, either, and we live in a grifting era-- if you aren't clear about where you stand I have to look up whatever else your members have written to clarify it myself. This is what I've said over and over this week, starting with my first comment three articles ago-- leaving euphemisms and implications unexplained and unclear creates a void of understanding, and if the void you've left is filled with anxiety or confusion, *that's your fault* for not preempting it more carefully. This is the work I do in my own writing all the time, and I don't even have a PhD or a research fellowship which lends the weight of responsibility that you all have to deal with. If ~the institution which calls itself The One Percent~ disagrees with Exposito-Campos's paper's conclusion, or if he wants to provide clarification on how his opinions have changed, you're free to write that whenever you feel like making time for it.
Democracy is good but it's also fucking fragile. Part of the current American struggle with regards to democracy is that it's impossible to know who to trust, and we are faced with such a firehose of information every day while being unable to tell the difference between a trustworthy expert and a random layperson just talking shit. There are an infinite number of grifters and ideologues offering manipulation in place of the truth, some of them without realizing it, and coming off as *anything but that* requires active effort even if your heart is in the right place. I agree that everyone's experiences deserve to be researched and considered, but that is not the same thing as sharing unfiltered testimonials from the authoritative position of a science communicator. As I've said multiple times now, if I can tell the difference, I'm not sure why y'all apparently can't, and you seem annoyed by the fact that you have managed to erode my good faith so thoroughly & so quickly.
Jesse you put out a lot here. The problem is I don't completely know your background and understand everything you've gone through. Apparently you de-transitioned. This is why my writing is peppered with my own experience. To give some background and as a way to bolster the main points of all the comments I've made. At this point I'm at the deep end of the pool, with a subject I know some things about. People like Christy are focused on the subject because they are conducting their research. My Substack presence allows for the subject of de-transition, but only as one of many topics tied to the patient experience. If specific or broad points about the transgender de-transition experience emerge, I will consider them and possibly comment. So there's value in this. But I believe I understand where you're coming from and I already voiced my concerns and put out my warnings. And I praised this entire process since it does get away from the usual Facebook type of Trans Tit for Tat that becomes annoying and contributes nothing meaningful or useful to anyone except the TERFs, LGB exclusivity, the MAGA crowd etc. As for a reasonable approval process, I'm not sure what you were getting at exactly. And no, I don't know what that hypothetical process is supposed to be except for the WPATH recommendations. I mean we need to have a chat or a form to expand upon all these things if there was to be some kind of community discussion (or more of a Blog where people can check in and share over time. Without somebody's selfish little paywall dominating everything. I understand that people are trying to make a living and they need to be compensated for their time, but I'm not here for ego trips, dogma, or more gatekeeping. We transgender people want to capitalize on our experience and there's nothing wrong with that. But our small population and communities are crowded when it comes to that. I have already praised Substack, but I've also mention how we need to take what's gleaned from our writings and discussions and have it effect those in power who are not on Substack. Our voices need to be heard by the people that have power and who are not in our broader LGBTQ+ community or subsets of trans communities. Hence the echo chamber or just preaching to the choir, which has some value I suppose since we can learn from each other. Reasonable guidelines and patient gatekeeping is not rocket science, or at least it shouldn't be. People should be able to access the system. The problem is there is no system.An approval process or gatekeeper could just mean a family physician or a referral to an endocrinologist by your family physician. A few years back my primary doctor referred me to the community health doctors that were specifically caring for the transgender patients in my area. Another Choice which I tried to pursue, was one of the few independent endocrinologists who did transgender patients. The only problem is he required getting a psych evaluation before being considered for hormones. That wasn't a problem since I was bipolar with a long history with psych. No big deal. But still I refused because I decided it was degrading and unnecessary for me. The other option was being worked on at the same time. So the endocrinologist with the psych requirements was my backup plan and my last resort if I couldn't do anything else. We have all kinds of research and there's enough from every major medical organization saying transgender care is legitimate, necessary, and even life-saving. And my story that I gave you bears this out. So it's a matter of giving power to people that will act on the research and consensus. A big problem is research on transgender people may have no audience except its own academic community. We saw what happened in Utah last week when I study on treatment for transgender children emerged and gave the green light to care for Trans children and gender diverse children and teens. Or something along those lines. I didn't read everything about it but I got the main points. And of course the politicians decided it didn't matter. The destruction and prevention of research on transgender people is in the news and it's no secret what's going on. Organizations such as WPATH have been developing standards that could be used, and we could have a legitimate system with provider membership being the norm for doctors and surgeons whose treat us transgender patients. But the anti-transgender groups don't want this. They want things fragmented. They want things in disparate parts. Confusion. Pathology instead of psychiatry in our favor and giving us the green light to get what we want when we want. We are consumers of the medical establishment. If I go to a dentist, or I need treatment for my bad back etc. We consume their services. But when it comes to transgender care it's seen as totally different and blown out of the water and all hell breaks loose because we are not supposed to change our bodies with surgery or hormones as a way to relieve our suffering. They don't want standard care for transgender people. They fault patients for approaching their transition with self-directedness, when the truth is patients are forced to much of the time. There's too much to say on all this. And any hope for solid progress regarding true standards of care is being dismantled before our eyes. And now we are seeing progress halted or completely destroyed. With remaining resources spread so thinly, attention to detransitioners as a group and an identity maybe too much to ask. I never said I had all the answers, I just threw my two cents in about a few things. The people in power already have or they want to change the rules for abortion care, transgender care, the way kids are taught, and so on. There's a lot going on. I started reading some of your Substack and I'll take a look again. Take care. Hang in there. And fight the good fight.
They certainly seem to think that the question of how to care for both trans & detrans people at the same time means that some amount of trans suffering is simply the cost of doing business. I don't know what to say to that except "fuck you, from the bottom of my heart." At minimum, this is not a foregone conclusion. I would never say such a thing if the roles were reversed, as if we should simply pretend that regret is impossible and leave detrans people to fend for themselves without any recourse for living their lives beyond regret.
I finally looked up who is behind this substack and, I mean, I'll just drop this snippet of an article from Exposito-Campos, one of the byline names on this sub, "A Typology Of Gender Detransition and Its Implications for Healthcare Providors" (2021):
"This distinction between preventing and supporting detransition might be useful from a theoretical point of view, but it does not fit so well in a real-life clinical context, where healthcare providers have the responsibility to ensure that their patients’ decisions are thoughtful, well-informed, and beneficial in the long term. Imagine that a clinician identifies other issues, concerns, or factors that could be influencing one person’s GD and that may jeopardize the benefits of transitioning, ultimately leading to a detransition. In such a case, it would seem highly unethical to leave those matters unaddressed and not to be cautious before making a decision.
This is not an argument for restricting access to gender-related healthcare. Instead, it intends to highlight how important it is for healthcare providers to develop an integrated view of each patient by carrying out comprehensive exploratory assessments."
This whole "I'm not touching you!" tactic is apparently the norm for these researchers, as if restricting access isn't really restricting access if they just say "no it isn't." The *obligation*-- rather than the *option to choose*-- comprehensive exploratory assessments etc is exactly what has prevented me from getting top surgery despite a full decade of trying, and is exactly what makes trans people so skittish about the topic of detransitioners. I can't imagine why they don't name this particular option-- that these kinds of assessments might be opt-in rather than obligatory-- unless they're either intentionally protecting medical authority for its own sake, or because they're too stupid to even consider it. It seems intuitively obvious to me, especially so for anyone even slightly aware of trans arguments on this subject, so I can only assume their motive is the former unless they decide to subtweet me some new clarifying essay that proves me wrong. I suppose I won't hold my breath for it.
80% of this article is about how regret is impossible to prevent, and that supportive care for detrans people is more effective than preventative care, and still it concludes that incompetent medical gatekeeping is preferable to none at all. It seems they are absolutely happy to beg the question that doctors have not only the right but the obligation to withhold care from people based on vibes. But I disagree in strongest terms that it's a doctor's job to judge whether my decisions are ~thoughtful~, or to act like the sole party responsible for ensuring I am ~well-informed~, and I am actively opposed to anyone who takes these presumptions for granted. That's, y'know, kind of the crux of the whole argument about what doctors should be expected to do about uncertain/dishonest/regretful patients, and dancing around it so intensely reads to me as incredibly cowardly and disingenuous.
No wonder they respond my comments with these passive-aggressive, euphemistic pieces about "defining detransition" and "making voices heard" and etc rather than just responding directly. This piece specifically seems to be telling me, a trans guy, to fuck right off out of policy discussions that are relevant to *my* access to healthcare, because I'm not part of their pet identitarian focus group/"it's not politics if we say its not politics." I don't know what I can reasonably conclude except that they know full well that if they put a fine point on the question of presumptive medical authority, they would find a bunch of American trans people telling them to go fuck themselves, and they don't have the spine or the sincerity to really face the content of that pushback.
This recent turn has made me sort of go from "these people seem like they're trying their best, even if I don't love the way they leave so much implied" to "oh these are fully just medical gatekeeping stans pretending they're anything but, okay. well, congrats on naming the problem and then going out of your way to make it worse." Shameful and unserious.
Are you for real. Do you really think people are out here transitioning on a coin toss, without EVER having had the thought? You've made it functionally illegal to be trans in most of the English speaking world. What the fuck is wrong with you? You only want to give a mic to detransitioners because you want actual trans folks dead. You're not principled. You're not reasonable. You're a bigot hiding behind essentialism and culture war.
Thank you for your comment. As the author of this article I would like to let you know that the AI generated image has been removed, and that such images will not be included in my pieces going forward.
Detransition is when they realize people like you convinced them they were “trans” but of course they’re not. Most trans people know it’s bullshit but they are in too deep and embarrassed to back out because they made such a big deal about being trans on the first place. It’s dead obvious.
I think the primary anxiety among trans people is that your research will be cherry-picked and attract the predictable anti-trans disapproval and condescension that is characteristic of Substack commenting sections. You already know where I stand. Meaningful discourse on transgender lives and experience should be welcomed. Including de-transition. Your writing is good and is offered in a serious tone that comes out of research without a specific agenda. Most do not appreciate or want this. They have no use for it. And they will not grapple with it or process it. They are on the periphery of the transgender experience and world, believing they understand it sufficiently. In the spirit of Neil Postman, they want a quick reconciliation and resolution of the "trans problem." They will use what you put out as they see fit. I expressed this concern last time. I won't pester you on this in the future. Your research is meaningful and with value, but its timing and presence has little appeal for many trans people in this oppressive environment. So we frown on it, or outright hate it.
Actually, I was attracted to the Neil Postman reference, as I had read that book as a journalism student way back when I was a young "man," and not a trans-lesbian. The child-like quality of much of the electorate coupled with an election process wrapped in slogans and advertising is, at least in part, why Donald Trump is in the White House a second time. And if you are trans, that reality stings whenever we choose to engage. As a country we "amused ourselves to death" and were complacent, while the Fox settled back into the hen house. Detransition will mean harm or death for some in this environment (and as a de/re-transitioner, I am not touching that one). Carry on.
Hi Kenzie, thank you for your thoughtful comment, you raise some interesting points and I agree that 'Most do not appreciate or want (research without a specific agenda). They have no use for it. And they will not grapple with it or process it.... its timing and presence has little appeal for many trans people in this oppressive environment.' This is something I would like to explore in a future article.
I also agree that the current political climate vindicates many of Postman's conclusions, and not in a positive way. Much of his writing feels unfortunately prophetic.
I’ve been reading your comments on this blog’s posts and I really appreciate that you’ve been sharing your thoughts. It’s been helping me challenge and refine my thoughts.
I’m a detransitioner who never really felt understood or represented like the way you have in this piece and it’s a breath of fresh air. There’s very few spaces to have discussion about detransition and all its implications, it’s claustrophobic. Sometimes I give up on any meaningful true discussion happening cause it’s bond to be a hot potato moving from one side to the next without anyone ever slowing down enough to examine it.
I’m in a weird state between support for gender affirming care for trans people and also overwhelming caution about medical transition, not so much because of I blame the doctors per say but more so the motivating factors that might lead some to medically transition when they really shouldn’t. It’s hard to want to add an extra layer of protective wrap because it will be annoying to trans folks but it might save a potential detransitioner a great deal of pain and regret. It’s complicated as you already know, but the simple act of having another person actually say it that isn’t on a reddit board is a hopeful start.
I think your approach is the most honest one and I appreciate it.
Thank you for sharing this with us. Please feel free to engage with some of our other previous posts. We also have a few written by detransitioners. It's always nice to hear from detransitioned people to get feedback.
"If a detransitioned person understands their experience as one of medical malpractice, the onus is on you to accept that." I think this phrase is doing a lot of heavy-lifting about what I think is the crux of the friction between the two groups you've described. Assessment of malpractice is not a feeling or a "definition of detransition," it's an opinion about policy and an assertion about what doctors should and should not do. If a narrative of detransition is one of malpractice, that is a political opinion, one that affects people other than detrans people, and it isn't wrong for people to weigh in on a policy proposal that affects them.
If doctors are effectively presenting transition as, like you say, an advertisement-- like, "do this, it'll fix you! you'll feel good about your body and gender and never be depressed again!"-- I would agree that this is uninformed-if-not-wholly-unethical and a total betrayal of informed consent. If someone asks for guidance on what to do about their gender feelings, and either receives bad advice (like "just do it and figure out how you feel later, it'll be fine") or none at all, I would agree that is a deep injustice. These are situations where it would be reasonable to feel betrayed, or like a doctor has failed their duty of care.
But I don't think that caring for someone who feels regretful is equivalent to agreeing with whatever they think should have happened instead. If someone considers it malpractice that doctors did not withhold care when they were insistent it was what they wanted, when they fit the WPATH standards of care (which imo are fairly reasonable, though I have my gripes), then no, I am not obligated to agree that malpractice has occurred. Empathy does not oblige me to lend a listening ear to people whose opinion is that *the only way* to deal with their feelings of regret is to create policy which would simply make others feel regretful instead.
This kind of conflation between narrative self-determination/empathy and policy agreement is exactly what leads trans people to think that any empathy for detransitioners-as-a-group requires agreement with the specific detransitioners who have made anti-trans political grandstanding their entire personality/career. I can feel very sad for what those people have been through, I can consider their situations & feelings when thinking about what I support policy-wise, and still consider them monstrously immoral, ignorant, and manipulative people who should not be given a megaphone.
I think the primary anxiety among trans people when it comes to engaging sympathetically with detransitioners is that we will always be posed as groups who need conflicting accommodations, that we are playing a game of tug-of-war which must always have a loser. I think this framing is completely unethical-- it begs the question of whether its even possible to provide compassionate care for *everyone at once*, which is what I actually want to see happen-- and I disagree that compassion obligates me to agree with or listen to people who propose it.
Hi Jesse. Thank you for your comments. Just a couple of points,
First, at no point in this article do I make the argument that transition is presented by doctors as an advertisement. The argument I make here is about representations of detransition, specifically, about partial ones that present detransition as, for example, exclusively defined by medical regret and extreme complications, at the negation of other forms of detransition, and why this might be the case. This piece is a theoretical exploration of representations and constructions of detransition, and the philosophical reasoning underpinning certain reactions to detransition. The legitimacy of these reactions as accurate or objective understandings of reality is not the point.
Second, '"If a detransitioned person understands their experience as one of medical malpractice, the onus is on you to accept that." This line was an illustration of something I had written in a previous, unpublished piece. It was not meant to be a central argument in this one, and in hindsight I would clarify that I am primarily referring to positionality in a research context.
We are in agreement that a solution in which compassionate care is provided for all is the best one.
Rereading it, I can see how that was your intent. I would much rather believe that The One Percent has made an error in communication than an error in baseline ethical philosophy. But I followed y'all for months and a series of "its sooo hard to talk about this we must be very careful" followed by "the hidden cost of overzealous activism in media" is such a hypocrisy it makes all of your careful phrasing up to that point seem like a manipulative ploy. Considering the efforts The One Percent has put into trying to demonstrate self-awareness, I'm unsure how that piece-- or any of these immediate follow-up pieces, including the one that was ostensibly a response to my complaints about it-- managed to slip through whatever editing process y'all follow.
Again it seems that y'all are not actually very good at addressing a potentially-hostile audience-- a problem that I personally navigate every time I write about gender/politics/culture, so I'm well aware of what is easy and what is extremely hard when it comes to communicating. Considering your institutional credentials, published credits, and access to actual policy-makers (such as WPATH), the weight of responsibility (and the level of expected rigor) on you is much higher than mine, and you either learn how to shoulder that or you simply name problems only to make them worse.
Whether you address that or not from here on I suppose is none of my business since I've already unfollowed. Substack is not sending me notifications of new replies to my comments here, so the only way I see them is if I keep going out of my way to check, and at this point I don't trust y'all enough to think this is worth my time. Feel free to reach out directly if you end up posting something that honestly addresses literally anything I've brought up in my replies.
First, I want to thank all of you for the responses. It's great to have a dialogue on Substack. Your publication and discussion here is showing me where my thinking is probably too constrained by my own personal experience. So you are broadening my horizons which is appreciated, although sometimes uncomfortable.
In examining my own feelings and motivations I will admit that the detransitioners that make it their political career for the consumption of the anti-trans establishment out there has a way of overtaking my thinking on the subject. But the potential for serious long-lasting harm to transgender people is great. And this is probably why I offer up a contentious response with my Substack writings. Healthcare access is already being limited for trans gender people and I'm one of those that believes there should be easy access after a reasonable approval process. With transitioning regarded as just another medical condition (and yes we really have to separate medical transition from non-medical). With available care for the patient to achieve a level of comfort, not perfection. This is what I want for myself. And my girlfriend, who's coming home from Canada soon completed a full medical transition years ago with great success. She presents as a cisgender woman 100% When I first met her I didn't know she was transgender (and no, that gold standard outcome should not rule our lives; I myself am trans binary, complete with lipstick nail polish and makeup. And I don't apologize for it). What the medical community can offer a transitioning person is quite amazing. And if somebody wants that it should be available to them. Without having their psychological and financial well-being under tremendous pressure and great threat in the process. And I will admit that I wasn't one of those trans persons that was carefully managed or gatekeeped. My access to hormones was remarkably easy (although providers did know I had a lengthy history of self-care). There wasn't such a system back when I was age 30 and wanting hormones and transgender care and management. Wanting it badly. But having therapists shrug it off along with more than one psychiatrist. Looking back, it's truly heartbreaking. And now at age 60 it's gotten better (which is why my anti-transgender people, you are seeing so many transitioners out there "overnight." They're not hidden anymore). My personal story is sorely lacking in any comprehensive support, and includes the all too typical alcoholism and suicide attempts. I'm bipolar, and it's a complicated story, but I presented in a state of near psychosis wanting to cut my genitals and bleed to death only to be given an untrained therapist for 12 weeks which got me nowhere (except still alive instead of dead). That particular day almost got me sent to inpatient psych. But I believe that psychiatrist did not want to hospitalize me for my severe life-threatening gender dysphoria because it would have been stigmatizing (back in the DSM 3-R days). In hindsight I believe that's what her (political) motivations were because I surely needed to be treated (and psychiatry is politics not only medicine). I was a danger to myself. Instead I was left to limp along. Now with the diagnosis of Gender Identity Disorder-NOS. Any diagnosis should go along with meaningful treatment options, but back then that didn't happen for me. So I accessed hormones from overseas pharmacies when the internet was beginning to be a reliable source of information and products. The advent of the internet is what saved me, not what caused me to be transgender. I saved myself because of the internet, and not because of the sorely lacking medical system which simply did not accommodate people with gender dysphoria in any reliable way. We've come a long way from that. Slowly, and later with rapid establishment of transgender care. And that's why a lot of this discussion has a way of paining me and reminding me of the trauma that I experienced throughout my life regarding my transgender condition. It's sad and completely unnecessary for a person to go through all that. And now here we are. Complete transgender healthcare was beginning to be part of the larger medical establishment. Only to be placed under serious threat with the current Trump administration. And of course the anti-transgender government officials do not want that care to continue. As feisty Greta Thunberg would say "how dare you!"
Thank you, I appreciate your candor, genuinely. I think it's very hard to be self-aware about how much experiences/loyalties/feelings affect our beliefs-- it's definitely a constant & effortful thing for me, anyway, and the high stakes of the issue make it wayyy harder than it should be.
"Easy after a reasonable approval process." Again, this is limiting access to healthcare for people like me who would not pass whatever approval process you can cook up, and who cannot afford (with time or money) to pursue assessments and would not willingly consent to them even if I could. That's wholly the crux of the beef here, is what constitutes "a reasonable approval process" and how much doctors should be obligated to *withhold* care by conflating that deprivation with *providing* care. I am not the one with credentials and status and the authority to decide on someone else's behalf what "reasonable" looks like.
Again, as I stated in a below comment, it seems the guys behind The One Percent have agreed that the current provision of care is incompetent and totally inadequate, while reserving the right to gatekeep it anyway. This is not for the sake of *all patients* so much as for the sake of a specific category of patients-- detransitioners-- and comes at the expense of people like me. Like you, I have a long list of mental health contraindications to just "letting me do what I want" that even a very very good and well-informed doctor or therapist would struggle to understand or advise on.
I would love to see that change such that doctors *can and do* give competent advice, with solid backing in both empirical data and coherent philosophy-- but I would also like to reserve the right to get what I need even if I decide that I don't want or need their advice. I feel like this "more, not less" approach to healthcare-- preserving the agency that patients currently have while educating doctors to give better advice to those that want it-- is an extremely obvious solution (even though there are still a million questions about how to pragmatically enact it!), one which The One Percent has repeatedly refused to name. The implication is that people like me are simply the cost of doing business if it means protecting detrans people from regret, which I find irresponsible and unconscionable. They can change that any time, but this recent series of pieces has left me extremely distrustful that they are capable of talking about this with the level of responsibility required for either advising WPATH standards or explaining a fraught issue to the general public on substack.
"Again, as I stated in a below comment, it seems the guys behind The One Percent have agreed that the current provision of care is incompetent and totally inadequate, while reserving the right to gatekeep it anyway."
We have stated this no where in any of our posts. We agree with much of what you've laid out here, Jesse. Where we differ is that we believe in academic freedom and that within the context of research ethics and care delivery, everyone has the right to have their experiences researched and considered. This is also fundamental to a healthy democratic society and within the LGBTQ+ community.
Our goals of this Substack are laid out here: https://theonepercentdetrans.substack.com/p/why-do-we-study-detransition
And in our first post:
https://theonepercentdetrans.substack.com/p/the-one-percent-a-detransition-focused
While we understand than many trans people can find learning about detransition unsettling, this does not mean researching or discussing these experiences is not valuable or important to do.
I was referencing a published research paper by Exposito-Campos, referenced there, which I only looked up because you have *implied it repeatedly* with the way you talk about transition. You certainly haven't stated that you feel anything else, either, and we live in a grifting era-- if you aren't clear about where you stand I have to look up whatever else your members have written to clarify it myself. This is what I've said over and over this week, starting with my first comment three articles ago-- leaving euphemisms and implications unexplained and unclear creates a void of understanding, and if the void you've left is filled with anxiety or confusion, *that's your fault* for not preempting it more carefully. This is the work I do in my own writing all the time, and I don't even have a PhD or a research fellowship which lends the weight of responsibility that you all have to deal with. If ~the institution which calls itself The One Percent~ disagrees with Exposito-Campos's paper's conclusion, or if he wants to provide clarification on how his opinions have changed, you're free to write that whenever you feel like making time for it.
Democracy is good but it's also fucking fragile. Part of the current American struggle with regards to democracy is that it's impossible to know who to trust, and we are faced with such a firehose of information every day while being unable to tell the difference between a trustworthy expert and a random layperson just talking shit. There are an infinite number of grifters and ideologues offering manipulation in place of the truth, some of them without realizing it, and coming off as *anything but that* requires active effort even if your heart is in the right place. I agree that everyone's experiences deserve to be researched and considered, but that is not the same thing as sharing unfiltered testimonials from the authoritative position of a science communicator. As I've said multiple times now, if I can tell the difference, I'm not sure why y'all apparently can't, and you seem annoyed by the fact that you have managed to erode my good faith so thoroughly & so quickly.
Jesse you put out a lot here. The problem is I don't completely know your background and understand everything you've gone through. Apparently you de-transitioned. This is why my writing is peppered with my own experience. To give some background and as a way to bolster the main points of all the comments I've made. At this point I'm at the deep end of the pool, with a subject I know some things about. People like Christy are focused on the subject because they are conducting their research. My Substack presence allows for the subject of de-transition, but only as one of many topics tied to the patient experience. If specific or broad points about the transgender de-transition experience emerge, I will consider them and possibly comment. So there's value in this. But I believe I understand where you're coming from and I already voiced my concerns and put out my warnings. And I praised this entire process since it does get away from the usual Facebook type of Trans Tit for Tat that becomes annoying and contributes nothing meaningful or useful to anyone except the TERFs, LGB exclusivity, the MAGA crowd etc. As for a reasonable approval process, I'm not sure what you were getting at exactly. And no, I don't know what that hypothetical process is supposed to be except for the WPATH recommendations. I mean we need to have a chat or a form to expand upon all these things if there was to be some kind of community discussion (or more of a Blog where people can check in and share over time. Without somebody's selfish little paywall dominating everything. I understand that people are trying to make a living and they need to be compensated for their time, but I'm not here for ego trips, dogma, or more gatekeeping. We transgender people want to capitalize on our experience and there's nothing wrong with that. But our small population and communities are crowded when it comes to that. I have already praised Substack, but I've also mention how we need to take what's gleaned from our writings and discussions and have it effect those in power who are not on Substack. Our voices need to be heard by the people that have power and who are not in our broader LGBTQ+ community or subsets of trans communities. Hence the echo chamber or just preaching to the choir, which has some value I suppose since we can learn from each other. Reasonable guidelines and patient gatekeeping is not rocket science, or at least it shouldn't be. People should be able to access the system. The problem is there is no system.An approval process or gatekeeper could just mean a family physician or a referral to an endocrinologist by your family physician. A few years back my primary doctor referred me to the community health doctors that were specifically caring for the transgender patients in my area. Another Choice which I tried to pursue, was one of the few independent endocrinologists who did transgender patients. The only problem is he required getting a psych evaluation before being considered for hormones. That wasn't a problem since I was bipolar with a long history with psych. No big deal. But still I refused because I decided it was degrading and unnecessary for me. The other option was being worked on at the same time. So the endocrinologist with the psych requirements was my backup plan and my last resort if I couldn't do anything else. We have all kinds of research and there's enough from every major medical organization saying transgender care is legitimate, necessary, and even life-saving. And my story that I gave you bears this out. So it's a matter of giving power to people that will act on the research and consensus. A big problem is research on transgender people may have no audience except its own academic community. We saw what happened in Utah last week when I study on treatment for transgender children emerged and gave the green light to care for Trans children and gender diverse children and teens. Or something along those lines. I didn't read everything about it but I got the main points. And of course the politicians decided it didn't matter. The destruction and prevention of research on transgender people is in the news and it's no secret what's going on. Organizations such as WPATH have been developing standards that could be used, and we could have a legitimate system with provider membership being the norm for doctors and surgeons whose treat us transgender patients. But the anti-transgender groups don't want this. They want things fragmented. They want things in disparate parts. Confusion. Pathology instead of psychiatry in our favor and giving us the green light to get what we want when we want. We are consumers of the medical establishment. If I go to a dentist, or I need treatment for my bad back etc. We consume their services. But when it comes to transgender care it's seen as totally different and blown out of the water and all hell breaks loose because we are not supposed to change our bodies with surgery or hormones as a way to relieve our suffering. They don't want standard care for transgender people. They fault patients for approaching their transition with self-directedness, when the truth is patients are forced to much of the time. There's too much to say on all this. And any hope for solid progress regarding true standards of care is being dismantled before our eyes. And now we are seeing progress halted or completely destroyed. With remaining resources spread so thinly, attention to detransitioners as a group and an identity maybe too much to ask. I never said I had all the answers, I just threw my two cents in about a few things. The people in power already have or they want to change the rules for abortion care, transgender care, the way kids are taught, and so on. There's a lot going on. I started reading some of your Substack and I'll take a look again. Take care. Hang in there. And fight the good fight.
They certainly seem to think that the question of how to care for both trans & detrans people at the same time means that some amount of trans suffering is simply the cost of doing business. I don't know what to say to that except "fuck you, from the bottom of my heart." At minimum, this is not a foregone conclusion. I would never say such a thing if the roles were reversed, as if we should simply pretend that regret is impossible and leave detrans people to fend for themselves without any recourse for living their lives beyond regret.
I finally looked up who is behind this substack and, I mean, I'll just drop this snippet of an article from Exposito-Campos, one of the byline names on this sub, "A Typology Of Gender Detransition and Its Implications for Healthcare Providors" (2021):
"This distinction between preventing and supporting detransition might be useful from a theoretical point of view, but it does not fit so well in a real-life clinical context, where healthcare providers have the responsibility to ensure that their patients’ decisions are thoughtful, well-informed, and beneficial in the long term. Imagine that a clinician identifies other issues, concerns, or factors that could be influencing one person’s GD and that may jeopardize the benefits of transitioning, ultimately leading to a detransition. In such a case, it would seem highly unethical to leave those matters unaddressed and not to be cautious before making a decision.
This is not an argument for restricting access to gender-related healthcare. Instead, it intends to highlight how important it is for healthcare providers to develop an integrated view of each patient by carrying out comprehensive exploratory assessments."
This whole "I'm not touching you!" tactic is apparently the norm for these researchers, as if restricting access isn't really restricting access if they just say "no it isn't." The *obligation*-- rather than the *option to choose*-- comprehensive exploratory assessments etc is exactly what has prevented me from getting top surgery despite a full decade of trying, and is exactly what makes trans people so skittish about the topic of detransitioners. I can't imagine why they don't name this particular option-- that these kinds of assessments might be opt-in rather than obligatory-- unless they're either intentionally protecting medical authority for its own sake, or because they're too stupid to even consider it. It seems intuitively obvious to me, especially so for anyone even slightly aware of trans arguments on this subject, so I can only assume their motive is the former unless they decide to subtweet me some new clarifying essay that proves me wrong. I suppose I won't hold my breath for it.
80% of this article is about how regret is impossible to prevent, and that supportive care for detrans people is more effective than preventative care, and still it concludes that incompetent medical gatekeeping is preferable to none at all. It seems they are absolutely happy to beg the question that doctors have not only the right but the obligation to withhold care from people based on vibes. But I disagree in strongest terms that it's a doctor's job to judge whether my decisions are ~thoughtful~, or to act like the sole party responsible for ensuring I am ~well-informed~, and I am actively opposed to anyone who takes these presumptions for granted. That's, y'know, kind of the crux of the whole argument about what doctors should be expected to do about uncertain/dishonest/regretful patients, and dancing around it so intensely reads to me as incredibly cowardly and disingenuous.
No wonder they respond my comments with these passive-aggressive, euphemistic pieces about "defining detransition" and "making voices heard" and etc rather than just responding directly. This piece specifically seems to be telling me, a trans guy, to fuck right off out of policy discussions that are relevant to *my* access to healthcare, because I'm not part of their pet identitarian focus group/"it's not politics if we say its not politics." I don't know what I can reasonably conclude except that they know full well that if they put a fine point on the question of presumptive medical authority, they would find a bunch of American trans people telling them to go fuck themselves, and they don't have the spine or the sincerity to really face the content of that pushback.
This recent turn has made me sort of go from "these people seem like they're trying their best, even if I don't love the way they leave so much implied" to "oh these are fully just medical gatekeeping stans pretending they're anything but, okay. well, congrats on naming the problem and then going out of your way to make it worse." Shameful and unserious.
I wish that all of the children and young adults considering transition would read the detrans blogs.
Are you for real. Do you really think people are out here transitioning on a coin toss, without EVER having had the thought? You've made it functionally illegal to be trans in most of the English speaking world. What the fuck is wrong with you? You only want to give a mic to detransitioners because you want actual trans folks dead. You're not principled. You're not reasonable. You're a bigot hiding behind essentialism and culture war.
I *hate* you.
Unsubscribing. It is completely unethical and completely unnecessary to use AI generated images
Thank you for your comment. As the author of this article I would like to let you know that the AI generated image has been removed, and that such images will not be included in my pieces going forward.
Detransition is when they realize people like you convinced them they were “trans” but of course they’re not. Most trans people know it’s bullshit but they are in too deep and embarrassed to back out because they made such a big deal about being trans on the first place. It’s dead obvious.