How I slowly changed my mind about gender affirming care

A gender journey of a different kind

Photo by Cedric Fox on Unsplash

Culturally speaking where we are today is not where we were when I started my gender transition. I’ve come a long way from those days too.

I was diagnosed with Gender Identity Disorder - High Intensity in 2003 at the age of 23. I started on cross sex hormones in 2004. I had my last gender transition-related surgery in 2010. When I embarked down a medicalized path, some truths were still held to be self-evident: people couldn’t literally change sex, gender medicalization was largely experimental and a treatment of last resort, the treatment involved potentially serious physical health risks, the changes were mainly cosmetic, and longterm outcomes were largely unknown.

I accepted those risks because the alternative seemed worse. I was tired of being a social misfit. Gender transition represented an opportunity for me to blend in to society more effectively. And, in large part, it worked. But I didn’t believe that I was actually literally turning into a male. Instead, I believed I was some kind of intersex being and because the world was binary I needed to do something to fit in as best I could. I wanted to integrate into society. While I asked to be tested for intersex conditions, my doctor refused, stating it was unlikely I had such a condition. I wanted desperately some physical marker to explain my difference. I never found one, other than years later learning that I had autistic traits. Autism is considered a neurodevelopment disorder.

As recently as 2017 I still very much believed what I’d been told by the community I thought I belonged to: that gender-affirming care was a force for good, that the world was filled with heteronormative bigots who hated trans people, that detransition was rare, that no one was getting harmed, and that there was such a thing as an internal gender identity that was unchangeable and unchanging.

Then in 2018, I read Jesse Singal’s article for The Atlantic, in which he highlighted voices that I hadn’t heard before. I kept waiting for the detransition stories I was seeing more of online, to be debunked as false rumours or just a small minority. While detractors claimed only 1% of transitioners would detransition, the ‘rare’ voices of detransitioners seemed to be expanding online at an alarming rate. I discovered Benjamin Boyce’s Youtube channel filled with interviews with people who had once thought they were trans and then came to realize that they were not. I discovered Genspect’s Detrans Awareness Day webinars. It was uncomfortable to realize that detransitioners were not a small cohort of outliers, but a growing presence that needed to be reckoned with.

Listening to story after story of people not so different from me, who came to realize that their transition was not the panacea they’d been told it would be, felt like a wrong note in an otherwise harmonious gender affirming symphony. Their counter-narratives to the narrative I was used to hearing was like a fly buzzing around in an otherwise quiet room. I kept trying to swat it away as irrelevant, the ravings of a small minority. But eventually I realized that I needed to deal with the fly. It took a few more years for me to do so.

In 2017-2018 I returned to university to get my Master’s in Social Work. Part of what motivated me to do so, was wanting to improve the quality of life for people like me — people who belonged to the 2SLGBTQ+ community; and more specifically, people who were trans. At the time, I naively still thought of the 2SLGBTQ+ as one community. I still believed that if straight people were just nicer to us, we would magically all be healthy. I offered the obligatory Trans 101 trainings to my peers and colleagues. I called upon them to be allies in our fight for human rights.

For the final year of my Master’s degree I did a capstone project looking at trans identity development and the different pathways I saw for people coming to conceive of themselves as trans. For example, there were those who had, since childhood, felt at odds with their sex and who desired a medical transition in order to integrate into mainstream society as the opposite sex (sometimes called transmedicalists). There were others who did not think in binary gender terms but saw themselves as something else entirely (e.g. nonbinary, genderfluid). Some did not want to blend in at all; they wanted to deconstruct gender norms and do away with gender roles entirely. Some saw trans as an identity in its own right, while others saw it as a process that ended once your medical transition was done.

As I met more trans people in person and online, what struck me was how different we all were from one another. Trans people’s motivations were clearly not the same, nor did we even have the same definition of what it meant to be trans. But what we all seemed to have in common was a disdain for straight people’s ignorance. It felt good to blame all our problems on the close-minded straights. Odd that we expected straight people to know our needs, when we did not have a clear understanding of our own wildly divergent and sometimes contradictory needs. Activist trainings often involved commiserating over the ‘emotional labour’ we had to do to educate straight people about who we were. Reflecting on this now, I wonder who we thought should do the educating if not us.

The online trans communities I belonged to were a mish-mash of people with different embodiment goals and understandings of their identities. And while these communities claimed to embrace diversity, that diversity did not extend to allowing critical, nuanced conversations about detransition experiences of regret or trans women in sports or trans women in women’s prisons or medicalizing children.

While those who developed the protocols that came to be called gender affirming care claimed no particular preferred outcome for their interventions, in practice it certainly didn’t feel neutral. The gender affirming care providers and researchers I was studying were singing the praises of cross sex hormones, surgery and puberty blockers as ‘life-saving medicine’ and ‘medically necessary care’. Every person I knew who expressed that they were trans seemed to get approved for hormones or surgery with minimal exploration of their motives or investigation of their psychological needs. Some were not assessed at all.

This wasn’t healthcare, I realized. Or not healthcare as I had always understood it. This was consumer-based care, using the tools of healthcare, where the client was the expert and the healthcare provider was simply a drug dispensery. You could just as easily replace the healthcare provider with a robot for all the critical thinking they were expected to display.

I reflected back to my own so-called GID diagnosis. I had gone to see a specialist because I had wanted help to better understand myself. I thought that the specialist was critically assessing me according to some standard of evidence and that based on his assessment he had determined that I was indeed trans. I now realized that this wasn’t true. I may have thought that his role was to tell me whether I was really trans, but he had already diagnosed me — if you can call it that — before he ever met me. That’s what self-ID means. There is no real diagnostic process. It’s just a rubber stamp and off you go.

I realized that if I chose to become a clinician at the end of my graduate degree, I would likely be expected to write letters of support for others to medicalize just like my so-called specialist had done for me. The thought disturbed me. And my discomfort about this left me feeling like a bad trans person. If transition had been so wonderful, why was I hesitant to give others the same opportunity I had. It took a while for me to be honest enough with myself to acknowledge that transition had not been so wonderful for me after all. I didn’t necessarily want to rubber stamp others into make the same decisions I’d made.

That acknowledgement was a turning point for me. I started to train a more critical eye on the things I’d been told were true. E.g. that GAC was life-saving (it is not true that puberty blockers lower risk of suicide) or that GAC was medically necessary (based on what?). I read the Cass Review, which commissioned multiple peer-reviewed systematic reviews and found the same thing that every other systematic review to date had found. The evidence for GAC was of low quality/low certainty.

I looked at the studies that proponents of GAC use to bolster their claims and found small sample sizes, high loss to follow-up rates, biased study designs, and attempts to bury or cover up findings that did not support their claims (see the Alabama Brief to the US Supreme Court for a disturbing overview of WPATH’s attempts to bury their own commissioned systematic review). And those claims about detransitioners — that they’re rare or inconsequential? There’s little evidence to back that up either. In the US, the number of legal challenges are growing.

If real, high quality studies that GAC was an effective treatment for gender dysphoria were to emerge, I would be more than willing to recalibrate my views. So far, though, the studies that proponents use to defend the practice have proven underwhelming. Most gender affirming providers have not tracked their clients’ long term outcomes. I know this from personal experience. None of the doctors who prescribed me hormones or performed my surgeries ever bothered to follow up with me. They probably count me among their success stories.

And so, here I am. I see no way back to a social life as a woman after more than 20 years of hormone treatment and surgical procedures — not without great disturbance to my own and family’s life. I have a social work career and a family I painstakingly built that I will not disrupt further by undergoing additional legal name changes or surgical procedures. I’ve given enough of my body and soul to the wrong-headed project of GAC.

I’ve decided to live my life a male-appearing female, at least for now. There’s cognitive dissonance in this, but I’ll survive. I choose to focus on using what little time I have left to do what I can to make sure the next generation receives accurate information and high quality care. They deserve as much. That is my mission.