Sex

To better understand the factors that lead young people to identify as transgender, and then to detransition, data analyst M. Lal and psychiatrist Stephen B. Levine analyzed the stories told by 37 detransitioners—25 biological females and 12 biological males—on publicly available video testimony.4 Their scholarly goal was to identify the main factors (they call “pathways”) into transition and those that eventually led them to change course. Of course this group is not representative of all detransitioners, as if such a sample could ever be created, but their stories corroborate much of what is already known about the young people who find themselves caught in the gender-affirming world and later struggle to get out. Most of the group had originally transitioned in their mid-teens, and detransitioned in their 20s and some even their late 30s.

To know how and why these women and men abandoned their trans identities, we need to know how they adopted them to begin with. Consistent with almost all other studies, Lal and Levine found a high prevalence of concurrent conditions long known to accompany gender dysphoria in young people: psychological disorders (notably autism spectrum disorder, ADHD, eating disorders); sexual abuse; childhood neglect and a history of abusive relationships; and, sadly, homophobia. When young people take a deep dive into the internet to find explanations of their symptoms and suffering, they encounter communities that actively persuade adolescents who are uncomfortable with their bodies, or who have emotional disorders, that they are “really” trans and their problems would vanish with puberty blockers and cross-sex hormones. Many of Lal and Levine’s participants explicitly described the message they heard over and over: “if you are uncomfortable in your body, you are transgender.”

Well, no, you probably aren’t. There are many reasons adolescents (or anyone else) might feel uncomfortable with their bodies. Shall I count the ways? But the normal discomforts, pleasures, and surprises of puberty are magnified for young people on the autism spectrum, who, Lal and Levine found, misattributed the concrete thinking styles, sensory processing difficulties, and social deficits typical of autism to having gender dysphoria. One explained how having a transgender identity provided “a structured, rule-based community” that alleviated his social isolation. Another said that the dysphoria label “perfectly fit” his “severe OCD, undiagnosed autism, and a general sense of alienation.” Participants with ADHD spoke of how transitioning provided a focused goal for their hyperfixations, soothing their unflagging restlessness.

A second route to transitioning, for nearly half of this cohort, was the motive not to become the opposite sex but rather to escape the sex they were. Many had been sexually abused: One young woman’s distress over her developing breasts “was just from sexual abuse,” she said, yet when she told that to her physician, she was given puberty blockers immediately. Another described his transition as “surgical self-harm” to destroy the “boy whose presence was only worthy of contempt” from his father.

In a gloomy reflection of the state of male-female relations today, a significant number of the participants wanted to transition as a way of opting out of the heterosexual dating market. “[My] eating disorder and dysphoria came from the same place,” said one young woman. “If I had less fat, I would look less female.” Several of these women wanted to create a nonsexual, androgynous body rather than a masculine one, to escape the feeling that their body “was on display—like it was somehow ‘there for boys’ or ‘there for men.’”

For their part, several biological males described transition as a “flight from manhood” and a way to suppress what they felt was an overactive libido. (Note to boys: That’s normal, guys—you’re teenagers.) One said he wanted a “sexual lobotomy” to destroy the “brainwashing” that male sexuality was inherently evil. Some wanted to distance themselves from cultural claims of “toxic” masculinity and the “predatory” male; one associated a “caricature of maleness” with being “brutish” and concluded that “I can’t possibly be that.” Another said he had absorbed “a lot of rhetoric about how much men suck.”

Finally, a third route to transitioning was homophobia, another factor that turns up repeatedly in studies of adolescents in gender clinics. Eleven biological males transitioned primarily to escape the stigma associated with being gay; one said that he “100%” wanted to avoid the shame of homosexuality. Several biological females felt that living as a trans man was preferable to living as a masculine lesbian; one transitioned in an effort to bypass the complexities and stigma she associated with being lesbian.

Yet, in what has become routine in this research area, the NHB study’s findings and conclusions later crumbled under scientific reexamination. As a methodological criticism published (to its credit) in the NHB last month—over a year after the original study—shows, the observed elevation in suicide attempts came from a small sample (roughly 100 youth) in a single state (Idaho), at a time when that state’s “anti-transgender” laws were not even in effect. Further, the researchers did not properly control for confounding factors. (The Society for Evidence-Based Gender Medicine has published its own methodological analysis, which is worth reading.)

First things first, it’s not that young people have become less woke, more religious, or more conservative. It’s also not that they’re spending less time on social media. Kaufmann tested all those hypotheses, and found no support for any of them.

One hypothesis he did find some support for, though, is that the trend is partly due to changes in mental health. Youth mental health hit a low point during the pandemic, and has since bounced back to some degree. Consistent with the idea that this shift drove changes in identification, statistically controlling for mental health weakens the time trend considerably. It doesn’t eliminate it entirely, however, so it can’t just be down to changes in mental health.

Another possibility is that identifying as non-binary or non-heterosexual was, to some extent, a youth fashion that’s now going out of fashion. As Kaufmann put it, the decline “seems most similar to the fading of a fashion or trend. It happened largely independently of shifts in political beliefs and social media use, though improved mental health played a role.”

[T]he study also identified 3,382 genes that showed sex-biased expression in at least one of the six brain regions. A closer look at these genes revealed a set of 133 genes with consistent sex differences in their average expression levels across all cell types and all regions studied. “That’s very much a ground zero for the molecular effects of sex,” says study co-author Armin Raznahan, a child and adolescent psychiatrist also at the National Institute of Mental Health.

Colorado’s 2019 “Minor Conversion Therapy Law” defined “conversion therapy” as “attempts or purports to change an individual’s sexual orientation or gender identity, including efforts to change behaviors or gender expressions or to eliminate or reduce sexual or romantic attraction or feelings toward individuals of the same sex.” It banned treatments, including talk therapy or counseling, that could help minors resolve their gender dysphoria and align their identity with their biological sex.

These laws have been sold by conflating coercive practices with helping gender-confused children—many of whom will have been deliberately confused by LGBTQ public school curricula—become comfortable with their own bodies. Colorado’s law essentially sought to lock children into the path toward “transition”—a staggering Orwellian irony, since “transition” is itself just another form of “conversion.” This is precisely why LGBTQ activists shifted from using the phrase “gender transition” to “gender-affirming therapy”: to enable them to claim that there was not actually a “conversion” from one gender to another being perpetrated.

Thus, according to LGBTQ activists and their political allies, to oppose the attempt to convert someone from one gender to another through social transition, puberty blockers, cross-sex hormones, and sex change surgeries is “conversion therapy.” In order to clear up any confusion that this inversion might cause, Colorado’s law specifically listed an exception to its “conversion therapy” ban: “Assistance to a person undergoing gender transition.” A child could be counseled into gender transition, but it was illegal to counsel a child out of gender transition.

“Colorado may regard its policy as essential to public health and safety,” Justice Neil M. Gorsuch wrote for justices from across the ideological spectrum. “But the First Amendment stands as a shield against any effort to enforce orthodoxy in thought or speech in this country.”

Two of the court’s liberal justices — Elena Kagan and Sonia Sotomayor — sided with the majority. […]

A lawyer for Mrs. Chiles, Jim Campbell of the Alliance Defending Freedom, called the decision a significant win for free speech and common sense.

“States cannot silence voluntary conversations that help young people seeking to grow comfortable with their bodies,” he said in a statement.

In her court filings, Mrs. Chiles said she was not seeking to “cure” clients of same-sex attractions or to “change” their sexual orientation, but rather to help patients with their own stated goals, which sometimes include “seeking to reduce or eliminate unwanted sexual attractions.”

On Tuesday, the American Society of Plastic Surgeons came out in opposition to providing gender-transition surgeries to minors. The recommendation, the first of its kind from a mainstream medical association, was published in a nine-page policy statement that marks a watershed moment in these debates. It’s part of a broader rethink among many experts, a reminder that science can trump ideology when investigators follow time-tested, evidence-based processes.