While it’s likely going to take me an enormous amount of page space and several weeks to form a full, detailed critique of BBC’s “Transgender Kids: Who Knows Best”*, I thought that there was nonetheless enough information within Sarah Ditum’s article “Transgender Kids: why doctors are right to be cautious about childhood transition” to respond to. This is because she admits that she hasn’t yet seen the documentary. Neither have I, which at least allows us to respond in specifics without consulting it altogether.

Knowing how much is going to be dusted up in this documentary, no doubt peddled by well meaning but ignorant cis folk, the trans feminists you know and love on the internet are likely going to have to work overtime to overcome the sheer injection of misinformation we can anticipate from trans-antagonistic feminists.

Ditum, in brief, says absolutely nothing new, and nearly nothing correct.

The BBC Two documentary Transgender Kids: Who Knows Best? won’t be broadcast until 9pm this evening, but that hasn’t stopped a lot of people from forming very firm opinions about it. There has been the inevitable petition, and yesterday, the Guardian published a critical article stating that “the transgender community is ‘very scared and very worried’” by a programme that no one interviewed had, as yet, seen. The focus of that concern is a Canadian doctor called Ken Zucker, who, according to his critics, is a discredited proponent of “conversion therapy” who has prevented trans children from obtaining appropriate treatment and was fired for gross misconduct.

Our first and only accuracy in this article. Despite the fact that Ditum acknowledges that Dr. Zucker has been discredited for a reason, she is going to rush in and defend him by characterizing his critics as some kind of trans cabal. Because of course, that’s all the feverish conspiratorially-bent TERF mind can do: Envision losses at the hands of a conspiracy, rather than admit their viewpoint is not widely shared among experts who know better.

But in his decades-long career, Zucker supported hundred of children and adolescents with gender identity disorder (GID), some of whom went on to live happily in their birth sex and some of whom eventually had sex reassignment surgery (SRS). The allegations against him stem from an external review commissioned by his employer, the Centre for Addiction and Mental Health in Toronto (CAMH) – a review which was withdrawn from CAMH’s website after investigations showed that many claims were unsubstantiated and one key charge was demonstrably false. As the journalist Jesse Singal wrote: “it’s hard not to come to an uncomfortable, politically incorrect conclusion: Zucker’s defenders are right. This was a show trial.”

We’re quoting Jesse Singal now? What a delightful coincidence.

Jesse Singal’s blatantly dishonest obfuscation on trans issues is well noted, and his conclusion on Zucker’s trial is specious at best. Of Singal’s work, I wrote**:

The closest thing to support I can find among Zucker’s former patients is Kay Brown–who, ironically, is an activist. She is characterized by an exhausting and tedious tendency to twist herself into pretzels to justify gatekeeping gender healthcare models despite considering herself to be abused by such a system. Yet even she manages to condemn Zucker’s clinic (even if she argues elsewhere for similar ideas).

Yeah. Not exactly a ringing endorsement for Zucker’s Real Science.™ You’ll excuse me while I search for the world’s tiniest violin with which to mourn Zucker’s career.

If the strongest support you can find from those subject to a treatment is an internally inconsistent activist, and you champion this treatment as being scientifically objective while arguing that activists are unreliable, then you are a hypocrite. If you don’t think the responses of those actually subject to a treatment are important in assessing its effectiveness, then you do not understand how scientific medicine actually fucking works. Jesse Singal appears to be in over his head.

To reiterate, the evidence we have from patients in support of Zucker’s aversion methodology is a single conflicted testimony from exactly one patient.

So why the theatrics over the clinic’s closure? The clinic’s been operating for decades with little evidence to suggest it works, and all we hear is the panicked braying of proponents over a backdrop of doom and thunder.

Ditum notes that “a key charge” was demonstrably false. However, Ditum’s characterization of that particular testimony is vastly overblown. The full report on the Centre for Addiction and Mental Health’s Gender Identity Clinic in fact states: “However, in the course of this review, two predominant themes emerged as areas of concern for the reviewers: firstly, the GIC appears to operate as a insular entity within CAMH and the community at large, and secondly, the GIC appears to be out of step with current clinical and operational practices.” The report also goes on to state regarding the findings completely independent of the retracted testimony: (emphasis mine)

The current assessment and treatment approaches need to be revised. Gender variance versus gender dysphoria should be distinguished and explained. The aim to reduce suffering can be achieved with a client-centred and family supportive approach. To move towards this goal, it is recommended that WPATH, CPATH & AACAP guideline-informed care paths be utilized, across the age spectrum. Some specific examples include, but are not limited to:

a) Explain these at the start of assessment (informed consent/harm reduction/client-centred)

b) Refrain from treatment of the child that targets reduction of gender-variant behaviors or use of language that pathologises these.

c) Refrain from allowing parent alone to choose the treatment path

d) Educate parents and children about gender expression, gender identity, gender variance across the lifespan

e) Assist all families with communication and acceptance within and outside the family

f) Liaise with schools to provide advice on inclusion and obtain collateral about social adjustment and any protection needs

g) Refer teens taking hormone-blockers for gender-affirming hormone treatments when ready and eligible in collaboration with endocrinologists involved.

h) Staged sexual history interview using suggested approach:

i. Age-appropriate questions (pre-pubertal sexual history is not required)

ii. One may rule out paraphiliae with 2 screening questions: “How do you feel about yourself when you dress in your preferred clothing?” Follow-up, if unclear, “Does it affect your sexual confidence or your overall self-confidence?”

iii. Inquire about attraction and whether sexually active late in the assessment

iv. Inquire only about safe sex practice use at assessment

v. Inquire about details of sexual practices only when assessing for treatment that can affect sexual function and inform patient about the reason for these questions (informed consent)

So here we have a number of recommendations implying that such pesky practices as “informed consent” were not being practiced at Zucker’s clinic.

Well gosh, Ditum, the poor man has been ousted for no reason, clearly.

To put the sarcasm aside for a moment, I don’t think you can look at these revelations and conclude anything except that Zucker is ethically bankrupt: While conflating gender variance and gender dysphoria is a time-honoured bungle in methodology to support a priori transphobic beliefs, informed consent is not optional, nor is grilling a 7 year-old on their sexual practices. Can we honestly look at this and find nothing objectionable?

You can read more of the Report here, and you’ll note that very little of it even needed patient testimony and that the main voices in support of it were the parents, not the patients. There’s a reason Dr. Zucker hasn’t received an apology for the investigation as a whole–because almost all the findings stand even without the aforementioned testimony.

For Ditum to then say*** (emphasis mine) “Zucker supported hundred [sic] of children and adolescents with gender identity disorder (GID), some of whom went on to live happily in their birth sex and some of whom eventually had sex reassignment surgery (SRS)” is her first bit of dishonesty. Ditum just finished admitting that Zucker’s methods were found to be objectionable, and we went straight to the source to get specifics. The clinic was closed for serious allegations of violating medical ethics. It could hardly be said that this constitutes “support.”

Remember, it’s mostly parents and cisgender stakeholders who objected to the clinic’s closure.

Back to Sarah Ditum:

Even so, these claims continue to recycled by those who endorse a “gender affirmative” approach to trans children – where the child’s assertion of their identity is accepted immediately and uncritically – and reject Zucker’s more critical practice. Such claims are very hard to reconcile with the thoughtful Zucker who appears in the BBC documentary, who exudes neither the sinister bigotry his detractors credit him with nor the bitterness that might seem reasonable in the victim of an intellectual witch hunt. However, this much is clear: he’s adamant that reflexively deferring to children who say their physical sex is wrong risks not only putting children on an inappropriate pathway to surgery, but also missing the varied issues and strains that might be behind such feelings.

Again, Ditum has falsely characterized the gender affirmative approach to gender nonconforming children when she says it “the child’s assertion of their identity is accepted immediately and uncritically.” These sorts of lies are dangerous and will kill people, because Ditum is now obfuscating a well documented practice with splendid results.

Contrast Julia Serano’s description of gender affirmation: (all bold emphasis added)

In growing recognition of these problems (and as part of the more general evolution away from gatekeepers who held transgender people to transphobic standards), contemporary trans health providers are increasingly adopting a “gender-affirming” model for transgender and gender non-conforming children. Rather than being shamed by their families and coerced into gender conformity, these children are given the space to explore their genders. If they consistently, persistently, and insistently identify as a gender other than the one they were assigned at birth, then their identity is respected, and they are given the opportunity to live as a member of that gender. If they remain happy in their identified gender, then they may later be placed on puberty blockers to stave off unwanted bodily changes until they are old enough (often at age sixteen) to make an informed decision about whether or not to hormonally transition. If they change their minds at any point along the way, then they are free to make the appropriate life changes and/or seek out other identities.

Three “ifs.” Sarah Ditum claims that gender affirmation is built on the immediate and uncritical acceptance of the identity. This is blatantly false. Gender affirmation is built on immediate and uncritical acceptance of the child, regardless of whatever gender identity they come to understand themselves as. 

But Sarah Ditum would have gender nonconforming children subject to further psychiatric abuse from the likes of Zucker, instead.

Don’t take Julia Serano’s word for it, though. Let’s go straight to the doctors who practice gender affirmation: (spacing added to make it more readable, emphasis added)

In this model, gender health is defined as a child’s opportunity to live in the gender that feels most real or comfortable to that child and to express that gender with freedom from restriction, aspersion, or rejection. Children not allowed these freedoms by agents within their developmental systems (e.g., family, peers, school) are at later risk for developing a downward cascade of psychosocial adversities including depressive symptoms, low life satisfaction, self-harm, isolation, homelessness, incarceration, posttraumatic stress, and suicide ideation and attempts [D’Augelli, Grossman, & Starks, 2006; Garofalo, Deleon, Osmer, Doll, & Harper, 2006; Roberts, Rosario, Corliss, Koenen, & Bryn Austin, 2012; Skidmore, Linsenmeier, & Bailey, 2006; Toomey, Ryan, Díaz, Card, & Russell, 2010; Travers et al., 2012].

While the developmental impact of our approach has yet to be rigorously studied, some evidence suggests that gender-nonconforming children are negatively impacted when given the message by therapists, doctors, or families that their gender expression must conform to traditional gender roles associated with their birth-assigned gender [Hill, Menvielle, Sica, & Johnson, 2010]. Psychotherapies attempting to tweak a child’s gender identity or expressions have been shown to suppress authentic gender expression and create psychological symptoms [Bryant, 2006; Green, Newman, & Stoller, 1972]. What we can deduce is that these psychotherapies are unsuccessful because they aim to alter a child’s emerging gender identity (i.e., an internal sense of self) by attempting to change the child’s nonconforming gender expression (i.e., a behavior). Similar behavioral efforts to change aspects of sexual identity (i.e., reparative psychotherapies for homosexuality) have also proven unsuccessful, deleterious, and lacking in efficacy [for a review, see Anton, 2010]. Professional health organizations, including the American Academy of Pediatrics (AAP), the American Psychiatric Association (APA), and the American Psychological Association, recommend against implementing such change efforts in clinical care [AAP, 1993; Anton, 2010; APA, 2000].

…

Myth No. 1: Gender-affirming approaches conflate gender identity and gender expression; therefore, any child who exhibits gender nonconformity is believed to be transgender.

Nothing could be further from the truth. Given that the gender affirmative model purports that gender presentations are diverse and varied, gender identity itself is multiple in its possibilities, and can be paired with infinitely varied presentations. We recognize that non-transgender individuals express their identities in manifold ways, and embrace the welcome diversity that this facilitates. We also acknowledge that the majority of gender-nonconforming children presenting for clinical care related to gender dysphoria are desisters unlikely to mature into transgender individuals [de Vries, Steensma, Doreleijers, & Cohen-Kettenis, 2011; Drummond, Bradley, Peterson-Badali, & Zucker, 2008; Green, 1987; Steensma, McGuire, Kreukels, Beekman, & Cohen-Kettenis, 2013; Wallien & Cohen-Kettenis, 2008; Zucker & Bradley, 1995].

Thus, we dispute the notion that any child who exhibits nonconforming gender expression be considered transgender. Our stance, as gender-affirming practitioners, is that children should be helped to live as they are most comfortable. For a gender-nonconforming child, determining what is most comfortable is often a fluid process, and can modify over time. Therefore, in a gender affirmative model, gender identity and expression are enabled to unfold over time, as a child matures, acknowledging and allowing for fluidity and change. Support, problem-solving, communication and acceptance can facilitate a child’s self-understanding and choices, and allow time and space for exploration and self-acceptance within an infinite variety of authentic gender selves, whether it be in identity, expression, or both. To the extent possible, parents and others should be supported to endure what can be a confusing and socially challenging period.

So there it is. Sarah Ditum wants you to be suspicious of any methodology that suggests you shouldn’t be a flaming asshole to your child so as to facilitate their wellbeing.

Back to Sarah Ditum:

In other words, children who present as trans might not simply be “girls born in boys’ bodies” and “boys born in girls’ bodies”, and appropriate treatment might involve far more subtle approaches than altering a child’s body to match their “true” gender

Oh, you mean the thing that gender affirmation accounts for when it says “We also acknowledge that the majority of gender-nonconforming children presenting for clinical care related to gender dysphoria are desisters unlikely to mature into transgender individuals”?

Sarah Ditum hasn’t got the foggiest idea of what she’s criticizing.

Highlighting this view makes Transgender Kids: Who Knows Best? an oddity in coverage of trans issues, and a valuable one. Trans people are more prominent than ever before in news, factual programming and drama; but presentation of the underlying causes is, almost without exception, extremely basic. For example, a 2015 item on trans children for the BBC’s Victoria Derbyshire show begins with images of fashion dolls overlaid with a child’s voice saying: “I didn’t want to be a boy. I feel like I’m in the wrong body.” (The charity Mermaids, which offers support for families with trans children and has criticised tonight’s documentary, recommends this video on its “resources for parents” page.)

I truly hope you discover my criticisms of you one day, Sarah Ditum. Not only have I just demonstrated that I am well aware that gender nonconformity is not itself an indication of a gender variant identity, but so have all of the trans feminists whose work I regularly examine. This isn’t a surprise to us, but then again if Ditum could be bothered to actually Google gender affirmation, she might find that all her paid hand-wringing turned out to be unnecessary.

Never mind that Ditum, not having seen the documentary, could hardly be qualified to suggest the work as a whole is an “oddity.” Ditum’s confirmation bias has no doubt erased all recollection of the nuanced and detailed conversation trans feminists attempt to contribute in this dialogue, assuming we can ever get past the background radiation that is societal transphobia.

Back to Ditum:

Trans campaigners are often at pains to distinguish gender stereotypes from gender identity, and yet parents of trans children consistently refer to their child’s behaviour and tastes when they’re supplying backstories. The segue in sexism here is obvious. At one point in Transgender Children: Who Knows Best?, the father of a socially and surgically transitioned teenage transgender girl tells the documentary that he knew his family had made the right decision when he saw his child running, and thought “that’s just like a girl running” rather than “look at my son, he runs like a girl”.

In true trans-antagonist fashion, Ditum just breezed past a number of extremely complex concepts. Three short sentences which will take me ~1,500 words to address. No wonder it’s so hard to find enough spoons to respond to TERF-cluster arguments.

Okay, so, first statement: “Trans campaigners are often at pains to distinguish gender stereotypes from gender identity.” While I know vaguely what Ditum is referring to, she ought to be citing it. Regardless of what she specifically means, we need only know the background I covered here. I wrote:

We’ll get to the data in just a moment, but there’s another a point I need to make first: The simplistic narratives cisgender, mainstream media received from its trans interviewees were attempts to explain our experiences by being intentionally reductive and simple. To then argue that these reductions–the only thing mainstream media allowed itself to air or print when it came to trans people–somehow represent a consistent thread in gender variant psychology, is a bit like trying to write an essay about a novel off the cliffnotes. Cis people asked for simple explanations, so we gave them “blank trapped in a blank’s body” and “I always knew.” If those explanations have failed to enlighten you, it’s because this isn’t a simple concept.

…

I could go on. The point is that virtually every stereotype about trans women is manufactured by the gatekeepers to our healthcare. Cry and give me hysterics, or you’re not real enough for healthcare. Wear dresses, make-up, and heels, or you’re not real enough for healthcare. Tell me you hate your body every minute of every day, or you’re not real enough for healthcare. Tell me your interests are as unthreatening as possible to existing gender hierarchies or you’re not real enough for healthcare.

At no point were trans people actually asked to give their narratives. We had, still have to in some places to some degree, give the narrative, or get out.

If it seems like there’s no nuance in transsexual narratives, especially the safe ones we give to mainstream media, it’s because doctors beat nuance into oblivion by ejecting diverse patients from their system. Our stereotypes are merely adaptations to a system that is unconscionably hostile to any deviation it perceives. 

No shit it comes across as internalized stereotypes. Convincing others we believed this was and to some extent still is literally our strategy for survival. Stereotypes is all the doctors would accept.

This is what frustrates me on a deep level about tracts of the TERF-cluster argumentation which rely on the perception that trans people embody stereotypes. For one, the same post I linked to also discusses research which demonstrates that trans people aren’t even consistently more likely to adhere to gender stereotypes than cis people. This assumption that trans people embody gender stereotypes then quite literally becomes an article of faith, since the evidence actively contradicts it.****

And still, the areas where evidence shows that trans people are more likely to embody stereotypes are also areas that implement gender gatekeeping–as in, cisgender doctors who impose what requirements you have to meet to get healthcare. Sarah Ditum is then purporting to blame trans people for the standards implemented by doctors who have power over us. So when Ditum flippantly says “The segue in sexism here is obvious” she ought to understand, as ought to her readers, that the sexism is imposed upon us by cisgender doctors. Our transitions do not necessitate celebration of sexism and it is a lie of omission to insist so.

Again we revisit Ditum’s statement:

At one point in Transgender Children: Who Knows Best?, the father of a socially and surgically transitioned teenage transgender girl tells the documentary that he knew his family had made the right decision when he saw his child running, and thought “that’s just like a girl running” rather than “look at my son, he runs like a girl”.

Yes! An anecdote about a father who apparently has a weak understanding of pseudoscience is clearly an indictment on the health and happiness of transgender kids across the United Kingdom!

Checkmate, atheists!

Fuck me. I’m going to be very forthright about this: I am angry as hell that you actually get paid to write puff pieces in the vein of a freshman journalist who hasn’t figured out the difference between his asshole and his mouth hole.

Back to Ditum:***

Stories from the other side, though, can be similarly as disquieting: the father of a teenage girl who vehemently identified as a boy but ultimately desisted (as approximately 80% of children with GID eventually do) sounds ragged with anger as he talks about battling the girl’s wish to have short hair and dress in boyish clothes. Watching the programme, one wonders whether the care the girl received at CAMH wasn’t as much about adjusting her family’s ideas about how to be female as it was about treating her dysphoria. Context, after all, is everything. As the neuroscientist Gina Rippon puts it in the documentary, briskly dismissing beliefs in inherently sexed brains: “We live in a gendered world […] A gendered world produced a gendered brain.”

Okay, so since I seem to be stuck in Groundhog Day and find myself repeating myself over and over, I’m going to frame this in nice big letters:

but ultimately desisted (as approximately 80% of children with GID eventually do)

THAT IS A BALD-FACED LIE.

~80% of children admitted to gender-related care WERE NEVER TRANSGENDER TO BEGIN WITH:

For starters, the most cited study (Steensma) which alleges a 84 percent desistance rate, did not actually differentiate between children with consistent, persistent and insistent gender dysphoria, kids who socially transitioned, and kids who just acted more masculine or feminine than their birth sex and culture allowed for. In other words, it treated gender non-conformance the same as gender dysphoria. Worse, the study could not locate 45.3 percent of the children for follow up, and made the assumption that all of them were desisters. Indeed, other studies used to support this also suffered from similar methodological flaws.

As a result, the 84 percent desistance figure is meaningless, since both the numerator and denominator are unknown, because you have no idea how many of the kids ended up transitioning (numerator), and no idea how many of them were actually gender dysphoric to begin with (denominator). When Dr. Steensma went back in 2013 and looked at the intensity of dysphoria these children felt as a factor in persistence, it turned out that it was actually a very good predictor of which children would transition.

In other words, the children who actually met the clinical guidelines for gender dysphoria as children generally ended up as transgender adults. Further research has shown that children who meet the clinical guidelines for gender dysphoria are as consistent in their gender identity as the general population.

Sarah Ditum, I have at this point absolutely no reason to believe you are arguing in good faith. You just perpetuated another dangerous lie that will kill the children you’re concern trolling. Most of the children admitted to gender-related care are admitted on the basis that their behaviour is nonconforming. Practitioners of gender affirmation know this, and you’re trying to paint it as a railroad?

You’re trying to make the claim that children who’ve never broken their legs don’t need a cast, so we should just get rid of casting as a treatment for broken bones.

Back to Sarah Ditum

The costs of putting a child on the wrong path can be huge. We hear a lot about the dangers of suicide for trans children who don’t receive affirming treatment (although Zucker points out that his research has found suicidality among trans children is no higher than among children with depression, anxiety or ADHD), but inappropriate affirmation is no less damaging. A young woman called Lou, who started hormone treatment and had a double mastectomy before realising she didn’t want to be a man, tells the documentary that she now feels “grotesque”. The female body that had horrified her so much during puberty now seems normal to her. The flat-chested, bearded self she has now appears to her as grotesque.

You’ll forgive me if I find your concern disingenuous after the lies you’ve been spewing unchecked. “The costs of putting a child on the wrong path can be huge” but it’s fine to subject it to trans kids, apparently.

As for Zucker’s findings on suicide, I’ve been Google-fuing for 15 minutes and can’t locate it. So I say again, Sarah Ditum, cite your claims. Or perhaps you’d like to address that the suicide rate of children with ADHD is 5% which is a stark fucking contrast to 41% in trans folk. The “same?” Show me where Zucker can support that specious claim.

Plus, there’s this delightful gem that would seemingly rustle the jimmies of TERF-cluster argumentation:

A young woman called Lou, who started hormone treatment and had a double mastectomy before realising she didn’t want to be a man, tells the documentary that she now feels “grotesque”. The female body that had horrified her so much during puberty now seems normal to her. The flat-chested, bearded self she has now appears to her as grotesque.

Never mind the fact that this anecdote (not “datum”) supports the existence of gender dysphoria, a phenomenon that many TERFs insist is simply internalized gender roles. Well, now suddenly Lou’s “internalized gender role” deserves support from TERFs?! All because Lou has been swept up in an anti-trans crusade, or possibly consciously choosing to engage in one.

Here’s a hint: If you believe Lou’s suffering for feeling “grotesque” is based off a genuine relationship with her body then you can only consistently conclude that trans people are being honest when we describe our relationships with our bodies. Why is it that Lou’s experience validates the existence of gender identity but when trans kids talk about the same thing it’s all suddenly “oh no we can’t transition you as a child we have to wait until puberty has done its damage”?

It’s a rhetorical question, I know the answer. “Cisgender supremacy” is part of my definition for TERFs for a reason, so I suspect the answer is “Sarah Ditum views trans kids as less valuable and therefore dismisses the slim possibility of erroneously administered care in favour of weighing the needs of one cis child over 99 trans children.”

Back to Ditum:

It’s a deeply upsetting sequence, but an important one because it’s a reminder that there is no one simple answer here. Having to live in a body that you know is not right is surely a profound and terrible anguish: that’s true whether you think you’ve been denied vital gender-affirming treatments, or if your body has been irreversibly altered by operations you now regret. The challenge for doctors is to recognise which is which, and give children the right support. The attacks on Zucker have been effective. Around the world, clinicians now keep their concerns about gender affirmation to themselves: they know what the price of speaking out might be. But, as this documentary shows, the price of stifling that discussion can be almost unimaginable harm.

Whew, it’s a wonder your smoke machine doesn’t break with how much strain you put on it.

We’ve already covered why Zucker’s clinic was closed. It wasn’t because he questioned gender affirmation, it’s because he engaged in interventions without informed consent and posed psychosexual analyses to children.

We already know gender affirmation models acknowledge the difference between gender variance and gender dysphoria, and we already know that experts are mindful of the need to make the distinction.

And now, Sarah Ditum can finish off her column of lies with a grand phrase like “Around the world, clinicians now keep their concerns about gender affirmation to themselves.”

Well, gee, how happy I would be if your career finally fucking crashed and burned after the abysmal quality of your works lying and defaming about trans people. Sadly, you’re still being paid to treat transgender children like a fucking football.

But don’t let facts get in the way of your persecution complex.

-Shiv

---

 

*TERFs, apparently. TERFs know best. You know, the people who organize their entire careers around the suspicion and denigration of trans people. Yep. That suicide rate will climb down any minute now once we decide the “ghastly parody” feminists are the correct consultants for welfare of trans children.

**Links to Kay Brown’s blog have been removed in the quotation so as to prevent this post from being auto-flagged on her Word Press. She’s, uh, easy to rouse.

***Note the implicit prejudice. Only the children who go on to live in their assigned sex are “happy,” the descriptor vanishes for those who opt for SRS. Gender affirmation is described as “disquieting,” and is set on par with desistance. “Inappropriate affirmation” is “no less damaging,” but Ditum doesn’t discuss how infrequently it occurs or which model they were subjected to. I don’t know whether this tactic is deliberate but loaded adjectives seem to be abundant in trans-antagonistic writing.

****Crip Dyke has also pointed out in the comments another way perception of trans folk is distorted–thanks to the efforts of assholes like Sarah Ditum, trans folk as a whole are quite suspicious of any institutions which express interest in us. Thus the trans women most likely to be targeted for vitriol–nonconformist and masculine-presenting–self-select and do not participate, skewing the proportion of participants in favour of feminine-conforming trans women.