Standard disclaimer: This is my mostly anecdotal of my experience transitioning and should not be understood to be some kind of monolithic representation of gender variance as a whole.

Today’s topic is definitely one of the bigger areas where I set strong and clear boundaries: This is always–ALWAYS–turned into a football for TERFs and religious reactionaries to pass back and forth in a bid to justify inserting themselves between trans folk and our doctors. This conversation very definitely isn’t about you, cis folk, so don’t make it about you.

I speak of one of the most loaded landmines in the entire discourse of gender variance, no matter the disciplinary approach: Regrets related to transitioning. If I’ve called numerous trans-antagonistic lobbies dishonest before, you ain’t seen nothing yet.

Pro-Choice in Every Regard

Despite the best efforts of forced birthers to say otherwise, pro-choice in family planning does not mean “terminate all pregnancies.” As far as dishonesty goes, its an effective smear, by now a stubborn trope that informs much of the harassment and violence people accessing abortion receive. If I held any Shakespearean notions of honour, I would declare the users of this smear tactic “dishonourable scoundrels,” “foul knaves,” or something to that effect, mostly because it is a scummy form of manipulation that frames pro-choicers as being the very thing our opponents are: anti choice.

The same foul knaves are at work whenever transition regrets are brought up. It works like this: Anybody who has kept up to date with gender variance research and doesn’t have their head firmly planted up their ass will advocate for a “gender affirmative” healthcare model to serve trans people. Gender affirmation does not mean “all people subject to this program MUST transition” any more than family planning means “all pregnancies MUST be terminated.” What it does mean is that the subject is simply given a non-judgemental space to explore the meaning of their gender, whether that be playing, crossdressing, trying activities typically gendered contrary to the child’s assigned sex, or simply good old fashioned conversation where they search for words for this thing they’re feeling. The objective of gender affirmation is to facilitate a happy child, regardless of how that child comes to understand their gender. And that means transitioning is a set of options to be considered, not that it’s the end game for all–or even most–children in care.

The contrasted system is a gender gatekeeping model, where a psychiatrist has often arbitrary expectations of what makes one a “true” transsexual, and that your referral to transition services is contingent on meeting those criteria. For example, it was quite common to expect of trans women to be super ultra femme, and if they didn’t meet those expectations, they could have their access to healthcare restricted or removed. So consider me skeptical that erroneously transitioning is a big problem in affirmation models when it has been gatekeeping models railroading its participants. Even I would wilt under such a program, giving that I’m not particularly femme. If I was required to get fake nails and wear five layers of make up and get a perm and wear big fluffy dresses and stilettos, all the time, or risk losing my healthcare, then I’d be pretty fucking miserable too.

Because there isn’t a foolproof trans test, there is no way to objectively verify that any given child entered into any given gender program is actually trans. This is the crux behind the “80% desistance” myth, a myth staunchly defended by the now-disgraced Kenneth Zucker. The myth states that 80% of children expressing gender variance cease to express said variance by the time they mature. The problem with the myth is that it relies on the assumption that all of the kids entering the program are trans because they exhibit gender nonconformity. But if we accept that there isn’t an objective, measurable way to determine transness, how does one know a subject of Zucker’s awful clinic is actually trans?

The heuristic performed by parents seeking to help their kids has always been gender nonconforming behaviour. When Zucker says 80% of his kids grow up to be cis, he isn’t actually demonstrating a method that “fixes” trans kids. He’s demonstrating that most of the kids in his program were never trans to begin with, because they were taken to his clinic for perceived “cross gender” behaviour. They didn’t turn cis, they were always cis! They acquired an understanding of their gender, and figured it was the external expectations they didn’t like, or that they had fun playing with their expression, or that they just didn’t give a single fuck about what other people thought a proper man/lady does. Those experiences are not exclusively trans or cis, they’re entirely ordinary consequences of our society’s peculiar social construct around gender roles.

Gender nonconformity might indicate conflicts in gender identity, but the relationship between the two is weak at best. So it is wrong to state that your program, in which participants are admitted off the former, in any way, can affect the latter. And that is why transitioning is not typically presented as an option unless a child consistently and persistently states they feel they are their identified gender, not simply that they’re curious about what it’s like to wear a dress or that they prefer power tools over nail polish.

Because I support the gender affirmation model, which gives its participants room to explore and understand what their gender means to them, that by definition means I do not support single narrative conceptions of what it means to be a man, woman, someone in between, both, neither, or whatever the case may be. What I support are people’s options. Options which include things like transitioning (as well as which details within transition they will pick), not transitioning, or yes–changing one’s mind about gender transitioning after having started, i.e. detransitioning.

What I’m against is politicizing a decision that should be personal, between a patient and their hopefully competent doctor.

Which brings me to the next part of this debacle:

 

What if I have regrets?

I accept that this is possible, in the more general sense that any and all decisions a person makes even with informed consent might turn out differently from what a person was expecting. This is a risk with all medical interventions. There are a number of life-saving procedures which leave the patient with rather unpleasant side effects, and it’s not uncommon for said patients to have issues with said side effects.

For some reason, this is an argument to oppose gender affirmation healthcare, even though “it could go wrong!” is true for literally all medicine ever in all time everywhere, literally. (Spoiler: The reason is transphobia).

So yes, I could have regrets about transitioning. The question is first what those regrets are tied to: The side effects, which in this case include occupying a position devastatingly low in the kyriarchy? or whether I am wrong about my gender and made a genuine mistake? The second question is: How likely are either of these scenarios to occur, and how does that probability rank up next to my experience of gender dysphoria?

In one sense, I “regret” my much smaller paycheque than my pre-transition paycheque. In one sense, I “regret” dealing with street harassment and multiple sexual assaults. I “regret” having to disclose my gender history in public, in broad open daylight, in case my conversational partner reacts poorly. But these are all side effects of misogyny and/or transmisogyny, not of gender transitioning per se. And the hard truth is that I never would have known how exactly I would feel about a gender transition until I actually tried it. Kinda like everything else you ever make a decision about–you have estimates and guesses as to how something will go and then you have confirmation thereof when you do it. If you require 100% certainty about everything you do, you probably don’t get out much–or perhaps you underestimate the sheer amount of stuff that can happen to you simply because you’re alive.

In other words, what regrets I have are not due to me being trans and transitioning, but to the way people respond to being trans and transitioning (which is, most of the time, badly). Incidentally, this is also the most commonly recited reason for regretting transition, although you wouldn’t know that by the trans-antagonistic crowd’s feverish writings. Instead of reporting why transition is sometimes regretted, they simply go “THIS PERSON ISN’T 10000% SATISFIED WITH THEIR LIFE RESTRICT TRANSITION SERVICES!!” Of course, as I just said, what most trans folk regret is getting shat on, everywhere we go.

Except for bras. I regret bras. #FreeTheTitties

What if transitioning itself is a mistake?

Ceasing or attempting to reverse a transition is sometimes called “detransitioning.” These individuals do exist, folks who detransition not because trans folk are reviled everywhere we go, but because they were mistaken about their gender identity. Obviously I empathize, as a detransitioning person may have had changes happen to their body they are not comfortable with, which is basically what puberty as a closeted trans kid is like. It’s more stressful than stock-fare puberty, and I wish it on no one.

Remember that the main reason folks are subjected to any kind of gender identity related healthcare model is most often because they display gender nonconforming behaviour. And the function of the gender affirmation model, which keeps transition services available as a potential option, has the stated goal of facilitating a child that grows into happy, resilient, and functional adult, regardless of how they identify. Ultimately it is ignorance which drives people to assume gender nonconforming behaviour implies a trans identity. Although it is sometimes the case, it is certainly not a strong enough relationship to be a reliable causation. If you want to reduce the number of kids unnecessarily admitted to these programs, then educate parents that gender nonconforming behaviour by itself is not a reliable indicator of trans identities, then teach them to listen to their kids if said kids start talking identity.

What this means is for these folks who feel they transitioned in error, whatever healthcare model they were subjected to failed them.

Important caveat which I’ll repeat: “Whatever healthcare model they were subjected to.” That’s important, because gender affirmative healthcare models are far from universal. And it’s not always clear what model a detransitioner was subjected to before they start informal careers akin to “ex-gay” activists, where they try to insert themselves between affirmative healthcare providers and people who aren’t mistaken about their identity. It would be funny, if people weren’t seriously persuaded by these activists, if these ex-trans folks were railing against gender affirmation models when it was a gender gatekeeping model that railroaded them to begin with.

So I mean, sure, I could be wrong, as could anyone questioning their gender and whether this process is right for them. But how often does it occur that transition is a mistake in relation to identity?

Not terribly often: a 2001 longitudinal study reported 0 patients with regret, a larger study in 2014 reported 2% patients with regrets. I mean, there are already plenty of medical procedures available with a higher failure rate than 1 in 50, but there’s no movements dedicated to ending those. 

 

The gap between “possible” and “likely”

As I’ve conceded, I might regret my decisions in transition. And if I do, I know with 100% certainty that the moment I declare it, my post will be held up my TERFs and religious reactionaries all over the internet as a warning to those “rapey men trying to encroach on wombyn’s turrirtury.” The frustrating dishonesty is this: All medical interventions carry a degree of risk, and exhibit a wide range of results, and all interventions have unhappy patients. Trans medicine is only being singled out because we are, as a demographic, widely viewed with suspicion and disrespect. That there are double standards at play is less likely to occur to folks who are determined to reinforce their transphobia and gender preconceptions. People who feel they have transitioned in error deserve our support, but it does not follow that the support provided is to restrict the modes of healthcare which serve the other 49 of 50 patients and save our lives.

-Shiv