Life

Sacred Bodies

Transitioning is an effective medical treatment that improves millions of lives. Why are we so fixated on the few who regret it?

A child looks on during a press conference at the U.S. Capitol.
Blue, an 11-year-old transgender child of an active duty serviceman, looks on during a press conference at the U.S. Capitol condemning the ban on transgender service members on July 26, 2017.
Justin Sullivan/Getty Images

This post is part of Outward, Slate’s home for coverage of LGBTQ life, thought, and culture. Read more here.

The problems with Jesse Singal’s cover story for the Atlantic, “When Children Say They’re Trans,” have a way of creeping up on you. It purports to be a nuanced portrayal of a thorny issue: parents who want to do right by their trans and gender nonconforming kids, navigating a system and a society not necessarily optimized for that. But as the piece goes on—notably without a single happy, well-adjusted trans teen among its host of central characters for the first 9,000-plus words—it becomes apparent that certain voices and fears are privileged over others. This, unfortunately, is a trend that can be seen throughout Singal’s history of biased reporting on trans lives.

One precursor to this cover story is particularly revealing: his defense of Kenneth Zucker, a disgraced advocate of anti-trans “reparative” therapy, as the victim of an activist-driven, unscientific crusade against his “politically incorrect” practices. In the Atlantic piece, Singal notes that reparative therapy “has harmed and humiliated trans and gender-nonconforming children” and “is now viewed as unethical.” But Zucker is never mentioned by name, nor does Singal admit, here or elsewhere, that he’s been wrong about the perceived “excesses” of trans activism before. His other long-standing fixation—one that manifests more overtly in the current cover story—is with those who “detransition”: by his definition, “people who undergo social or physical transitions and later reverse them.”

Detransitioners exist, and trans people are perhaps uniquely positioned to understand and empathize with their pain at the incongruence between their identities and how they might be perceived. But as Harron Walker notes in Jezebel, only a specific subset of detransitioners—namely cisgender women and girls who misinterpreted mental health issues or more general gender nonconformity as signs that they might be trans, only to realize later that this was not the case—are of interest to Singal and the media writ large. Those who are intimidated back into the closet, those who are battling intense stigma both internally and institutionally, those who begin the process only to find that their insurance won’t cover their transition—none of these people are given a voice. I know more than one trans man who might have been counted among Singal’s tomboys who were saved from themselves if profiled in their mid-teens—never mind that they were repressed, miserable, and would in fact go on to transition. But such is the double standard of the piece. A fourteen-year-old who outgrows her dysphoria is celebrated, her self-knowledge taken as definitive; a fourteen-year-old who seeks to transition is still in flux and must be given time to change their mind.

Like many trans people, I understood my own gender identity from a young age. But even for those who come to it later or more gradually, waiting for it to pass is not a neutral path; if blockers had been an option when I was 10, I could have been spared an expensive, invasive surgery at 20. The possibility that a cis body might be put through irreversible, undesired change is far more horrifying to Singal than that a trans body will be—despite the fact that that’s exactly what cis puberty represents to bodies like mine. As author, activist, and biologist Julia Serano has eloquently explored, this difference in valuation is not unique to Singal, though he plays into these prejudices and anxieties with uncommon gusto—even if it means straying from his purported theme of trans and gender non-conforming adolescents. The detransitioner we spend the most time with, now 36, was well into adulthood when she first sought out hormones.

Just as Singal only acknowledges a certain type of detransitioner, he likewise refuses to engage meaningfully with the far larger mass of trans people who correctly recognized their own readiness to transition. While he pays limited lip service to the stakes and urgency of access to care through statistics, only trans people who were forced to wait and were ultimately grateful for it are named and allowed to share their stories. The trans adolescent, in Singal’s world, never knows best.

This is not the first time he has disregarded inconvenient accounts from trans people—and in the absence of these voices, he is responding to a strawman. Trans people and trans advocates don’t argue that desistance—per Singal again, instances in which an individual ceases to experience dysphoria “without having fully transitioned socially or physically”—is itself a “myth,” though they’ve written compellingly on the shoddiness of some of the underlying science. It’s not in our interest or anyone else’s for a child to be wrongly identified as trans, but it’s just as painful for a trans child to be misidentified as cis or denied access to care in the hopes that they might grow out of it—which, as others have noted, makes it all the more troubling that well-meaning parents who Google “my kid says she’s trans” might find Singal’s article first.

Within the piece, Singal seems to use the parents of detransitioners as a proxy for his own anxieties about the “ruin” of cis bodies—and fails to push back against the misconceptions that inform their concerns. The first parents featured express the worry that if they “had heeded the information they found online, [their daughter] Claire would have started a physical transition and regretted it later.” The reality is that a twelve-year-old with no history of dysphoria would not have been administered testosterone—official guidelines call for “an expert multidisciplinary team of medical and MHPs” to oversee such treatment in anyone under 16—and certainly wouldn’t have been eligible for surgery. At most, she would have been put on blockers: a kind of “pause button” for puberty, which can resume unimpeded if the child is not, in fact, trans.

Later, Singal writes that the pair were told “the most important thing they could do was affirm their daughter, which Heather and Mike interpreted as meaning they should agree with her declarations that she was transgender”—but this interpretation, too, is wrong. Clinically, all that “gender-affirmative care” entails is giving children the space to explore their identities and listening when they speak about their experiences. If they identify persistently, consistently, and insistently with a gender that does not match the sex they were assigned at birth, that exploration might include social transition—changing the pronouns used to refer to them, and perhaps their name, in order to see whether that feels right. Sex hormones and surgery do not enter the picture until years down the line, and as a paper published in May put it succinctly, “There is no evidence that affirmative support traps cisgender youth in a transgender identity. Affirmative care does not equate to transition.” But in his tacit praise of the parents who waited and his decision to foreground misguided transitions, Singal reinforces the notion that simply allowing children to entertain the possibility puts them on an inexorable path to transness, expedited and abetted by this model of care.

Implicit in Singal’s body of work on trans children is the sense that he is telling a difficult but essential truth that others are unwilling to acknowledge, but neither the media landscape (which is littered with pieces exactly like this one, down to the same subjects) nor the medical one reflects this. For legacy publications with enormous resources and readerships to focus endlessly on the handful who regretted their transition—and simultaneously to claim we are in an unprecedented era of trans positivity that’s sweeping up misguided children—is disingenuous at best. It’s an idea that has more than a whiff of the intellectual dark web mentality about it: No one is willing to engage with our politically inconvenient opinions … except the New York Times, the Atlantic, the Wall Street Journal, major TV networks, and prestigious publishing imprints. And this framing seems to willfully ignore both the social context and human cost.

There are many unanswered questions and concerns about trans healthcare that do go largely unacknowledged in mainstream media. And there is a real and complicated story to be told about the hyper-medicalization of dysphoria—the phenomenon that prevents some trans people from accessing care while leading others to be misidentified as such. That this was instead the story the Atlantic chose to tell, and that it was entrusted to a man whose own neuroses leave him so unqualified to tell it, is a loss for cis and trans people alike.