What Is Gender Transition?
A primer on transition, transgender medicine, and gender ideology
I’m a former trans person, what’s often called a detransitioner. I began a “male-to-female” medical transition when I was fifteen and ceased it when I was twenty-three. I took synthetic estrogen tablets for most of that time starting when I was sixteen, was briefly on progesterone, and spent a number of years on a chemotherapy medicine used off-label to halt puberty in children called Lupron, although I stopped taking that after I had my testicles surgically removed. A more in-depth personal account of my transition can be read here.
I’m writing this because I think it’s worthwhile to have a piece I can direct people to who haven’t thought deeply about transition before and want to understand the perspective of people who oppose it, but I think it will also be valuable to people who are already familiar with the subject.
1. What Is Medical Transition?
Medical transition is the attempt to make someone’s body appear like the body of the opposite sex through medicine and surgery.
It can include a number of different treatments, although the typical route is a synthetic hormone regimen which mimics the natal sex hormone of the opposite sex, which for male-to-female transsexuals is often paired with either a puberty-blocking medication like Lupron or a testosterone-blocking medication like cyproterone acetate or spironolactone. The purpose of this treatment is to cause a person’s body to develop secondary sexual characteristics of the opposite sex, such as beards on females and breasts on males. This is often referred to as “gender-affirming hormone therapy”. Hormone therapy can cause sometimes-painful atrophy of sex organs including thinning of the vaginal wall in women which can lead to tearing, changes in mood and behavior including increased risk of depression and psychosis, increased risk of heart attacks and strokes, and is irreversible. Puberty blockers prevent normal maturation of the body, which is also irreversible, and may also cause early-onset osteoporosis and cognitive impairment. The American College of Pediatricians goes into detail on this subject here.
Some people also choose to have their bodies surgically altered. Be warned: these procedures are gruesome when described frankly. Some of these alterations for male-to-female transsexuals include breast implants; shaving down the trachea to shrink the Adam’s apple; shaving down the skull, breaking it in several places, and installing artificial bone to make it appear more feminine (facial feminization surgery); and the creation of an artificial, dysfunctional “vagina” via skin grafts from the thigh or colon and inversion of the penis to create a permanent open wound in the crotch which the body is constantly trying to heal and which needs to be held open by regularly forcing objects into the cavity, or “dilating” (vaginoplasty). Female-to-male transsexuals might get their breasts removed, which leaves permanent scars on the chest and sometimes necessitates having the nipples removed and then sewn back on (a double mastectomy); the removal of the uterus and ovaries (hysterectomy/oophorectomy); and one of several options for creating an artificial, dysfunctional “penis” such as flaying skin off the arm or leg to create an inflatable flesh tube which is attached to the crotch (phalloplasty) or cutting ligaments around the clitoris to increase its apparent length (metoidioplasty). Within transgender communities these procedures are often referred to euphemistically with terms like “top surgery” and “bottom surgery”.
My friend Ritchie has written about his firsthand experience transitioning and getting bottom surgery, a.k.a. vaginoplasty. His whole Substack is worth a read, but this piece in particular deserves your attention. He gets brutally honest about the realities of vaginoplasty and the complications he’s suffered as a result of his transition. It doesn’t go as badly for everyone as it did for him, but even in the best-case scenario a person’s healthy sex organs are being taken apart and rearranged. Loss of sensation and function is inevitable, and for guys, the removal of the testicles renders us sterile, permanently destroys the endocrine system, and leaves us permanently reliant on the medical establishment for hormone replacement, even if we decide to detransition. Conveniently for that medical establishment, it also turns us into captive patients who will keep coming back for more of their product. The same is true for women who have their uterus and ovaries removed.
So, what is gender transition? It’s not a way of turning someone into the opposite sex. That’s nowhere near possible with current technology. It’s a process which causes a person’s body to adopt certain secondary sexual characteristics of the opposite sex by interfering with their endocrine system and which gives them useless parodies of opposite-sex genitalia via barbaric surgical procedures. It’s turning people, sometimes children, into permanent medical patients. It’s a medical scandal on the scale of the lobotomy, if not worse. It’s castration, sterilization, and mutilation.
2. What Is Gender Dysphoria?
Gender dysphoria is a medical diagnosis given to people with a strong desire to be the opposite sex.
The DSM describes gender dysphoria as “the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender.” This is a bit of a tricky definition, because it needs to encompass a wide range of different types of gender dysphoria, from the delusional belief that one actually is the opposite sex, to the delusional belief that one should be the opposite sex, to the less-delusional-but-still-unsubstantiated belief that one would be happier as the opposite sex. Gender dysphoria is often accompanied by other mental illnesses, particularly autism, anxiety, and depressive disorders. It can be diagnosed in children, adolescents, or adults.
The source of gender dysphoria is a contentious matter. An average transgender person would likely claim it results from having a gender identity which is different from your physical sex (or “assigned sex at birth”). This is a spiritual belief, not based in reality; and, as I’ve detailed here, is internally inconsistent. To believe in gender identity means you believe in a gendered soul, which is part of a larger metaphysical belief system—or series of systems—around gender and transition. The people who believe in this stuff really do believe it, and they believe it with their hearts; for them, it’s a matter of faith, and not up for rational debate.
More radical trans people might claim that gender dysphoria is a transphobic myth and the real purpose of transition is not to ease dysphoria but to induce gender euphoria, the joy of shaping one’s body to more perfectly match their inner self-conception. Like gender dysphoria, gender euphoria is a nebulous term, although a contingent of sexologists, conservatives, radical feminists, and even some transsexuals believe it euphemistically refers to a feeling of sexual satisfaction from the fulfillment of an extreme fetish known as autogynephilia (autoandrophilia for women), a sexual compulsion to transform oneself into the opposite sex. This is another theory as to the source of gender dysphoria, and is often paired with the concept of the HSTS (homosexual transsexual), a gay person (usually a gay man) who develops gender dysphoria as a result of their desire to be desirable to heterosexual members of their sex or to fit in to heteronormative society.
What’s often obfuscated in all of this discourse, though, is the fundamental nature of gender dysphoria: a wish to be the opposite sex. In some cases, this wish might be the result of a fetish. Sometimes, it might be because a person is gay. Sometimes a lonely teenager who spends too much time online might get the idea into their head that they’d be happier if they were the other sex. Sometimes people (usually girls and women) suffer sexual trauma and think that it wouldn’t have happened if they’d been born the other sex. Sometimes people with OCD or autism develop an obsession with the concept of changing sex. There are many reasons someone might wish they could change their sex! It happens!
Calling this gender dysphoria, or autogynephilia, or HSTS, is pathologizing this wish and turning it into a problem: something to be treated and medicalized. It isn’t something that can be treated through medicine, though. No procedure can make a person change sex, or make someone comfortable in a body they refuse to identify with. But a lot of people are invested in pretending otherwise.
3. What Is Gender Transition?
Gender transition is a scam, and a brilliant one.
The first level of the scam goes like this: you have a small population of people who desire to be the other sex and (sometimes because they’re part of an online community encouraging them and pushing them on) are willing to do anything to have that dream fulfilled. That means there’s a market for hormone treatments and surgeries, which don’t work, but which desperate people are willing to convince themselves will work. You sell these treatments to the people who are willing to undergo them—and you claim they have a condition called “gender dysphoria'“ which makes these treatments medically necessary so that insurance will pay for them. This is a simple scam: you’re just selling a shitty product to desperate people, claiming that it’ll solve their problems.
The second level of the scam goes like this: now that some people have undergone these fake treatments and been fucked over by them, those people are incentivized to promote them. This seems counterintuitive, but it works because the treatments are irreversible. Admitting to yourself that transitioning was a mistake is soul-crushing, and is something you want to avoid at any cost. You can’t go back and have a normal life, ever, especially if you went all the way and had surgeries. Instead, you’ll want to live the best life you can, which is difficult if being trans means you’ll be rejected by society. So you become an advocate for trans rights, trans equality, and access to trans “healthcare”. You recruit sympathetic people into your movement, encourage more people (especially kids and the mentally ill, who are more likely to be drawn in) to transition, and try to get laws passed to normalize transition, stave off the pain of your mistake, and try to have a decent life. More and more people get the treatments, meaning there’s more and more money to be made investing in them. At this level of the scam, transition looks like a pyramid scheme, where every new recruit wants to recruit more people to recoup their losses.
The third level of the scam goes like this: you now have a social movement around transition. (The trans movement has found a lot of success piggybacking off the gay rights movement, as my friend David discusses here.) In some places, especially liberal circles, it’s trendy to be trans. Having a trans friend or family member is a subtle way to signal that you have high-status values. And criticizing transition in any way is absolutely socially unacceptable. Being “transphobic” can cost you friends, audiences, even your whole career. Discussion of how bad the “treatments” actually are, or the many people hurt by the trans movement—the gay kids being railroaded towards mutilation, the autistic teenagers being sterilized, the women whose intimate spaces and livelihoods are being trampled by male-to-female transsexuals—is seen as vicious blasphemy. At this level, transition looks like a cult—or even a religion. It has a doctrine, it has taboos, it has sacraments. The people who believe in it believe with utter faith, faith that can’t be shaken by worldly things like evidence or rational arguments. Trans women are women; trans men are men; gender-affirming care saves lives.
Transition is fake medicine for people with a fake disease, pushed by a fake civil rights movement, justified by a fake ideology, and covered up by a fake religion, all to make money off of irrational teenagers and mentally ill adults in the throes of the worst delusional episode of their lives. Huge sums of money are being made and spent on castrating children, autistic people, homosexuals, and extreme fetishists, and turning them into permanent piggy banks for plastic surgeons and pharmaceutical executives. It’s the scam of the century.
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You are my favorite new voice on these issues. Brilliant!
This is the best summary on this whole issue I've seen. Thank you for sharing your hard-won insight and perspective, which surely will help crack the facade of those who encourage this delusional system. This post encapsulates so many threads into such a clear and concise narrative, it should be required reading. Thank you again.