DETRANSITION: DEALING WITH THE FALSE PROMISES

OF GENDER TRANSITION

by

Diane Roselli

Liberty University

A Dissertation Proposal Presented in Partial Fulfillment

of the Requirements for the Degree

Doctor of Philosophy

Liberty University

[November, 2024]
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ABSTRACT

Until recently, sex change surgery was rarely performed and on adults only; however, the

discovery of cross-sex hormones, advances in plastic surgery, and the Dutch protocol

contributed to the use of a treatment regimen for children consisting of puberty blockers

(GnRHa), cross-sex hormones, and sex reassignment surgery, known as gender-

affirmative treatment (GAT). A growing number of individuals, who opted to undergo

the transition process, are detransitioning by ceasing hormone therapy or requesting

corrective/reconstructive surgery. Their lived experiences are relatively unknown because

most detransitioners drop out of treatment, are silenced by trans activists, and are not

acknowledged by medical organizations. This study used the unobtrusive method of

collecting anonymous data from a social media website which were then coded,

categorized, condensed into themes, and analyzed in a qualitative study to help identify

the medical and psychological needs of detransitioners. Data consisted of 200 comments

obtained from detransitioners, unsolicited and unedited, unless necessary to maintain

anonymity, exposing the unfortunate results of medical transition on children and

adolescents and the difficulty of detransitioners finding competent medical care. Results

revealed four major themes: Coercion, Influence, and Misinformation; Serious Health

Problems; How Transitioners are Failed by Others; and Self-Blame. Despite recent

research and the UK Cass Review showing no evidence exists to support prescribing

hormones to children, exposing questionable medical treatment, and European countries

reevaluating the treatment of gender dysphoric children, the “trans” individuals dictating

the standards of care in the U.S. staunchly continue to ignore the science, promote the

ideology, support gender-transition in children, and ignore the detransitioners.

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Keywords: detransition, transgender, gender dysphoria, transition, social media.

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TABLE OF CONTENTS

ABSTRACT ....................................................................................................................... ii

List of Tables .................................................................................................................... vi

List of Figures .................................................................................................................. vii

CHAPTER 1: INTRODUCTION TO THE STUDY ..........................................................1

Introduction .............................................................................................................1

Background ..............................................................................................................2

Problem Statement ..................................................................................................7

Purpose of the Study ................................................................................................9

Research Questions and Hypotheses .....................................................................10

Assumptions and Limitations of the Study ............................................................10

Theoretical Foundations of the Study ....................................................................11

Definition of Terms ...............................................................................................12

Significance of the Study .......................................................................................15

Summary ................................................................................................................17

CHAPTER 2: LITERATURE REVIEW ..........................................................................18

Overview ...............................................................................................................18

Description of Research Strategy ..........................................................................19

Review of Literature .............................................................................................20

Biblical Foundations of the Study .........................................................................68

Summary ...............................................................................................................73

CHAPTER 3: RESEARCH METHOD ............................................................................77

Overview ...............................................................................................................77
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Research Questions and Hypotheses ....................................................................78

Research Design ....................................................................................................78

Participants ............................................................................................................82

Study Procedures ..................................................................................................82

Instrumentation and Measurement ........................................................................83

Level of Validity ....................................................................................................86

Credibility, and Authenticity .................................................................................86

Data Analysis ........................................................................................................88

Delimitations, Assumptions, and Limitations .......................................................89

Summary ................................................................................................................91

CHAPTER 4: RESULTS ..................................................................................................93

Overview ...............................................................................................................93

Descriptive Results ................................................................................................93

Study Findings .......................................................................................................95

Summary ..............................................................................................................122

CHAPTER 5: DISCUSSION ..........................................................................................124

Overview .............................................................................................................124

Summary of Findings ..........................................................................................126

Discussion of Findings ........................................................................................129

Implications .........................................................................................................149

Limitations ..........................................................................................................167

Recommendations for Future Research ..............................................................169

Summary .............................................................................................................176
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REFERENCES ...............................................................................................................179

List of Tables

Table 1 ...................................................................................................................... 96-113

Table 2 ............................................................................................................................139

Table 3 ............................................................................................................................140

Table 4 .............................................................................................................................159
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List of Figures

Figure 1 ...............................................................................................................................6

Figure 2 ...............................................................................................................................8

Figure 3 .............................................................................................................................38

Figure 4 ..............................................................................................................................87

Figure 5 ..............................................................................................................................89

Figure 6 ............................................................................................................................115

Figure 7 ............................................................................................................................127

Figure 8 ............................................................................................................................139

Figure 9 ............................................................................................................................139

Figure 10 ..........................................................................................................................141

Figure 11 ..........................................................................................................................142

Figure 12 ..........................................................................................................................144

Figure 13 ..........................................................................................................................145

Figure 14 ..........................................................................................................................152

Figure 15 ..........................................................................................................................153

Figure 16 ..........................................................................................................................153

Figure 17 ..........................................................................................................................154

Figure 18 ..........................................................................................................................165

Figure 19 ..........................................................................................................................165
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CHAPTER 1: INTRODUCTION TO THE STUDY

Introduction

Transgenderism may be a solution in search of a problem. Gender dysphoria is the

latest psychological contagion that has resulted in an overwhelming number of children

and adolescents, (having grown exponentially since 2011), experiencing a crisis of

identity and deciding to transition to the opposite sex. Transgenderism is wildly popular

on social media, and recently, in mainstream media as the only solution to psychological

distress, such as same sex attraction, or feeling uncomfortable with certain body parts,

without due regard to unknown long-term consequences and the ethics of informed

consent. Medicine defers to transgender children by unquestioningly affirming their

perceived gender (known as affirmative treatment) and causing iatrogenic harm through

harmful drugs and irreversible procedures. The law is complicit in the progressive

protection of the “right” of transgender children to transition, when, in fact, it is failing to

safeguard children’s human rights (Brunskell-Evans, 2019).

The recent phenomenon of detransitioners who are in the process of ceasing

pharmacological transition (some “cold turkey” with no medical supervision) or are

requesting reconstructive surgery to reverse gender transition is increasing and should be

a wake-up call. The real number of detransitioners and their anguish is not known

because many opt to suffer in silence, unable to obtain proper medical care. The lasting

harm done to their bodies in the name of modern sexual ideology (the new cause celebre)

and the medical system’s lack of recommended guidelines to help them heal, coupled

with shame, regret, and how the adults in their lives allowed this to happen (Soh, 2020),

has driven them to search for support and advice online.

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Background

In 1950, when the term “gay” meant “happy,” 24-year-old George William

Jorgensen, Jr. traveled to Denmark to undergo experimental surgery to become a woman.

Christine Jorgensen returned to the United States in 1952 and became an instant celebrity

bringing the possibility of sex change into the public sphere (Reay, 2014). Those who

wished to change their sex (at that time predominantly male-to-female) received

hormonal treatment from Harry Benjamin (author of The Transsexual Phenomenon,

1969) or traveled to Casablanca for surgery from the French gynecologist Dr. Georges

Burou at his sex reassignment clinic, “Clinique du Parc.” His technique for vaginoplasty,

developed in 1956, is still the predominant surgical approach used today (Bhinder &

Upadhyaya, 2021).

Robert Stoller, a member of both the psychiatric and psychoanalytic

establishments, introduced the concept of “gender identity” into the literature (Drescher,

2020). The term “transsexuality” became widely recognized and, as French

psychoanalyst Catherine Millot stated, there was no transsexuality before Benjamin and

Stoller (Professor of Psychiatry at the School of Medicine, UCLA) “invented it” (Reay,

2014, p. 1044).

Richard Green, who studied medicine at Johns Hopkins under John Money and

did his psychiatric training at UCLA with Robert Stoller, edited, with John Money, the

multidisciplinary treatment textbook: Transsexualism and Sex Reassignment (1969).

With Dr. Stoller, he supported the American Psychiatric Association’s (APA) decision to

remove homosexuality from the Statistical Manual of Mental Disorders second edition

(DSM-II) and served on the DSM-III psychosexual disorders subcommittee that

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recommended including transsexualism (later to become gender dysphoria in DSM-5) in

the new edition (Drescher, 2020).

During the 1970s, Dr. Benjamin along with a group of therapists and

psychologists formed the Harry Benjamin International Gender Dysphoria Association

(HBIGDA). This association outlined standards of care for transgender individuals and in

2007, HBIGDA was renamed the World Professional Association for Transgender Health

(WPATH) (Bhinder & Upadhyaya, 2021). Benjamin had an essentialist view of

transsexualism and had little regard for psychiatrists and psychoanalysts who, in his

opinion, regarded transsexuals as homosexuals, neurotics, transvestites, or schizophrenics

(Drescher, 2020). Benjamin believed transsexuals suffered from a biological disorder

rendering psychotherapy useless.

At that time, in the history of transsexuality (transgender), psychoanalysts were

wary of transexual treatments, argued that physicians were treating fantasies rather than

diseases, and referred to the patients as delusional and borderline psychotics (Drescher,

2020). A prominent psychoanalyst, Lawrence S. Kubie, critical of the term “transsexual,”

believed the processes (endocrinological or surgical) involved in sex change were too

simplistic, masked the complexity of the problem, and combined a false diagnosis with

“dramatic” medical intervention (p. 1045). Kubie was convinced that the term gender

transmutation fed into neurotic fantasies and led people to believe alchemy was possible.

Some physicians had become more candid regarding the results of the

experimental surgeries begun in 1967. The 1974 Stanford report noted that almost half of

the male-to-female patients and a quarter of the female-to-male patients suffered

complications and suggested that surgery was not proven to be the treatment for
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transsexuals. In the journal Plastic and Reconstructive Surgery, Johns Hopkins reported

the male-to-female patient “is not – and never will be – a real girl but is, at best, a

convincing simulated female. Such an adjustment cannot compensate for the tragedy of

having lost all chance to be male and of having, in the final analysis, no way to be really

female” (Reay, 2014, p. 1060).

Jon K. Meyer, a psychoanalyst at Johns Hopkins, argued that the term

“transsexualism” had become too rapidly accepted as a diagnosis and surgery was not the

proper treatment. He suggested the more comprehensive term, “gender dysphoria

syndrome.” This led to the sudden closure of the clinic in 1979. The closing of many

gender clinics in the U.S. in the 1980s led to the disappearance of transsexuals into

society; however, trans individuals aligned themselves with LGBT advocates in the new

“gay liberation movement.”

Although sex reassignment surgery was performed predominantly on adults, Dr.

John Money, considered a brilliant but controversial psychologist, who founded the

Gender Identity Clinic at Johns Hopkins, believed that gender was learned rather than

innate. Johns Hopkins Hospital became the first academic institution in the United States

to offer gender affirming surgery. Dr. Money argued that gender identity could be created

socially with “nurture over nature” and conducted what has since been viewed as an

unethical experiment (Bhinder & Upadhyaya, 2021). “David” Reimer (born Bruce), an

identical twin born in 1965, had his penis irreparably damaged during a circumcision. Dr.

Money advised that David be sexually “reassigned” as a female and be raised as a girl.

With the approval of his parents, at 22 months, David underwent extensive surgery and

became “Brenda.” Dr. Money’s theory was that if a child were raised as a particular
 5

gender (nurture), that would determine the child’s gender identity as opposed to their

biological sex (nature). Despite the fact that Money proclaimed David’s transition a

“success” to reinforce his theory and justify his experiment, David was troubled,

complained he felt like a boy, refused female clothes and toys, and suffered from suicidal

depression in adolescence. Upon learning the truth from his father, at 15 years old, David

underwent treatments to revert to a male identity and continued to suffer psychological

trauma throughout his life. He endured unemployment, the failure of his marriage, and

the suicide of his schizophrenic twin brother before taking his own life at 38 years old.

The results of Money’s experiment called into question the ethics of performing sex

reassignment on infants and children (Mcleod, 2023).

Areas that were home to transgender individuals reacted to transgender

discrimination during the 1960s, resulting in sit-ins and riots in Los Angeles,

Philadelphia, San Francisco, and New York. Trans activists allied themselves with the

LBGT and gay rights movement with the Stonewall riots in New York marking a turning

point. Although this made some inroads for acceptance, by the late 1970s, there were

major setbacks. Federal social service funding was cut back, and transgender individuals

were regarded as dangerous or possibly mentally ill. In the 1980 American Psychiatric

Association’s (APA) fourth version of the Diagnostic and Statistical Manual of Mental

Disorders (DSM-IV) transgenderism was diagnosed as gender identity disorder (GID),

later changed to gender dysphoria (GD) in the DSM-5, and no longer considered a

pathology, whereas gender identity disorder had been included as a disorder in DSM-III

coinciding with the removal of homosexuality.

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As recently as 2016, surgical sex reassignment was not covered by health

insurance because it was considered “cosmetic” or “experimental” (Stryker, 2016).

“Whereas gender identity was rooted in the sexed body in the 1960s – 1980s, in later

decades it is the sexed body that must correspond with gender identity" (Figure 1)

(Gonsalves, 2020, p. 1010).

Figure 1

Relationship between Gender Identity and the Sexed Body

Gonsalves (2020, p. 1011)

Historically, religion, rooted in Judeo-Christian beliefs, has played a strong role in

gender and sexual behavior. Deuteronomy 22:5 forbids cross-dressing: “A woman shall

not be clothed with man’s apparel; neither shall a man use woman’s apparel. For he that

doeth these things is abominable before God” (Douay-Rheims Holy Bible, 5th Printing,

2009). Orthodox Jewish tradition interprets Leviticus 22:24 as a prohibition against sex

reassignment surgery: “You shall not offer to the Lord any beast that hath the testicles
 7

bruised, or crushed, or cut and taken away; neither shall you do any such thing in your

land” (Douay-Rheims Holy Bible, 5th Printing, 2009).

Socially unacceptable behaviors considered “sins” became, through science,

“illnesses” or psychiatric disorders. For instance, demonic possession became insanity,

and drunkenness was redefined as alcoholism (Drescher, 2020). “While physicians and

psychiatrists are often accused of seeking power and control, there are also altruistic

reasons for turning ‘sinners’ into ‘patients’: the medical model’s promise of hope for

treatment and cure” (p. 318).

Problem Statement

The politicized ideology of gender identity, which maintains there is no binary

definition of sex – male and female – has infiltrated children’s lives (Whitehall, 2018). In

the United States, more than 60 clinics, associated with children’s hospitals, treat children

self-reporting as gender-dysphoric, with experimental pharmacological and surgical

interventions, known as gender-affirming treatment (GAT), causing unnecessary bodily

harm (Biggs, 2022; Giordano, 2019; Hruz, 2020; Marchiano, 2017; Marchiano, 2021;

Robles, 2021). Not based on valid scientific evidence or standards that justify Western

medicine (Whitehall, 2018), these treatments can interfere with emotional and cognitive

development, ignore underlying psychological problems (Moschella, 2021), and leave a

child physically mutilated (Biggs, 2022).

The belief that the concept of innate gender identity can be reliably identified by

children as young as 3 to 5 years old is rejected by the scientists and healthcare

professionals who believe children have only a superficial understanding of sex and

gender (Malone, 2019). It may be “a self-assessment of one’s stereotypical degree of

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‘masculinity’ or ‘femininity,’ and it’s wrongly being conflated with biological

sex…being male and being female both come with a wide range of personalities,

preferences, and possibilities” (p. 3). Those who endorse gender identity believe that

personality and behavior identify one’s sex. This biological falsehood may contribute to

the growing number of children and adolescents complaining of gender dysphoria. Dr.

William Malone, an endocrinologist, asserts that a child’s behavior exists in a behavioral

spectrum and a “sex atypical” profile is “part of the natural distribution of personalities

within each sex” (p. 2). See Figure 2.

Figure 2

Malone (2019, p. 2)

An unprecedented number of children who believe they will be happy as the

opposite gender are on social media sites, propagating the hysteria (YouTube and

Tumblr) and watching videos and dramatic testimonials of celebrities and young people
 9

modifying their bodies with hormones and surgery (Marchiano, 2021; Pilgrim &

Entwistle, 2020). One study reported that 65% of the teens who decided they were

transgender were frequent users of social media and actually learned about the concept

online (Littman, 2019).

Recently, an increasing number of young people are coming forward to publicly

share their transition regrets, which include insufficient assessment of psychological

problems before being prescribed drugs and poor outcomes after transition (Jorgensen,

2023). The medical challenge of detransitioners is finding knowledgeable physicians who

can respond to their clinical needs, resulting in accepting suboptimal care, or stopping

gender-affirming hormones on their own without medical supervision (MacKinnon et al.,

2022). The number of detransitioners is unknown and may include the large number of

patients lost to follow-up after gender transition, based on research outcomes: 36% in the

Dutch study and more than 40% in other studies.

Detransitioners, advised by pro-trans activists not to advertise negative outcomes,

inadequate assessment, and possible coercion (Entwistle, 2021; Gribble et al., 2023), are

considered to be traitors to the trans-active community and have not been acknowledged

as a population (Entwistle, 2021) by medical organizations. Some have reported being

bullied, becoming socially isolated, and resorting to social media for answers.

Purpose of the Study

The purpose of this qualitative phenomenological study is to explore the post-

transition lived experiences of individuals who detransitioned (or are in the midst of

detransitioning) by either discontinuing gender-affirmative hormone therapy or by

reconstructive surgery following gender transition. The post-transition difficulties include

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health problems, struggles with detransitioning, and the effect on relationships, resulting

in dependence on social media for support, information, and advice. There is scant

research regarding the lives of detransitioners and even less information regarding

healthcare for those who detransition.

Research Question(s) and Hypotheses

Research Questions

RQ1: What are the lived experiences of detransitioners regarding medical and

psychological support, and are they made to feel ashamed for detransitioning?

RQ 2: Do detransitioned individuals receive support from family and friends for their

decision to detransition?

RQ 3: How much do the detransitioners depend on social media for camaraderie,

support, information, and advice?

Assumptions and Limitations of the Study

The limitations of the study include the inability to directly engage an individual

with follow-up questions to gain more details. The study is not interested in whether or

not the detransitioner returns to their biological sex or wishes to continue to be

considered “transgender,” but only in the lived experiences that triggered the

transitioner’s decision to detransition, including psychological, medical, and social

motivations. Some studies focus on “regret” as the main reason when describing

detransitioning; however, this study is not concerned with only regret but all reasons for

detransition. Some of the studies that measured regret did not wait an appropriate amount

of time after transitioning before interviewing the participants, ignoring the confounding

variable of the “honeymoon period” of the intervention (Cohn, 2023).

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Challenges include the number of detransitioners, which is unknown and may

include the large number of patients lost to follow-up after gender transition.

Detransitioners drop out of treatment (and out of sight) without informing the original

physician. Littman (2021) found that 76% of detransitioners did not return to or notify

their clinician. Data include the comments obtained from detransitioners on social media,

unsolicited and unedited, unless necessary, to maintain anonymity.

Theoretical Foundations of the Study

Gender detransitioning is at the center of a fierce debate, that, for the most part, is

happening quietly. Very little is known about detransitioners: how many there are, their

needs, and how they can be helped. The medical community, other significant

institutions, and government can control how people perceive things (Pakaluk, 2023).

The nomenclature of “gender reassignment surgery” replaces the term “sex change,”

fundamentally denying biology and reinforcing the idea that the body is an instrument of

human desires, further influencing fantasies of self-creation (Daly, 2016). Hasson (2017),

an attorney and fellow at the Ethics and Public Policy Center (EPPC), comments “…the

alliance of trans activists have arrogated themselves the right to rewrite history, silence

critics, brand their own ideologically driven opinions as ‘fact’…” (Adams, 2017).

Christianity has been accused of “emphasizing ideology, scripture, and fear” (p. 146).

The EPPC, founded in 1976, works to “…apply the riches of the Jewish and Christian

traditions to contemporary questions of law, culture, and politics…” ([Link]).

Anyone not aligned with the new political orthodoxy is boycotted and shamed by

the “cancel culture.” Christian theology “elevates the relational difference between male

and female, gender ideology seeks to undermine it – or even eliminate it” (Grabowski,
 12

2022, p. 54). Many theological scholars argue that religious bioethical voices need to be

part of the public dialogue regarding the purpose, sanctity, and dignity of the body (Roy,

2020). Christian bioethicists regard human life as sacred and intrinsically valuable. The

traditional Christian ethical worldview believes medical procedures must always depend

on therapeutic intent, and sex and reproduction features should not be altered or

eliminated because this is an affront to God and a rejection of creation.

The literature involving childhood gender dysphoria and the belief that gender

affirmative care (puberty blockers, cross-sex hormones, and sex reassignment surgery) is

the sole relief, omits moral reasoning and ignores irreversible outcomes. Agreeing with

Thomas Aquinas, for an act to be morally permissible it must be good or neutral, the

primary intent must be good, and the good effect must not be achieved through a bad act,

negative effects must be avoided as much as possible, and good results must outweigh the

bad (Roy, 2020). Gender Ideology may be “a cautionary tale about how human pride and

trying to usurp the place of God can lead to disaster on a global scale” (Grabowski, 2022,

p. 58).

Definition of Terms

The following is a list of definitions of terms that are used in this study.

Conversion Therapy – The pejorative term for any attempt to help a child become

comfortable with their natal identity (usually talk therapy) instead of gender-affirming

treatment (Whitehall, 2018).

Cross-Sex Hormones – Hormones that disrupt gonadal function and result in infertility.

Testosterone is prescribed for females transitioning to males with a risk of cardiovascular

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disease, and estrogen, prescribed for males transitioning to females, can increase the risk

of thromboembolic stroke (Hruz, 2020).

Detransition – Refers to the process of either discontinuing puberty-blockers or cross-

sex hormones or requesting surgery to reverse the original transition. The area is under-

researched and the number of detransitioners is unknown (Withers, 2020).

Dutch Protocol – Clinical management of children suffering from gender dysphoria. It

originated in the Netherlands in 1987 and initially included a “watchful waiting”

approach before proceeding to medical interventions (de Vries & Cohen-Kettenis, 2012).

Gatekeeping – Refers to the requirement of an assessment and referral letter from a

mental health professional before prescribing cross-sex hormones. It is considered

“dehumanizing” by transgender advocates (Ashley, 2019).

Gender-Affirming Treatment (GAT) – The belief that children should be allowed to

live in their “preferred” gender without question (D’Angelo, 2020).

Gender Dysphoria - For a person to be diagnosed with gender dysphoria, there must be

a marked difference between the individual’s expressed/experienced gender and the

gender others would assign him or her, and it must continue for at least six months

(DSM-5. American Psychiatric Association).

Gender identity - Refers to the basic conviction of being a man, woman, or other gender

(e.g., bigender, genderqueer, gender questioning, gender nonconforming) (American

Psychological Association). A theoretical construct invented by American psychologists

and psychiatrists, it is an unverifiable feeling with no physical manifestation (Biggs,

2022; Brunskell-Evans, 2019).

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Informed Consent – Physicians are mandated to obtain informed consent from a patient

before performing medical procedures. It includes providing all available information

regarding the benefits and risks of a procedure and assessing the ability of the patient to

understand the information (Shuster, 2019).

Medical Transition – Usually begins with the administration of puberty blockers

(skipped by some clinicians) then cross-sex hormones, followed by sex reassignment

surgery (Marchiano, 2017; Robles, 2021).

Puberty Blockers (GnRHa) – Gonadotopin-releasing hormone analogues (GnRHa) are

prescribed to children to halt puberty, a key period of development and maturation

(Pilgrim & Entwistle, 2020) by blocking the release of hormones from the pituitary gland

(Whitehall, 2018). These medications are prescribed “off label”, and, according to the

U.S. Food and Drug Administration (FDA) “have not been thoroughly investigated in

populations with normally timed puberty” (Hruz, 2020).

Rapid Onset of Gender Dysphoria (ROGD) – Sudden or rapid gender dysphoria in

post-pubertal females which usually occurs after extensive exposure to social media

(Littman, 2018).

Sex/Gender Reassignment Surgery – Surgical procedures that are part of the transition

process, which include (euphemistically labelled) “top surgery” (double mastectomy) and

“bottom surgeries” (vaginectomy, hysterectomy, metoidioplasty, phalloplasty,

vaginoplasty, and orchiectomy) (Exulansic, 2023).

Social Contagion/Peer Contagion – Refers to behavior spread through a population

where peers mutually influence each other (Littman, 2018).

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Social Transition – An individual adopts the name, pronouns, and dress of the opposite

sex (Whitehall, 2018).

Transgender - Refers to having a gender identity that differs from one’s sex assigned at

birth (American Psychological Association). May also refer to individuals who are in the

midst of or have already completed gender transition (Bell, 2020).

Transphobia – A pejorative label for a clinician who does not believe gender-affirming

care is the only solution and anyone who wishes to use “thoughtful engagement” to

understand a child suffering from gender dysphoria (Bell, 2020).

Transsexual – The term that pre-dated “transgender,” also used to describe individuals

with “genital-atypical anatomy,” was coined by Harry Benjamin (Reay, 2014).

Watchful Waiting – The original Dutch Protocol contained elements of a therapeutic

approach including evaluation of the child’s cognitive level and psychosocial functioning

before any medical interventions (de Vries & Cohen Kettenis, 2012). The American

Academy of Pediatrics (AAP) rejects the “watchful waiting” approach (Cantor, 2020),

labeling it “outdated.”

Significance of the Study

The significance of this study is to give a voice to the underserved population of

detransitioners, who may be suffering from not only physical but also emotional and

psychological problems and a lack of support. Many do not report the decision to

detransition to their original (transition) physician(s) due to mistrust and the difficulty in

finding competent medical care as a detransitioner (Exposito-Campos, 2023). The

medical community is focused on gender-affirming treatments, ignoring the fact that

there are no clinical guidelines or preferred medical treatments for detransitioners. Many
 16

detransitioners suffer from comorbidities such as depression, anxiety, PTSD, and autism

spectrum disorders (Vanderbussche, 2022), and are ashamed to seek professional help.

These problems may have pre-dated the onset of gender dysphoria, left

undiagnosed, and not alleviated by gender transition (Jorgensen, 2023). Detransition

remains under-researched and poorly understood, regardless of the fact that the number

of these individuals is increasing. There are more than 50,000 registered accounts on

Reddit r/detrans alone that are marginalized individuals seeking peer support. Many

detransitioners report worsening mental health after transitioning and feeling harmed by

the physicians and the healthcare system (Jorgensen, 2023). There is a need to know the

extent of the phenomenon of detransition, understand the experiences and healthcare

requirements of this population, and create healthcare protocols to improve their lives.

A significant factor, not generally addressed in gender dysphoria studies, is the

prohibitive cost of gender-affirming surgeries, which are entirely cosmetic and medically

unnecessary; nevertheless, they are covered by many insurance companies, thanks to the

Affordable Care Act, including Medicare and Medicaid (tax-funded), because they are

linked to a diagnosis of gender dysphoria and, if not covered by the insurance companies

would be considered discrimination (Exulansic, 2023). The costs of transitioning include

a lifetime of hormones, during and after the transition, that bodies do not naturally

produce. It is remarkable that not providing proper medical care to detransitioners is not

considered “transphobic.” Surgeries performed on detransitioners to reverse gender

transition, including the necessary hormones and medications, may not be covered by

insurance because they are not related to a “diagnosis.” There are three bills currently

before state legislatures (Texas, Florida, and Arizona) mandating insurance coverage for
 17

detransitioning costs, and the organization “Do No Harm” is proposing a detransitioner

“bill of rights.”

Summary

Gender transition is a lifelong commitment to maintenance after the puberty

blockers, cross-sex hormones, and sex reassignment surgeries. The mass hysteria of child

transgenderism has resulted in increased incidents of detransition. The affirmative care

model takes as fact what the child says and encourages parents, schools, and other

authorities to do the same. Instead of treating gender identity as a “neurotic fantasy”

medicine attempts to treat psychological distress as physical pain that can be relieved

with hormones and surgery (Marchiano, 2021).

The individuals who regret their decision to transition either mid-way through the

process or after it is completed are bullied and shamed by the transgender and the LGBT

communities. Ignoring detransition suggests “a disquieting cabal of secrecy about

transgenderism” (Klavan, 2020). Publicly discussing young people who regret

transitioning endangers the entire concept of gender transition, creating a society of

intimidation and silence.

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CHAPTER 2: LITERATURE REVIEW

Overview

The number of detransitioners is unknown, and most of the literature uses terms

such as “rare,” “very rare,” and “incredibly low” (Cohn, 2022) to describe the number of

individuals who regret the decision to transition and either discontinue the intervention by

ceasing the dosage of puberty blockers/cross-sex hormones or detransition by requesting

reconstructive surgery to reverse the transition (Exposito-Campos et al., 2021; Littman,

2021; Vandenbussche, 2021). Reasons for the ignorance regarding the detransitioner

population include trans activists reporting 1% regret after sex reassignment surgery.

Contrast that with 20% regret for knee surgery reported by physicians (Exulansic, 2021).

The reluctance of detransitioners to return to the clinician who oversaw the original

transition includes possible negative reactions from the medical community. One study

reported that only 24% of the 100 detransitioners who participated in the study informed

their physicians of their decision to detransition (Littman, 2021).

Not enough is known about this group, and limited attention is paid to detransition

and transition regret in academia (MacKinnon et al., 2023). Gaps exist in the quality and

accessibility of medical care, including information regarding stopping or changing

hormones and long-term effects of hormones for detransitioners (Jorgensen, 2023). In

addition, there is the need for psychological support for mental health problems and the

acceptance of physical changes that cannot be reversed (Marchiano, 2021; Pullen

Sansfacon et al., 2023; Vanderbusshe, 2021). This manuscript examines available

research regarding the current state of detransition knowledge, to challenge assumptions,

and identify inconsistencies.

 19

Description of Search Strategy

More than one publication are cited from the following journals: Archives of

Sexual Behavior, Journal of Sex & Marital Therapy, The BMJ, Clinical Child Psychology

and Psychiatry, Australasian Psychiatry, Social Work & Christianity, Child and

Adolescent Mental Health, The Catholic Thing, International Journal of Qualitative

Methods, The International Journal of Psychoanalysis, The American Mind, A

Publication of the Claremont Institute, BJ Psych Bulletin, PLoS ONE, Psychological

Perspectives, Inventing Transgender Children and Young People, The Linacre Quarterly,

and American Journal of Psychiatry, JAMA.

Search terms used: transgender, gender identity, gender transition, detransition,

cross-sex hormones, puberty blockers, Dutch protocol, gender dysphoria, and social

media. Books cited are: Ayad, S., Marchiano, L., & O’Malley, S. (2023), When Kids Say

They’re Trans: A Guide for Parents; Grabowski, J. S. (2022), Unraveling Gender: The

Battle Over Sexual Difference, Joyce, H. (2021), Trans: When Ideology Meets Reality,

Shrier, A. (2020), Irreversible Damage: The Transgender Craze Seducing Our

Daughters, Soh, D. (2020), The End of Gender: Debunking the Myths about Sex and

Identity in Our Society, Valenstein, E. S., (1986), Great and Desperate Cures: The Rise

and Decline of Psychosurgery and Other Radical Treatments for Mental Illness.

The Bible used for biblical research is Douay-Rheims Holy Bible, 5th Printing

(2009). (Original translation 1568). The letters of St. Paul are used extensively, including

Corinthians, Galatians, and Ephesians. The Old Testament books of Leviticus and

Deuteronomy are cited. Passages cited in Christian-oriented and theological studies are

used as a foundation.
 20

Review of Literature

The Dutch Approach

The best description of the treatment procedure, to become known as the Dutch

approach or the Dutch protocol, is the de Vries and Cohen-Kettenis (2012) study. A

specialized gender identity clinic for children and adolescents opened in the Netherlands

in 1987 and has treated children 12 to 18 years old in ever increasing numbers. Now part

of the VU University Medical Center in Amsterdam, the clinic’s screening and diagnostic

procedures have influenced the treatment of gender dysphoria internationally since 2000

and are practiced throughout the Western world, including Australia (Biggs, 2022;

deVries & Cohen-Kettenis, 2012; Pilgrim & Entwistle, 2020; van der Loos et al., 2023;

Whitehall, 2018). Originally, the Dutch method was comprised of five phases or stages.

Phase 1 was social transitioning whereby the child adopted the dress and persona of the

opposite sex following diagnostic sessions. Phase 2 involved puberty blockers, Phase 3

the administration of cross-sex hormones, and Phase 4 involved sex reassignment

surgery. Phase 5, the lifetime commitment to hormone therapy and maintenance of the

uro-genital system, was not mentioned in promotional literature (Whitehall, 2018).

The Dutch protocol, based on the original study of 55 participants, required

several diagnostic visits, weighing various symptoms over a long period of time, to

determine if the children suffered from gender dysphoria. Assessing psychosocial

functioning, cognitive level, and psychopathologies were elements of the therapeutic

approach, and recommendations included no medical transition, or social transition,

before puberty. Therapy included convincing children that the idea that they were “born

in the wrong body” may be a fantasy (de Vries, & Cohen-Kettenis, 2012; Malone. 2019;
 21

Marchiano, 2017; Moschella, 2021; Shrier, 2022, Soh, 2020; Withers, 2020). Today, the

mere discussion of this topic would be considered “conversion therapy” (Bell, 2020;

Zucker, 2012).

The observation of comorbid psychiatric problems resulted in the child being

referred to a mental health agency for treatment. The purpose was that children can

benefit from psychotherapy to deal with not only gender dysphoria but also self-image,

anxiety, depression, and behavioral problems. The Amsterdam clinic did not provide

medical interventions before puberty, adopting a “watchful waiting” approach while

making certain no psychological problems existed. The diagnostic assessment not only

provided information regarding treatment options, but also included discussions

regarding unrealistic expectations, and regularly scheduled appointments with a

psychologist to provide counseling during puberty suppression (de Vries & Cohen-

Kettenis, 2012).

If diagnosed with gender dysphoria and considered eligible for treatment, children

were treated with puberty suppressors (GnRHa) at 12 years old (Tanner Stage 2) until age

16 when they progressed to cross-gender hormones; however, some females achieve

Tanner Stage 2 at 8 or 9 years old (Malone, 2021). Puberty suppression (referred to as a

diagnostic tool) remained rare until GnRHa were introduced in 1996 and administered to

the first adolescent in 1998. At 18 years old, adolescents became eligible for gender

reassignment surgery.

The positive outcomes of the treatment were based on flawed evidence and

assumptions. Puberty suppression was described as part of the diagnosis instead of a

treatment and was labeled as completely reversible, based on a case study of one patient,
 22

and has been administered to children as young as 8 years old (Biggs, 2022), indicating

the eligibility age of medical interventions has been significantly lowered over time

(Malone, 2021). Known as luteinizing hormone-releasing hormone agonists (GnRHa),

the drugs used to suppress puberty include triptorelin (Decapeptyl or Gonapeptyl) used in

the Netherlands and Great Britain, and leuprorelin (Lupron) used in North America, and

are licensed to treat several medical conditions but are not licensed to treat gender

dysphoria (Biggs, 2022; Withers, 2020).

An influential article by Delemarre-van de Waal and Cohen-Kettenis (2006) was

published and financed by Ferring Pharmaceuticals, the manufacturer of triptorelin, and

became the Dutch protocol manifesto. Remarkably, the study stated, “It is not clear yet

how pubertal suppression will influence brain development” (p. S137) notwithstanding

the fact that the authors continued and still continue to insist that puberty suppression is

completely reversible, with no lasting effects on the child. GnRHa, originally prescribed

to treat prostate cancer and precocious puberty, are powerful drugs (Withers, 2020) that

are also used to chemically castrate sex offenders (Biggs, 2019).

When the Dutch protocol became the standard of care, validity was based on

nonrandomized studies, the use of small samples (Clayton, 2021; Safer, 2021),

questionnaires that included meaningless questions, potential for recruitment bias, the

exclusion of patients refusing to participate in the follow-up (Hruz, 2020), lack of double-

blind studies, and high dropout rates in longitudinal studies (Biggs, 2019; D’Angelo,

2018; Hruz, 2020; Withers, 2020). In the original study of the Dutch method consisting

of 55 patients (with no long-term outcome data available) (Malone, 2021), the death of a

patient who died of necrotizing fasciitis as a result of vaginoplasty should have halted the
 23

treatment on others; however, it was ignored and the study continued (Pilgrim &

Entwistle, 2020). The one attempt to replicate the study (outside of the Netherlands)

showed no psychological improvements using the Dutch method (Malone, 2021).

Evidence of side effects of the GnRHa drugs and hormones eventually became known,

and emerging data indicated that puberty blocking drugs and cross-sex hormones can

have irreversible harmful effects (d’Abreva et al., 2020). The claim that puberty

suppression was a diagnostic tool and not a treatment also circumvented the problem of

the necessity to obtain informed consent from 12-year-old children (Biggs, 2022).

The comprehensive treatment regimen gained in popularity in other countries,

including the United States, where Norman Spack, an endocrinologist and co-founder of

the Gender Management Service at Boston Children’s Hospital (2007), developed a

program based on the Dutch protocol. He also contributed to the 2009 Endocrine Society

guidelines, and, as a celebrity doctor, argued that children, even toddlers, can definitively

know their gender and should not be permitted to endure puberty (of their biological sex)

at the risk of suicide (Marchiano, 2021). Children should receive the “benign”

intervention of puberty blockers with no minimum required age. Parents of transgender

children in England were told to go to the United States to obtain GnRHa due to cautious

British clinicians who questioned the treatment and were labeled “transphobic,”

demonstrated by the replacement of Dr. Di Ceglie, the founder and director of the

London clinic. By 2021, the number of similar clinics in the U.S. grew to 40 (Marchiano,

2021); however, the original five-phase method of the Dutch protocol has been perverted

to omit not only “watchful waiting” but also psychotherapy for prepubertal children
 24

(Phase 1), suggesting instead a rush to Phase 2 - prescribing pharmacological

interventions (Schwartz, 2021).

The World Professional Association for Transgender Health (WPATH), an

international interdisciplinary, professional organization that creates “standards of care,”

refers to puberty suppression as “breathing space” for a child to explore their identity

without the distress of puberty; nevertheless, it is clear from the literature that almost all

children taking GnRHa progress to cross-sex hormones (Biggs, 2022; Maxwell et al.,

2019). To label puberty blockers as benign is disingenuous because they can adversely

affect bone-density and fertility and are not approved by the Food and Drug

Administration (FDA) for use in healthy children experiencing puberty at the normal time

in their development. Gonadotropin-releasing hormone analogs (GnRHa), used for this

purpose, are FDA approved for treatment of uterine fibroids, not to suspend puberty.

In 2016, the FDA ordered drugmakers to add a warning regarding the risk of

possible psychiatric side-effects of the drugs when used to treat precocious puberty, and

to closely monitor adverse events when reported by users. On its label for Lupron

(leuprolide), AbbVie indicates: “Psychiatric events have been reported in patients such as

crying, irritability, impatience, anger, and aggression” (Respaut et al., 2022, Reuters

Report). Many physicians have reported to Reuters that they have requested that Abbvie

(Lupron), Endo (Supprelin LA implant), and other drug companies seek FDA approval

for puberty blockers in treating gender dysphoria in children, including conducting

clinical trials. The drug companies have declined, and the drugs continue to be used “off-

label,” making less-expensive alternatives more difficult to procure (Respaut et al., 2022,

Reuters Report).
 25

Few longitudinal pediatric gender transition studies exist, and no randomized

control trials are available comparing outcomes of different interventions for gender

dysphoria (Pilgrim & Entwistle, 2020). Despite weak scientific evidence, the Dutch

protocol has become standard practice, and proponents continue to confirm its success.

The two Dutch studies that formed the foundation of “reliable research” regarding the

success of the Dutch protocol are de Vries et al. (2011) and de Vries et al. (2014). Both

exhibited a high risk of bias by including only successful cases in the report, using non-

randomly selected participants, and not evaluating physical health outcomes. A London

clinic attempted to replicate the de Vries et al. (2011) study but could not duplicate the

positive results regarding puberty suppression. “Research should include a more

objective evaluation of the effects of gender reassignment interventions on bone, brain,

cardiovascular health, malignancies, and overall morbidity and all-cause mortality” (p.

690). Using different methods and plagued with high rates of attrition none of the

subsequent attempts at replication were successful (Biggs, 2022). In an attempt to stifle

scientific debate, any further discussion on this topic has been labeled as “science

denialism” based on ignorance, religious zeal, and transphobia (Abbruzzese et al., 2023).

Origins of Gender Affirmative Therapy

Although studies have not included alternative treatment options for gender

dysphoria, such as psychotherapy or a wait-list control option (Zucker, 2019), the Dutch

model, referred to as gender affirming therapy (GAT), has flourished in the United States,

and has become a justification for easy access to hormones (Levine, 2018). In addition,

the new construct of “gender identity,” a condition invented by American psychologists

 26

and psychiatrists, was aided by the discovery of cross-sex hormones and advances in

plastic surgery.

The American Psychiatric Association’s (APA) Diagnostic and Statistical Manual

of Mental Disorders (DSM-5) (2013) replaced the term gender identity disorder (GID)

(considered a pathology in the DSM-IV) with the term gender dysphoria (GD), thereby

removing stigma from the condition. The 2018 policy statement published by the

American Academy of Pediatrics (AAP) rejected the “watchful waiting” approach

(Cantor, 2020), labeling it “outdated” and stating it is the physician’s role to affirm,

instead of question, the child’s perceived gender (regardless of age) at the risk of being

characterized as being “unfair and deceptive” (Robles, 2021). The American

Psychological Association (APA) acknowledges “Psychologists understand that gender is

a nonbinary construct that allows for a range of gender identities and that a person’s

gender identity may not align with sex assigned at birth” (APA, 2015, p. 834). The World

Professional Association of Transgender Health (WPATH) Standards of Care, seventh

edition (SOC 7), published in 2012, has rejected psychological counseling (Hruz, 2020)

and, although it warns that “no formal prospective studies exist,” promotes cross-sex

hormones “on demand” (Pilgrim & Entwistle, 2020).

Individuals over 18 years old can obtain cross-sex hormones from what Planned

Parenthood refers to as their “informed consent” clinics without a referral from a mental

health clinician (Marchiano, 2021). The eighth edition of the WPATH’s SOC (2022)

includes a new chapter regarding adolescents but neglected to add a chapter regarding

detransitioners, despite requests to do so. The American Academy of Pediatrics (AAP)

endorses gender affirmation as the only acceptable approach and treatment of gender
 27

dysphoria. Due to a lack of standards, some clinicians are promoting skipping puberty

blockers and proceeding directly to cross-sex hormones (Robles, 2021). Fast-tracking

children to cross-sex hormones was verified by the Reuters special report (2022) that

indicated of the 121,882 children (ages 6 to 17 years old) diagnosed with gender

dysphoria from 2017 to 2021, 4,780 children were prescribed puberty blockers and

14,726 initiated cross-sex hormones (Respaut et al., 2022).

Gender affirming therapy (GAT), also known as the gender-affirmative model of

care (GAMC), is the undisputed method of treating gender dysphoria in the United States

and has resulted in a peculiar form of paranoid thinking (Bell, 2020). The gender

affirmative model takes the child’s narrative at face value; therefore, clinicians are

discouraged from employing thoughtful analysis and are expected to affirm the child’s

perceived gender identity without question, providing a false promise that physical

transition will solve their problem while ignoring the possibility of comorbid psychiatric

conditions, and leaving them unaddressed (Hruz, 2020; Levine et al., 2022; Littman,

2018; Marchiano, 2021; Pilgrim & Entwistle, 2020; Shrier, 2022; Whitehall, 2020),

A gap exists between the formal Dutch protocol as it was originally designed and

current clinical practice which dispenses with the three to six months of psychotherapy

preceding medical intervention. Diagnostic criteria are unimportant because the child’s

self-reported gender dysphoria is the diagnosis (Biggs, 2022).

Scientific Research

“Trapped in the wrong body,” for which there is no objective scientific evidence

(Bell, 2020; Blake, 2021; D’Angelo, 2020; Evans, 2022; Levine et al., 2022; Malone,

2019; Moschella, 2021; Robles, 2021; Shrier, 2022; Soh, 2020), is the narrative of most
 28

children and adolescents presenting to clinicians in unprecedented numbers. The absence

of scientific literature has resulted in standards that are based on “clinical consensus” and

“expert opinion” instead of bench studies, animal experiments, and human trials

(Labuschagne, 2021; Whitehall, 2018). In Australia, several conditions must be fulfilled

before live experimentation is approved on rats, including biological plausibility,

laboratory findings, a pilot project, “blinded” intervention, and analysis by disinterested

assessment. In evidence-based medicine a new treatment undergoes rigorous research,

preferably the double-blind randomized control trial (DBRCT) (the current gold standard)

to minimize bias and confounding effects before being introduced as a routine treatment

(Clayton, 2023; Whitehall, 2020).

There is considerable evidence, mentioned in several publications, that the

majority of pre-adolescent children (from 80% to as high as 96%) who present as gender

dysphoric will stop insisting they are the opposite gender by the time they reach puberty

or late adolescence, without medical intervention (Bell, 2020; Biggs, 2022; Bruskell-

Evans, 2019; Cantor, 2019; Clayton, 2022; d’Abrera, 2020; Ehrensaft, 2018; Evans,

2022; Giordano, 2019; Grabowski, 2022; Griffin et al., 2020; Hruz, 2020; Jelsma, 2022;

Joyce, 2022; Labuschagne, 2021; Levine et al., 2022; Littman, 2021; Marchiano, 2017;

Moschella, 2021; Robles, 2021; Schwartz, 2021; Shrier, 2022; Soh, 2020; Steensma et

al., 2010; Turban & Ehrensaft, 2018; Withers, 2020) and consider becoming gay and

lesbian adults. The Littman (2021) study found that many detransitioners could not

accept themselves as gay or bisexual and regarded transition as the only solution.

Informed Consent
 29

Informed consent is a major issue and an important ethical concern. The level of

maturity necessary to make a competent decision regarding complex medical

interventions is uncertain (d’Abrera et al., 2020). Whether or not children and adolescents

can make a decision that puts their entire future at risk regarding their physical

development, fertility, and brain development, with no guarantee of success – a physical

resolution to relieve immediate psychological distress – is not the only problem (Pilgrim

& Entwistle, 2020). The competency of the parents to understand the experimental nature

of the treatment is in doubt when they are providing consent for minor children (d’Abrera

et al., 2020) who cannot sign an informed consent document, but instead, provide assent

while their parents (or legal surrogates) sign the informed consent (Levine et al., 2022).

Medical informed consent has its roots in ethical theory and law and is founded

on the principles of beneficence, justice, patient autonomy, and malpractice. It relies on

the appropriate age of the patient and the mental capacity of the patient to make

cognizant decisions. Disclosure of the risks and benefits of the treatment by the clinician

for a condition and any available alternatives that exist to alleviate it must occur before

signatures are obtained on an informed consent form (Levine et al., 2022). This is a

contentious point when there are no “best practices” known to the medical community

regarding gender transition. This allows medical practitioners to emphasize benefits,

minimize risks, neglect to mention alternatives, and possibly withhold vital information

(Shuster, 2019).

Informed consent was established following the Nuremberg Code to eliminate

abuse from physicians based on the gruesome experiments conducted on humans by the

Nazis during World War II (Shuster, 2019). The Nuremberg Code emphasizes the need
 30

for “understanding consent” on the part of the patient, the necessity for an outcome that

cannot be achieved by any other means, the existence of experimentation based on

previous knowledge including animal studies, and the risks that the intervention should

not exceed the expected benefits (Whitehall, 2018). Informed consent includes the

clinician’s obligation to inform patients of the risks of a medical intervention, support

patient rights, and provide autonomy whereby the patient possesses self-determination in

health-related matters (Shuster, 2019).

A court case in the United Kingdom – Quincy Bell & Mrs. A v The Tavistock and

Portman NHS Foundation Trust & Ors (2020) – involved the alleged inability of an

adolescent (16-year-old Keira Bell) to consent to the administration of puberty blockers

(GnRHa) to treat gender dysphoria (Malone, 2021; Moreton, 2021). Kiera Bell, a former

patient of the Gender Identity Development Service (GIDS), run by the Tavistock and

Portman National Health Service (NHS) Foundation Trust (Tavistock), brought the claim

for judicial review. After transitioning to a male identity, Kiera Bell, who chose to

detransition, claimed that the information from the GIDS was “misleading and

insufficient” (Moreton, 2021, p. 702), and that children under 18 are not Gillick

competent to consent (Brunskell-Evans, 2019). “Gillick competent” is the consent

competency level, recognized in the United Kingdom for children under 16 years old, set

by the ruling associated with Gillick v West Norfolk and Wisbech AHA (1986) wherein

physicians were alleged to have encouraged unlawful sexual activity by providing

contraceptives and advice to girls under 16 years of age. The court held the physicians

were not guilty.

 31

Regarding Bell v Tavistock, the judgement of the divisional court was in Kiera

Bell’s favor – considering puberty blockers to be experimental and respecting the

testimony of Dr. de Vries that only 1.9% of patients on puberty blockers did not progress

to cross-sex hormones. In addition, the court decided that the treatment of puberty

blockers was “lifelong and lifechanging in the most fundamental way imaginable”

(Moreton, 2021, p. 703). In 2021, the Appeals Court overturned the Divisional Court’s

rulings in Tavistock’s favor, citing the Divisional Court lacked the authority to reach such

a judgment, and the Gillick rule was too restrictively applied, by maintaining that

children under 16 would have “enormous difficulties” understanding and weighing all the

factors in the decision to use puberty blockers (Bell, 2023).

Following this event, the lead staff member of the Tavistock GIDS, who raised

concerns regarding the adequacy of child safeguarding, took legal action against

Tavistock for the undermining of her position, resulting in a finding in her favor, and the

confirmation that an atmosphere of intimidation existing in the GIDS. Dr. David Bell (no

relation to Kiera Bell) submitted a report regarding the grave concerns of the staff which

resulted in disciplinary proceedings being initiated against him. He originally presented

those concerns to the Trust's board in August 2018, maintaining that GIDS was "not fit

for purpose" and "children's needs are being met in a woefully inadequate manner."

Children were being pressured into medical interventions with minimal assessment (Bell,

2023). As a result, the NHS of the United Kingdom ordered a review of clinical

guidelines, known as the Cass Review, and echoing Dr. Bell, the review (interim)

criticized the “affirmative model,” labeling the services of the GIDS inadequate and

unsustainable. The report also noted that the staff were “under pressure to adopt an
 32

unquestioning affirmative approach.” The NHS announced the closure of the Tavistock

GIDS which finally occurred in March 2024.

Proponents of affirmative care respond to a child’s sense of urgency regarding

transition. The conventional medical model of “informed consent” is being bypassed in

this new area of medicine (Shuster, 2019), leaving the physician with no official

treatment guidelines (d’Abrera et al., 2020) and no required mental health evaluation;

therefore, physicians are pressured to confirm the child’s self-diagnosis (Levine et al.,

2022). The usual discussion of potential negative effects of treatment is not occurring

when children are requesting medical interventions that permanently modify their bodies

and cause infertility (Evan, 2020).

Shuster (2019) addressed the gap that exists in how informed consent is

understood in clinical practice from the providers’ perspectives. The findings showed a

difference between the theory of informed consent and its actual practice in transgender-

specific medicine. Inconsistencies were obvious in clinicians’ descriptions and their

understanding of informed consent, and admittedly there were times they did not use the

standard model of informed consent with their patients. Findings from other research

suggest that patients may be coerced into transitioning with questionable informed

consent tactics.

The informed consent model (ICM) of gender affirmative treatment does not

require an assessment of gender dysphoria prior to the initiation of gender-affirming

hormones, maintaining that it is sufficient that individuals understand the benefits of

cross-sex hormones without a formal diagnosis. The emergence of this view is to support
 33

the effort to depathologize gender dysphoria and remove the barriers to affirmative care

(MacKinnon et al., 2023).

One study (Ashley, 2019) argued that to require patients with gender dysphoria to

undergo a psychological assessment, also known as “gatekeeping,” before receiving

hormone replacement therapy (HRT), is hostile and unethical, and the self-reporting of

the condition is sufficient. It further stated that self-reporting represents epistemic

authority, implies automatic diagnosis, and represents “informed consent” as would self-

reporting physical arm pain; however, a psychological assessment of gender dysphoria

would not question the validity of the self-reported symptoms but instead clarify the

causes and may introduce other options (Pilgrim & Entwistle, 2020; Saad et al., 2019).

The Ashley (2019) model of informed consent is not consistent with the standard

model used for medical treatment. Psychological assessment is widely used for patients

prior to undergoing cosmetic surgery and elective procedures, is considered good practice

(Saad et al., 2019), and is not considered “dehumanizing” (Ashley, 2019). Furthermore,

the same standard should apply to transgender and non-transgender patients regarding

elective medical procedures (Saad et al., 2019).

A recent event of importance regarding informed consent is the release of internal

documents of the WPATH contained in the report, “The WPATH Files,” by journalist

Michael Shellenberger (2024), published through his nonprofit organization

Environmental Progress. Video of an internal WPATH panel called “Identity Evolution

Workshop” (May 6, 2022) revealed WPATH members admitting that it is impossible to

obtain proper informed consent from young patients. Dr. Daniel Metzger, a Canadian

endocrinologist, stated that explaining such things as the risk of becoming infertile and
 34

other medical implications to those who have not studied biology in high school is like

“talking to a blank wall.”

In response to doctors and therapists of the WPATH, hesitant to prescribe cross-

sex hormones to individuals with dissociative identity disorder, Dr. Karasic, a California

psychiatrist, countered, “The mere presence of psychiatric illness should not block a

person’s ability to start hormones if they have persistent gender dysphoria, capacity to

consent, and the benefits of starting hormones outweigh the risks” (WPATH discussion,

2024). “Their whole paradigm [is] falling apart over the last three years” (Shellenberger,

2024, The Daily Signal Interview).

Gaps in Medical Research

In the medical world, gender dysphoria should be treated in a way consistent with

the scientific definition of sex as a binary biological trait involved in procreation, not as a

condition with vague symptoms that cannot be verified (Marchiano, 2021). Gender

dysphoria must not be confused with disorders of sexual development (DSDs), the rare

cases of genital ambiguity or congenital deformity, affecting less than 0.02 % of all

infants (Hruz, 2020), and usually corrected by surgery preferably before the child reaches

18 months.

Absent a blood test, imaging process, X-ray, or genetic analysis to diagnose

gender dysphoria, evaluation is exclusively based on the self-reporting of the patient and

may also be confounded by the existence of co-morbid psychological factors, such as

depression, anxiety disorders, sexual abuse, other major traumas, autism spectrum

disorder, borderline personality disorder, and intolerance and fear of being gay (Bell,

2023; Brunskell-Evans, 2019; Hruz, 2020; Whitehall, 2020; Zucker, 2019). “The
 35

symptoms of gender dysphoria are subjective and unfalsifiable” (Marchiano, 2021, p.

351).

Deficiencies in medical research include the risks of GnRHa drugs and cross-sex

hormones. GnRHa drugs adversely affect bone density and halt puberty until cessation of

the drugs allegedly allows puberty to resume; however, the normal developmental and

time-dependent process of puberty has been interrupted and cannot be completely

“reversed” (Hruz, 2020, p. 38). Ceasing puberty blockers to “resume” puberty or moving

forward with cross-sex hormones both have an impact on future health (Ashley, 2019).

Consequences of cross-sex hormones include disruption of gonadal function

resulting in infertility. The effects of dangerous drugs and irreversible surgery on

children’s developing brains are woefully under-researched (Hruz, 2020: Whitehall,

2018; Withers, 2020). Early studies ignored key outcomes like the negative effects of

cross-sex hormones, possible comorbid mental disorders (Whitehall, 2018), and adverse

effects on fertility and bone density (Clayton, 2021; Safer, 2021; Schwartz, 2021). The

controlled substance testosterone, prescribed for females transitioning to males, is a

habit-forming anabolic steroid that can be psychoactive and has other risks known to the

medical community (Exulansic, 2022). Long term use of testosterone is associated with

cardiovascular risk, and estrogen (for males transitioning to females) can cause

thromboembolic stroke. The vast majority of (almost all) children who take puberty

blockers will advance to cross-sex hormones (Biggs, 2022; Maxwell et al., 2019;

Moreton, 2021; Turban & Ehrensaft, 2018).

Withers (2020) and Biggs (2022) mentioned an animal study (rarely referenced in

transgender research) of sheep, administered puberty blockers and subsequently tested, a

 36

year after cessation of the drugs. The sheep were significantly less able to navigate a

maze, their fear and stress responses were permanently affected, and autopsy revealed a

measurable change in the hippocampus, an area of the brain connected to spatial memory,

providing evidence that GnRHa drugs compromise cognitive function (Biggs, 2022;

Griffin et al., 2020; Pilgrim & Entwistle, 2020; Whitehall, 2020; Withers, 2020). Another

animal study involving the leuprolide (Lupron) treatment of mice (Anacker et al., 2020)

resulted in profound depressive effects on female behaviors and notable activity in the

hippocampus. Specific behavior consisted of hyponeophagia, despair-like behavior,

neuroendocrine responses to mild stress, and hyperactivity of the dentate gyrus.

Although no human studies have examined the neuropsychological impact of

puberty suppression, there is research suggesting puberty blockers impact brain structure

and social and cognitive development in mammals (Baxendale, 2024). There is no

evidence that the effects of puberty blockers are reversible in animals. Expert consensus

from 24 international specialists in neurodevelopment, gender development, and puberty

indicated nine important areas of the brain that may be impacted: executive function,

social awareness, functional connectivity, brain structure/volume, emotional awareness,

IQ, risk-taking, processing speed, and memory. Because puberty is a sensitive period for

brain organization, suppressing sex hormone production could alter neurodevelopment.

Many experts suggested continued assessments of transgender youth through their mid-

20s when prefrontal development is near completion (Chen et al., 2020).

Most of the research and publications regarding the risks and benefits of puberty-

blocking drugs and cross-sex hormones fail to mention effects on an adolescent brain.

Adolescence is a sensitive “window of opportunity” for the development of executive

 37

functions and social cognition (Baxendale, 2024, p. 1157). The “critical window” is when

the brain requires specific input for the development of a function, and, if it does not

occur the function will be “permanently compromised.” The windows are staggered

throughout development from birth to the third decade of life (p. 1157). Hormonal

changes in puberty are not only responsible for the development of secondary sex

characteristics, but also frontal cortical circuits and hippocampal and amygdala

connectivity. Medicine’s current understanding of the pre-programmed critical windows

of brain development indicates they are not reversible. If, as pro gender ideology activists

insist, the changes made by puberty-blockers were completely reversible, “it would mean

that puberty is very different from the other pre-programmed windows of opportunity in

neuropsychological development…” (p. 1158).

A study of a group of girls (N=25) by Mul et al. (2001) (referenced by Baxendale,

2024) indicated a loss in both performance IQ and full-scale IQ three years into treatment

with puberty blockers. A key characteristic of IQ, as measured by the Wechsler

Intelligence Scales, is that it should remain stable throughout a child’s development. In a

single case study, Schneider et al. (2017) (referenced by Baxendale, 2024) studied an 11-

year-old child (male to female), before being treated for gender dysphoria with GnRHa

and assessed the patient’s IQ at 11 years and 11 months (IQ=80). The patient was re-

assessed at 13 years and 3 months (IQ=71) and 14 years and 2 months (IQ=70). In verbal

comprehension, there was a total loss of 15 points over this timeframe. See Figure 3.

Figure 3
 38

Adapted from Schneider et al., (2017)

Dr. John Whitehall, Professor of Pediatrics at Western Sydney University in

Australia, is a prominent outspoken opponent of affirmative medicine to treat childhood

gender dysphoria. He opposes the Australian “standards of care” because they are not

based on standards that comply with Western medicine but rather clinical consensus

a.k.a. “expert” opinion (Whitehall, 2018). He described clinicians as having tunnel vision

in their appraisals and mentions the critical knowledge gaps including the impact on

fertility, effects on growth and cardiovascular function, and treatment withdrawal. He

mentions the possibility of the promotion of dysphoria for the emotional gain of parents,

known as Munchausen’s disease by proxy, and refers to the phenomenon as a

psychological fad encouraged by the media and promoted on websites.

The Role of Psychiatry

Therapy helps patients understand themselves and make rational decisions

especially during adolescence, a turbulent period of psychological and physiological

changes. Turmoil and confusion that occur with the physical and emotional changes of
 39

puberty can benefit from a psychological assessment that considers all aspects of the

patient’s personality (Clark & Spiliadis, 2019; Evans, 2022). Affirming gender-confused

children’s wish to medically transition and proceeding immediately to medical

interventions can result in sterilization and a lifetime of medication (Bell, 2020, 2023;

Evans, 2022; Griffin et al., 2020; Marchiano, 2020; Withers, 2020), whereas

psychotherapy may uncover and treat deeper problems such as family pathology or

depression (Schwartz, 2021), and address the root cause of the problem instead of

providing false hope that changing the body (Moschella, 2021) will alleviate the non-

specific distress of a child who wishes to become a different gender (transition or die)

(Watt, 2019). Nevertheless, transition advocates see the use of puberty blockers as

providing “time” to assess the gender dysphoria instead of applying therapy before

prescribing puberty blockers, referring to therapy as unjustified and possibly rooted in

“psychological inertia or subtle prejudices towards trans lives” (Ashley, 2019, p. 229).

Branstrom and Pachankis (2020) published a paper to demonstrate the success of

gender reassignment surgery regarding patient anxiety disorder. It proved to be incorrect.

Reacting to criticism, in August 2020 a correction to the original study was published,

pointing out that anxiety disorders were worse for patients who had sex reassignment

surgeries than for those who did not (Anderson, 2020).

Since the widespread use of medical interventions, efforts to identify non-medical

or psychological strategies have been, for the most part, abandoned. A psychiatric and/or

psychological approach to the gender incongruence problem has been labeled “gender

identity change effort” (GICE) and deemed harmful because it may cause the child to feel

shame (Turban & Ehrensaft, 2018). Currently, 20 states ban this type of common sense
 40

“talk therapy.” Any attempt to treat gender dysphoria, other than by encouraging a

medical transition, is considered damaging to the patient. The World Professional

Association for Transgender Health (WPATH) takes the stance that not to accept and

support an individual’s perceived gender identity is unethical.

Proponents of the affirmative care model describe co-occurring mental health

issues (depression, anxiety) as merely secondary factors, with gender dysphoria being the

primary diagnosis instead of the possible explanation that the gender dysphoria is

secondary to the primary mental health diagnosis of autism spectrum disorder or

borderline personality disorder (Zucker, 2019). Managing a psychological problem with

physical treatments such as hormones and surgery lacks plausibility. For example, similar

disorders such as anorexia nervosa and bulimia are not treated with “affirmation” therapy

(Marchiano, 2020; Whitehall, 2020).

Church and Spiliadis (2019) conducted a study of 12 adolescents and focused on

two case reviews of adolescents (12-years-old at the outset of assessment) who met the

criteria (DSM-5) for gender dysphoria and were requesting medical intervention. Case 1

was an adolescent (a male wishing to transition to female), referred by a general

practitioner and diagnosed with Asperger syndrome. Case 2 consisted of an adolescent (a

female wishing to transition to male), referred by Child and Adolescent Mental Health

Services, who had been hospitalized for a restrictive eating disorder and was considered

high risk for self-harm. Neither child had been administered puberty blockers or other

medical interventions but had socially transitioned. Both were treated with face-to-face

assessment sessions, some including their family.

 41

Case 1 was seen seven times over an 11-month period at which time, the

clinicians were informed that he no longer identified as female. One final session, 10

months later, convinced clinicians that he was comfortable as a “guy”; however, open-

ended psychotherapy was recommended. Case 2 attended nine face-to-face sessions over

the course of 13 months, formed a meaningful therapeutic relationship, considered the

clinicians her support group, and returned to using her birth female name before being

discharged from the service (Clark & Spiliadis, 2019).

In both cases, the common themes that emerged were experiences of bullying, a

sense of isolation, communication difficulties, and distress related to puberty emerged

prior to the feelings of gender dysphoria. Over the course of the psychosocial assessment,

they understood the source of their distress and decided against medical intervention,

highlighting the need for psychological/psychiatric assessment prior to pharmaceutical

and surgical interventions (Clark & Spiliadis, 2019). A study (Turban et al., 2020),

resulting in flawed conclusions, assigned the term “gender conversion therapy” to

psychiatric treatment of any kind (implying it was unethical) and launched a media

campaign promoting legislative bans on psychiatric treatment for gender dysphoria,

equating all psychological care with gender conversion therapy (D’Angelo et al., 2021;

Withers, 2020). Their compromised analysis was used to justify the notion that

psychotherapy is harmful and associated with psychological distress which contributed to

the claim that any “non-affirming” treatment is harmful. “Conversion therapy is double-

speak for any attempt to reduce gender dysphoria by helping the child become

comfortable with its natal identity, and not ushering the child onto the pathway of

affirmation” (Whitehall, 2018, p. 78).

 42

The U.S. Kaiser Permanente study investigated 1333 American children

diagnosed as transgender and gender non-conforming, 251 of whom were aged 3 to 9,

and in that group, mental illness was common (ADHD, depression, autism, and conduct

disorders). Overall, the occurrences of mental disorders were 3 to 13 times higher than in

cisgender (heterosexual) individuals. There is no follow-up study to reveal what

happened to these children (Whitehall, 2018).

The Cass Review, an independent review of gender identity services for children

and young people provided at the request of the United Kingdom’s NHS, stated in the

interim report, that whereas the original Dutch method routinely provided therapeutic

support to children in advance of medical intervention, or when considered appropriate,

instead of proceeding directly to early hormone intervention, psychotherapy is now no

longer considered integral to the current NHS process (Cass, 2022). Gender affirming

protocols view a child’s sense of urgency as a reason to omit psychotherapy and rush

headlong onto the path of bodily metamorphosis with its unacceptable high risks to avoid

reality (Marchano, 2021; Schwartz, 2021).

Many clinicians argue that allowing a child, who wishes to transition, to go

through naturally-timed puberty causes unnecessary suffering (Evans, 2022); however,

the administration of puberty blockers validates the idea, in the child’s mind, that puberty

is something to be feared, requiring medical intervention (Schwartz, 2021). There is no

empirical test to ascertain if the child is suffering from gender dysphoria (Brunskell-

Evans, 2019); however, it is considered a biological (not psychological) issue that should

be treated medically (not psychologically) (Withers, 2020) to make a healthy body

 43

conform to psychologically disordered thinking - “a paradoxical use of the healing art”

(O’Donovan, 1983, p. 136).

The task of analysis is to help patients come to terms with that which cannot be

changed and aid adolescents with bodily reality instead of using medical interventions as

“Promethean efforts to subdue biological reality” (Marchiano, 2021, p. 827). Medical

transition may be an attempt to evade psychological distress and divert attention from

psychological problems; therefore, it is the therapist’s task to maintain analytic neutrality

and avoid collusion with the patient’s wish to medically transition and possibly suffer the

consequences of poor judgment (Moschella, 2021; Withers, 2020).

Psychiatrists should be empowered to remain impartial and treat gender confused

patients with best quality measures as opposed to an ideology because affirming the

patient’s view is not the role of therapy (Eisenberg, 2023). “Psychiatry sits on this knife-

edge; running the risk of being accused of transphobia or, alternatively, remaining silent

throughout this uncontrolled experiment” (Schwartz, 2021, p. 297).

Medical Ethics

The most fundamental moral imperative of medical practice is “first, do no harm"

(Bell, 2020; Bell, 2023; Giordano, 2019; Schwartz, 2021). A lack of caution appears to

exist in the treatment of gender dysphoria despite the scarcity of high-quality evidence on

long term effects. Drug and vaccine development require a long period of testing before

clinical use, whereas, in the case of gender transition, the services are the trial (Pilgrim &

Entwistle, 2020).

An ethical psychotherapeutic approach to gender dysphoria, which may actually

be effective, should be the first-line treatment, possibly reducing the need for risky and
 44

irreversible medical interventions whose long-term consequences remain unknown (Bell,

2023; Clayton, 2021; D’Angelo et al., 2021). Contemporary society treats transgender

patients as “customers” who can demand drugs and interventions without a formal

diagnosis, forcing physicians to proceed with gender-affirmative treatment (GAT),

reducing members of the medical professional to technicians (Hall, 2021; Robles, 2021;

Shrier, 2020). According to affirmative treatment, complying with the patient’s self-

diagnosis and transforming the body is the only permissible solution and nothing should

stand in its way (Bell, 2020). “Even thinking about cause is very often regarded as an act

of hostility” (p. 1033), and any thoughtful treatment can be viewed as “transphobia.”

The lack of consensus raises the question of what constitutes a “good enough”

assessment (Churcher Clark & Spiliadis, 2019, p. 341). The word psychopathology has

acquired a stigmatizing connotation when used with the condition of gender dysphoria as

opposed to conditions such as anxiety, restrictive eating, and depressive disorders.

Gender affirming clinicians often have passionate beliefs about patient rights, may view

gender dysphoria as an exception, and collude with the patient to diminish their distress

as a form of beneficence. In doing so, physicians may jeopardize the child’s future by

administering cross-sex hormones and removing healthy organs and tissue - breaking the

thousands-year tradition of nonmaleficence (Levine, 2018).

Risk of Suicide

One justification for urgent medical transition, without delay, is the concern

regarding the risk of suicide; however, there is no clear evidence that gender affirmation

reduces this risk (d’Abrera, 2020; D’Angelo, 2018; Evans, 2022; Levine, 2018;

Moschella, 2021; Schwartz, 2021; Withers, 2020; Zucker, 2019). The risk of suicide is
 45

not unique to adolescents with gender dysphoria. It occurs also in those suffering from

anxiety and depression, but the topic has become contentious and attracts intense media

scrutiny. Parents’ comments in the media stating they would rather have a “trans kid than

a dead kid” or a “living son than a dead daughter” are not only misleading but alarming

(Eisenberg, 2023; Joyce, 2022; Joyce, 2021; Shrier, 2022; Soh, 2020; Zucker, 2019).

“Parents seem to have collectively lost their minds” (Joyce, 2021, p. 94).

Dhejne et al. (2011), using a long-term population-based study, compared 324

transgender individuals, who had received sex-reassignment surgery between 1973 and

2003 to a control group, and found that the transgenders were five times more likely to

attempt suicide and 19 times more likely to die by suicide. Prior to 2011, knowledge of

the outcomes of studies regarding mortality and psychiatric morbidity were limited due to

the small number of post-surgical participants. Most post-transition studies do not use a

comparison group and ignore the missing data of patients lost to follow up (D’Angelo,

2018; Grabowski, 2022; Hruz, 2020; Levine, 2018; Moschella, 2021). Dhejne et al.

(2011) investigated death by suicide, cardiovascular disease and tumor, and morbidity,

specifically psychiatric disorders. The findings showed not only a high rate of suicide,

suicide attempts, and cardiovascular disease, but also high rates of depression, psychiatric

hospitalization, and low quality of life compared to the general population.

Some physicians, in their zeal to help their patients, view affirming gender

dysphoric children’s wish to transition as suicide prevention, instead of providing the

“conventional” treatment of psychotherapy. The argument that a patient who does not

receive the drugs demanded of the clinician will commit suicide has been weaponized by

trans activists. The threat of suicide can result in physicians doubting themselves, losing
 46

sight of the tools of empathic listening, and believing extraordinary measures must be

taken, instead of addressing suicide threats with psychotherapy (Levine, 2018; Schwartz,

2021; Withers, 2020).

Research has shown higher rates of mortality, suicidal behavior, and psychiatric

morbidity in transgendered individuals, establishing that gender-affirming treatment does

not reduce the risk of suicide. Furthermore, there are no studies comparing experimental

gender transition with psychiatric treatment or no treatment (d’Abrera et al., 2020).

Social Transition

Social transition is when an individual, wishing to “pass” as their perceived

gender identity, adopts the dress, hairstyle, and affectations of the opposite sex. Some

therapists view this transition as less harmful than pharmacological or surgical

intervention and more easily reversed; however, it represents one step in the process of

the gender affirmative approach (Giordano, 2019).

Adolescent girls can purchase binders online to flatten breasts

([Link]

binders+for+women%2Caps%2C184&ref=nb_sb_noss_1). The uncomfortable

compression devices can cause back and shoulder pain, chest pain, shortness of breath,

and bruised and fractured ribs and are not a good long-term solution. They can also

permanently damage tissue, leaving breasts flat and wrinkled (Shrier, 2022). “Packers”

are prosthetic penises and testicles that produce a crotch bulge (Joyce, 2021), and devices

can be purchased to enable girls to urinate standing up.

Males transitioning to females have choices of “tucking” underwear – underpants

specifically designed to compress and flatten genitals and “tucking” gaffs, and tight
 47

clothing that is worn under underwear to yield the same result

([Link]

ucking%2Caps%2C112&ref=nb_sb_ss_ts-doa-p_4_7). Steel-boned corsets are available

for those who want an hourglass figure, and while waiting for hormones to enlarge

breasts, there are breast plates and silicone breast forms for realistic shape and

movement. Most of these products, in addition to “butt lifters” and “hip wideners,” can

be purchased from [Link].

Children’s Hospital Los Angeles posts resource pages on the website providing

instructions and tips to the parents of gender dysphoric adolescents regarding binding and

tucking and where to purchase the necessary devices, despite the fact that binding can

cause costochondritis, an inflammation of the cartilage that connects a rib to the

breastbone (sternum). Socially transitioned children may thrive short-term; however, no

evidence exists regarding long-term benefits of social transition (Malone, 2021).

Those in favor of social transition in prepubertal children argue that it permits

children to live in the gender that “feels most authentic” (Ehrensaft et al., 2018, p. 251).

Although admitting that puberty blockers and cross-sex hormones cause infertility,

Ehrensaft dismisses this as solely the concern of parents who want a genetically related

grandchild (Marchiano, 2017), an attitude that is a “serious breach of medical ethics” (p.

358). The previous version (7) of the WPATH SOC (2011) maintained “watchful

waiting” guidelines and emphasized the developmental stage of puberty before socially

transitioning. Nevertheless, clinicians were facilitating social transitions in prepubertal

children and not abiding by the WPATH SOC 7 guidelines. A convenience sample of 20

surgeons from the United States, interviewed in 2017 regarding sex reassignment surgery
 48

on minors, indicated that more and more surgeons were performing genital surgeries on

minor children, believing them to be psychologically ready for surgery (Ehrensaft et al.,

2018).

Medical Risks

The risks of long-acting puberty blockers include osteopenia (low bone density),

altered height, and impaired special memory, and can be complex. Cross-sex hormones

create the appearance of the sexual characteristics of the opposite sex (Brunskell-Evans,

2019; Hruz, 2020). Testosterone is a Schedule III controlled substance with a legitimate

medical use; however, it is an anabolic steroid, normally taken by males for muscle

growth, which can be psychoactive, induce euphoria, and cause psychological

dependence (Exulansic, 2022). It replaces mental sharpness with mood elevation and

heedlessness and appears to have a positive effect on anxiety (Shrier, 2022).

When taken by a female, wishing to transition to a male, the dosage is 10 to 40

times greater than would normally be biologically produced to achieve the desired

“appearance.” It permanently affects the size of external female genitalia, causing pelvic

pain, and can result in pressure necrosis and impaired circulation. Other complications

include polycythemia, type 2 diabetes, blood clots in a deep vein or in the lungs, vaginal

atrophy, muscle aches, cramping, endometriosis, high blood pressure, high cholesterol,

and increased risk of diabetes, stroke, and cell mutation causing endometrial cancer

(Exulansic, 2022; Mayo Clinic, n.d.; Shrier, 2022). Some of the same negative side

effects can occur from the administration of high dosages of estrogen to a male wishing

to transition to a female. Additional negative consequences of estrogen include high

levels of triglycerides, potassium, and prolactin, and nipple discharge (Mayo Clinic, n.d.).
 49

Sex reassignment surgeries are euphemistically called “top surgeries” and

“bottom surgeries.” For females, transitioning to males, the initial and most popular

surgery is a double mastectomy – the removal of healthy organs (breasts), with biological

capacities, not lumps of flesh that can be replaced if the patient changes her mind.

Surgery includes removing breast tissue and excess skin, removing and reattaching

nipples and areolas, and liposuction to remove excess fat (Cleveland Clinic, n.d.). Poor

outcomes can include infection, seroma, pain, bleeding, oozing, scarring, skin flaps, and

the necessity for additional liposuction (Cleveland Clinic, n.d.; Shrier, 2022).

Dr. Johanna Olson-Kennedy, Medical Director of The Center for Transyouth

Health and Development, and Attending Physician at Children’s Hospital Los Angeles, is

a vocal proponent of performing mastectomies on minors. “Professional guidelines and

clinical practice should consider patients for chest surgery based on individual need

rather than chronologic age” (Olson-Kennedy et al., 2018, p. 432). When speaking about

the procedure being appropriate for healthy girls, her response is that it “is no big deal”

([Link] In her opinion, if teenaged girls can

decide which college to attend, they can decide to have their breasts removed.

Bottom surgeries include metoidioplasty that releases the connective tissue

holding the enlarged clitoris in place, shapes it into a tiny penis, and if possible, runs the

urethra through it. Some individuals also undergo a scrotoplasty to create a scrotum.

Vaginectomy involves excising the vagina and sewing it shut, and it may be performed at

the same time as removing the uterus and cervix (hysterectomy) and removal of the

ovaries (oophorectomy). Problems that may occur are scarring of the ovaries and fibroids,

which causes excessive bleeding – the result of high testosterone doses. Phalloplasty, the
 50

construction of a neophallus, requires skin from the body. Generally, the surgeon “de-

sleeves” the forearm by peeling off the skin, fat, nerves, and blood vessels, leaving the

arm disfigured and, in some cases, disabled. Negative outcomes include internal sores,

blood clots, creation of an open wound, scar tissue and strictures, and a urethra that leaks,

requiring some individuals to wear a catheter. Positive outcomes are considered “weak”

and complication rates are high (Cleveland Clinic, n.d.; Exulansic, 2023; Shrier, 2022).

The top surgery of bilateral augmentation mammoplasty is performed on males

transitioning to females. Implants are placed under the breast tissue if the breasts are

large enough. If cross-sex hormones have not enlarged the breasts sufficiently, an initial

surgery implanting tissue expanders in front of the chest muscles may be needed,

followed by saline injections every few weeks, then another surgery to remove the

expanders and insert the implants (Mayo Clinic, n.d.).

The first stage of bottom surgery includes a partial or total penectomy (removal of

the penis) and possible removal of the scrotum and testicles (orchiectomy). Risks include

infection, excessive bleeding, lymphedema in the legs, fluid leakage in the scrotum, and

blood clots. Vaginoplasty begins with penile inversion in which the penile shaft and

urethra skin are inverted and shaped into a canal resembling a vagina. There is a tendency

for the area to become inflamed and shrink, necessitating the patient to dilate, a painful

process of inserting rods of varying girth daily which may cause tears in the tissue. A

major complication of this surgery can result in “vaginal stenosis” requiring revision

surgery (“colon vaginoplasty”) using a segment of the colon to replace the inverted penile

shaft. Orchiectomy is the surgery that removes the testicles to eliminate the production of

male hormones (Exulansic, 2023; Shrier, 2022). Other risks include infection, excessive
 51

bleeding, nerve injury, blood clots, vesicovaginal fistula (requiring surgery), and

rectovaginal fistula (requiring surgery) (Cleveland Clinic, n.d.).

Christopher Inglefield, surgeon and founder of the London Transgender Clinic,

stated in Silke Steidinger’s documentary film “Trans-Actions” (2019), “The only

established and documented cure for gender dysphoria is surgery” (Entwistle, 2021). One

study showing excessive optimism regarding surgery as the identified cure of gender

dysphoria and suggesting that it reduces anxiety and depression, helped to legitimize its

use (Branstrom & Pachankis, 2020).

These complicated surgeries, not for the faint of heart, are available not only for

those suffering from gender dysphoria, but also for anyone who wishes to undergo the

procedures. A formal diagnosis is not necessary. The surgeries are cosmetic, not for the

relief or cure of a disease or medical problem and can result in very serious and

permanent medical difficulties. An important turning point regarding the availability of

these expensive procedures is the Affordable Care Act (ACA) of 2010 that barred health

insurance companies from discriminating based on gender identity and sexual orientation.

As a result, health insurance companies began covering the cost of hormones and sex

reassignment surgeries with no evidence surgery positively affected gender dysphoria

(Kalin, 2020). Despite the current myth that a person can change their sex through

surgery, it is inherently impossible. Surgery will not provide a patient with the sex organs

or reproductive capacity of the opposite sex, and transition can delay the healthy

developmental integration of the mind and body of a young person (Bradley, 2021).

There have been many beneficial medical advances in the 20th century; however,

the history of medicine also includes examples of what can be referred to as “dangerous
 52

medicine” (Clayton, 2022, p. 691). Malaria fever therapy, for individuals suffering from

general paralysis of the insane (GPI), was used until the 1950’s before being replaced by

penicillin. Another innovative therapy, endorsed without regulation and lacking empirical

evidence, was the prefrontal lobotomy, used in the early 20th century, resulting in its

originator, Egas Moniz, receiving the Nobel Prize for Physiology or Medicine in 1949, as

did Julius Wagner-Jauregg, responsible for the malaria fever “cure” (1917), in 1927. The

press praised these medical heroes and their use of desperate remedies, and the use of

psychosurgery provided credibility to the profession of psychiatry (Clayton, 2022). The

surgical procedures were not subject to the same testing and restrictions usually applied

to new drugs including research, demonstrations of therapeutic effects, and controlled

outcome studies (Valenstein, 1986). Another example of malpractice in psychiatry is the

fraudulent “recovered memory” crisis of the 1980s (Klavan, 2020).

Detransition

Detransitioning is a problem, ignored by most researchers, concerning those who

are dissatisfied with the decision to transform their body (detransitioners) with sex

reassignment surgery who are angry and feel they have been left “mutilated and in limbo

between neither wholly male nor female” (Hakeem, 2008) and those who are interrupting

the process by ceasing hormones, generally without medical supervision. This has created

a secondary crisis of detransitioners in need of specialized medical and psychological

care.

Detransitioners have reported experiencing regret regarding irreversible physical

damage, surgical complications, postoperative pain, unsupportive family members,

stigma, and lack of social support from the transgender community (Gribble et al., 2023;
 53

Jorgensen, 2023; MacKinnon et al., 2022). Some report feeling uncomfortable with the

changes made to their bodies causing a new form of gender dysphoria (Pullen Sansfacon

et al., 2023). Some blame the physician for prescribing gender transition as the only

documented cure, and minimizing possible adverse effects and medical complications,

coupled with “perfunctory informed consent” (Block, 2023; Entwistle, 2021; Jorgensen,

2023). This leaves the detransitioning survivors with no guidelines of best practices for

clinicians to follow, no recommendations for safely stopping hormone therapies, and no

advice regarding their medical and psychological treatment (Jorgensen, 2023).

Turban et al. (2021) argued that external factors (unsupportive social

environments); such as pressure from spouse, family, friends, and employer, and

discrimination are the main causes of detransition. Turban et al. (2022) believed that

detransition has been politicized and used as evidence to criminalize gender affirmative

care. Furthermore, the narrative of transgender advocates is that most detransitioners, if

given time, will retransition. In contrast, Vandenbussche (2021) found that more common

reasons for detransitioning were the realization that transition did not alleviate their

dysphoria, subsequent health concerns, and, eventually, alternatives were found to deal

with the gender dysphoria. Not only did affirmative care not reduce the symptoms of

mental distress but may have exacerbated them. Similar results have shown that

detransitioners believed providers paid specific attention to gender dysphoria despite the

co-existence of other conditions causing psychiatric distress – “diagnostic

overshadowing” (Gould et al., 2023).

Much of the research ignores the (possibly lifetime) consequences of medical

intervention to treat gender dysphoria such as sterility, loss of breasts, damaged genitals,
 54

hair and voice changes, and lifelong dependence upon hormone medication (Cohn, 2023).

Many participants in a survey of 100 detransitioners (Littman, 2021) believed they did

not receive an adequate evaluation, and more than half stated that the counseling they

received was overly positive regarding the benefits of transitioning without sufficiently

apprising them of the risks. One strength of the study (Littman, 2021) was the large

number of participants, indicating that the population of detransitioners is unknown, and

likely, underestimated. Some detransitioners have reported not being offered alternative

solutions, and not being properly informed of negative health implications resulting in

pressure and coercion to transition (Entwistle, 2021; Gribble et al., 2023; Littman, 2021;

Pullen Sansfacon et al., 2023; Vanderbussche, 2022) and forced into a “rigid model of

transition” (Vanderbussche, 2022, p. 1609).

A study of 78 detransitioners (18-33 years old), residing in the United States, who

identified as transgender for a minimum of 6 months (average was 5 years) and

detransitioned at least 6 months prior to participating, was conducted by Littman et al.

(2022). It included a survey of 13 psychiatric diagnoses the individuals may have

received before identifying as gender dysphoric, and findings showed high rates of

anxiety (>60%) and depression (>62%) prior to gender dysphoria. The outcomes related

to self-harm were notable: 71% self-harmed before gender transition, 64% during the

transition, and 23% after ceasing to identify as transgender. High levels of previous

diagnoses of mental problems (90% of participants) pre-dated gender dysphoria.

Participants reported marked psychological improvement after detransitioning and

cited lack of improvement of gender dysphoria as one of the main reasons for

detransitioning, not external reasons such as family rejection, peer pressure, transphobia,
 55

or religious beliefs. The sample population had invested a great deal of time, effort, and

medical measures in their transition before deciding to detransition (Littman et al., 2022),

suggesting sufficient exploration of preexisting psychological conditions did not occur

(Littman, 2021; Pullen Sansfacon et al., 2023; Respaut et al., 2022; Sanders et al., 2023;

Vanderbussche, 2022).

Research, for the most part, has overlooked detransitioners and their unmet needs;

there are no clinical guidelines for physicians, and scientific evidence is scarce

(MacKinnon et al., 2023; Pullen Sansfacon et al., 2023). Detransitioners have reported

feeling betrayed by medical professionals and either stop seeing physicians or avoid

health care due to physicians not believing them, refusing to help them, or lacking the

clinical knowledge regarding treatment (Hildebrand-Chupp, 2020; Jedrzejewski, 2023;

Jorgensen, 2023; Littman, 2021; MacKinnon et al., 2022; Vanderbussche, 2022).

Detransitioning can be physically and psychologically challenging, and medical research

should improve clinical protocols to treat those stopping cross-sex hormones (some “cold

turkey” with no medical supervision) and those requesting surgery to reverse transition

(Eisenberg, 2023; Hildebrand-Chupp, 2020; Jedrzejewski, 2023; Vanderbussche, 2022).

Detransitioners who regret their decisions and those who have experienced

negative transition outcomes are worthy of study, instead of being dismissed or ignored.

Themes related to transition regret are inadequate counseling, surgical complications, and

overestimation of expectations. Many detransitioners were suffering from psychosocial

issues at the time of transition that have now been exacerbated. Detransitioners are an

under-researched, silent, and marginalized population with unique needs and no voice

(Hakeem, 2018a; Exposito-Campos, 2021), and detransitioners face isolation, shame,

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trauma, loss of social support, blame, and harassment from those who supported their

transition, particularly the outright rejection from the LGBT community (Exposito-

Campos, 2021; Marchiano, 2020; Valdes & MacKinnon, 2023; Vanderbussche, 2022).

A 2023 article “How a Few Stories of Regret Fuel the Push to Restrict Gender

Transition Care,” by Maggie Astor, published in the New York Times, claims that only

2% to 13% of individuals who transition to the opposite gender decide to detransition.

Shellenberger’s non-profit organization Environmental Progress fact-checked the article,

revealing the evidence does not support the New York Times’ assertion. Dr. Marci

Bowers, a transgender woman and president of the WPATH, stated “acknowledgment

that de-transition exists to even a minor extent is considered off limits for many in our

community.”

The Role of Social Media and Mainstream Media

Many children learn about the concept of transgender online on sites such as

YouTube and Tumblr, and detransitioners, feeling isolated also turn to social media for

information and advice. There are media reports almost daily regarding “authentic” trans

kids and their brave and proud parents, awarding them special status (Marchiano, 2021).

Other pro-transition websites include Transgender Heaven, Gender Identity

Research and Education Society (GIRES), Mermaids (Biggs, 2022; Entwistle, 2021;

Marchiano, 2021), and Gendered Intelligence which provides gender diversity workshops

regarding recognizing, including, and nurturing transgender young people (Brunskell-

Evans, 2019). These sites represent a safe area for gender-confused children, and the

online participants become their replacement family and community (Jelsma, 2022).

Children binge on videos by transgender YouTubers showing girls how to bind their
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chests and “pack” in order to pass as males and are fed misinformation regarding gender

dysphoria (Entwistle, 2021). They are taught narratives to support why they are

transgender so as to be able to repeat them to their parents and clinicians with a sense of

urgency (Littman, 2018; Schwartz, 2021), where their imagined gender identity is

validated without question (Littman, 2020). More than one psychiatrist mentioned

noticing a “shared identity” wherein a number of young people shared identical accounts

of their childhood probably obtained from online coaching (Kaltiala-Heino, 2018:

Withers, 2020). The Internet is promising children a “scientific” path, with new

technology, to bodily metamorphosis, and it has been adopted as the primary intervention

instead of psychoanalysis (Schwartz, 2021).

Unfortunately, the topic has become an international phenomenon constantly

discussed and endorsed not only on social media but also on mainstream media. It is

politicized and treated as a fashion statement. “The media has proactively, if not sagely,

termed the controversies about gender transition as a culture war” (Levine, 2021, p.

3527).

It is political ideology that drives the hypothesis of transgenderism and the

endorsement of gender affirmative treatment as the only acceptable solution, shutting

down any discussion or debate with the threat of “transphobia” (Evans, 2020).

Transgender activists control the medical community, the media, and education,

promoting their opinions as facts resulting in a conflict between faith and religion that is

“reality and science on one side and, on the other, dark forces of conservative

Christianity” (Adams, 2017, p. 146).

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The wish to transition is part of a social contagion, similar to anorexia, of

individuals with an “innate vulnerability” (Watt, 2019, p. 16) regarding trans-affirming

narratives online (Littman, 2018). Many individuals have reported being deceived into

transitioning, believing it would change them into someone else, after being subjected to

trans ideology. Detransitioners have reported feeling “inauthentic” and fearing the

hostility of people who may feel deceived after being misled by the convincing online

trans ideology content (Sanders et al., 2023).

Videos of young transitioners documenting the transition process exist on

YouTube and these “brave” individuals “become something special and unique”

(Marchiano, 2021, p. 354) and their parents are seen as heroic. The transgender condition

is glamorized as part of a progressive social movement and has become, as Jung wrote, a

“psychic epidemic” (p. 345).

An online survey (Stella, 2016c) conducted on Tumblr by a detransitioned

woman, and open for two weeks, was completed by more than 200 women. The findings

showed that 64.5% of the detransitioned women reported that their gender dysphoria

improved after detransitioning, Remarkably, 67.8% felt they were not given adequate

counselling and information before transitioning, and 65% received no therapy or

counseling.

The significance and proliferation of social media has increased the risk of

psychopathology in children. In addition to transgender ideology, the increased use of

social media is related to the rise in adolescent mood-disorders, self-harm, and suicide

(Haltigan et al., 2023). The most notable social media networks associated with this

phenomenon, are Tumblr, Instagram, and TikTok. Instagram promotes non-suicidal self-
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injury (NSSI). Tumblr, founded in 2007, originally targeted outcasts, provided

camaraderie, and became a place to fantasize by creating online identities. Accounts

promoting eating disorders, self-mutilation, and suicide were popular until they were

banned by Tumblr in 2012 (Haltigan et al., 2023). TikTok, launched in 2018,

accumulated approximately one billion followers by 2021. It has received recent scrutiny

as a “potential conduit” for mental disorders (Haltigan et al., 2023) and has been

characterized as a “sick-role subculture” (Harness & Getzen, 2022). Muller-Vahl et al.

(2021) researched a form of “mass sociologic illness” (MSI) also known as “mass

psychogenic illness” (MPI) that is spread solely by social media which they more

specifically named “mass social media-induced illness” (MSMI). Clinics in several

countries noticed a high number of adolescents presenting with Tourette-like symptoms;

however, all patients presented with almost identical movements and vocalizations

following the release on social media (YouTube, TikTok, and Instagram) of videos

(2019) showing people who claimed to be suffering from Tourette syndrome. The

phenomenon of platforms such as TikTok is understudied and their use poses challenges

for mental health clinicians when interpreting symptoms as “genuine” or manufactured

(Harness & Getzen, 2022).

Littman (2018) collected data from 256 parents regarding gender dysphoria in

their children (adolescents and young adults). The findings provided detailed information

regarding a new phenomenon – rapid-onset gender dysphoria (ROGD). ROGD is gender

dysphoria that appeared suddenly either during or after puberty (considered late-onset),

and happened in “peer clusters,” mostly among females. This subcategory of gender

dysphoria occurred following excessive use of social media, specifically Tumblr and
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YouTube videos of transitioners. Parents reported their children’s announcement of

transgender identity occurred after increased exposure to social media, similar to anorexia

nervosa, and encouraged by positive reinforcement by peers. Demographic changes

included the substantial increase in the number of females wishing to transition into

males (Littman, 2018).

In her book Irreversible Damage: The Transgender Craze Seducing Our

Daughters (2020), Abigail Shrier stated this is the way anorexia and bulimia are spread

when adolescent girls, dissatisfied with their bodies, commiserate online. Moreover, the

“influencers” on social media advise teenage girls (1) if they “think” they are trans, they

“are”; (2) they do not need to be certain to start taking hormones; (3) if their parents love

them, they would be supportive; (4) they can be “genderfluid” and reserve the right to

change their mind.

Popular sites like Reddit and Tumblr not only convince young people that

nonspecific symptoms are probably gender dysphoria, but also instruct them how to

deceive parents and clinicians in order to obtain cross-sex hormones. The majority of

parents believed their child was using language learned online because it was not the way

the child normally spoke, sounded memorized, and “the threat of suicide was huge

leverage” (Littman, 2018, p. 21). Parents who took their children to a clinician

complained that the child’s mental health was not assessed, making them doubt the

competence and professionalism of the healthcare provider. Parents also described being

ignored regarding their concerns because clinicians were eager to begin gender-affirming

treatment. Recently, clinicians have reported seeing more females, suffering from ROGD

in their practice (Littman, 2018).

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An important and visible online event occurred when Amazon banned Ryan

Anderson’s book: When Harry Became Sally: Responding to the Transgender Moment;

thereby discouraging future writers and publishers from writing and publishing works

that may offend the supporters of transgender ideology (Blake, 2021). Ryan Anderson

responded that “Biology is not bigotry.” In an article in the Wall Street Journal, Amazon

stated the book violated Amazon's content guidelines regarding “offensive content” such

as hate speech, abuse or sexual exploitation of children, pornography, glorifying rape or

pedophilia, and terrorism (Wall Street Journal, 2021). Book banning may be one of the

ways of powerful supporters to silence the dissension and celebrate the ideology.

Mainstream media cannot resist a story about a brave transgender child: however,

in 2021, CBS aired a 60 Minutes broadcast regarding detransitioners, which included

interviews with detransitioners and doctors that was empathetic toward detransitioning.

YouTube deleted the complete broadcast from their platform; however, there was a

second video with Leslie Stahl (60 Minutes Overtime) explaining that the purpose of the

show was to discuss transgender healthcare, not detransitioning. The “damage control”

video was the result of pushback from transgender activists. One of the physicians

interviewed by Leslie Stahl was Dr. Marci Bowers, who has performed more than 2000

sex reassignment surgeries and who performed surgery on Jazz Jennings, the young boy

whose journey to become a girl (beginning at age 5) is the focus of a television reality

series I Am Jazz. In the series, there is an episode dealing with her third “bottom” surgery

(vaginoplasty) because of severe complications resulting from the two preceding

surgeries. During an on-air discussion, there was a public admission by the physicians,

(one of whom was Dr. Bowers), that this was innovative (experimental) surgery with no
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predictable results, confirming that doctors are experimenting with children and learning

as they go.

In January 2017, National Geographic magazine published a single-topic issue

“Gender Revolution” complete with a downloadable “Discussion Guide” to teach the

basics of this new knowledge. This was followed by (February 2017) a two-hour

documentary – Gender Revolution: A Journey with Katie Couric to show that transgender

is not a new thing; the “repression of gender freedom was the work of colonization and

Christianity” (Matthews, 2020).

Effect on Education

Calls for tolerance and dignified acceptance of transgender individuals have

morphed into aggressive methods to control society. They demand they be addressed as

they, their, them, and by the non-binary pronouns such as ze, sie, hir, co, and ey, (a policy

that has been adopted in schools), sometimes under penalty of law. People have lost their

jobs over this issue, resulting in lawsuits. In New York City, “misgendering” can result in

a fine of up to $250,000 (Grabowski, 2022).

Schools believe they are “safe havens” for transgender children by educating

toddlers in gender diversity, without parental knowledge, and inviting drag queens to read

sexual diverse stories to children at Drag Queen Story Hour ([Link]),

recently causing a demonstration outside a Public Library in Brooklyn. The Human

Rights Campaign’s efforts to “queer” schools have enlisted corporations like Wells Fargo

to support the Welcoming Schools plan, which provides gender identity curricula to

schools beginning with kindergarten (Kao, 2021).

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Schools, acting in loco parentis, address children by their “preferred” pronouns,

demand faculty and their classmates do the same, and allow them to use restrooms of

their gender identity, not their birth gender. Transgender children are given time off from

class to receive transitioning drugs and hormones against the wishes of their parents

(Shrier, 2020). These misguided accommodations should not occur, especially in faith-

based schools. The objective reality of male and female has become subjective belief

(Bradley, 2021).

The educational system in the U.S. is wholeheartedly contributing to the

transgender phenomenon, beginning with the radicalization of the teachers’ unions.

California, Illinois, New Jersey, and Colorado have mandatory LGBTQ classes from

which parents cannot opt out their children. (They can, however, opt out of sex-ed

classes.) The ACLU, Planned Parenthood, and the Gay and Lesbian Independent School

Teachers Union supply materials to be taught in classes. Biologically nonsensical

gibberish (“genderbread person”) is taught to kindergarteners, and transgender

adolescents are revered as celebrities in high school. Genderbread Person has morphed

into the mythical creature of the ‘Gender Unicorn’ in children’s popular culture, and is

featured in teaching and learning resources (Davies-Arai, 2020). Children are being

educated in the principles of queer theory, an incomprehensible construct that transgender

lobbyists have translated into child-friendly language and graphics.

Teachers and others in authority are creating gender confusion. On the website of

the Michigan Department of Education, there are detailed instructions for how teachers

should discuss sexual orientation with their students and how students can keep this

activity from their parents (Arnn, 2022). The children have become part of a social
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engineering project, overseen in America by the administrative state. The educational

process is dominated by “stakeholders” – those who have a financial or political interest

in what is taught. “Teachers, for example, are required to learn a whole new lexicon of

words and ideological concepts based on the reordering of reality according to queer

theory” (Davies-Arai, 2020, p. 155).

Unfortunate Consequences

The bias regarding those who question the pervasive gender affirming care and

the unhesitating acceptance of perceived gender is obvious in the list of those who have

been denigrated, fired, or forced to retire. Anecdotal evidence of botched surgeries, lack

of counseling, and dubious informed consent are ignored. Individuals report having their

lives ruined, and those who attempt to disclose this information are vilified.

The United States Professional Association for Transgender Health (USPATH),

sponsored by the WPATH, held a conference in Los Angeles in 2017 to affirm their

dedication to transgender health, discuss SOC-8, and validate transgender obsession as

“normal.” The conference descended into chaos initiated by trans activists – “blind

believers and wounded followers” – who disrupted the first talk by Kenneth Zucker, a

psychologist with several years’ experience treating gender dysphoria, who was

scheduled to speak on several panels (Hasson, 2017). The protestors accused the WPATH

of causing violence and inaccessibility because hotel security was called to quell the

disruption. Dr. Zucker, the lone cautionary voice regarding the treatment of children, was

eliminated from the program, followed by an apology from the WPATH to the

transgender community. More demands followed. The trans activists demanded that the

WPATH hire transgender individuals as consultants and give them input into conferences
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and seats on WPATH scientific committees. The trans activists’ rage was successful, and

the results paint a disturbing picture of the medical community and destroying all

credibility of the WPATH (Hasson, 2017). Bias continues to dominate the WPATH.

Jamison Green, a transgender male, served as president from 2014 to 2016, and Dr. Marci

Bowers, a transgender woman is the current president of the WPATH.

Dr. Kenneth Zucker led the clinic at the Toronto-based Centre for Addiction and

Mental Health (CAMH) for 35 years, participated in writing the definition of gender

dysphoria for the DSM-5, and contributed to the WPATH’s Standards of Care. After an

external review, in 2015, the clinic was closed, and Dr. Zucker was dismissed, charged

with practicing conversion therapy on transgender youth (Hall, 2021). Defending himself,

Dr. Zucker, a highly respected expert on gender dysphoria, and no longer a proponent of

affirmative care, said the clinic actively tried to encourage young patients to accept their

biological sex. "The term has been inappropriately expropriated from the way the term

was used to critique clinicians who were treating mainly adult homosexual men who

didn't want to be gay — and it was also used coercively in some instances" (Dr. Zucker,

The Canadian Press). In 2018, after 500 mental health professionals signed an open letter

to CAMH regarding his treatment the CAMH apologized to Kenneth Zucker and agreed

to pay him more than $500,000 (Shrier, 2020).

In 2019, Kirsty Entwistle, a clinician working at the Gender Identity Development

Service (GIDS) in Leeds, operated by the Tavistock Centre, wrote an open letter to the

service director outlining her “grave concerns” regarding the dishonesty of labeling

puberty blockers as “completely” reversible, when, in reality, the effects of the drugs

were not known. She was labeled a whistleblower and “the enemy within.”
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Marcus Evans, a psychologist employed by GIDS, and governor on the Board of

Tavistock, was particularly worried about the method of treating vulnerable young

people. In 2019, after 35 years, he resigned from the Tavistock board of governors (Soh,

2020) in protest over the Trust’s failure to address the serious concerns that Dr. Bell and

some parents had raised that children were being “fast tracked” to gender transition.

After the resignation of Marcus Evans, a controversial report written by David

Bell regarding GIDS was leaked to the press. He worked as a senior consultant and senior

doctor at Tavistock for more than 25 years, in charge of its scientific program, and a staff

governor of the trust (elected in 2018). Dr. Bell, a psychiatrist and psychoanalyst, wrote a

report (he termed “a matter of conscience”) that he was not permitted to send to the

Council of Governors, which necessitated his obtaining legal counsel. The report, based

on the concerns of 10 GIDS staff members, was similar to the letter from concerned

parents regarding inadequate clinical assessments and early medical interventions (Evans,

2020). In November 2018, Bell received two letters threatening disciplinary action,

accusing him of “bullying” and fictionalizing case studies, and questioning his

credentials. His report cited the high percentage of gender dysphoric patients who also

suffered from trauma, autism, sexual abuse, and ADD (Evans, 2020). In 2020,

disciplinary procedures were begun against Dr. Bell for being a whistleblower, and in

January 2021 he retired.

Lisa Littman, trained in obstetrics and gynecology, introduced the hypothesis of

rapid onset gender dysphoria (ROGD) in her 2018 article published on PLoS ONE. The

article sparked intense criticism, and trans activists accused her of being biased and

spreading misconceptions about transgender people. PloS ONE conducted a rigorous

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post-publication additional peer review resulting in the methods and findings of the

original study remaining relatively unchanged (Lisa Littman, Quillette interview, 2019).

In 2018, Dr. Harriet Hall, a retired family physician and Air Force Colonel, wrote

a review of Lisa Littman’s research study of rapid onset gender dysphoria (ROGD) and

was labeled “transphobic.” Dr. Hall’s book review of Abigail Shirer’s’ book –

Irreversible Damage: The Transgender Craze Seducing Our Daughters, (Shrier, 2020) –

was retracted by the Science-Based Medicine website ([Link]).

Abigail Shrier’s book Irreversible Damage: The Transgender Craze Seducing Our

Daughters was characterized as “anti-trans,” banned by Target, and Amazon suspended

advertising. Activists accused Shrier of being a bully and a bigot, and she was fired from

her job with the Rhode Island Department of Health (Hall, 2021).

Gender-neutral spaces (restrooms, changing rooms, shelters, and prisons) are

dangerous for women despite the complaints of the progressives regarding

discrimination. Gender-neutral spaces provide opportunities for sex offenders to gain

access to women because rapists are allowed to record their gender as (trans) female.

Women have been exposed to convicted sex offenders in shelters (Toronto), and male-

born rapists and those convicted of violent crimes are housed in female prisons resulting

in the sexual assault of female inmates (United Kingdom) (Soh, 2020). President Biden

(2019) believes sexual identity in prison should be what the inmate declares it to be, not

the prison (Soh, 2020). The double-standard and hypocrisy are apparent in allowing

males, identifying as females, to compete in sports against women, despite the difference

in height, upper body strength, wrist and hand size, muscle mass, lung capacity, and bone

density (p. 212).

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Sexual orientation and gender identity are becoming protected classes under the

protection of the revised Civil Rights Act (the Equality Act, currently before the Senate).

The federal bill passed in the House of Representatives on February 25, 2021, and,

among other things, it would “prohibit an individual from being denied access to a shared

facility, including a restroom, a locker room, and a dressing room, which is in accordance

with the individual’s gender identity” thereby eliminating any distinction between

biological men and women.

Gender ideology is ruining families, by questioning a parent’s right to deny

affirmative medical interventions for their children. Transgender activists have sued

hospitals for declining to perform hysterectomies on healthy women. Judges have

removed children from the custody of parents who opposed hormonal interventions

(Moschella, 2021).

Biblical Foundations of the Study

There exists a clash between Judeo-Christian and secular progressive worldviews,

and science has lost its integrity by enforcing conclusions, not supported by science, and

becoming subordinated to advocacy that “shuts down debate by vilifying those who do

not share the approved view of the moment” (Adams, 2017, p. 141). Except for “sins of

the flesh” (e.g., fornication, sodomy), scripture does not directly address gender-related

problems; however, there are references to creation and the sanctity of the body in the

Bible. The human body, male or female, is a gift from God (Daly, 2016) and a reminder

of identity in Christ. In 1 Corinthians (6:15), Paul writes “Know you not that your bodies

are the members of Christ?” (Douay-Rheims Holy Bible, 5th Printing, 2009). Language

referring to the body of Christ is prominent in Paul’s theology and implies the body is of
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moral significance. “Now you are the body of Christ and members of member” (Douay-

Rheims Holy Bible, 5th Printing, 2009, 1 Corinthians, 12:27). In this vein, Christians are

encouraged to reject practices that treat the psycho-physical body as able to be

manipulated and separated from the self (Song, 2007). “For no man ever hated his own

flesh, but nourisheth and cherisheth it, as also Christ doth the church” (Douay-Rheims

Holy Bible, 5th Printing, 2009, Ephesians, 5:39).

Todd T. W. Daly, a Christian ethicist, asserts that in Christian anthropology the

body is linked to the soul to form human identity, and believes there is neither a

psychological justification nor a social justification for gender reassignment surgery

affecting the core identity created by God (Roy, 2020). The National Catholic Bioethics

Center (NCBC) warns against the “gender ideology movement” and its falsehoods, re-

affirming that the Catholic anthropological position is that a human being is a body-soul

unity; and neither hormone therapy nor genital modification will change God-given

identity, rendering surgery futile (Jones, 2018). The NCBC views gender transition as

morally harmful and an act against God that prevents human flourishing – attempting to

“alter what is unalterable” – and to establish a false identity. This reduces sex to an

option, not an immutable biological fact. “And God created him to his own image; to the

image of God he created him. Male and female he created them” (Douay-Rheims Holy

Bible, 5th Printing, 2009, Genesis 1:27). In 2019, the Vatican Congregation for Catholic

Education declared “Gender ideology denies the difference and reciprocity in nature of a

man and a woman and envisages a society without sexual differences, thereby

eliminating the anthropological basis of the family” (Bradley, 2021).

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In Summa Theologica, Thomas Aquinas (1225-1274) argued that a healthy bodily

member should not be maimed for the benefit of the whole person, known as the

“principle of totality” (Jones, 2018; Kaczor, 2018; Song, 2013). Sex reassignment

surgery involves removing healthy organs and tissue in an attempt to relieve

psychological distress without scientific basis, and “violates the body-soul union,

disregards the principle of totality and integrity, and debases the dignity of humanity”

(Robles, 2021, p. 259). If the principle of totality does not justify sex reassignment

surgery, which is the removal of healthy reproductive organs, then the procedure would

be considered mutilation. Mutilation can be defined as the deliberate destruction of

biological function or it is the immediate consequence of surgery (Jones, 2018;

Grabowski, 2022; Kaczor, 2018). Aside from mutilation, bioethicists have argued that the

possible psychological benefits of gender reassignment surgery “do not compensate for

the loss of bodily integrity” (Kaczor, 2018, p. 738).

Christians believe in the goodness of creation, especially the human body, and

gender reassignment surgery challenges Christian ethics (Daly, 2016) and rejects the

Christian doctrine that man is created in God’s image (imago Dei) body and soul.

Christians regard nature as a “gracious gift of the Creator, not as a problem to be

overcome” (O’Donovan, 1983, p. 142). Christian bioethicists believe that human life is

sacred and valuable and surgical procedures must uphold the normative aspects of the

human body, have a therapeutic intent, and preserve God’s design; otherwise, it is

regarded as an affront to God and a rejection of his creation (Engelhardt, 2000). “Or

know you not that your body is the temple of the Holy Ghost, who is in you, whom you

have from God; and you are not your own? For you are bought with a great price. Glorify
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and bear God in your body” (Douay-Rheims Holy Bible, 5th Printing, 2009, 1 Corinthians,

6:19-20).

Surgical alterations may change an individual outwardly to be able to pass as the

opposite sex, but cannot change one’s immutable biological sex (Labuschagne, 2020;

Roy, 2020; Withers, 2020). “Who changed the truth of God into a lie and worshipped and

served the creature rather than the Creator who is blessed forever. Amen” (Douay-Rheims

Holy Bible, 5th Printing, 2009, Romans 1:25). Non-invasive talk therapy (psychotherapy)

can be used to help relieve children of their distress. Christ promises relief from suffering

“And he said to me: My grace is sufficient for thee: for power is made perfect in

infirmity” (Douay-Rheims Holy Bible, 5th Printing, 2009, 2 Corinthians, 12:9).

Due to the misinformation proliferated in the media, most people believe that sex

is “assigned” at birth and gender is socially constructed, a scientifically unsubstantiated

theory supported by the American Psychological Association (APA) (D’Angelo, 2020;

Hruz, 2020; Labuschagne, 2021) and other significant institutions. This defines gender

“as a moveable point along a spectrum that is fluid and changeable” (Feser, 2020, p. 2), a

definition that is contrary to Christianity and challenges the fundamental meaning of life

(Lawler, 2023). Pope Benedict XVI responded to the gender theory in a speech on

December 23, 2008 (Feser, 2020, p. 2):

What is often expressed and understood by the term ‘gender’

ultimately ends up being man’s attempt at self-emancipation

from creation and the Creator. Man wants to be his own master,

and alone – always and exclusively – to determine everything

that concerns him. Yet in this way he lives in opposition to the

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truth, in opposition to the Creator Spirit.

Modern philosophers argue that happiness can be attained without seeking “the

things that are above” (Douay-Rheims Holy Bible, 5th Printing, 2009, Colossians 3:1),

making religion nonessential. Augustine taught that Christianity is encapsulated in the

verse sursum corda (lift up your hearts) and is more than the flesh – “For the flesh lusteth

against the spirit; and the spirit against the flesh” (Douay-Rheims Holy Bible, 5th Printing,

2009, Galatians 5:17). Augustine argued that the life lived totally for the body is not

worth living (Gonzalez, 2023).

Modern society rejects the traditional view of binary gender (innate and

immutable) rooted in creation rendering research on biblical manhood and womanhood

important; however, in a world dominated by social media and opinion there is no need

for evidence (Jelsma, 2022; Labuschagne, 2021).

The traditional view of gender binary is rejected in modern times.

That is why research on biblical manhood and womanhood is important,

and why studying the effects of a broken society on humankind is

imperative. Single-parent families and same-sex-parent families are

on the rise – with destructive consequences (Labuschagne, 2021, p. 9).

Proponents of gender ideology believe the ideology is based on scientific

knowledge; however, science has been subordinated to advocacy, the term “conservative”

assumes bias, and morally conservative Christian groups have been labelled “hate

groups” (Adams, 2017). Transgenderism has created a conflict between science

(disinterested researchers) and religion (fear-mongering peddlers of Bible quotations) (p.

146). Christianity, in its quest for the truth, sees no conflict between faith and reason
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(Grabowski, 2022), indicated in the words of Pope John Paul II (1998) but as “two wings

on which the human spirit rises to the contemplation of truth.”

Gender ideology attacks the foundations of Christian anthropology and rejects the

body, marriage, human fertility, and the doctrine of creation. It has been referred to as

“the culture of death” by Pope John Paul II (Milner, 2022), in which moral "crime” such

as abortion and euthanasia are viewed as individual rights. In Evangelium Vitae (1995),

he stated, “Choices once unanimously considered criminal and rejected by the common

moral sense are gradually becoming socially acceptable.” Gender ideology is a modern

expression of Gnosticism, a heresy that defines salvation as secular ideas combined with

technology, promising happiness through self-expression. “There is no human nature to

realize just as there is no God who created it” (Grabowski, 2022, p. 117). Trans activists

are not interested in tolerance and coexistence and consider the Christian view of sex and

the body as hateful, resulting in political and social “culture wars.” Paul warns the

Ephesians, “Put you on the armor of God, that you may be able to stand against the

deceits of the devil. For our wrestling is not against flesh and blood; but against

principalities and powers, against the rulers of the world of this darkness, against the

spirits of wickedness in the high places” (Douay-Rheims Holy Bible, 5th Printing, 2009,

Ephesians 6:11-12).

Summary

Childhood gender dysphoria, once so rare, is now an epidemic, partly due to the

widespread availability of affirmative care treatment and easy access to puberty blockers,

cross-sex hormones, and sex reassignment surgery, indicating the medical community

may be creating transgender children. The failure to explore the possible comorbid
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mental health conditions of self-identified transgender children has resulted in a rush to

medically transform children’s bodies (GAT) in a misguided effort to solve all their

problems. Unnecessary, permanent physical changes without addressing psychological

issues and lacking adequate scientific justification (Withers, 2020) is a major concern.

The literature does not adequately address sterilization, an unintended consequence

(Withers, 2020) of trans-affirmative medicine, nor does it look too hard at long-term

negative effects by conducting longitudinal studies. While hormones and plastic surgery

can change the external appearance of a person’s body, it is physically impossible to

change one’s biological sex. Affirmative care gives false hope to those suffering from

gender dysphoria (Moschella, 2021) or for those who merely wish to change gender.

Enthusiastic physicians and theorists treating vulnerable patients, in the current cultural

and politicized environment, results in a contagion-like spread of “perceived” gender

dysphoria that presents as vague symptoms that cannot be objectively substantiated

(Marchiano, 2021).

Recent literature emphasizes affirming the patient’s self-diagnosis and supports

transitioning while ignoring detransitioning. The topic has become an international

phenomenon, endorsed not only on social media but also on mainstream media. “The

media has proactively, if not sagely, termed the controversies about gender transition as a

culture war” (Levine, 2021, p. 3527). The proponents of gender ideology, with its

powerful supporters, know how to shape public perception by condemning the use of the

term “sodomy,” and sanitizing “queerness,” thus holding speech hostage and silencing

dissention (Blake, 2021; Lawler, 2023).

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The current surge in cases of gender dysphoria is dominated by the presentation

of adolescent-onset, often with comorbidities (Cohn, 2023). Individuals decide to

detransition for diverse reasons: serious consequences from medical interventions

including sterility, unnecessary mastectomy, harmed genitals, lifelong dependence on

medication, regret, grief, depression, and social consequences such as rejection, lack of

support, loss of friends and family, and self-blame. Linking detransitioners to supportive

peer groups may reduce distress and feelings of isolation (Butler & Hutchinson, 2020).

The recently published Standards of Care (SOC 8) of the WPATH contains

recommendations for clinicians regarding gender transition, including newly added

chapters on the treatment of non-binary individuals and eunuchs; however, despite

requests from professionals to include a chapter devoted to detransition, this did not

occur. The increasing number of detransitioners shows that their quality of life is not

improved, after transitioning. “Attempts to align the body with misperceptions will never

accomplish the intent because the genetic consistency of every cell remains, and

functional anatomy of the opposite sex cannot truly be surgically constructed” (Robles,

2021, p. 269).

Besides perpetuating the lack of recommended clinical guidelines for healthcare

professionals regarding the unique experiences and needs of the detransitioners, the

WPATH is not acknowledging the phenomenon and is contributing to the invalidation of

this population (Exposito-Campos et al., 2023). Marci Bowers, MD, the president of the

WPATH, is openly transgender, as are many of the high-ranking medical professionals

who support gender transition. The Cass Review, written by Hilary Cass, President of the

Royal College of Pediatrics and Child Health, is responsible for England’s National
 76

Healthcare Service’s (NHS) decision to close GIDS/Tavistock, and is a vote of “no-

confidence” in the WPATH. GIDS/Tavistock closed its doors on March 31, 2024.

Public health authorities in Finland’s Council for Choices in Health Care

(COHERE), Sweden’s National Board of Health and Welfare (Socialstyrelsen), and

England’s NHS recognize the lack of scientific evidence related to pediatric gender

transition. While Finland, Sweden, and England are changing their approach to gender

affirmative care by taking a more conservative stance regarding children, the American

medical establishment is staying the course (Abbruzzese et al., 2023). Gender affirmation

is now considered part of “holistic care” and the American Medical Association (AMA),

(2022) insists “the science is settled” (p. 674).

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CHAPTER 3: RESEARCH METHOD

Overview

“Qualitative research is conducted when little is known about a phenomenon or

the present knowledge or theories about it may be biased” (Cypress, 2019, p. 264).

Qualitative data may include a wide range of materials, such as conversations, images,

videos, observations, and interviews, and diverse methods of research and analysis. The

phenomenology approach is used for this research wherein the researcher avoids

(suspends) all preconceived ideas and beliefs regarding the phenomenon to best

appreciate the lived experiences of the participants. The researcher identifies patterns and

reduces the experiences to a common meaning or concept (essence).

The process of thematic analysis, involving applying codes, formulating

categories, and clustering categories into themes, is an inductive process that reveals

patterns that emerge from the data. Meanings are not imposed on data before analysis to

agree with a theory, concept, or hypothesis. Regarding detransition, not having firsthand

knowledge of the topic, data are not analyzed based on personal feelings but grouped into

meaningful units. Significant statements of the participants help to develop a structural

description of how the phenomenon was experienced.

The question(s) directing the phenomenological study is/are critical and must

contain clarity and focus and the data must reflect experience. Vivid statements, with

concrete and experiential detail provide the essence of “living through” the experience

and add substance to the findings (Creswell & Poth, 2018). The research questions

inquire about the lived experiences of detransitioners regarding medical support and

psychological support concerning the decision to detransition and if the healthcare

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community shamed them for their decision. In this method of obtaining data, participants

are not asked direct questions. Content from the posts provides information regarding the

topics which also include past or current support from family and peers, and how

important social media is regarding support and advice.

Research Questions

RQ1: What are the lived experiences of detransitioners regarding medical and

psychological support and are they made to feel ashamed for detransitioning?

RQ 2: Do detransitioned individuals receive support from family and friends for their

decision to detransition?

RQ 3: How much do the detransitioners depend on social media for camaraderie,

support, information, and advice?

Research Design

Phenomenological Approach

The outcomes and experiences of detransitioners are variables that cannot be

easily measured or quantifiable and would be best served by qualitative research using a

phenomenological approach. This approach, with its philosophical origins, describes the

lived experiences of individuals regarding a phenomenon or concept, specifically what

they experienced and how they experienced it (Creswell& Poth, 2018).

The phenomenological approach focuses on experiences regarding a phenomenon

and integrates the results into an in-depth description of the phenomenon (Cresswell &

Poth, 2018). This represents the best approach for a proposal to study the phenomenon of

the recent rapid rise in self-diagnosed transgender children and adolescents but also the
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increase in the number of young adults regretting their decision and detransitioning to

their birth gender.

Focus

The narrow focus of this paper concerns detransitioners who medically

transitioned as children or adolescents, who later question their ability to have provided

informed consent and may have been coerced into believing they were transgender.

Detransitioners are a segment of the population, silently suffering from physical problems

and mental health issues that, sadly, are of their own doing. “Bracketing” (epoche)

enables researchers to gain a fresh perspective on the phenomenon being examined. As

described by Cresswell and Poth (2018), “investigators set aside their own experiences”

(p. 78). Having no firsthand experience with the phenomenon of childhood gender

dysphoria, transition, and detransition, background information comes from a review of

the literature, current political policies, and healthcare organizations.

Purposive sampling, which selects participants who meet pre-selected criteria,

best functions as a means to address the research questions. It also eliminates the

quantitative research problem of meeting a required number of participants and the

dilemma of generalizability. The sample consists of those who experienced or who are

experiencing detransition by ceasing hormone therapy (currently or in the past) or are

undergoing reconstructive surgery (now, in the past, or are considering it) and are a

minimum of 18 years old. Although Reddit ([Link]) allows posts from

adolescents as young as 13 years old, a condition of becoming a member of the

subreddits that are used as a data source (r/detrains, r/actual_detrans, and r/ask_detrans) is

the individual must be 18 years old.

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The data consist of 200 comments posted between June 2023 and June 2024, not

necessarily from 200 different participants. The three Reddit subcategories are areas

where detransitioners, regardless of where they are in the process, can safely and

anonymously ask questions, respond to questions, or just vent. The three subreddit areas

of Reddit are monitored by moderators, are detransition-friendly, and include rules such

as be tolerant, be civil, and never promote cross-sex hormones or surgery.

Ethical Considerations

Reddit, sometimes referred to as “the front page of the Web” (Reagle, 2023, p. 1),

has become one of the most prominent online platforms with 73.1 million daily active

users (as of March 2024) and more than 100,000 subreddits. Reddit offers anonymity

through the use of pseudonyms and fairly permissive content policies; however, the

smaller the subreddit the more difficult it is to maintain the anonymity of participants.

Some researchers make use of Reddit’s Application Programming Interface (API), which

is free and publicly available to access posts and metadata, or by using Pushshift, a social

media data-collection program that collates data and provides public data dumps

(Proferes et al., 2021). Neither of these applications are used in this paper due to

algorithms that may be able to identify the participants and uncover deleted comments.

Only active comments available on the subreddits are collected (Reagle, 2023).

The comments may be paraphrased and contain only short actual quotes because it is not

difficult to identify sources from long verbatim quotes. Reagle (2023, p. 12), in his study

regarding the use of data from social media sites, states “Again, topic sensitivity, user

vulnerability, venue affordances, and how the data is [sic] used and reported need to be

considered.”
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Collecting data by means of this online venue provides anonymous information in

a broad and general context, consisting of statements from participants regarding their

detransition experiences. It is the next best alternative to collecting data by observation in

a real-world setting to identify significant patterns. The data are publicly available, low-

cost, and naturalistic in textural form (Hookway, 2008). “Observing” reactions and

experiences of this vulnerable population online, without being intrusive, provides

unfiltered and rich data from the voices of the participants because they feel empowered

to react unselfconsciously on a sympathetic, non-judgmental website, where their

comments are confidential and anonymous. As stated in Cypress (2019), “Most

importantly, listen and learn the language and values of the group” (p. 269).

Informed consent is not an issue in this method of data-gathering because the

participants (authors) are not recruited, comments are not solicited, questionnaires are not

completed, and there is no interaction between the participants and the researcher.

Appropriate use of the Internet and maintaining anonymity when posting comments is the

participant’s responsibility as is the knowledge that there is no expectation of privacy on

a public forum. Online data are used for other purposes. It is a well-known fact that many

employers will conduct Internet searches prior to hiring new employees (von Benzon,

2018). The researcher’s responsibility is to be absolutely certain to protect the anonymity

of the participants by eliminating login IDs and other identifiable information, and re-

phrasing the posts when necessary. The method of transforming the data into results

includes coding the information into meaningful units, grouping the units into themes,

and summarizing the themes into a holistic context, followed by a synopsis of the

research findings (Groenewald, 2004).

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Participants

Purposeful sampling of individuals is not a probability sample, but rather an

intentionally selected sample of those who can provide the best information to the

researcher regarding the research problem. Anticipated ethical issues are respect for

individuals (privacy), concern for their welfare (minimize harm), and justice (equitable

treatment). Participants articulate their lived experiences (first-order narratives), and the

researcher must find “…common experiences, themes and the overall essence of the

experience…” (Cresswell & Poth, 2018, p. 183).

Permissions are not needed in this type of data collection as there are no known

risks. All attempts are made to protect the privacy and assure the anonymity of the

participants. This method of online data collection provides anonymity of the participant

to the researcher except for a login ID (which is eliminated along with any information

that, with a little effort, could identify the participant) making it the safest process to

gather data from what is considered a marginalized group. Using a web-based platform is

an efficient method regarding cost and time. Qualitative research involves extensive

detail and interpretation of the particular as opposed to generalization of the information.

Study Procedures

Due to the sensitivity of the topic, participants are not recruited. A few brave

individuals have come forward to testify publicly regarding their negative treatment

(socially and medically); nevertheless, many detransitioners do not publicly admit their

decision to detransition and do not seek professional help (Exposito-Campos et al., 2023).

The data are collected from an empathetic website ([Link]) that protects the

anonymity of those posting messages, by using a login ID. The participants are not
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known to the researcher, and all methods are used to protect their privacy, including

avoiding any information that may identify them. The data-gathering of 200 comments

posted within the last year would be considered unstructured.

The text-based data are coded and delineated into units of meaning. The units are

scrutinized to eliminate redundancy, then clustered into meaningful themes to elicit the

“essence.” Significant topics are separated into general and unique themes (Groenwald,

2004). No software packages are used. A composite summary reflects not only the

common themes but also individual variations.

Anticipated themes are internal reasons for detransitioning, including poor

surgical outcomes, medical problems, depression, regret, no amelioration of gender

dysphoria, discovery of co-morbid psychiatric difficulties, and external reasons such as

family reactions or religion. Nevertheless, categories and themes are not predetermined

or developed from a hypothesis (deductive analysis). Inductive analysis, a strength of

qualitative research, is used. The coding process identifies essential concepts and patterns

gained from data analysis. Codes are condensed into categories, categories reduced to

themes, and themes identify findings (Bingham, 2023).

Instrumentation and Measurement

Data Collection Approach

Data collection approaches for qualitative research are observation, interviews,

and focus groups. Analysis of documents is generally applied as background information

and recorded communication can be used to augment observation. The method of

“observation” in this paper is allowing young adults to express themselves in their own

words. Qualitative methods are effective in identifying intangible factors, such as social
 84

norms, socioeconomic status, gender roles, ethnicity, and religion. “The strength of

qualitative research is its ability to provide complex textual descriptions of how people

experience a given research issue. It provides information about the ‘human’ side of an

issue – that is, the often-contradictory behaviors, beliefs, opinions, emotions, and

relationships of individuals” (Mack, et al., 2005, p. 13).

Data Interpretation

In qualitative studies, data may produce outcomes that were not determined in

advance and may also identify findings that are applicable beyond the immediate

boundaries of the study. Absent quantitative statistics, qualitative research must interpret

the data which requires creative and critical capabilities to decipher meaningful themes

and interpret and make sense of the data (Creswell & Poth, 2018). The data collection

reports how individuals view their experiences differently. Participants’ statements are

used rather than the researcher’s interpretation or generalization of the participants’

communication.

Qualitative research views events and values from the perspective of the

participants being studied and views social phenomena through their eyes, in an

unstructured and open design, possibly producing unexpected issues (Silverman, n.d.).

The “measure” of a phenomenon may encounter values or concepts that are problematic

and not able to be analyzed by statistical logic. Because inductive reasoning is the

mainstay of qualitative research as opposed to deductive reasoning used in quantitative

research, interpreting the collected data is vital to the outcome. Numeric and statistical

data, not generally used in qualitative studies, are easier to analyze; however, the

qualitative researcher must separate “what exists at the broad philosophical level
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(assumptions) and what operates at a more practical level (interpretive frameworks) …”

(Creswell and Poth, 2018, p. 18.). Referring to detransitioning, statistical data may be

vital in a study investigating the number of “detransitioners”; however, this paper

examines the personal experiences of those who have detransitioned.

Purposive Sampling

Purposive sampling identifies participants based on selected criteria without

respect to the size of the sample (Mack, et al., 2005). “Purposive sampling, one of the

most common sampling strategies, groups participants according to preselected criteria

relevant to a particular research question” (p. 16). A large sample population is not as

important in qualitative research as it is in quantitative research where statistics and

generalizability are relevant in supporting a hypothesis. Qualitative research uses a more

flexible, iterative style of eliciting and categorizing responses to questions, or in this case,

comments, and posts. Exploring a phenomenon is not the same as attempting to confirm a

hypothesis. “Qualitative inquiry represents a legitimate mode of social and human

science exploration, without apology or comparisons to quantitative research” (Creswell

& Poth, 2018, p. 6). Phenomenology describes what participants have in common to

develop a composite description and discussion of the essence of the individuals’

experiences.

The sample consists of detransitioners who experienced or who are experiencing

detransition by ceasing hormone therapy (currently or in the past) or undergoing

reconstructive surgery (now, in the past, or are considering it) and are a minimum of 18

years old (required by the subreddits of [Link] used in this study). The

subreddits used are r/detrans, r/actual_detrans, and r/ask_detrans; however, for the
 86

protection of the participants, the specific subreddit is not linked to the posts. The data

consist of 200 comments posted within the last year, not necessarily from 200 different

participants.

Level of Validity (Figure 3)

Testing the validity of a phenomenological study first involves the validity of the

research question(s), articulated in a clear and concise manner. The study should rely on

experientially descriptive accounts, while avoiding personal perceptions, opinions, and

beliefs, and should be properly rooted in primary not secondary data sources (Creswell &

Poth, 2018). Validity standards in qualitative research is a challenging issue due to the

incorporation of rigor, subjectivity, and creativity, while maintaining a scientific process.

Transferability, not generalizability to other populations, is a significant goal of

qualitative research and it can be “threatened by an overemphasis on a scientific method

as opposed to the art and creativity of interpretation” (Whittemore et al., 2001, p. 526).

Validity criteria guards against the researcher creating theories that do not

authentically represent the findings. Attention to specified criteria and claims to

knowledge should be specific, while clearly stating threats to validity, which may include

distortion, bias, and inadequate portrayal of participants. Whittemore et al. (2001) argued

that “…a phenomenological investigation will need to address investigator bias

(explicitness) and an emic perspective (vividness) as well as explicate a very specific

phenomenon in depth (thoroughness)” (p. 529).

Credibility and Authenticity (Figure 4)

Credibility, a goal of qualitative research, is an accurate interpretation of the

meaning of the data reflecting the experiences of the participants in a believable way.
 87

Authenticity, or remaining true to the phenomenon, is linked to credibility. Integrity must

ensure that the unique interpretation of data by the researcher is valid. The investigator

should have a discerning eye for biases, distortion, and conjecture, making a self-critical

attitude imperative (Whittemore et al., 2001). Descriptions of data should be vivid and

faithful without excessive detail. However, creativity in qualitative research allows for

imaginative ways of organizing and analyzing data while remaining grounded in the

scientific process.

Figure 4:

Contemporary Synthesis of Validity Criteria in Qualitative Research

Whittemore et al. (2001)

The amount of scientific rigor with which a study is conducted helps ensure the

credibility and reliability (consistency) of the final outcome. According to Noble and

Smith (2015), methodological strategy affects the trustworthiness of the findings.

Reliability relies on the consistency of analytical procedures including allowing for bias,
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and an audit trail that supports transparency by revealing the researcher’s decisions and

process in a clear and consistent manner (Lester et al., 2020). Replication of research

depends on the ability of an independent researcher to understand the methodology and

apply it to another study, and its importance is further indicated by its ability to verify the

original findings and expand their validity. Since qualitative research is unique and

“observations” occur in a specific timeframe replication may result in similar but not

exactly the same outcome, “….no ways exist of perfectly replicating the inquirer’s

analytical thought processes” (Cypress, 2019, p. 269).

Data Analysis

Various interpretive frameworks exist in qualitative research that attempt to

understand the world, focus on specific issues, are sensitive to the participants, respect

individual differences, and may call for reform (Creswell & Poth, 2018). After organizing

and transcribing data, the thematic method of analysis consists of coding the data

(reducing the data into identifying patterns) then categorizing (aggregating) the coded

data into meaningful themes. Codes can be short, descriptive words or phrases that

connect statements and experiences with the study’s concepts or theories, and categories

can reflect similarities, differences, and relationships (Lester et al., 2020).

Collecting data from an online source, with no input from the researcher, reduces

the possibility of the participant being influenced by the researcher and supports the

accuracy of the post or comment, minimizing alternative implications (Creswell & Poth,

2018). For this paper, data are summarized and developed manually. No data analysis

software package is used for creating codes, developing categories, or generating themes.

Qualitative data analysis, generally described as a nonlinear, iterative process, has, as its
 89

aim, a reflection of an overall and nuanced understanding of the data, the logical

connection to the purpose of the study, and how it responds to the research question(s)

(Lester et al., 2020).

The researcher usually begins with a description of personal experience(s) with

the phenomenon; however, in this case, no personal experience exists so the focus will be

immediately directed to the participants in the study. Significant statements are grouped

into clusters to avoid repetition. The textural description of the experience describes

“what” occurred while a description of “how” an experience occurred is referred to as the

structural description. If both descriptions are provided by the participant, the researcher

can create a “composite” description incorporating both “textural” and “structural”

(Figure 5) (Creswell & Poth, 2018).

Figure 5:

Template for Coding Phenomenological Study

Cresswell & Poth (2018)

Delimitations, Assumptions, and Limitations

The outcomes of qualitative research are shaped by the researcher’s assumptions

and the manner in which they seek information. The researcher’s personal history, views,

and political and ethical interpretations are brought to the study. Critics state that “….
 90

qualitative data analysts fall back to the three I’s – insight, intuition, and impression”

(Dey, 1995, p.78 as cited in Creswell & Poth, 2018).

Gender detransition is a contentious topic and a researcher with a Christian

worldview may approach the study with strong biases. Believing that individuals are

created in the image of God (imago Dei) and that sex (gender) is innate and binary may

remove some objectivity from the research; however, it is an important point of view that,

ethically, must be mentioned. The dignity of all research participants must be respected

(Mack et al. 2005).

A recent document, Dignitas Infinita (2024), issued by Pope Francis, mentions the

fact that there is debate among experts regarding the scientific efficacy of gender identity,

and that human life is a gift “to be accepted with gratitude and placed at the service of the

good.” The personal self-determination supported by gender identity theory not only puts

one in competition with God but makes oneself God. The narrow focus of this manuscript

is to discover the needs of individuals who may be disappointed with themselves, regret

their decisions, angry with physicians and psychiatrists, and be experiencing self-hatred

(Evans, 2020).

Qualitative research may produce reams of observation narratives, making it more

difficult to analyze since it does not consist of numerical or “cause and effect” data.

Making sense of large amounts of data means getting a sense of the whole (Cypress,

2019), a difficult task, as is filtering irrelevant information from important information

and identifying significant patterns. The data require interpretation and judgments related

to what is meaningful. “Interpretation also might be within a social science construct idea

or a combination of personal views as contrasted with a social science construct or idea”

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(Creswell & Poth, 2018, p. 195). The qualitative researcher should scrupulously avoid

bias in interpreting data. The dilemma of the possibility of participants pretending to be

detransitioners or in the process of detransitioning and posting dishonest comments

exists, and the inability of the researcher to pursue a topic by asking probing questions is

a limitation; however, no personal contact with the participants allows for a degree of

objectivity.

Summary

Rigorous and trustworthy qualitative research can produce actionable findings due

to its flexibility and capacity to generate theory from data (Bingham, 2023). Differing

from quantitative research which uses numbers and statistics to support a hypothesis with

an aim toward generalizability, qualitative research is systematic and organized and can

produce consistent findings that possess transferability. Data are collected anonymously

from an online website that is empathetic to detransitioners. The focus of the study is a

deeper understanding of the poorly understood phenomenon of detransitioning, not

measurable by quantification, through the comments of those posting on three subreddits

of [Link]. This is as close to a real-world, naturalistic setting as possible when

dealing with a marginalized vulnerable population, most of whom are unwilling to

discuss the topic publicly. A nonjudgmental approach, driven by the research questions,

examines data for patterns and relationships, learns the values of the participants, and

transforms data into findings.

Scant information regarding detransition exists due to the lack of research

regarding unpopular topics. In the last decade, there has been a significant increase in

social and media interest in gender transition; however, lack of clinical research has
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resulted in a limited understanding of the number of detransitioners and the experiences

and motivations underlying detransition. Not only does the extent of the phenomenon

need to be known, but also the characteristics and specificities of detransition to aid in

implementing comprehensive protocols, which should be responsible and caring, for the

healthcare needs of detransitioners (Evans, 2020; Exposito-Campos et al., 2023).

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CHAPTER 4: RESULTS

Overview

The purpose of the manuscript is to memorialize the lived experiences of those

who regret transitioning to the opposite gender. One method to collect this type of data,

while protecting the identity of the participants, is retrieving comments from social

media. Anonymous statements posted by individuals, using [Link] to ask questions,

gain information, or just vent, are a reliable way of “observing” a population sample

unobtrusively and the information can be used to understand the struggles of

detransitioners. These can include physical and mental health issues, loss of social and

familial support, and feelings of guilt and shame (Ayad et al., 2023). The three subreddits

used to collect data are r/detrans (53,000 members), r/actual_detrans (9,600 members),

and r/ask_detrans (2,655 members). The specific subreddit, from which a posting is

collected, is not identified. There is a sufficient number of members of the three

subreddits to provide adequate data for the research questions, which include the lived

experiences regarding medical and psychological support, social and familial support,

and how much detransitioners need to rely on social media for validation, information,

and advice. The posts used for this study are the personal lived experiences of the

participants, not generalized statements, political views, or personal attacks on others.

Descriptive Results

The data consist of 200 anonymous postings on a social media website

sympathetic to detransitioners and those who regret transitioning. Detransition is a

relatively recent phenomenon and the lived experiences of those who have detransitioned

are poorly understood (Sanders et al., 2023). One way to understand the experiences of
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detransitioners is the narratives posted on social media, a similarity shared with

transitioners, many of whom were influenced by social media, convinced they suffered

from gender dysphoria, and encouraged to transition. While “trans-affirming narratives”

dominate social media, there are few safe and affirming websites for detransitioners

where they can share information, resources, and support (Sanders et al., 2023). Trans-

affirming messages, embracing transition and promoting cross-sex hormones and sex

reassignment surgeries, can manipulate those susceptible to being influenced.

As an example, about 25% of the approximately one billion active users who log

on to TikTok every month are between the ages of 10 and 19 years. Adolescents use the

platform to discuss mental health issues, creating challenges for mental health

professionals, who should be aware of the TikTok subculture. TikTok posts videos

instructing young people how to self-diagnose autism by using the Ritvo Autism

Asperger Diagnostic Scale-Revised (RAADS-R). De-stigmatizing and romanticizing

mental illness contribute to unhealthy and unsafe behaviors (Harness & Getzen, 2022).

Discussing self-diagnoses and creating videos of their physical symptoms contributes to

individuals’ showcasing their “sick role.” Many young people have gone to great lengths

to remain in a sick role resulting in attention and support which can create facetious

disorders and reinforce ungenuine symptoms.

Activists and some professionals give little thought to the needs of desisters and

detransitioners and, in fact, are reluctant to acknowledge their existence. No clear

guidance exists on how to work with this population (Butler & Hutchinson, 2020).

Study Findings

Definition of Terms Used in the Posts

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ADHD – Acronym for attention-deficit/hyperactivity disorder.

ASD – Autism spectrum disorder.

Binder – Compression garment used to flatten breasts.

BPD – Acronym for borderline personality disorder.

Bottom Surgery – Euphemism for surgery such as vaginoplasty

Cisgender, Cis – Gender identity matches sex assigned at birth.

Desist – Same as detransition.

Detrans – Short form of detransition or detransitioner.

DIEP Flap – Breast reconstruction surgery. DIEP (deep inferior epigastric perforator

artery) is a blood vessel in the belly. A surgeon uses blood vessels, fat and skin from the

belly to rebuild breasts.

Endo – Short form of endocrinologist.

Eunuch – Castrated individual, listed as a gender identity in the WPATH Standards of

Care 8.

FtM – Female to male transition.

FtMtF – Female to male to female transition (detransition).

Genderfluid – Gender identity that changes over time.

HRT – Acronym for hormone replacement therapy.

Influencer – Online personality with followers.

MtF – Male to female transition.

MtFtM – Male to female to male transition (detransition).

Neurodivergent – Term to describe one whose brain functions differently from what

would be considered typical. Examples include ADHD and autism spectrum disorder.
 96

Non-Binary – Not exclusively male or female. (Usually part of the LGBT community.)

OCD – Acronym for obsessive-compulsive disorder.

Plume – Trans-led healthcare, available in most states.

SA – Acronym for sexual abuse.

SRS – Acronym for sex reassignment surgery.

T – Abbreviation for testosterone.

Top Surgery – Euphemism for mastectomy.

Trans – Short form of transition, transitioner, or transgender.

Unalive or Unalived – Another term for suicide.

UTI – Acronym for urinary tract infection.

Table 1

Textural Narratives with Key Words and Categorized.

Postings Key Words Category

I don't understand "trans culture". I don't like the hypersexuality, kink “Trans” Culture
hypersexuality or kink associated with
transness.

Every place I go except maybe on YouTube - hate for detransitioners “Trans” Culture
detrans/desisters receive such scorn and hate.

People say desisters or detrans aren't serious or personal responsibility “Trans” Culture
should take personal responsibility for what
happened due to their Trans experience and
suck it up and have Zero empathy or
concern.

The trans culture is toxic. toxic “Trans” Culture

I missed my female body desperately and the binding, hormones, “Trans” Culture
freedom to be who I was without hurting hostile, toxic
myself and my health with binding and
hormones and socializing with a crowd that
was so toxic and hostile.
 97

When you really look into this stuff what you are pushed by social media “Trans” Culture
seeing are patterns of behavior being pushed
by social media and influencers.

It seriously is a cult. From the therapist to the cult “Trans” Culture

endocrinologist, to the surgeon, they were all
either gay or lesbian.

I was enamored by trans influencers back then and influencers, escape “Trans” Culture
wanted their life, I saw it as an escape out of
a miserable existence, mistreatment from
almost everyone I knew for being an
effeminate gay male.

And they (researchers) tend to reinforce the "this detransition research “Trans” Culture
population is insignificant and politically
uncomfortable, so we're not going to dwell
on them further" narrative.

No wonder the kids love the trans thing. You get toxic “Trans” Culture
to act out whoever you want and get fun
little sayings and get to be part of an
oppressed minority allowed to weaponize
basically anything as a victim to bully others.
I miss it, the toxicity was delicious.

The point of transgender medicine is not to assist money-making “Trans” Culture

or heal, but it sure sounds good right? It's a
way to make money off mentally ill people
and to sterilize targeted populations.

And then it snowballed into allowing transition to insurance payments, “Trans” Culture
be a moral good on top of insurance lucrative
companies willingly shelling out hundreds of
thousands of dollars for cosmetic procedures
making it a highly lucrative field to prey
upon the mentally ill plus as a society we
were all curious what would happen if you
toyed around with gender.

I know for a fact that I would not have been suicidal “Trans” Culture
completely and totally convinced that I
would kill myself without a mastectomy at
20 yrs. old if I wasn’t told at 11 years old
that some people were born in the wrong
body.

It was a lie that transition is a ticket to fulfillment. transition lie “Trans” Culture

Hey, I got brainwashed into this. brainwashed “Trans” Culture

Sometimes I feel like the goal behind this stuff is maximizes harm “Trans” Culture
to maximize harm. The behavior of the
activism seems to match the idea of causing
as much physical, mental, and social harm as
possible.
 98

That feeling when you realize you've been a test medical test subject “Trans” Culture
subject in a progressive medical and social
experiment.

Genderfluid identity did not exist before Tumblr. genderfluid created by “Trans” Culture
It was made up online. Tumblr

I’m happy that I’m not alone in thinking that genderfluid trend “Trans” Culture
gender fluidity is a huge trend, and nothing
of substance.

I think a lot of us stay quiet and never say detransitioners remain “Trans” Culture
anything because of the massive amount of quiet
pressure from the community which no
longer wants us.

It's really cult-like within the "community". If you cult-like community “Trans” Culture
question or need to step out, it's met with a
lot of backlash.

It’s a socially contagious ideology. ideology contagion “Trans” Culture

I was pressured into transitioning by the older pressured “Trans” Culture

trans surrounding me and got so suicidal to a
point I almost unalived [sic] myself.

And as soon as I left that circle and moved away left the community “Trans” Culture
from the 'heterosexuality is evil, subverting
gender roles is the ultimate moral goal'
mindset.. I detransitioned.

But was I pressured, by both peers my age and pressured “Trans” Culture
those older than me, from pre-teen until 20
when I transitioned, to be LGBT and
specifically trans? Yes, I was.

For FtMs especially I think the social contagion is social contagion “Trans” Culture
huge.

50 years ago, those (FtM) would be just lesbians lesbian “Trans” Culture
trying to be free and happy.

Everyone who disagrees with them is a 'narcissist'. disagreement is abuse “Trans” Culture
Any conflict with others is 'abuse' and and trauma
'trauma'. Having differing opinions than
them is 'violent', 'dismissive' and 'hurtful'.

There's something so deeply cowardly, avoidant, cowardly, cult-like “Trans” Culture

and cult-like about this. Every negative
emotion in life is reinterpreted through a
victim narrative.

I'm not surprised you were rejected. LGBT culture LGBT culture “Trans” Culture
has evolved to have its own orthodoxy.
 99

Acceptance is a one-way street for certain

experiences and not for others.

The concept of regret is so hushed down that I hushed regret “Trans” Culture
think it’s difficult to even consider
alternative treatment options

The prevailing narrative is medical transition push to medical “Trans” Culture

saves lives, and so there is a huge push transition
towards it for people with dysphoria.

They are so ideologically corrupted that they will ideologically corrupted “Trans” Culture
ignore a child's red flags and allow them to
transition in the hopes it magically solves
their severe mental issues, and then they
convince child and parent this is the only
way to "fix" their kid.

Escapism was ecstasy. escapism “Trans” Culture

I was really happy in the first few years of my feeling low “Trans” Culture
transition. It was fun and exciting. All the
new stuff to learn. I felt like a new person.
But once that worn off, that same feeling of
being low continued. It just kept getting
worse actually because now the pressure of
being a trans woman was on top of it.

I desisted years ago. I have a male nonbinary toxic “Trans” Culture

friend who is an upsetting reminder of the
toxic therapy-speak in the leftist trans milieu,
not all limited to gender identity. Everything
they say is as if a genderqueer filter were
placed over their most radical and
misanthropic thoughts. It's a constant
misappropriation of therapy-speak and
political sympathy.

Was a form of escapism to be someone else. It sort escapism “Trans” Culture

of helped since I really didn't like myself
much, but eventually I realized I still had a
lot of the same problems plus new ones.

Claiming every bit of gender non-conformity as a vicious, damaging “Trans” Culture

potential sign of transness, while going on to ideology
say every questioning person is trans - such a
vicious and damaging culture/ideology.

Came to the realization the trans movement is a run from trauma “Trans” Culture
way to run from actual trauma healing and
ignoring the health concerns.

The choice to mimic the opposite sex using mimic opposite sex “Trans” Culture
hormones and surgery is a construct we have
come up with and labeled “trans”.
 100

It isn't humane to even be doing these so-called gender affirming “Trans” Culture
gender affirming surgeries and on top the surgery messes
cross sex hormones that are dangerous and with your brain
cause all sorts of health issues, it messes
with your brain emotions everything, it's
insane to me that this is called treatment.

If someone wants to transition, you have to let transphobic “Trans” Culture

them, or it’s transphobic. It didn’t use to be
like this before it became so politicized.

When you throw in the WPATH's attempts at WPATH normalizing “Trans” Culture
normalizing eunuchs as a protected identity eunuch as a
class (rather than what they are, a historical gender
act of pederasty and torture) I start getting
borderline conspiratorial about this shit.

I was also shamed and bullied by transgenders for shamed, bullied “Trans” Culture
leaving and speaking out about my
experience.

What a lot of people are calling "discrimination" transness as scapegoat “Trans” Culture
is actually a very justified critique of
ideology and medical treatment. Normal,
healthy, and level-headed people can see that
a huge number of young people are flocking
to "transness" as a scapegoat rather than
dealing with their real internal issues.

When I detransitioned I was one of the lucky ones, deep-spiritual Belief in

it is because some deep spiritual and whole- experience God/Religion
body physical experience healed me.

It's hard enough to say that I was healed of God healed me Belief in
transgenderism and thus detransitioned. It's God/Religion
even more taboo to suggest God healed me.

I just started going back to church and have been returned to church and Belief in
dipping my toes back into traditional God/Jesus belief God/Religion
God/Jesus belief; I'll try leaning more into
my old Christian beliefs in the external God.

Additionally, the rhetoric that binders are binders Failed By Others

completely safe (worn 8 hours a day/5 days a
week) is frankly complete bullshit. I binded
[sic] 2-3 days a week for 3-5 hours or less
(the longest I ever wore one was 6 hours)
and I ended up with a serious shoulder injury
that seems to be permanent.

My mom pushed my transition. She wanted to be pushed by mother Failed By Others

the trans mom so bad. I was a wreck and
tried to kill myself at 17. Now I'm an adult
and I realize how brainwashed I was. I've
moved in with my dad and he's helping me
detransition.
 101

Like she (mother) was pushing so hard for me to pushed by mother and Failed By Others
get top surgery as a minor, and threatening doctor
my dad if he tried to stop her. Pushing the
doctor and they both kept pushing me. I
can't get a tattoo but yeah chop my tits off.

I do not have a doctor with relevant expertise in doctor with no Failed By Others
discontinuing hormones. expertise

I also have FtM friends who transitioned. They lied to by doctors, Failed By Others
were lied to by doctors. Some were harmed lifelong patient
by metoidioplasty and almost died. A lot of
losses. Loss of sexual function. Loss of
bladder control. Becoming a lifelong medical
patient with clueless doctors who don't
actually care.

Therapy can help resolve feelings of dysphoria therapy Failed By Others

and help the person accept their body as it is.

It did make me question the judgement of the blame self Failed By

people around me when I realized they let Others
me do this as a minor, but I only have myself
to blame.

People did try to stop me, but I had doctors and pushed by doctors and Failed By Others
therapists pushing for this so there was not therapists
much my parents could do.

The push to get gender-affirming cosmetic surgery pushed into surgery Failed By Others
is what led so many of us to enable our body
dysmorphia in the first place.

We all have been failed by these people we failed by others Failed By Others
thought were trustworthy.

Personal connections and professionals. They professionals did not Failed By Others
absolutely did not have our best interests at have best
heart. interests

I would recommend therapy, but it's a fraught therapy – not gender Failed By Others
topic nowadays, with complete gender affirmation
affirmation ubiquitous among therapists.

I just want someone to be held accountable for hold someone Failed By Others
allowing me to get bottom surgery. accountable

I was in the room when my endocrinologist said to endocrinologist made Failed By Others
my parents “would you rather an alive dangerous
daughter or dead son.” It’s such a dangerous statement to
statement, especially in front of the child. parents

I AM going to blame the medical professionals medical professionals Failed By Others

who treated a clearly mentally ill teenager blamed
with hormones and surgery. I AM going to
 102

blame my endo for playing fast with my

health and I put an enormous amount of
blame on my therapist for writing me a letter
for voluntary amputation when she knew full
well that was a trauma response.

When people talk about detransition they ignore binding Failed By Others
the long-term harm that binding can have on
our bodies. There needs to be more
discussion about the permanent effects that
can occur with binding.

The idea of stopping the tremendous expansion of stopping puberty Failed By Others
physical, emotional and intellectual
development of puberty is insane. Hate that
lie about "the pause button."

I cannot be what I want without being chained to long-term medical Failed By Others
doctors and delusion. It’s insane how people reality
ignore the reality of long-term medical
transition.

They did not prepare me as a 17 year old for the extreme medical Failed By Others
realities of living socially as trans or the repercussions
extreme medical repercussions of a
transition, especially during the long term.

I am practically disabled from that drug disabled Hormone

(testosterone). Complications

I don’t want to detransition but I’m worried that I access to hormones Hormone
won’t always have access to HRT. Complications

I've been off and on hormones so much. I'm off replace hormones Hormone
hormones again and this time I intend to Complications
commit and find other ways to deal with
these issues.

I’ve been feeling depressed, fatigued and have depressed, fatigued Hormone
been dealing with candida and dermatitis Complications
since stopping T.

My skin has been so dry, loose and wrinkly, zero aging woman Hormone
libido, and napping daily. It’s been a bit of a Complications
weird change from feeling like a teen boy to
an aging woman.

Exhausted and annoyed I still have to deal with exhausted Hormone

these things (physical problems) a year since Complications
stopping T.

I knew hormones ware not good for my body, and hormones, grief Hormone
at the very end of my transition this caused Complications
me a lot of grief and stress.
 103

I am scared my immune system is permanently compromised immune Hormone

compromised because of the reckless T system Complications
dosing from the plume* doctor.

Low immunity to candida fungus after stopping T. candida Hormone

Complications

I was on such a strong dose I don’t even know strong hormone dose Hormone
how I was allowed to be prescribed Complications
spironolactone 200mg and 8mg estrogen
daily… at 23 years old.

It's truly a crazy world we live in. I think hormones easily Hormone
hormones will be available OTC soon. available Complications

It’s been 2.5 years since I’ve been off hormones. ruined life Hormone
Things should have snapped back quickly Complications
but they didn’t so… no. I feel like I’ve
ruined my life and I’m very upset at myself.

On T: panic attacks and paranoia, heart physical ailments Hormone

palpitations, dizziness, brain fog, muscle and Complications
joint pain when sick, loss of emotions. Off T:
progressing incontinence, uterine cramps,
muscle atrophy, hot flashes (first 3 months).

I am now off estrogen and puberty blockers. developmentally Hormone

realizing how developmentally behind I am. behind Complications
Behind my classmates and am
underdeveloped in certain aspects.

The relief you may get from transition is not life-long patient, not Hormone
worth the lack of freedom you have from desired gender Complications
needing constant doctor visits, inevitable
damage to your reproductive organs,
possible surgical complications, social
difficulties, and knowledge that you will
never truly be your desired gender.

I felt way more balanced energetically and mood self-medicating Hormone

wise on T. Now I just smoke weed to self- Complications
medicate.

It takes time. I took a long time titrating off T takes long time Hormone
before I fully stopped. Complications

Was experiencing very painful cramping despite cramps, blood Hormone

not having periods which made me wonder pressure, Complications
what on earth was going on internally. Also cholesterol
had problems with high blood pressure and
cholesterol.

I liked the mood boost (from T) but it was risky mood boost Hormone
for long term health. Complications
 104

I just want to remind everyone, that lifetime of medical Hormone

transgenderism will bring a lifetime of issues Complications
medical issues to treat, correct, medicate.

I don't regret my top surgery, but I'm really atrophy, UTIs Hormone
starting to regret going on T and my Complications
hysterectomy. I've been struggling with
atrophy and UTIs.

My mistake was quitting T cold turkey. Not quit hormones cold- Hormone
recommended. I think it was especially hard turkey Complications
for me because I am a person who also has
mood swings.

HRT is seen as the “next step” and baseline even hormones Hormone
if surgery isn’t on the table just yet. It’s a Complications
recipe for a fast track to medicalization.

When I went to my endocrinologist, my father and endocrinologist not Hormone

I were assured T was safe, medically honest regarding Complications
necessary for trans youth and their mental hormones and
health. He never told me about the high risks physical health
for atrophy or possible hysterectomy as a problems from
result of that, or the risk of increased transitioning
cardiovascular disease/development of
ovarian cysts/bladder dysfunction/overall
extreme degradation to physical health that
medical transition often induced.

The people who let me do it blame me. I was put blame others Hormone
on medication that made me gain 70 pounds Complications
and now my stomach is really big and
doesn’t fit my tip surgery and top surgery
doesn’t grow with the rest of your body so
now I always look like a pregnant man.

And my endo wasn't truthful about the detrans rate endocrinologist not Hormone
and didn't tell us about the side effects of T, truthful Complications

2 years on T when I decided it wasn't worth more complications of T Hormone

complications. Complications

I personally feel much happier. I’ve only just come out as detrans to Hormone
started to come out as detrans to the people people Complications
closest to me and just being honest with
myself and others has made me feel more
connected to people instead of feeling
disconnected and alone. There’s things I
mourn like my voice.

I thought I was old enough to make this decision too young for decision Informed Consent
and I absolutely wasn’t.

It took me until about 25 to start realizing I really brain not fully Informed Consent
fucked up. It’s like I could feel the moment developed
my brain fully developed/matured.
 105

It's on the doctors, the state, and your parents for doctors, others Informed Consent
allowing you, the child, to lead. Children responsible
cannot give consent.

It was informed consent at Planned Parenthood - rushed into Informed Consent

mastectomy through informed consent too mastectomy
because I, stupidly, paid out of pocket. I was
just in such a rush with everything, and
looking back I think a lot of that was because
I was chasing validation from those around
me.

Did we give consent if we were told medical consent Informed Consent

intervention was the only “cure” for gender
dysphoria?

Others have mentioned therapy being the other therapy Informed Consent
option, especially when other underlying
issues may be interfering with the patient.
It’s possible that some of us may classify
under “coercive consent,” we were told that
we will likely self-delete if we didn’t go
through medical intervention.

I was never provided an alternative to transition, no alternative Informed Consent

by my endo or therapist.

I believe we need better safeguards and testing for safeguards Informed Consent
gender dysphoria vs. “informed consent”.

Mental health issues that looked a lot like being mental health Misdiagnosis
trans.

Psychiatrists took my symptoms and were very labeled dysphoric Misdiagnosis

happy to label me a "classic case of gender
dysphoria".

I transitioned as a kid and had (state-funded, messed up teenager Misdiagnosis

practically ungatekept [sic]) SRS when I was
still a really messed up teenager.

I had been diagnosed with bipolar & OCD and am bipolar, OCD Misdiagnosis
wondering if it was a manic episode.

Getting off HRT (after 1.5 years of a pretty high solve real issues Misdiagnosis
dose) actually allowed me to tackle the real
issues that I was trying to cover up by
transitioning.

Medical transition as panacea for the hypochondriac Misdiagnosis

hypochondriac with body issues.

I was diagnosed with gender dysphoria after a 15- GD after 15 Misdiagnosis

minute conversation with the gender intake min. appt.
 106

specialist.

Because sometimes it is easier or faster to cut up complex psychological Misdiagnosis

breasts and genitals rather than resolve issues
complex psychological issues.

I was in psychosis for years and everyone can psychosis during Misdiagnosis
agree that I was sick before during and after transition
the surgery. I held it to myself for a whole
year praying it was just top surgery
depression like everyone was saying but it
never got better. then I was put on anti-
psychotic (drugs) and came out of a fog. And
went even lower because I couldn’t lie to
myself anymore.

When I told my psychiatrist I felt like a man she no therapy Misdiagnosis

said it is not an illness and I shouldn't go to
therapy for it, I should start transition ONLY
AFTER ONE SESSION WITH ME.

The psych I was seeing - who knew the factors autism, sexual abuse Misdiagnosis
that I now recognize as being common
among other detrans women like having
autism and being a victim of SA - kept
insisting I was trans in denial. The psychs
[sic] I’ve seen since all operate similarly, just
with different angles. some say I must be
nonbinary, and this is part of my “gender
journey” and others want me to explore my
“internalized transphobia.”

My dysphoria was caused by my eating disorder eating disorder Misdiagnosis

& being heavily bullied as a child for my
weight. So I felt disconnected from my body,
also from womanhood. My psychiatrist told
me it is not s problem to be trans and said I
should just transition after ONE SINGLE
SESSION.

She diagnosed me with an adjustment disorder, adjustment disorder, Misdiagnosis

anxiety/depression, and considered I might anxiety,
have BPD. She never made me aware as a depression, BPD
minor that my feelings were common in teen
girls and that there was a high likelihood I
would grow out of it.

Every single medical professional knew every step mentally unwell, Misdiagnosis
of the way that I was an unstable, mentally suicidal
unwell, suicidal teenage girl and they did
nothing to actually help me. What they did
do was give me temporary alleviation for my
dysphoria, followed by extreme, lifelong
trauma that surpasses my initial mental
issues tenfold. I will never forgive any of
them.
 107

I did not consent to 3 mini strokes, renal failure, mini-strokes, atrophy, Misdiagnosis
primary ovarian insufficiency, vaginal and renal failure,
vulva atrophy. Those things were just an ovarian
"unknown risk," but they are also somehow insufficiency
my own fault for not knowing enough. I was
vulnerable, suicidal, and not in any place to
make medical decisions like that. I was a
casualty of medical malpractice.

Gays, mentally ill, and autistics are vulnerable to vulnerability Misdiagnosis

gender affirming care.

I don't believe it was gender dysphoria.. rather an dissociative Misdiagnosis

extreme case of dissociative conviction.

Personally, before trans ever entered my brain, I pro-anorexia websites Misdiagnosis

got influenced by pro anorexia websites.

Changing the body will not help mental issues! mental issues Misdiagnosis

I detransitioned after 8 years. 13-21 I identified ADHD, BPD Misdiagnosis

myself as a male. I convinced myself of this
due to gender dysphoria caused by trauma
and being neurodivergent (ADHD) and
having a personality disorder (BPD) made
me feel different and confused about my
place in society, and without proper
assessment I decided to transition.

I no longer believe that the first line of treatment psychiatric disorders Misdiagnosis
for a psychiatric disorder is medical
intervention. We don’t immediately place
temporary or permanent feeding tubes in
anorexia.

Sexual induced desire to be a woman which was porn addiction Reason For
amplified by porn addiction. Transition

I just knew it wasn't right I knew it was being fetish Reason For
fueled by a fetish. Transition

I’m having trouble parsing gender envy vs gender envy, attraction Reason For
attraction, Transition

Doing something due to external pressures will external pressures Reason For
just lead to regret someday. Transition

A possible theory is that when I was 14 I manic episode Reason For

experienced an extended manic episode Transition
where I wanted to transition into a man. I
just stubbornly stuck to it because I didn't
want to add fire to the arguments of
transphobes and people who insist that all
trans kids are just "going through a phase."
 108

I transitioned because of trauma. trauma Reason For

Transition

The trauma, the reason behind my wanting to arrested development Reason For
transition, kept me in arrested development. Transition
This really clouded my decision making.

Obsessive belief that I couldn't let go of mixed obsession, misogyny Reason For
with major internalized misogyny and body Transition
issues.

I started at 15, been on and off inconsistent with T. manic episode Reason For
I'm 28, off again also fearful that this is yet Transition
another phase/obsessive belief/manic
episode like the initial transition.

I was sucked into this idea that I'd be happier as a convinced Reason For
woman. Transition

But to take the euphoria so far as to medically euphoria Reason For

transition when there is no debilitating Transition
dysphoria and no hatred for your physical
body, I feel is misguided.

I may have been influenced by the media to be media Reason For

trans in the first place; they convinced me Transition
that not liking my feminine body means
you're FtM.

I learned to associate femininity with weakness had to become a man Reason For
and submissiveness, and I felt like the only to be self- Transition
way I could be independent, self-sufficient, sufficient
and strong was if I was a man.

I feel so ashamed and embarrassed. ashamed, embarrassed Self-Blame

I don't feel I can date for fear of bringing those tricking people Self-Blme
issues into the life of my partner, or of being
in some way predatory or "tricking" people.

I'm feeling exhausted and stuck halfway in stuck in-between Self-Blame

between.

I’m just burnt out by transition and social aspects burnt out Self-Blame
of living as a non-passing trans woman.

I've ended up just feeling essentially genderless, Self-Blame

genderless/androgynous, and that I'm a trans androgynous
woman just because people say I'm one.

It's so important to be able to recognize when transition sucks Self-Blame

transition sucks.

I've been living as male since I was about 15. I pretend it is fine Self-Blame
lost my teens as a normal girl and all of my
20s as a woman. I feel so far gone. I made
 109

my bed; I should lay in it. It's easier for

everyone in my life if I pretend everything is
fine. I'm not strong enough to transition all
over again.

Looking like a girl with a deep voice. It's all just painful, my fault Self-Blame
so fucking painful. Knowing it's all my fault
makes it so much worse.

The first months were filled with euphoria. But euphoria ended Self-Blame
the exact opposite has been the case.

The cloud lifted, and I realized I could love myself love myself as born Self-Blame
the way I was born.

Just knowing I could've just been a totally normal horrible decisions Self-Blame
woman with a normal voice kills me and I'm
struggling so badly with the horrible
decisions I made to lead to this life I'm
forced to live.

After almost 8 years and having multiple surgeries feminine gay man Self-Blame
to make me look female, I realize I'm just a
feminine gay'ish [sic] man.

But I'm done pretending I'm a woman. It's not done pretending Self-Blame
right nor fair to actual women.

Make choices that use common sense. We can't pretend Self-Blame

"transition" that's impossible. We can only
pretend.

When I look back on my transition I really only live a lie Self-Blame

remember ever feeling anxious, scared, and
miserable and like I was trying to live a lie in
honor of self-hatred and insecurity with
being woman.

Transitioning really put my life on hold in some put life on hold Self-Blame
ways, it was always “I’ll truly be myself and
able to live my life once I reach this
milestone” and so on and so on.

I’m just saddened by the physical trauma of surgery problems Self-Blame

surgery, the numbness, and the scar as a
reminder of my choice to use surgery as a
form of self-erasure.

Did I feel like I fucked up my whole life when I ruined life Self-Blame
realized I needed to detrans?

It feels isolating to have a non-standard body. isolated, non-standard Self-Blame

body
 110

I feel like I’ve tried everything. I’m at a loss, a can’t heal Self-Blame
breaking point. I just can’t heal and move on,
please help me.

Feels isolating that I am left to work through my isolated, regret Self-Blame

feelings of regret and process of grieving
mostly alone, because it’s too
politicized/stigmatized a topic for my friends
and family.

I had a double mastectomy at age 17. The scars, mastectomy regret Self-Blame
the numbness, the way my stomach pokes
out because the weight distribution is all out
of whack. I can’t believe what I did to
myself. It pains me every day.

Now that I’ve detransitioned … I regret it. I wish I regret Self-Blame

never did it. What I needed back then was
for someone to guide me and really put
things into perspective.

But I regret it. Transitioning is so stupid, so so regret, transition is Self-Blame

stupid. Why the fuck would you ever do that stupid
to yourself? If you’re considering it, don’t do
it. It’s a bullshit life.

I gave up the best parts of my life and years for stupid fantasy Self-Blame
some stupid fantasy.

I mutilated and self-harmed myself by doing this mutilated self Self-Blame

and I totally regret it.

I’m just not the same. Mentally, emotionally, foolish decision Self-Blame
sexually… all because of my foolish
decisions at a young age!

Throwing away all those binders felt like a breath binders Self-Blame
of fresh air by getting rid of those 5 binders
that almost ruined me.

Everything feels like it’s getting better, and my healthier after Self-Blame
body feels healthier. detransition

I feel like I have to give my body back what I took give back to body Self-Blame
away from it all those years.

I'm mourning the loss of my late teens and all my lived a lie Self-Blame
20s pretty much living a lie.

If detransition is a process of grieving, then I'm in therapy Self-Blame

the acceptance stage. I've had some awesome
therapy, It took time and emotional effort (re:
therapy) to get to where I am today.

From binding I got some bruise scarring due to the binding bruising Self-Blame
constant pressure. Those haven't gone away.
 111

Most trans regret/second thoughts tend to kick in regret Self-Blame

about 5-9ish years in.

I've wasted precious years in my confusion. wasted precious years Self-Blame

I hate what I see in the mirror.. permanent changes self-hate Self-Blame

to a temporary situation I thought wasn't.

Now, I have nothing, no one.. or nothing.. just regret.. regret, shame Self-Blame
after clarity.. and so much shame.

Transition is a lonely place because at the end of self-loathing Self-Blame

the day you’re disconnected from your body.
Your description of a form of self-harm is
very accurate. Transition was driven by self-
loathing; I honestly think most transitions
are.

I put myself in this shitty situation (ie having put myself in situation Self-Blame
transitioned despite not needing it) so I
should be able to get myself out of it as well.

It’s not fair that an ill-informed decision I made ill-informed decision, Self-Blame
when I was freshly 18 will haunt me for the ashamed
rest of my life. It really gets me down
sometimes. This is the only place I can talk
about this part of my life. I am too ashamed
of it to confide in anyone but internet
strangers, not even my therapist.

Medical care post-detransition is the hardest, most pathologized by Self-Blame

shame-inducing thing for me. I have doctors in
definitely had medical doctors pathologize detransition
me and have had awkward moments with
staff around my appearance/voice.

I believe in gatekeeping and believe that most gatekeeping, Self-Blame

psychotherapy is not conversion therapy. psychotherapy
Affirmation only is simply extreme.

I couldn't imagine starting testosterone as the pain surgery pain Surgical

I've been left with from SRS would only be Complications
amplified times 10 by having more "activity"
in that region from testosterone.

How to cope with regretting top surgery? I mastectomy regret Surgical

genuinely do not know how to cope with Complications
losing my breasts. I got a double mastectomy
in 2021.

I had a hysterectomy and oophorectomy. When I sudden menopause Surgical

started detransing [sic], I was put on an from surgeries Complications
extremely low dose of estrogen and went
into sudden medically induced menopause.
 112

My heart hasn’t recovered, I now have diabetes, diabetes, heart Surgical

and an undiagnosed chronic illness. problems Complications

What really gets me is the lack of follow-up I had. no surgery follow-up Surgical
I was approved for surgery eventually and Complications
that seemed to be the end of it in their eyes. I
would have thought that they would
monitored me to observe the long term
mental and physical health effects of doing
this and to see how well it worked.

Issues with reproductive organs didn’t hit until physical, reproductive Surgical
year 5. Same with high blood pressure and problems Complications
cholesterol. It was a wakeup call of like, do I
really wanna [sic] live like this forever?

I have a lot of grief about the mastectomy and mastectomy grief Surgical
inability to nurse, ultimately view my Complications
transition as a big mistake.

The surgeon said I have to be 22 for silicone mastectomy Surgical

implants and my original surgeon who did Complications
the mastectomy refuses to answer the phone
or schedule a consultation.

Just a reminder I received fat grafting to the fat-grafting procedures Surgical

breasts, and it is a slow progression. I still Complications
have another 2-4 procedures. My 3rd
procedure should be in July.

I detransitioned in 2019 it’s been a long process I breast reconstructions Surgical

have been off T ever since have had 2 breast Complications
reconstructions. (1 original and one complete
revision.) I have also had a secondary scar
revision and nipple tattooing.

Top surgery at 28. Started having health health complications Surgical

complications (I had had them for a good bit Complications
longer. Told to me by others and providers
they were aspects typical of male puberty).
My scars started to have serious pain. It was
thin skin to bone. Constant vocal pain.
“Lower pain” external as well as internal
“glass shard” like pain.

Had a double mastectomy just over ten years ago. breast reconstruction Surgical
Last year I underwent breast reconstruction Complications
in the form of DIEP flap reconstruction – (no
implants), and my new breasts have been
constructed using my own stomach fat and
skin. Surgery results in a tummy tuck-like
scar, fully hip to hip, Recovery is hard and
painful.

I'm sterile... my parts don't function.. I have no sterile Surgical

desires. Complications
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Drugs, transition, moving states. All temporary deeper hell Surgical

happiness to fill a void that didn’t lead to Complications
long term satisfaction, instead it all paved a
road to a deeper hell than when you began.

You’re losing a body part for cosmetic reasons, cosmetic reasons Surgical
and the surgery isn’t risk free or painless. Complications

I was on T for 8+ years, had top surgery, lost a lot mastectomy Surgical
of head hair, can't pass as female anymore, Complications
etc, but still going strong with my
detransition and such plans.

There's so much for me to look presentable as a not passing as female Surgical

woman and feel feminine. Daily face Complications
shaving, weekly near full body shaving,
wearing wigs and breast forms, etc, plus
putting in time and effort into clothes,
makeup, wig styling, etc, and still not
passing as female.

I developed a spastic bladder sphincter which bladder problems, Surgical

prevented me from fully evacuating my UTIs Complications
bladder. This, coupled with thinning of the
vaginal/urethral tissues, led me to develop
chronic UTIs. This resolved by itself when I
started taking estrogen replacement (I have
no ovaries/uterus).

I had a mastectomy, and my uterus and ovaries unnecessary Surgical

removed. I have taken testosterone for many mastectomy, Complications
years, and all of this wasn't necessary. I removal of uterus
didn't need body parts amputated and a and ovaries
psychoactive substance called steroids to feel
better.

It is barbaric and no one should have to go beautiful body not Surgical

through that just to feel whole. Everyone is needing to be Complications
born with the right body. Everyone has altered
his/her own beautiful body that doesn't need
to be altered or to have bits amputated.

Only concern for minors and vulnerable people irreversible harm to Surgical
who do irreversible harm to themselves. If minors Complications
you have to cut off body parts or sterilize
yourself to affirm yourself, it just seems
opposite of what affirmation and self-love
means?

Clustering of the 200 textural narratives results in 8 categories: “Trans” Culture

(n=45 or 22.5%); Self-Blame (n=42 or 21%); Hormone Complications (n=28 or 14%);

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Surgical Complications (n=21 or 10.5%); Misdiagnosis (n=21 or 10.5%); Failed by

Others (n=19 or 9.5%); Reason for Transitioning (n=13 or 6.5%); and Informed Consent

(n=8 or 4%). See Table 1. The four major themes resulting from the data are Coercion,

Influence, and Misinformation (“Trans” Culture and Reason for Transition), Serious

Health Problems (Hormone Complications and Surgical Complications), Failed by

Others (Misdiagnosis, Informed Consent, and Failed by Others), and Self-Blame (Self-

Blame).

Coercion, Influence, and Misinformation

The theme Coercion, Influence, and Misinformation includes the trans-affirming

narratives (or trans ideology) that young people are exposed to through peer groups,

social media, and mass media. These communities champion gender-affirming medicine

and transition, promoting cross-sex hormones and gender-affirming surgeries and “do not

allow dissent, disagreement, or alternative views” (Yoo, 2018, p. 184). The proponents of

gender ideology are not interested in tolerance and coexistence, labeling Christian views

of the body, marriage, and sex as offensive and hateful (Grabowski, 2022, p. 173).

Vulnerable adolescents are targeted, embraced, and supported in their undertaking of

transition. The decline of the nuclear family contributes to the need for some to look for a

new place to “belong,” providing further impetus to the concept of identity politics.

Detransitioners use words like toxic, hostile, damaging, vicious, dismissive, and

cult to describe the trans community that contributed to misleading them and describe

transitioners as able to “act out whoever you want” and embrace victimhood by

becoming a member of an “oppressed minority.” One detransitioner was “convinced I

would kill myself without a mastectomy” and another was assured transition would
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“magically solve problems.” Figure 6 depicts the progression of emotions leading to

transition followed by the regression resulting in detransition.

Additional reasons for transitioning include porn addiction, fetishes, and, as one

detransitioner stated, confusion regarding “gender envy vs. gender attraction.” Online

social contagion can mislead a vulnerable male to believe “I would be happier as a

woman” or a susceptible female to consider “I could be independent, self-sufficient, and

strong, if I was a man.”

Figure 6

[Link]

The postings indicate that many of the individuals ultimately came to the

realization that transition to another gender is biologically impossible. “…I’m done

pretending I’m a woman,” “We can’t ‘transition’ that’s impossible. We can only

pretend,” and “…I was trying to live a lie.” Therapy can convince young people that
 116

“living inauthentically is unsustainable for our mental well-being” (Ayad et al., 2023, p.

232).

Serious Health Problems

The theme of Serious Health Problems is partially fueled by the reckless

prescribing of cross-sex hormones and sex reassignment surgery. The negative side

effects of testosterone (T) are evident. “I am scared my immune system is permanently

compromised because of the reckless T dosing from the Plume doctor.” Detransitioners

reported that the side effects include “low immunity to candida fungus after stopping T,”

“very painful cramps…problems with high blood pressure and cholesterol,” and

“depressed, fatigued and…dealing with candida and dermatitis since stopping T.”

Because of its addictive qualities, many detransitioners repeatedly start and stop

testosterone. “On T: panic attacks and paranoia, heart palpitations, dizziness, brain fog,

muscle and joint pain when sick, loss of emotions. Off T: progressing incontinence,

uterine cramps, muscle atrophy, hot flashes (first 3 months).”

The data reveal the obvious problems with the careless prescribing of testosterone

and the tendency of transitioners to self-medicate. “I felt way more balanced

energetically and mood wise on T. Now I just smoke weed to self-medicate.” High levels

of testosterone have been shown to improve mood and decrease feelings of sadness;

therefore, stopping the drug can be risky, evidenced by some of the postings. “My

mistake was quitting T cold turkey…hard for me because I am a person who has mood

swings” and “I liked the mood boost, but it was risky for long term health.”

Very real regret, regarding surgery, is evident in the posts. “My heart has not

recovered, I now have diabetes, and an undiagnosed chronic illness,” “I’m sterile…my
 117

parts don’t function…I have no desires,” and “I had a mastectomy…uterus and ovaries

removed…on testosterone for many years, and all of this was not necessary.” Grief and

sadness are palpable. “If you have to cut off body parts or sterilize yourself to affirm

yourself, it just seems opposite of what affirmation and self-love means,” “I have a lot of

grief about the mastectomy and inability to nurse,” and “I genuinely do not know how to

cope with losing my breasts.”

Tang et al. (2022) conducted a study of the gender-affirming mastectomies, the

most common surgery, performed on 209 female adolescents, between 12 and 17 years of

age (median age of 16), from January 1, 2013, to July 31, 2020. The incidence of the

surgery increased 13-fold over the time period. Findings showed for patients with greater

than 1-year follow-up (n = 137; 65.6%), at least one complication in 7.3% (n = 10),

which included hematoma (3.6%), infection (2.9%), hypertrophic scars requiring steroid

injection (2.9%), seroma (0.7%), and suture granuloma (an immune reaction to the

sutures) (0.7%); 10.9% underwent revision (n = 15) (p. 325). It is notable that of the 209

participants, only 137 were available for follow-up. The research mentioned the variables

associated with the participants’ mental health history (depression, anxiety, and eating

disorder) but did not indicate if or how they were addressed. Nevertheless, Tang et al.

(2022) quoted the Dunker anonymous survey of plastic surgeons: “Experienced gender

surgeons report that ‘regret after gender affirming surgery is considered a rare outcome’”

(p. 329).

Detransition becomes another painful experience in the lives of transitioners. “I

received fat-grafting to the breasts…slow progression…still have another 2-4

procedures,” “have had 2 breast reconstructions (1 original and 1 complete

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revision)…secondary scar revision and nipple tattooing,” “I underwent breast

reconstruction…DIEP flap (no implants)…breasts constructed using stomach fat and

skin…surgery scar fully hip-to-hip…recovery is hard and painful,” and “I had a

hysterectomy and oophorectomy…when detransing was put on low dose of estrogen and

went into sudden medically induced menopause.”

Nevertheless, some detransitioners find a measure of comfort in attempting to

correct their mistakes. “Everything feels like it’s getting better, and my body feels

healthier,” I feel like I have to give my body back what I took away from it all those

years,” “The cloud lifted, and I realized I could love myself the way I was born,” and

“I’ve had some awesome therapy…to get where I am today.”

Failed by Others

The theme Failed by Others includes misdiagnoses and/or missed diagnoses. It is

evident that many detransitioners feel betrayed by the medical profession. “Psychiatrists

took my symptoms and were very happy to label me a ‘classic case of gender

dysphoria.’” “I had been diagnosed with bipolar and OCD and am wondering if it was a

manic episode,” and “I was diagnosed with gender dysphoria after a 15-minute

conversation with the gender intake specialist.” The lack of comprehensive assessment of

a patient’s symptoms is a recurrent theme. “When I told my therapist I felt like a man she

said it is not an illness, I shouldn’t go into therapy…I should start transition ONLY

AFTER ONE SESSION WITH ME,” “My psychiatrist told me it is not a problem to be

trans…I should just transition after ONE SINGLE SESSION,” and “The psych [sic] I

was seeing who knew about my autism and being a victim of SA – kept insisting I was

trans in denial.”
 119

It is difficult for young people to stand up to medical professionals who are telling

them they need to transition, especially when other comorbid factors exist. “She

diagnosed me with an adjustment disorder, anxiety/depression, and considered possible

BPD…never made me aware my feelings were common in teen girls and that there was a

high likelihood I would grow out of it,” “Every single medical professional knew every

step of the way I was unstable, mentally unwell, and suicidal…did nothing to actually

help me…gave me temporary alleviation of dysphoria, followed by extreme lifelong

trauma that surpasses my initial mental issues tenfold,” and “I was vulnerable, suicidal,

and not in any place to make medical decisions like that. I was a casualty of medical

malpractice.”

Valid informed consent is questionable in minors who are uninformed, unable to

comprehend the long-term effects of gender affirmative care, looking for validation, and

may be mentally unstable. The impulsive nature of the adolescent brain is not fully

developed to make complex medical decisions. “It took me until about 25 to start

realizing I really fucked up. It’s like I could feel the moment my brain fully

developed/matured,” “Medical transition as panacea for the hypochondriac with body

issues,” and “It’s possible that some of us may classify under ‘coercive consent,’ we were

told we would likely self-delete if we did not go through medical intervention.” The fact

that alternatives to medical transition are not offered is obvious in many of the postings.

“I was never provided an alternative to transition by my endo or therapist,” “Did we give

consent if we were told medical intervention was the only ‘cure’ for gender dysphoria?,”

and “I transitioned as a kid and had SRS when I was still a really messed up teenager.”
 120

The medical community, other professionals, and social media are not the only

ones responsible for encouraging gender transition in minors and not protecting them

from dangerous decisions. “It’s on the doctors, the state, and your parents for allowing

you, the child, to lead. Children cannot give consent,” “My mom pushed my transition.

She wanted to be the trans mom so bad…tried to kill myself at 17…moved in with my

dad and he’s helping me detransition,” “She (mother) was pushing so hard for me to get

top surgery as a minor…threatening my dad…pushing the doctor,” and “I just want

someone to be accountable for allowing me to get bottom surgery.”

Unfortunately, in some cases, the detransitioners continue to be mistreated by the

medical community. “The medical care post-detransition is the hardest, most shame-

inducing thing for me…definitely had medical doctors pathologize me,” “I am too

ashamed to confide in anyone but internet strangers, not even my therapist,” “I do not

have a doctor with relevant expertise in discontinuing hormones,” and “My original

surgeon who did the mastectomy refuses to answer the phone or schedule a consultation.”

Butler and Hutchinson (2020) suggested, in their study, that “…some who detransition

may need access to the professionals who helped them transition, that is, psychiatry,

endocrinology and surgery, amongst others” (p. 46).

Self-Blame

Many detransitioners blame themselves after the blind attraction to the delusion of

transitioning morphs into pain and suffering and the realization that the rest of their life

has been negatively affected by drugs and surgeries. “It’s all so fucking painful. Knowing

it’s all my fault makes it so much worse,” “I feel so ashamed and embarrassed,” “I’m

struggling so badly with the horrible decisions I made to lead to this life I’m forced to
 121

live,” “I lost my teens…and all of my 20s…I feel so far gone…I made my bed. I should

lay in it,” and “Did I feel like I fucked up my whole life when I realized I need to

detrans?”

Sadly, some of the posts appear to support the findings of Dhejne et al. (2011)

that transitioners are 5 times more likely to attempt suicide and 19 times more likely to

die by suicide. Research has shown that gender-affirming care (instead of conventional

psychotherapy) does not reduce suicide (d’Abrera et al., 2020). “I feel like I’ve tried

everything. I’m at a loss, a breaking point. I just can’t heal and move on. Please help me,”

“I hate what I see in the mirror…permanent changes to a temporary situation,” Now, I

have nothing, no one…just regret…after clarity…and so much shame,” and “I put myself

in this shitty situation…so I should be able to get myself out of it.”

The lack of comprehensive medical follow-up of transitioners is obvious in the

detransitioners’ posts. Existing research conducted within a year of detransitioning is

flawed because Dhejne et al. (2014) found the average, before regret materializes, is 8

years. Many are truly despondent and appear to need a support system. “Transition is a

lonely place…a form of self-harm is very accurate…driven by self-loathing,” “I

mutilated and self-harmed…and totally regret it,” and “Feels isolating…left to work

through my feelings of regret and process of grieving mostly alone…”

Belief in God and religion apparently play a very small part in the lives of young

people, especially those dissatisfied with their bodies, and very few mention a spiritual

aspect in their belief system. “When I detransitioned I was one of the lucky ones, it is

because some deep spiritual and whole-body physical experience healed me” and “I just

started going back to church…back into traditional God/Jesus belief; I'll try leaning more
 122

into my old Christian beliefs in the external God” represent two brave souls who thank

God for coming to their senses. “It's hard enough to say that I was healed of

transgenderism and thus detransitioned. It's even more taboo to suggest God healed me”

represents the more common view of young people.

Despite distancing themselves from the transition ideology, adolescents and

young adults have been immersed in the gender ideology that seeks to undermine or

eliminate the relational difference between male and female whereas Christian theology

elevates the differences. Gender transition is “…trying to usurp the place of God”

(Grabowski, 2022, p. 58).

Gender ideology promises its believers that a blend of secular ideas and

technology will provide happiness by changing their human nature and creating their own

gender identity. Faith and reason expose gender ideology for the delusion it is; however,

it appears a moral compass is lacking in young people based on the number of

adolescents presenting at clinicians for the fantasy of gender transition.

Summary

The posts collected from the detransition subreddits support the fact that gender

transition is a delusion. Many young people actually believe they can re-create

themselves in a different gender and ameliorate psychological distress by injecting

hormones and undergoing what can only be described as gruesome surgeries. A

prevailing theme of Serious Health Problems shows it does not solve their problems and

can leave them with long-term negative consequences and the realization that they no

longer can deny the concept of biology. The theme Coercion, Influence, and

Misinformation is the result of political correctness, the wish to become part of an

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oppressed minority, children exposed to queer role models, the acceptance of gender that

is fluid not binary, and the shaming of those who challenge the concept of gender

ideology. Failed by Others is a frequent argument of detransitioners for good reason.

Some individuals wish to be the heroic and progressive parents of “trans kids.” Educators

teach nonsense like “Genderbread Person,” praise the bravery of children transitioning,

and help them hide the fact from their parents. Clinicians, worried about losing their

livelihood, affirm their patients as gender dysphoric and fast track them into medical

transition, and legislators are crafting laws that are creating a new protected class.

Many of the detransitioners blame themselves; however, the adults in their lives,

who should have protected them, are complicit in allowing it to happen. The question of

informed consent is a major issue regarding the level of maturity necessary to make a

competent decision and the same concerns apply to parents who consent on behalf of

their children. They may understand very little of the medical complexities, benefits vs.

risks, high suicide rates, and psychiatric morbidity, and may not be fully informed of the

possible long-term consequences (d’Abrera et al., 2020). Beleaguered detransitioners feel

isolated, many grieve alone, and, as one individual stated “…temporary happiness to fill a

void that did not lead to long-term satisfaction, instead it all paved a road to a deeper hell

than when you began.”

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CHAPTER 5: DISCUSSION

Overview

The purpose of this study is to give voice to those who, after undergoing gender

transition (either partially or fully), regret the decision and wish to detransition. There is

scant longitudinal research regarding the negative aftermath of transition. Despite lack of

valid scientific evidence, studies continue to portray transgender children as “heartfelt

success stories” instead of “a lifelong commitment to maintenance” (Klavan, 2020). The

negative physical and psychological outcomes of gender transition are shrouded in

secrecy. Detransitioners are discouraged from going public with their regret by being

bullied, shamed, and ostracized.

While transitioning is championed by political ideology as the only acceptable

treatment for gender dysphoria, there is little discussion regarding the physical realities of

puberty-suppression drugs, cross-sex hormones, and sex reassignment surgery. “The

whole idea of treating gender dysphoria medically is to shift the focus of the problem

from the mind into the body” (Evans, 2020, p. 5). Instead of “watchful waiting,” doctors

are coerced into treating gender dysphoria by affirming the self-reported desired sex of

the patient and treating them with extreme deference so as not to be perceived as

controlling or repressive, resulting in transforming the medical profession into a

consumer culture.

Young people wishing to transition may find validation online; however,

therapists are also contributing to the rise in gender transitioning. Referring to themselves

as “gender therapists,” not an official title associated with special credentials or formal

training, therapists are not providing a careful diagnosis or exploring the trauma of the
 125

young patients who present with possible gender dysphoria. Their heavy-handed

acceptance of the patient’s self-diagnosis, reticence to express doubts regarding

affirmative care for fear of being viewed as bigoted or transphobic and endangering their

careers, is prevalent (Marchiano, 2017).

Detransitioning can be challenging both physically and psychologically. Data

show that detransitioners avoid healthcare because clinicians either do not have adequate

knowledge to treat them or are judgmental. Many of their stories are similar. As

impressionable teenagers, they were exposed to transition on social media sites, such as

Tumblr and [Link] and were convinced this was the solution to their

problems. [Link] is described as “a safe and welcoming place for

everyone in the transgender community to make friends and find joy on their journey”

([Link]). Initially, there is social acclaim for the transitioner from a

community of pro-transition influencers; however, the decision to detransition results in

rejection, shaming, and the loss of support from the very group that encouraged the

transition.

Data collected from [Link] for this study reflect the fact that bodies are not

infinitely malleable, and for some it is impossible to revert back to who they were before

transition. Detransitioners are referred to as “the wreckage washing up in the wake of

America’s mass youth transition” by Eisenberg (2023) who “are determined to have their

voices heard” (p. 38). Research continues to overlook detransitioners, and their unmet

physical and psychological needs persist due to a lack of clinical guidelines.

Summary of Findings
 126

Most detransitioners do not express regret immediately after sex-reassignment

surgery. As time passes, surgical complications such as long-term functional outcomes

and irreversible consequences become more pronounced. Reasons for regret include

inadequate pre-surgery counseling by the surgeon and no discussion of realistic

expectations. Decision-making regarding surgery, particularly cosmetic surgery,

“…requires patients and providers to consider potentially significant risks in exchange

for a desired but not guaranteed outcome” (Jedrzejewski et al., 2023, p. 209).

Jedrzejewski et al. (2023) conducted a multi-disciplinary study of normative

psychological responses such as grief and regret following sex reassignment surgery at

the Oregon Health & Science University (OHSU) Transgender Health Program (THP)

Regret and Request for Reversal Workgroup. Figure 7 shows the multidisciplinary

process for those individuals seeking reversal surgery who underwent sex-reassignment

surgery (referred to as gender-affirming surgery) from January 1, 2016, through July 31,

2021.

Overall, the study’s findings showed 14% of the patients expressed some form of

regret. The central themes of regret were inadequate preoperative counseling, surgical

complications, and unmet expectations, and these may be ameliorated by a thoughtful

mental health assessment conducted before the patient is fast-tracked to gender transition.
 127

Figure 7

Flow Diagram for Multidisciplinary Approach to Patients Seeking Reversal Surgery

Jedrzejewski et al. (2023)

For those who did not undergo sex reassignment surgery, the [Link] postings

(this study) reveal the suffering of struggling with the after-effects of cross-sex

hormones, specifically testosterone in female-to-male transitioning. Long-term

testosterone use has been associated with serious physical problems, many of which are

mentioned in the posts of detransitioners; however, few studies exist that explore specific

dysfunctions associated with testosterone. The research of da Silva et al. (2023) studied

68 transgender men (born female but identifying as male), over 18 years old, using an
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online questionnaire, conducted between September 2022 and March 2023. The mean

duration of testosterone therapy for the sample was 2.57 years (range was 3 days to 11

years). Findings showed that testosterone therapy is associated with gynecological

changes and pelvic floor dysfunction (PFD), including urinary symptoms, anorectal

dysfunction, and sexual dysfunction, and 94.1% of the sample suffered from at least one

of the PFD symptoms. The investigation showed the highest number of complaints were

regarding urinary incontinence, supporting the possibility of an interaction between

testosterone and urinary incontinence. The impact of urinary incontinence on the quality

of life can affect daily activities, social interaction, and self-perception (da Silva et al.,

2023).

Grief and anger are the two predominant emotions associated with the regret of

the detransitioners. Blaming themselves for the challenging physical and emotional

consequences resulting from bad decisions is uncaringly echoed by WPATH’s president

Dr. Marci Bowers. The transgender clinician, who refers to herself as a “gender-care

specialist,” states that patients (including minors) are ultimately responsible for their

choices regarding treatment and should not be “blaming the clinician or the people who

helped guide them. They need to own that final step” (Respaut et al., 2022, Reuters

Report).

It is apparent that clinical protocols do not exist for ceasing cross-sex hormones

safely. A recent publication of the Endocrine Society’s guidelines for gender-affirming

care (2017) does not address the issue as the Society’s spokesperson explains: “The

question of discontinuing hormone treatment is beyond the scope covered by the current

guideline.”
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Discussion of Findings

Despite the fact that medical evidence supporting gender transition is weak and

inconclusive, gender clinics continue to see a rapid rise in the number of young people

claiming a transgender identity (Jorgensen, 2022). It is reasonable that the exponential

increase in the number of adolescent transitioners most likely will result in an increase in

detransitioners. Making life-altering decisions as an adolescent is risky because the

human brain does not fully mature until the mid-twenties and the ability to plan and

prioritize are the last executive functions to develop. The pre-frontal cortex (decision-

making center) and the amygdala (emotional center) are still evolving and an adolescent’s

propensity to give precedence to emotions instead of facts interferes with their ability to

consider potential future outcomes when making an important decision (p. 2175).

The WPATH (SOC 8) removed the minimum age requirements for medical and

surgical care, and the “distress” criteria of the DSM-5. Any body modification desired

then becomes “medically necessary” (Abbruzzese et al., 2023). This includes acquiescing

to a male’s wish to be castrated to prevent him from self-surgery and bodily harm

(WPATH, SOC 8, Chapter 9).

Puberty Blockers – Impact on Brain Development

The first step in affirmative care is the prescribing of puberty blockers (GnRHa)

to children as young as 8 years old, with assurance that it is reversible and diagnostic. It

is not reversible because the effect on brain development is unknown, and it is not

diagnostic because over 95% of adolescents taking GnRHa proceed to cross-sex

hormones sending them on the pathway to gender transition (Biggs, 2022). The

detrimental effect of puberty blockers on the accrual of normal bone mass has been
 130

documented with the risk of osteoporosis in later life. The reality that many of the

children being prescribed GnRHa, if left untreated, may grow into gay or lesbian adults,

with their fertility intact (p. 14) continues to be supported in the literature (Bell, 2020;

Biggs, 2022; Bruskell-Evans, 2019; Cantor, 2019; Clayton, 2022; d’Abrera, 2020;

Ehrensaft, 2018; Evans, 2022; Giordano, 2019; Grabowski, 2022; Griffin et al., 2020;

Hruz, 2020; Jelsma, 2022; Joyce, 2022; Labuschagne, 2021; Levine et al., 2022; Littman,

2021; Marchiano, 2017; Moschella, 2021; Robles, 2021; Schwartz, 2021; Shrier, 2022;

Soh, 2020; Steensma et al., 2010; Turban & Ehrensaft, 2018; Withers, 2020). There is

extensive evidence that GnRHa continue to be prescribed “off label” and without clinical

trials.

The Pediatric Endocrine Society (PES) released a position statement in 2020 that

included the following:

Medical intervention for transgender youth and adults (including

puberty suppression, hormone therapy and medically indicated surgery)

is effective, relatively safe (when appropriately monitored) and has been

established as the standard of care. Federal and private insurers should

cover such interventions as prescribed by a physician as well as the

appropriate medical screenings that are recommended for all body

issues that a person may have.

Evidence of the impact of medications that interrupt puberty on brain function and

structure is further noted by Baxendale (2023), who identified 16 studies regarding the

neuropsychological impacts of puberty blockers. One remarkable fact mentioned was

female referrals for gender dysphoria, in the United Kingdom over the period between
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2009 and 2016, increased by more than 7000%. Puberty is a sensitive “window of

opportunity” for the development of executive functions and social cognition (p. 1157).

The critical “window” refers to specific periods of infancy, childhood, and adolescence

when the functions of the brain neuronal networks respond to internal and or

environmental inputs, and, if absent the correct input, are permanently compromised.

Puberty is not only responsible for the development of secondary sex

characteristics, but also the development of the frontal cortical circuits and the

connectivity of the hippocampus and the amygdala affecting impulse control and

decision-making. Studies indicate GnRHa have a detrimental impact on learning, social

behavior, and response to stress on mammals (Anacker, 2021; Hough et al., 2017). There

is no evidence that these effects are reversible. One human study (Mul et al., 2001) tested

a group of 25 children three years into treatment using the Wechsler Intelligence Scales

(shortened version) resulting in a decline of 7 points in performance and full-scale IQ

noted in the children. A single case study (Schneider et al., 2017) tested a gender-

dysphoric child (using Weschler) at 11 years 10 months (IQ=80) then again at 13 years 3

months (IQ=71) after two years of GnRHa treatment.

Longitudinal studies are urgently needed (Baxendale, 2023) beginning with

adequate baselines because this population (gender dysphoric children) contains a

preponderance of conditions such as autism, attention deficit hyperactive disorder

(ADHD), and other mental health difficulties associated with gender identity disorder.

Subsequent follow-up should continue until age 25.

Littman’s (2021) study of 100 detransitioners (69 of which were females

transitioning to males) revealed that 72.5% “…thought transitioning was my only option
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to feel better” which is supported by the statements in this paper indicating that other

options to treat gender dysphoria were not discussed. Regarding the sources identified by

the participants that encouraged them to transition, the most frequently reported were

social media and online communities. Clinicians were named as sources that pressured

them to transition “[My] [d]octor pushed drugs and surgery at every visit” (p. 3360) and

the majority (56.7%) felt their evaluation was inadequate, counseling was overly positive,

and the risks were not adequately addressed.

[Link] data, collected for this paper, are consistent with not only Littman’s

(2021) findings but also with Vandenbussche’s (2021) findings regarding the experiences

of detransitioners. Statements such as “My hormone blocker implant is several years old

and is only barely still functioning, but they will not remove it. It’s in my arm and I have

no contact with the doctor because he shut down his business apparently” and “I had no

medical help from the doctor who prescribed me T, she wanted nothing to do with me”

(p. 1612) express the negative medical experiences encountered. The difficulty finding a

detransition-friendly therapist is expressed by “It is very hard to find a therapist who

won’t tell you it’s ‘internalized transphobia’ or that dealing with dysphoria in other ways

is ‘conversion therapy’” and “I struggled to find a therapist who supported questioning

my trans identity and considering alternatives to transitioning; most only knew how to

encourage transitioning and reinforced the harmful ideas that led to my wrongly

identifying as FtM in the first place” (p. 1612). These arguments are further supported by

Hildebrand-Chupp (2020), Jedrzejewski (2023), Jorgensen (2023), and MacKinnon et al.

(2022).

The Deceptive Facade

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Some detransitioners, while realizing transition is a deceptive façade, still wish to

be seen and accepted as their preferred gender by others in the manner of follie a deux

(Hakeem, 2008). Statements such as “I’m just burnt out by transition and social aspects

of living as a non-passing trans woman,” “I’m done pretending I am a woman,” and “I

realize I’m just a feminine gay’ish [sic] man” are consistent with the research of Dr. Az

Hakeem, a consultant psychiatrist for England’s Portman Clinic (founded in 1931 as the

Psychopathic Clinic). As early as 2008 he stated that gender transition was attempting to

treat psychological distress by addressing the body and not the mind. He viewed gender

dysphoria as a delusional belief: “…surely the conviction that one is what one is not, is

also understood as a delusional disorder” (p. 183). A fellow psychiatrist (Dr. Elif Gurisik)

ran weekly psychotherapy groups for post-operative transitioners (then referred to as

transsexuals), who were confused and desperate (some suicidal), seeking therapeutic

help. Dissatisfied and unhappy with their gender transition, they exhibited anger and

resentment regarding their feelings of being mutilated and left in a limbo where they were

neither male nor female (p. 185). The current data, collected for this paper, are consistent

with Hakeem (2008). “It feels isolating to have a non-standard body,” “I’m feeling

exhausted and stuck halfway in between,” and “I've ended up just feeling essentially

genderless/androgynous…”

Edward Shorter, a medical historian, suggested that there is a pool of culturally

recognized symptoms that patients draw on to describe their maladies in order to be taken

seriously by the physician, resulting in a “shared diagnosis” (Ayad et al., 2023). Some

examples include anorexia nervosa, seldom seen until after the death of Karen Carpenter,

resulting in a social contagion among teenage girls followed by bulimia nervosa, and self-
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harming. Gender dysphoria is “…the latest way for teenage girls to hate their bodies” (p.

24).

The Canadian philosopher, Ian Hacking (1936-2023), coined the term “semantic

contagion” whereby naming a phenomenon (e.g., “born in the wrong body”) increases its

occurrence. Other examples include “multiple personality disorder” and “repressed

memory syndrome” (Ayad et al., 2023).

Misdiagnosis and Comorbid Psychopathologies

Misdiagnoses or missed diagnoses remain a significant problem and many

detransitioners discover that their gender dysphoria was related to other issues. An online

survey of 237 detransitioners confirmed that mental health comorbidities of the

participants were depressive disorder (70%), anxiety (63%), posttraumatic stress disorder

(33%), attention-deficit disorder (24%), autism spectrum condition (20%), eating disorder

(19%), and personality disorder (19%) (Irwig, 2022). Most of the participants stated they

did not receive adequate psychological or medical support. The data collected for this

paper support this theme: “…trauma and being neurodivergent (ADHD) and having a

personality disorder (BPD) made me feel different and confused about my place in

society, and without proper assessment I decided to transition,” “Personally, before trans

ever entered my brain, I got influenced by pro anorexia websites,” and “My dysphoria

was caused by my eating disorder & being heavily bullied as a child for my weight.”

A recent study corroborated these findings. Akgul et al. (2023) compared

comorbid psychiatric disorders in 22 transgender adolescents (8 FtMs and 14 MtFs) with

50 cisgender adolescents (21 females and 29 males) in a control group. There were no

significant differences in ages, paternal ages, parental education, number of family

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members, number of siblings, or monthly income between the groups. The results

showed that the psychopathologies in the transgender group were as follows: depression

(72.7%, n=16), oppositional defiant disorder (ODD) (45.5%, n=10), specific phobia

(22.7%, n=5), attention deficit hyperactivity disorder (ADHD) (18.2%, n=4), separation

anxiety disorder (18.2%, n=4), conduct disorder (9.15%, n=2), and social anxiety

disorder (4.5%, n=1) for a total of 72.2% of the transgender group suffering from

psychopathologies, similar to earlier reports. In the control group (cisgender), two were

diagnosed with anxiety disorder, two with ADHD, and one with depression.

Warrier et al. (2020) investigated the rate of autism and other psychiatric

diagnoses by using five independently recruited datasets consisting of 641,860

individuals who completed information regarding gender, autism, and

neurodevelopmental diagnoses. In agreement with other studies that showed autism

diagnosis “significantly elevated” in individuals at gender diversity clinics, the research

demonstrated the implications of elevated rates of autism and neurodevelopmental and

psychiatric conditions compared to cisgender individuals (Warrier et al., 2020).

Detransition-Friendly Social Media

One of the similarities that transitioners and detransitioners share is experiences

posted on social media. Trans-affirming narratives, promoting cross-sex hormones and

sex reassignment surgery target vulnerable individuals resulting in social contagion

(Littman, 2018; Marchiano, 2017; Sanders et al., 2023; Watt, 2019). Children, when they

encounter transgender content online, may be convinced they are dysphoric. “It is always

the weak – the scared, the lost, the vulnerable, the confused – who suffer most from what

results” (Klavan, 2020, p. 13). Sanders et al. (2023) collected and analyzed 130 posts
 136

from a global social media site, which included individuals contemplating gender

transition and experiences of detransitioners. In agreement with the data in this paper,

some expressed concern over the physicians who advocated for a medical-based

intervention instead of psychotherapeutic treatment after a “quick” diagnosis. One

individual remarked that they were told by a physician “…you will never be able to feel

comfortable…and [need to] drastically alter your body” (p. 1069). Other narratives talked

of being pushed to transition not only by professionals such as physicians and therapists,

but also family members, and trans-affirmative social media.

Ironically, the role of social media becomes significant for detransitioners,

representing a safe space for them to express their detransition narratives and establish a

connection with others experiencing similar tribulations. There are online sites, besides

the subreddits on [Link], that share information and provide a sense of community

to detransitioners. The Society for Evidence-Based Gender Medicine ([Link]) whose

website states “Our aim is to promote safe, compassionate, ethical and evidence-informed

healthcare for children, adolescents, and young adults with gender dysphoria,” provides

up-to-date information and studies. Some of the researchers referenced in this paper are

associated with this organization. The co-founders are William Malone (endocrinologist),

and Zhenya Abbruzzese (healthcare researcher). Board members include Julia Mason

(pediatrician) and Roberto D’Angelo (psychiatrist and psychoanalyst), and advisors

include Jane Wheeler (healthcare attorney), Richard Byng (general practitioner), Michael

Biggs (researcher), Sasha Ayad (behavioral therapist), Lisa Marchiano (social worker and

analyst), and Anastassis Spiliadis (psychotherapist and psychologist). SEGM exists solely
 137

through donations and is “free from political, ideological, religious, or financial

influences” ([Link]).

The detransition-friendly website, [Link], states, “We aim to provide

up-to-date, data-driven information about detransition / retransition” and offers

information, a bibliography, and support not only for detransitioners but also for

providers regarding treatment of detransitioners. The organization Genspect

([Link]) began in 2020; however, Genspect USA, launched in April 2024, is CME

accredited, and medical professionals can obtain Continuing Medical Education (CME)

credits for attending Genspect webinars and conferences. Genspect, founded and directed

by Stella O’Malley, provides up-to-date detransition research, current publications,

information regarding financial support for detransition lawsuits, conferences, and

symposiums. Kathleen Goonan, an internal medicine physician, and Stella O’Malley, a

psychotherapist, provide training to schools, organizations, and clinicians.

Genspect also lists helpful resources such as 4th Wave Now ([Link]),

Post Trans ([Link]), and Thoughtful Therapists ([Link]) in the

United States and other countries, and international parent support groups. Thoughtful

Therapists is a group of counsellors, clinical psychologists and psychotherapists from the

UK and Ireland concerned about the impact of gender identity ideology on children. The

site [Link] began as Detrans Voices in 2020, labels itself “safe social media”

and instructs members to “Break away from the nasty and corrupt people that messed up

your life!” ([Link]). Sex Change Regret ([Link]) provides a safe

place for detransitioner posts, detransition resources, and a bookstore. The Pique

Resilience Project ([Link]) was founded by 4 detransitioned women

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and provides a downloadable resource packet and a link to a podcast subset known as

Danger Ramen.

The message of [Link] is “No Child is Born in the Wrong Body.”

Established in 2015 Transgender Trend calls for evidence-based healthcare for children

and young people suffering from gender dysphoria and science-based teaching in schools.

It provides scientific excerpts from literature, resources, articles, and educational

materials for young children.

Do No Harm is an organization devoted to protecting children from gender

ideology. “We will fight to protect children from the dangerous ideology of ‘gender-

affirming care’” ([Link]/gender-ideology). The organization has, as its

mission, the protection of patients, physicians, and healthcare itself from radical, divisive

ideology. The website contains information regarding current issues, federal and state

policies, litigation, and research.

A 2016 online survey entitled “Female Transition and Subsequent

Reidentification” (Stella, 2016) was available from August 16 to August 30, 2016, posted

on Tumblr, Facebook groups (private), and the WordPress blog 4thWaveNow, resulting

in a surprisingly large number of respondents, and after removing questionable responses,

a sample of 203 female detransitioners remained. At a time when the term “detransition”

was not widely used and gender ideology proponents labelled it “very rare” the informal

survey, without complex methodology, uncovered a few stunning facts. The posts

showed that before transitioning, 65% of the women received no therapy (Figure 8) and

65% felt that detransitioning was beneficial (Figure 9 and Table 2).

Figure 8
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Stella (2016)

Figure 9

Stella (2016)

Table 2
 140

Stella (2016)

A subsequent study that validates the (Stella, 2016) survey data is the research of

Vandenbussche (2022), one of the first studies to examine the characteristics of the

detransition community in an attempt to identify the reasons (Figure 10) for

detransitioning and the needs of this population. Participants (N=237) were recruited

using social media. They were young, mostly female, with an average of living 4 years

transitioned, and showed a high prevalence of comorbidities. More than half of the

participants (54%) reported having had at least 3 diagnosed comorbid conditions (out of

the 11 conditions listed in the survey). The most prevalent diagnosed comorbid

conditions were depressive disorders (69%), anxiety disorders (63%), and PTSD (33%)

(Table 3).

Table 3

Vandenbussche (2022).

Figure 10
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Vandenbussche (2022)

Notably, the most commonly reported reason for detransitioning was that the

gender dysphoria was related to other issues (70%) and the second one was health

concerns (62%). Regarding being properly informed before transitioning, 45% of the

sample reported not feeling properly informed about negative health implications of the

medical treatments and interventions.

In addition to the reasons for detransition, the study also examined the needs of

this population which were divided into four categories: medical, psychological, legal,

and social needs. The most common medical need was accurate information on

stopping/changing hormonal treatment (49%), followed by complications related to

surgeries or hormonal treatment (24%) and access to reversal surgeries/procedures

(15%). The top two psychological needs were alternatives to medical transition (65%)
 142

and learning to cope with feelings of regret (60%). The main legal need was changing

back legal gender/sex marker and/or name (40%). Regarding social needs, the majority of

the respondents reported the need for hearing about other detransitioners (87%),

contacting other detransitioners (76%), support for detransition and dealing with negative

reactions (57%). Figure 11 shows that the most support came from social media and

online forums and groups sympathetic to detransitioners.

Figure 11

Vandenbussche (2022)

The comments in the current paper echo the comments from Vandenbussche

(2022) regarding empathetic therapists. “The biggest issue for me was that when I did try

to get support from a therapist or psychologist on entangling [sic] the actual reasons

behind my dysphoria and how to deal with it, and deal with detransitioning, nobody had

any clue or any experience, so they couldn’t help me…” and “It is very hard to find a

therapist who won’t tell you it’s ‘internalized transphobia’ or that dealing with dysphoria
 143

in other ways is ‘conversion therapy.’” Regarding finding competent medical care, the

following extracts were revealing: “I needed gender and transition experienced providers

to assist with my medical detransition, but none of them seemed to understand or provide

the type of care I needed…,” and “I still struggle to find a doctor who has knowledge of

detransition, and the effects HRT had on me…”

A survey was conducted by [Link] (r/detrans) and posted from January 2023

to February 2023 “…not only to better understand the demographic of people posting on

r/detrans but to address concerning and harmful rumors and misconceptions about the

population…” ([Link], 2023). After screening, the sample population (N=207) were

asked two questions related to their reasons for detransition and were allowed to select

four reasons:

A: What top reasons would you say you originally detransitioned for?

B: What top reasons now would you say you detransitioned, and decided against

staying transgender?

The bar charts in Figure 12 (female) and Figure 13 (male) display the initial

reasons for detransition (white bars) and the current reasons (black bars). The

predominant reasons were in opposition to pro-transgender research that continues to

assert that family reactions, religion, peer pressure, and discrimination (external reasons)

are motives for detransitioning (Turbin et al., 2022). The [Link] 2023 data

corroborated the proliferation of internal reasons for detransitioning including poor

surgical outcomes, medical problems, depression, regret, no amelioration of gender

dysphoria, and discovery of co-morbid psychiatric difficulties (Vandenbussche, 2021)

and support the data in this paper.

 144

Figure 12

Reasons for Detransition – Female

It is worth noting that the highest two reported reasons for female born people

were: Realizing gender dysphoria was related to other issues and concerns regarding
 145

health. The least reported reasons being lack of support, discrimination, and financial

concerns ([Link], 2023)

Figure 13

Reasons for Detransition – Male

The top reported reasons for male born people were realizing gender dysphoria

was related to other reasons, and that transition did not help their gender dysphoria. The
 146

least reported reasons were lack of support, financial concerns, and discrimination

([Link], 2023).

Biblical Foundations

Gender ideology’s views are opposed to Christian faith and human reason

(Grabowski, 2022) because Christians believe “…the sexually differentiated body is an

integral part of one’s identity…” (p.17) but saying this publicly may incite hatred. People

lose sight of themselves as “…the beloved handiwork of a loving Creator…” (p. 59) by

accepting the gender ideology worldview that indoctrinates children and reconfigures the

traditional family. The Christian author and researcher, Mary Eberstadt, argues that the

disintegration of the family, originally caused by the Sexual Revolution, resulted in

people looking for new places to “belong.”

Despite the well-intentioned belief that “…flesh is a prison from which the spirit

can be freed…” (Klavan, 2020), sex reassignment surgery tampers with the transcendent

core identity created by God. The morality of a medical procedure must always be

dependent upon therapeutic intent and to preserve or restore God’s design, not regarding

the body as an accessory that can be modified at will (Roy, 2020). Christian anthropology

links the body and soul forming one true identity which also plays a part in the

psychiatric condition labeled body integrity identity disorder (BIID), whereby an

individual wishes to have a healthy body part amputated. BIID is not listed in the DSM-5

but is mentioned in relation to body dysmorphic disorder (BDD). The DSM-5 states BDD

is treatable with psychotherapy (cognitive behavioral therapy [CBT] and family therapy)

and medication (antidepressants). The website of the Cleveland Clinic states “Ethically,

surgeons and providers won’t perform an amputation on a healthy limb without a clear
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medical need. This goes against the ‘do no harm’ principle of healthcare. The

consequences and risks associated with an amputation could be lifelong, dangerous and

deadly” ([Link]

biid).

Remarkably, this position is ignored when clinicians are removing healthy

breasts, organs, and genitals in the name of gender transition. The terms “lifelong,

dangerous, and deadly” could describe the irreversible surgical procedures of gender

affirmative care. The NCBC warns that the gender ideology movement propagates the

falsehood that hormone therapy and gender mutilation will change a person’s God-given

identity (Roy, 2020). The exponential rise in young people presenting as gender

dysphoric may be associated with the easy availability of treatment for what was once

considered an extremely rare condition. The chemical and surgical alterations that are

available may be creating the demand (Marchiano, 2019; Watt, 2020).

Sex reassignment surgery challenges not only the Hippocratic oath but also

Christian ethics and the Christian tradition that acknowledges the goodness of the human

body as created by God (Daly, 2016). The rise of “Nones” (non-Church-affiliated

individuals) in society increases what Augustine reasoned is the self-destructive behavior

hoping to give ourselves an improved tomorrow, or, as Bacon put it in the Novum

Organum, “…improvement of [mankind’s] estate, and an increase of their power over

nature…” making religion nonessential (Gonzalez, 2023). The lack of moral reasoning in

the gender ideology movement supports the notion that happiness can be achieved

without reference to a higher order and without seeking “…the things that are above…”

(Douay-Rheims Holy Bible, 5th Printing, 2009, Colossians 3:1). Thomas Aquinas, the
 148

Angelic Doctor, argued that sex is “an inseparable accident of the individual…an

attribute that is present as long as the individual exists.” It relates to the power to generate

and the unique ways in which male and female contribute to human generation (Newton,

2020).

Genetic manipulation of the body is complicit in the denial of the body having

moral significance (Song, 2007). “…[B]ut he that committeth fornication sinneth against

his own body” (Douay-Rheims Holy Bible, 5th Printing, 2009, 1 Corinthians 6:18). The

new philosophy of sex being “assigned at birth” and gender being a “…social role we

choose for ourselves” was condemned by Pope Benedict XVI (2012). The NCBC argues

that “the anthropological reality – that a person’s innate sexual identity cannot be

changed – has moral consequences” (Jones, 2018).

A few detransitioners recognized the misappropriation of morality with transition.

“And as soon as I left that circle and moved away from the 'heterosexuality is evil,

subverting gender roles is the ultimate moral goal' mindset.. I detransitioned” and “…

then it snowballed into allowing transition to be a moral good…”

The data for this paper reveal the understanding (albeit too late) of some of the

detransitioners regarding the contradiction of living their authentic existence as a male or

female instead of establishing a false identity in place of their true biological identity.

“Transition is a lonely place because at the end of the day you’re disconnected from your

body,” “…I’m a trans woman just because people say I’m one,” and “…I put an

enormous amount of blame on my therapist for writing me a letter for voluntary

amputation….”
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Identifying as the opposite sex can create cognitive dissonance and obsessive

thinking, making transitioners feel worse and causing distress and anxiety. Gender

transition is a belief that contradicts material reality and makes one struggle to be

something one is not. In the words of a detransitioner “I was not living in truth, regardless

of surgery, legal declaration, and proclamations of diversity and tolerance” (Anonymous)

(Watt, 2019).

Implications

The experimental aspects of gender affirming care remain at the center of the

transgender and detransgender controversy. In addition, the ethics of sex reassignment

surgery and other medical interventions used in gender transition are questionable,

particularly concerning children.

Importance of Recent Studies

Parents are blackmailed with the threat of suicide if they do not participate in the

affirmation of their child’s gender dysphoria. A recent study, published in Finland in

2023, examined a nationwide cohort of adolescents (N=2083), under 23 years-old

referred to gender clinics from 1996 to 2019 with matched controls and found that

providing adolescents with transgender drugs or surgeries did not provide any statistically

significant reduction in suicide deaths (Ruuska et al., 2024). Psychiatric morbidities,

common in this population, are the main predictors of suicide. “Therefore, the risk of

suicide related to transgender identity and/or [gender identity] GD per se may have been

overestimated” (p. 5). They conclude that gender dysphoria does not appear to predict all-

cause or suicide mortality and it is important to identify and treat comorbid mental

disorders to prevent suicide. Since 2020 Finland has opposed the WPATH’s Standards of
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Care, prioritizes psychotherapy over hormones, and rejects surgeries for gender-

dysphoric minors (SEGM, 2021). Psychotherapy is considered the first line of treatment

and surgeries are not permitted for children under 18 years old.

Another study from The Netherlands examined unhappiness identifying with the

gender aligned with one’s sex, from early adolescence to young adulthood, and its

association with self-concept, behavioral, and emotional problems. The study of 2772

adolescents found that gender non-contentedness (term used instead of gender dysphoria)

decreased with age and provided new insights into the association of gender dysphoria

with mental health problems (Rawee, 2024).

Dr. Hilary Cass, in an interview with the New York Times in May 2024, reiterated

that “…there is no comprehensive evidence to support the routine prescription of

transgender drugs to minors with gender dysphoria.” The British pediatrician published

the independent Cass Review (April 2024) (4 years in the making), commissioned by the

National Health Service (NHS) in England, and found the evidence “very weak” that

prescribing transgender drugs to minors is beneficial. She further stated that medical

organizations in the United States, specifically the American Academy of Pediatrics

(AAP), possibly reacting to “political duress,” are misleading the public. Although the

American Academy of Pediatrics announced a “systematic review” of its guidelines

would take place in August 2023, it continued to endorse its support for “gender-

affirming care” for children. “I respectfully disagree with them on holding on to a

position that is now demonstrated to be out of date by multiple systematic reviews”

(Cass, interview New York Times, 2024). In addition to the Cass Review, the Finland

research and the study from The Netherlands question the efficacy of prescribing
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transgender drugs and sex reassignment surgeries for children, a Mayo Clinic study from

April 2023 found that puberty-blocking drugs may cause irreversible damage to testicular

cells in young boys ([Link]

dysphoria/in-depth/pubertal-blockers/art-20459075).

The Norwegian Healthcare Investigation Board (NHIB) stated “research-based

knowledge for gender-affirming treatment (hormonal and surgical), is insufficient and the

long-term effects are little known” and recommended revising the guidelines for care of

gender dysphoric youth (May 2023). The French Academy of Medicine (FEAM) has also

recommended caution regarding the use of puberty blockers and surgery in the care of

gender dysphoric adolescents. The Swedish Agency for Health Technology Assessment

and Assessment of Social Services reviewed 9934 studies to determine the effects of

hormone treatment in children on “psychosocial and mental health, cognition, body

composition and metabolic markers” and concluded “long-term effects of hormone

therapy on psychosocial and somatic health are unknown, except that GnRHa

(gonadotropin-releasing hormone analogues) treatment seems to delay bone maturation

and gain in bone mineral density.” A key point of this research was that puberty blockers

prescribed to children should be considered experimental not a standard of care. England

has closed the Tavistock and Portman clinic, (GIDS) and has stopped prescribing puberty

blockers for children, except for those enrolled in clinical trials. Scotland's National

Health Service has paused prescribing puberty blockers to children and the Sandyford

clinic in Glasgow will no longer prescribe hormone treatments to adolescents under 18

years of age.
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Important research was recently conducted involving participants from the United

States and Canada and funded by the Social Sciences and Humanities Research Council

of Canada (SSHRC-CRSH). Known as the Detransition Analysis Representation and

Explanation (DARE) Study, its objectives included the different pathways leading to

detransition and related life experiences (MacKinnon et al., 2024). Eligibility to

participate in the online survey included residence in the U.S. or Canada, minimum 16

years of age, and the ability to answer (anonymously) survey questions in English,

French, or Spanish. After distributing flyers to organizations and gender-care facilities

and advertising on social media, 962 (70%) of the 1,377 completed surveys were

determined to be eligible participants after applying the exclusion protocol. The

conclusions extend the literature of detransition research; however, it must be noted that

the paper is in its unpublished, non-peer-reviewed pre-print form. The following graphics

demonstrate the demographics: age (Figure 14), country of residence (Figure 15), and sex

at birth (Figure 15). The significant results of the detransitioners are shown in Figure 16.

Figure 14

Age of Participants in the DARE Study

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MacKinnon et al., 2024

Figure 15

Country of Residence

MacKinnon et al., 2024

Figure 16

Sex at Birth

MacKinnon et al., 2024

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Figure 17

Identity after Detransitioning

MacKinnon et al., 2024

Medical Associations and States Opposed to Gender Affirming Care

In 2021, the case of Franciscan Alliance, Inc. et al. (Plaintiffs) v. Xavior Becerra,

Secretary of the U.S. Department of Health and Human Services and HHS was decided.

The Franciscan Alliance (a Catholic hospital network) and a Christian healthcare

professional association (Christian Plaintiffs) sued the HHS stating that Section 1157 of

the Affordable Care Act compelling clinicians to perform abortions and gender-transition

procedures or face penalties for unlawful discrimination violated the Religious Freedom

Restoration Act (RFRA) which states that the federal “[g]overnment shall not

substantially burden a person’s exercise of religion even if the burden results from a rule

of general applicability.” The court ruled that Section 1557’s did indeed violate the

RFRA and the HHS lacked the authority to prohibit discrimination based on gender
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identity. The Court granted the plaintiffs a permanent injunction from the enforcement of

Section 1557 (Civil Action 7:16-cv-00108-O).

The Catholic Medical Association (CMA) and the American College of

Pediatricians (ACPeds) filed a complaint in court, in 2021 arguing that Biden’s

transgender mandate violates RFRA and the U.S. Constitution and stating:

Doctors now face an untenable choice: either act against their medical

judgment and deeply held convictions by performing controversial and

often medically dangerous gender-transition interventions, or succumb

to huge financial penalties, lose participation in Medicaid and other

federal funding, and, as a practical matter, lose the ability to practice

medicine in virtually any setting (EWTN News, 2021).

The Association of American Physicians and Surgeon (AAPS), a national

organization of physicians in all specialties, founded in 1943, a pro-patient association of

physicians in the practice of private medicine, issued a statement in February 2023. The

statement, in part, counsels medical professionals to refuse to be coerced to participate in

procedures to which they have ethical or scientific objections or which they believe

would harm a patient. It also argues that “biological sex is determined at conception by

genotype and apart from rare anomalies, which result in ambiguous genitalia, sex is

correctly identified at birth—and is indeed obvious.” It further states that gender-

affirming procedures are generally irreversible, with unknown long-term risks, have a

high probability of causing sterilization, and commit a patient to a lifelong need for

medical, surgical, and psychological care. AAPS, whose motto means “all for the patient”
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believes “Gender-affirming care in minors is medically and ethically contraindicated

because of a lack of informed consent” (AAPS, 2023).

The American College of Pediatricians (ACPeds), founded by a group of

physicians wishing to form a pediatric organization that would not be politically

influenced, recently issued a position statement regarding gender incongruence in

adolescents and mental health. ACPeds takes the stance that gender dysphoric

adolescents are at higher risk for psychopathology than their peers who identify with their

biological sex, both before and after undergoing gender affirming treatment. Evidence is

lacking that gender affirming protocols, both medical and surgical, benefit the mental

wellbeing of gender-confused adolescents. Because of this “many European countries are

now cautioning against these interventions while encouraging mental health therapy.”

The ACPeds argues that “at minimum, long-term controlled trials should be

conducted if these interventions are to be continued” and more attention and support

should be provided to individuals wishing to detransition. The statement concludes with

“Therefore, the ACPeds cannot condone the social affirmation, medical intervention, or

surgical mutilation of children and adolescents identifying as transgender or gender

nonconforming. Rather, intensive psychotherapy for the individual and family to

determine and hopefully treat the underlying etiology of their gender incongruence

should be pursued” (ACPeds, February 2024). At a press conference in June 2024, the

ACPeds announced the launch of the Doctors Protecting Children Declaration posted on

[Link] To date, it has resulted in the signatures of 75,000+

physicians and healthcare professionals represented by co-signing medical organizations,

and 5,000+ individual signatures representing 59 countries.

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In June 2024, it was revealed on the ACPeds website that the American Academy

of Pediatrics (AAP) colluded with the World Professional Association of Transgender

Health (WPATH), to push for more access to children’s transgender interventions. The

Biden Administration health officials, including Adm. Rachel Levine (a biological male

who lives as a trans woman), Assistant Secretary for Health at the U.S. Department of

Health and Human Services (HHS), who wants to make “normalizing” gender affirming

care for kids a government priority, urged WPATH to remove age limits for transgender

interventions and WPATH obliged ([Link]

aap-and-biden-health-officials-colluding-with-wpath-to-push-transgender-interventions-

on-minors). Dr. Michael Artigues, President of the American College of Pediatricians

(ACPeds), released a statement which, in part, declares “We are appalled that the AAP

and top U.S. health officials put political interests ahead of science and evidence-based

healthcare when it comes to children…” The American College of Pediatricians entreats

the following organizations: the American Academy of Pediatrics, the Endocrine Society,

the Pediatric Endocrine Society, the American Medical Association, the American

Psychological Association, and the American Academy of Child and Adolescent

Psychiatry to “adhere to evidence-based research and cease harmful interventions.”

On July 10, 2024, the American College of Pediatricians (ACPeds) filed a lawsuit

against the Biden administration’s U.S. Department of Health and Human Services

(HHS) regarding its April 2024 reinterpretation of the rule in the Affordable Care Act

(ACA) Section 1557, that establishes so-called “gender-affirming care” as the new,

although unproven, “standard of care.” The ACPeds is represented by the Alliance

Defending Freedom (ADF), whose senior counsel described the Biden administration’s
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actions as “…vast overreach in health care.” Joining in the lawsuit are Arkansas, Idaho,

Iowa, Missouri, North Dakota, South Dakota, and Utah arguing that the rule violates the

First Amendment and the Fifth Amendment rights of healthcare providers.

The rule, mentioned in several lawsuits, which began as an anti-discrimination

provision, was hijacked by gender ideologues, and would remove federal financial

assistance from a healthcare provider or insurer refusing to provide or cover transgender

medical interventions for adults or minors. Violators of this rule could be excluded from

participating in Medicare and Medicaid, regardless of the physician’s belief that the

procedure could be harmful to the patient. There must be silent and terrified physicians

and healthcare workers, appalled by what is being done to children and determined to

stop it. Meanwhile, a federal judge temporarily blocked HHS from enforcing the law

against 15 other states who separately filed a similar lawsuit. Alliance Defending

Freedom (ADF), an alliance-building, non-profit legal organization committed to

protecting religious freedom, free speech, parental rights, and the sanctity of life, also

filed a similar lawsuit against HHS on behalf of the State of Florida and the Catholic

Medical Association (CMA).

The Transition Justice Project is a donation supported resource for detransitioners

that advertises on the website ([Link]) it “…connects detransitioners and

others negatively affected by gender medicine with legal assistance.” Donations are used

for litigation expenses including expert witness fees, and the website tracks current

detransitioner lawsuits (Table 4).

Table 4
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Dashboard of Current Detransitioner Legal Cases ([Link]) (2024)

The Transition Justice Project is a project of Partners for Ethical Care, “…a

secular, non-partisan, all-volunteer, grassroots nonprofit organization” whose mission is

“to raise awareness and support efforts to stop the unethical treatment of children by

schools, hospitals, and mental and medical healthcare providers under the duplicitous

banner of gender identity affirmation. We believe that no child is born in the wrong

body” ([Link]). The website provides news, events, videos, and

resources for detransitioners, materials for parents, and the remarkably long list of

companies and organizations that support Planned Parenthood.

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In June 2024, two bishops of the Catholic church released a statement regarding

the proliferation of “new rights” enforced by federal agencies that are associated with

promoting gender ideology. Charities and social service providers are required to

participate by requiring foster homes to “affirm” a child’s chosen gender identity. Sex-

separate bathrooms at a place of employment could be considered sexual harassment and

gender identity claims could be conflated with disability discrimination. Although the

rules make vague assurances that the agencies respect religious freedom, there is no

guarantee that religious freedoms will actually be honored because exemptions for faith-

based organizations will be judged on a case-by-case basis. This ideological worldview,

which Pope Francis called “the ugliest danger of our time,” is in direct opposition to the

common good.

The Texas supreme court ruled by a vote of 8 to 1 that a Texas law that prohibits

certain medical treatments for children with gender dysphoria does not violate the state

constitution. Justice James Blacklock, in his concurring opinion “holds that a boy is a

boy, a girl is a girl, and neither feelings and desires nor drugs and surgery can change this

immutable genetic truth, which binds us all” (National Review Online, 2024). Healthcare

providers with religious, moral, and medical objections to affirmative care are pushing

back. Machiavelli said, “Politics have no relation to morals.”

Right of Conscience

Conscientious objection was usually associated with abortion and euthanasia. The

concept of “right of conscience” gained prominence in the United States in the 1970s at

the time of Roe v. Wade. Specifically, the conscience provisions contained in 42 U.S.C.

300a-7 (collectively known as the “Church Amendments”) were enacted in response to

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whether recipients of federal funds were required to perform abortion or sterilization

procedures. In part they state:

No individual shall be required to perform or assist in the performance of

any part of a health service program or research activity funded in whole

or in part under a program administered by the Secretary of Health and

Human Services if his performance or assistance in the performance of

such part of such program or activity would be contrary to his religious

beliefs or moral convictions.

However, the reinterpretation of the Affordable Care Act contained a directive

known as the “final rule” (2016), restated by HHS in 2024, which construes

discrimination based on (biological) sex to also mean “sexual orientation and gender

identity.” The HHS bases the final rule on the 2020 case of Bostock v Clayton County

wherein Gerald Bostock was fired by Clayton County, Georgia, arguing that “An

employer who fires an individual merely for being gay or transgender violates Title VII

of the Civil Rights Act of 1964.” Gerald Bostock prevailed; however, Judge Alito, in his

dissent, argued that the Civil Rights Act protected individuals from discrimination based

on their biological sex – male or female – not sexual orientation or gender identity.

Conscientious objection in healthcare is the refusal of clinicians to provide an

intervention based on moral concerns. One recent study argued that although there are

various bioethical views and different opinions, withholding healthcare from gender

diverse individuals can result in adverse ramifications (Milionis & Toska, 2023). The

study viewed clinicians exempting themselves from transgender interventions citing

ethical reasons, may “further marginalize the already underprivileged gender-diverse

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population” (p. 1). The implications of the study were that gender-affirming treatment is

“neither elective nor cosmetic” and there are strong arguments against the interference of

conscientious objections regarding medical care. Milionis and Toska (2023) believe that

tolerance for conscientious objection cannot be unlimited because it places unnecessary

barriers to health care for transgender individuals and objectors should reconsider their

position. This viewpoint agreed with James et al. (2021), who argued the exercise of

conscience of the physician places significant burdens on the patients (transgender

individuals) described as “… the most vulnerable and historically excluded from

receiving equitable care” (p. 971). They further maintained it represents a failure of the

healthcare system and distinct discrimination “…under the guise of religious and moral

conscience…” (p. 971).

Milionis and Toska (2023) also agreed with the 2020 study of Fry-Bowers (2020)

that examined conscientious objection in healthcare wherein it was argued that

“…legitimate concern exists that moral disagreement is merely a pretext for

discrimination” and suggested that “…the burden of conscientious refusal falls

disproportionately on vulnerable populations…” (p. 120).

Flaws in these studies include no mention of minors and informed consent

regarding transgender patients (Fry-Bowers, 2020) and only one vague reference to

children or minors – “Most concerns pertain to the treatment of underage individuals…”

(Milionis and Toska. 2023, p. 3). The argument that the risk of complications cannot be a

rationale for withholding an intervention and the repeated implication that conscientious

objection may be discriminatory shows bias. Despite stating that the right of health

professionals to refuse to perform interventions because of moral concerns should be

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protected, there was no description or explanation describing how this would occur.

Finally, Milionis and Toska (2023) defined conscientious objection in the introduction as

“…refus[al] to provide legally and scientifically valid medical procedures…” (p. 2) based

on ethical concerns. Research has shown that puberty-blockers, cross-sex hormones, and

sex reassignment surgeries are not based on “scientifically valid” evidence for treating

gender dysphoria (Abbruzzese et al., 2023; Biggs, 2022; Clayton, 2023; Hruz, 2020;

Pilgrim & Entwistle, 2020; Whitehall, 2020). Gender affirming treatments continue to be

labeled experimental by researchers.

In 2019, the Trump Administration proposed a rule that would broaden the

existing federal “conscience laws” protecting the religious rights of healthcare providers

and religious institutions. After several legal challenges, a federal district court judge in

the Southern District of New York vacated the rule in its entirety applying it nationwide,

concluding the rule was “arbitrary and capricious,” beyond the enforcement authority of

HHS, and in conflict with federal law. This ruling was echoed by two judges stating the

rule violated the Administrative Procedure Act. The Christian Medical and Dental

Associations (CMDA) have filed a notice of appeal (Fry-Bowers, 2020). The CMDA is a

network of Christian medical and dental professionals “bringing the hope and healing of

Christ to the world through Christian healthcare professionals” ([Link]). The CMDA

released the Transgender Identification Ethics Statement in July 2024 reaffirming the

biblical understanding that man was created male and female and condemning

cooperation in medical and surgical interventions “… to alter, amputate, or reconstruct

normal tissue to conform to the patient's revised psychological sense of identity”

([Link]
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One reason behind the proposed new rule was the Department of Health and

Human Services' (HHS) Office for Civil Rights (OCR) received 343 complaints (a 300%

increase from the previous decade) in one year from healthcare workers stating they were

forced to comply with actions that they opposed on moral or religious grounds. Having

created the Division of Conscience and Religious Freedom (2018), Roger Severino, the

office's director, has made clear that protecting religious freedom is his priority because

he believes the government “…treated conscience claims with hostility instead of

protection" ([Link], 2019).

Soriano and Montero (2023) summarized the debate, regarding conscientious

objection in the medical profession, held at the College of Physicians of Madrid in 2022.

Conscientious objection, defined as the right to object to the performance of duties that

opposes one’s religious, moral, or philosophical convictions, was distinguished as “not

insubordination.” The original 2000-year-old Hippocratic oath specifically prohibits

abortion and euthanasia and is still used in approximately 11% of medical schools. The

more modern and more popular version, written in 1964 by Dr. Louis Lasagna, states “I

must not play at God,” and some medical schools use a third option – the Geneva

Declaration of the World Medical Association (WMA, 1948) – that contains a directive

that, even if threatened, a physician must not violate medical ethics.

On point, in the case of Arcopoli v. Elisabeth (2021), a psychotherapist

(Elisabeth) was accused of practicing “conversion therapy” on a female (lesbian) patient,

was sued by Acropoli (an LGBT organization), and was sanctioned based on a regional

law. After a clinical assessment, Elisabeth determined that the patient would benefit from

psychotherapy rather than medical interventions, which she considered as harmful,

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required by the LGTBIfobia law of Madrid. Elisabeth’s conviction was overturned by the

Regional Supreme Court (Soriano & Montero, 2023). Healthcare professionals cannot be

viewed as mere technicians performing the wishes of a patient, a healthcare

administrator, or a law. A physician is an active participant in medical diagnosis and

decision-making. (Figures 18 and 19).

Figure 18

Soriano and Montero (2023)

Figure 19

First the law or ethics? (Soriano & Montero, 2023).

If the patient’s request is considered potentially harmful, conscientious objection

allows the physician to avoid inflicting harm (Symons, 2023). The American Medical

Association’s (AMA) Code of Medical Ethics explicitly states that doctors have an
 166

obligation to try to change an unethical or unfair law and “ethical responsibility will be

above legal obligation” (AMA, 2001). Regarding sex reassignment of minors, the risk is

the prevailing ideology over science (Hruz, 2020) clearly supported by leading medical

journals and organizations (Soriano & Montero, 2023). This aberration is expressed in the

degeneration of the doctor-patient relationship whereby “…distinction between need and

wish here evaporates” (Bell, 2020, p. 1034).

Several scholars, who are critics of conscientious objection in the medical field,

believe that doctors should set aside their personal beliefs when a medical practice is

sanctioned by law and professional associations, maintaining that the Professional Duty

Argument (PDA) supersedes the right of conscience (Symons, 2022). The basis for this

argument consists of the following: (1) medicine has its own set of standards regulated by

professional associations and the law and (2) if one voluntarily joins the medical

profession one must comply with these standards. The fallibility of this stance “…reduces

professional morality to what is legal and condoned by relevant professional

associations” (p. 552). Laws may be unjust, and professional associations have condoned

practices in the past now considered repugnant. Blindly abiding by professional codes of

conduct, with no discretion, results in mindless conformity. Professional judgment should

not be acquiescing to patients’ wishes but using discretion to prevent harm and deliver

quality care.

The British Psychological Society’s (BPS) policy considers any clinician who

expresses doubts about gender affirming care to be “ethically suspect” because the doubts

may be the result of ignorance or prejudice, thus inhibiting ethical debate (Pilgrim &
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Entwistle, 2020). With the proliferation of gender affirming care “…the profession of

medicine lacks credibility in what has become the modern-day experiment on a suffering

population” (Robles, 2021, p. 267).

Limitations

Collecting data online, using social media is a limitation because there is no way

to ask probing or follow-up questions as there would be during in-person interviews;

however, this contentious topic renders it difficult to get individuals to participate in a

study where they would be directly engaged and possibly identified. Participants’

anonymity is a challenge and must be protected. Detransitioning has become a polarizing

topic and those who detransition are hesitant to discuss their negative experiences, except

in the company of empathetic listeners or anonymously on social media. Detransitioners

are advised by pro-trans activists not to share negative outcomes and questionable

gender-affirming medical experiences such as inadequate assessment and coercion

occurring before transitioning (Entwistle, 2021; Gribble et al., 2023). They are made to

feel like traitors to the trans-active community and have been subjected to bullying and

social isolation. Detransitioners have not been formally acknowledged as a population

(Entwistle, 2021) by medical organizations.

Other challenges include the number of detransitioners, which is unknown and

may include the large number of patients lost to follow-up after gender transition – a

recurrent problem in most research. Detransitioners drop out of treatment (and out of

sight) without returning (or informing) the original physician or clinic, and encounter

problems finding a physician able and willing to help them. There are no guidelines or

standards of care available for healthcare professionals to aid them in treating

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detransitioners and many detransitioners continue to suffer alone and in silence, the

serious consequences from medical interventions. Blaire White, a transgender on

YouTube is critical of the treatment of detransitioners by the gender identity activists.

“Detransitioning is something that is incredibly taboo within the trans community. A lot

of people who tell their stories of detransitioning are bullied, and shamed, and silenced”

(Klavan, 2020, p. 5).

The current study is not concerned whether or not the detransitioner returns to

their biological sex or wishes to continue to be considered “transgender,” but only the

lived experiences that triggered the transitioner’s decision to detransition. Negative

psychological, medical, and social experiences are of importance. Some studies focus on

regret as the main reason when describing detransitioning; however, this study examines

all reasons for detransition. Studies that measured only regret did not wait an appropriate

amount of time after transitioning before assessing regret or dissatisfaction regarding the

transition, ignoring the confounding variable of the “honeymoon period” immediately

following the intervention (Cohn, 2023). Detransitioning usually occurs an average of 7-8

years after medical gender transition. Much of the data for this study, collected from

[Link], were from those who had lived as a transitioner for several years before

detransitioning.

The postings on [Link] appear to be genuine and are treated as such. The

subreddits concerning detransition are monitored to eliminate frivolous and bullying

comments. The reasons for transitioning, mentioned in the posts, are illuminating. Some

vulnerable individuals were confused by the pressure of professionals, peers, and their

mothers, thus rendering their original decisions to transition problematic.

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Recommendations and Implications for Future Research

Impact of Final Cass Review

The final 388-page report, a singular notable event, provided a scathing

assessment of gender-affirming treatment (GAT) and pointed out that the concept of

accepting without question a child’s perceived gender originated in the United States (not

in Sweden, as incorrectly believed) before spreading internationally. Commissioned by

the National Health Servies (NHS) of England, the NHS responded to the Cass Review

by stating it would implement recommended changes and commission a similar review of

adult gender clinics. The Review analyzed 103 scientific papers with 2% considered high

quality, and 98% not.

The Cass Review suggested that, although the number of detransitioners are

unknown due to lack of long-term studies, the number is increasing. In the Review, the

term “detransition” was mentioned 75 times, clearly acknowledging it as a growing

phenomenon that cannot be ignored. Clinicians reported seeing an increase in

detransitioners because they move between clinics, and are hesitant to return to the clinic

that was responsible for the transition. The Swedish and WPATH guidelines mention

supporting detransitioners, but no method is provided regarding how this would be

managed. One young person from the University of York mentioned, when interviewed

in a qualitative study, “I felt like it wasn’t, you know, acceptable to go back, you know. It

wasn’t something that was talked about. It didn’t feel like an option that they wanted to

discuss even mention…”

Since the Review began (4 years ago) the narratives regarding detransition and

regret have become weaponized and the gender-affirming care supporters continue to
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maintain that cases of detransition are “vanishingly rare,” and similar to other studies

(Turban et al., 2022), are the result of external reasons such as lack of acceptance and

minority discrimination.

As a result of an audit conducted by GIDS/Tavistock, the timeline for (before its

closure), choosing to detransition was determined to be between 5 years and 10 years

(average 7 years) after transitioning. The Cass Review wished to have access to the audit

to study the presenting features and risk factors of children, such as alexithymia (inability

to recognize or express emotions) and interoception; however, the trust (GIDS/Tavistock)

did not agree. GIDS/Tavistock (closed in March 2024 as a result of information from

whistleblowers) was the only clinic that refused to participate in the Cass Review and

was criticized in the Review for “overtreatment,” obtaining consent not aligned with the

NHS, and maintaining disorganized records. Based on negative feedback regarding the

GIDS (rated as inadequate by inspectors in January 2021), the Review stated, “In

addition, the poor evidence base makes it difficult to provide adequate information on

which a young person and their family can make an informed choice.” (p. 34).

Puberty blockers to stop normally timed puberty will no longer be offered in NHS

clinics in England. Private and online clinics (abroad) will not be subject to the ban;

nevertheless, the government intends to regulate private clinics by limiting care for those

under 18 years old and banning the online hormone trade. As stated in the 2020 Interim

(Cass) Review, the systematic review of evidence “…showed no credible psychological

benefits of puberty suppression…” The Review recommended extreme caution if

providers are considering cross-sex hormones for children under 18 years old and even

discouraged social transition. Regarding hormone treatments, the Review cited previous
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studies. “There is evidence that masculinizing/feminizing [sic] hormone treatments alter

brain structure” (Ristori et al., 2020). “The neuropsychological impact of arresting

pubertal development with puberty blockers remains poorly understood” (Baxendale,

2024) (Cass Review, p. 114). England will restructure the delivery system of gender-

related services to align with the way other healthcare is delivered. Children suffering

from mental health conditions will receive psychotherapeutic and psychological services

and, hopefully, very few children will be treated with interventions to alter their bodies.

The Cass Review also assessed existing treatment guidelines and

recommendations of the WPATH, American Academy of Pediatrics (AAP), and the

Endocrine Society (ES) and found them lacking “developmental rigour [sic]” and rooted

in circular logic resulting in non-evidence-based guidelines. The WPATH and the ES

refer to each other rather than to high quality evidence. The Review condemned the toxic

nature of debate and the equating of psychological treatment to “conversion practices.”

Lack of adequate services for the detransition population was noted and the

recommendation was that the NHS should ensure that there are provisions available for

the physical and psychological needs of these individuals including “Those who

detransition should be carefully monitored in a supportive setting, particularly when

coming off hormone treatments” (Cass Review, 19.24, p. 227).

Critics of the Cass Review believe that it set the methodology bar too high, when,

in reality, the bar for gender transition studies has been set too low. The quality of

gender-affirming research, usually conducted with no control group, and an inadequate

understanding of benefits and risks is unethical resulting in “overmedicalizing” and

failing to provide a holistic model of care (Abbasi, 2024). The AAP and the Endocrine
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Society (ES) are standing by their guidelines and stated that the Review is rooted in the

“false premise that non-medical alternatives to care will result in less adolescent distress”

(Block, 2024, p. 1). The American Psychological Association, the American Psychiatric

Association, and the American College of Obstetricians and Gynecologists, all of which

support the affirmative care model, have remained silent regarding the Review; however,

the past president of the American Society of Plastic Surgeons (Scot Glasberg), now

president of the Plastic Surgery Foundation (PSF) agreed with Dr. Cass that gender

transition research was of “…low quality and low value to dictate surgical care…”;

nevertheless the websites of both organizations advertise gender transition surgeries.

The European Society for Child and Adolescent Psychiatry (ESCAP) released a

policy statement to safeguard gender confused youth from “…experimental and

unnecessarily invasive treatments with unproven psychosocial effects” while, in contrast,

the America Psychiatric Association focused on the “negative effects” of state legislation

(Block, 2024). The Cass Review has polarized the political landscape and the mainstream

media in the United States.

The Wall Street Journal stated that the Review “…shows wisdom and humility on

treatment of young people in contrast to the ideological conformity in the U.S. medical

associations” (Block, 2024, p. 2). Recent articles that advocate gender-affirming care and

use terms such as “misinformation,” “epistemological violence,” and “gender

essentialism” when discussing what they consider to be anti-trans efforts have been

published online by Scientific American (the oldest continuously published magazine in

the U.S.). In accordance with other gender ideology proponents, the editor in chief

declared “The research is clear, and all the relevant medical organizations agree.”
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Furthermore, on the website, Scientific American stated the recommendations of the

Review are based on prejudice (not evidence), bias, double standards in data

interpretation, substandard scientific rigor, methodological flaws, and inability to

substantiate claims, concluding that trans children need “louder allies”

([Link]

children/)

The Cass Review, according to an investigation by the British Medical Journal,

has had a crucial effect in the United Kingdom, Scotland, Wales, and parts of Europe

with the ceasing of the use of puberty-blocking drugs outside of research protocols

(Block, 2024). In the U.S., the HHS continues to maintain that gender-affirming care

improves the mental health of gender confused children and adolescents, and Rachel

Levine, the transgender HHS assistant secretary told NPR “…there is no argument among

medical professionals…about the importance of gender-affirming care” (NPR interview,

2022).

Hilary Cass, in the face of personal attacks, threatening emails, attempts to be

discredited, and accusations of collaborating on the ban of gender-affirming care in

Florida, has been advised not to travel on public transportation for her own safety.

Nevertheless, she is unwavering and continues to be “very angry” regarding the

misinformation that is promulgated by professional organizations, particularly in the U.S.

“But what some organisations [sic] are doing is doubling down on saying the evidence is

good, and I think that’s where you’re misleading the public” (New York Times interview,

2024).
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However, WPATH and USPATH remain “deeply concerned” and describe the

effects of the Cass Review as a breach of the rights of transgender youth because they are

being denied “medically necessary care” thus creating a “devastating situation”

([Link] 2024). WPATH and USPATH firmly stand by their standards

of care (SOC 8) in collaboration with Johns Hopkins University and label the Cass

Review an “outlier” not supported by robust technology and using selective and

inconsistent evidence.

Fortunately, some researchers view the Cass Review as a “moment of

opportunity” to substantiate that advocacy based on substandard evidence and the rush to

gender-affirming care had moved ahead of evidence-based medicine (Abbasi, 2024). The

Review labels the gender-affirming medical model as “fundamentally flawed” because

the pre-existing mental health problems of children are ignored. Moreover, regarding

detransitioners, Dr. Cass states "But what we need to understand is what's happening to

the majority of people who've been through these treatments, and we just don't have that

data” (Mackintosh, BBC News interview, 2024) – a situation ignored by the gender

ideology advocates.

A recent study (Horton, 2024), using terms such as “cis-supremacy” and

“prejudice” when describing the Cass Review, accused the UK of being hostile towards

trans children and their rights and the NHS of causing harm to trans people. Not

surprisingly, the author is self-described as a “…non-binary researcher, as a parent of a

trans child,” indicating bias in the approach to analyze the Review. The rights of children

being harmed were expressed as anything that can be considered non-affirmative

(conversion therapy) viewed as possible treatment. Horton (2024) narrowly construed

 175

describing children as “birth registered females/males” in the Review as misgendering,

delegitimising [sic], disrespectful, and potentially harmful (p. 8). Because there is no

blood test to diagnose gender dysphoria (a well-known scientific fact) it contradicts the

acceptance of the individual’s self-knowledge becoming the diagnosis, making the

clinicians, described by Horton, 2024 as “under-informed healthcare professionals,” (p.

13) responsible for the differential diagnosis. Regarding detransition, the study referred to

“desistance” as a highly disputed theory and a concept drawn from criminology

contradicted by a body of modern research.

The study (Horton, 2024), more emotional than objective, accused Dr. Cass of

“cisnormative” bias, adultism?, erasure of trans children, misgendering, marginalization,

and lacking trans-accountability. The number of times the terms cis-supremacy,

prejudice, and pathologization are used to emphasize rights, equity, and social justice was

revealing. The rights of children undergoing mutilating medical interventions disappear

in the angry rhetoric.

Grijseels (2024) is another critical commentary of the Cass Review which

examined the biological and psychosocial evidence. Less emotional than Horton (2024),

the study concluded that the Review is flawed and unbalanced, misrepresented causes of

detransition (mental health issues), and used poor scientific rigor to arrive at wrong

conclusions and recommendations. Turban et al. (2021), the study referenced by pro-

gender ideology activists, is mentioned several times. Turban et al. (2021) cites external

reasons for detransitioning including pressure from parents and society as opposed to pre-

existing mental health problems, and comorbidities. The data collected for the current

paper show that external reasons are not the major cause of detransitioning for many
 176

detransitioners. In fact, external factors, such as peer pressure, social media intimidation,

and in some cases parental pressure are cited as reasons for transitioning. The other major

assertion in Grijseels (2024) was the repeated mantra that the Cass Review is in conflict

with long-standing international standards (WPATH) thus “contradicting international

standards, and the large number of studies used to develop these standards” (p. 8).

A recent development concerns the British Medical Association (BMA),

England’s doctors’ union, and its decision to reject the findings of the Cass Review

regarding the dangers of puberty blockers. More than 900 physicians have resigned from

the BMA and published an open letter stating “It does not reflect the views of the wider

membership, whose opinion you did not seek” referring to the fact that the 69 members

of the council approved the policy to block the implementation of the Cass

recommendations at a “secret and opaque” meeting (The Times, 2024). The doctors

described the BMA’s opposition to the recommendations of the Cass Review as a

“pointless exercise”, and the leadership of the BMA as “abysmal and ideologically

captured” and influenced by the LGBT activists who have infiltrated organizations and

imposed their agendas.

Summary

Detransitioners, also known as desisters, are the individuals who, after undergoing

gender transition, regret their decision. They include those who cease hormone therapy

before completing the transition and those seeking surgery to reverse sex reassignment

surgery. The almost invisible group who wish to return to their biological sex is vilified

and isolated by the gender transition activists and ignored by the medical establishment.

There is no official diagnosis code (International Classification of Disease) for

 177

detransitioning. The lived experiences of detransitioners reveal not only the physical

consequences, psychological problems, and mental anguish they suffer, but also the

struggle to find adequate medical care. Physicians are coerced and bullied into affirming,

without question, the perceived gender of children as the actual diagnosis and informed

consent does not apply to complying with patients’ demands. Puberty blockers are

prescribed off-label to children as young as 8 years old and cross-sex hormones are

readily available (including online). Bilateral mastectomies are performed on young teen-

aged girls to alleviate psychological distress over dissatisfaction with their bodies.

Children and adolescents, without the ability to understand the risks and long-

term outcomes of gender transition, are not safe from those advancing radical

experimental medical procedures. Gender dysphoric children have become the new

victims (viewed as heroes) of the woke society, and politicalization of the topic has

shifted the focus from healthcare to creating a new protected class. Medical and other

professional organizations, governed by transgender individuals with their own agendas,

are heavily influenced by the LBGT community, and champion gender-affirming care.

Those who recognize detransitioners as life-long patients desperately in need of medical

assistance and support cannot remain silent. Until recently, the idea of changing one’s sex

was a foreign concept; nevertheless, with the aid of social media, the medical community,

and a submissive school system the notion took on a life of its own and has become the

latest adolescent obsession.

Barbaric sex reassignment surgery including the removal of healthy tissue and

organs, considered progress by some physicians and unconscionable by others, is

medicine’s contribution to the transgender insanity. Just as previous medical procedures,

 178

such as frontal lobotomies, are now unacceptable treatments, the future may regard this

era of “refashioning the body as the only permissible solution to painful conflicts about

gender” (Bell, 2020, p. 1036) as a dark period of healthcare. Dr. Abilash Gopal, a

psychiatrist who treats adolescents, stated “I predict that we will look back on this period

with deep regret” (Klavan, 2020, p. 10). Other countries, as a result of the Review, are

beginning to see that the benefits of gender transition do not outweigh the risks and are

moving away from what have been considered, without scientific basis, “standards of

care.” The transgender ideology has become a booming industry, a money-making

phenomenon for surgical wards and pharmaceutical companies. Gender ideology

(“queer” theory) is the enemy of the Christian faith and the nuclear family attempting to

make healthcare, professional organizations, and government complicit with its lies.

Distinct from other medical “conditions”, transgender has become a powerful political

stance, a divisive ideology, a distortion of the truth, and a cataclysmic threat that

undermines reality and attempts to infiltrate religion. “Beyond the physical atrocities is

an attack on the meaning of life itself – of how God made us and what His plan of

happiness is” (Lawler, 2023, p. 3). “For we are His workmanship, created in Christ Jesus

in good works, which God hath prepared that we should walk in them” (Douay-Rheims

Holy Bible, 5th Printing, 2009, Ephesians, 2:10).

 179

REFERENCES

4thWaveNow. [Link]

Abbasi, K. (2024). The Cass review: an opportunity to unite behind evidence informed

care in gender medicine. [Link]

Abbruzzese, E., Levine, S. B., & Mason, J. W. (2023). The myth of “Reliable Research”

in pediatric gender medicine: A critical evaluation of the Dutch Studies—and

research that has followed. Journal of Sex & Marital Therapy, 49(6), 673-699.

[Link]

Adams, P. (2017). The truth behind “gender ideology”. Social Work & Christianity,

44(3), 141-147. Downloaded from

[Link]

Akgul, G. Y., Budak, B. Y., Fis, N. P., & Yildirim, A. B. E. (2023). Executive functions

in adolescents with gender dysphoria. Applied Neurophysiology: Child.

[Link]

Alliance Defending Freedom (ADF). [Link]

Amazon. [Link]

American Academy of Child and Adolescent Psychiatry (AACAP).

[Link]

American Academy of Pediatrics (AAP). [Link]

American College of Pediatricians (ACPeds). [Link]

American Medical Association (AMA). [Link]

American Psychiatric Association (APA). Diagnostic and Statistical Manual of

Psychiatric Disorders (DSM-V, 2013). [Link]

 180

American Psychological Association (APA). [Link]

American Society of Plastic Surgeons (ASPS). [Link]

Anacker, C., Sydnor, E., Chen, B. K., LaGamma, C. C., McGowan, J. C., Mastrodonato,

A., Hunsberger, H. C., Shores, R., Dixon, R. S., McEwen, B. S., Byrne, W.,

Meyer-Bahlburg, H. F. L., Bockting, W., Ehrhardt, A. A., Denny, C. A. (2021).

Behavioral and neurobiological effects of GnRH agonist treatment in mice –

potential implications for puberty suppression in transgender individuals.

Neuropsychopharmacology, 46, 882-890. [Link]

00826-1

Anderson, R. (2020). Transitioning procedures don’t help mental health, Largest Dataset

Shows. The Heritage Foundation.

Arnn, L. P. (2022). Education as a battleground. Imprimis, A Publication of Hillsdale

College, 51(11).

Ashley, F. (2019). Gatekeeping hormone replacement therapy for transgender patients is

dehumanizing. Med Ethics, 45, 480-482.

Ashley, F. (2019). Thinking an ethics of gender exploration: Against delaying transition

for transgender and gender creative youth. Clinical Child Psychology and

Psychiatry, 24(2), 223-236. [Link]

Association of American Physicians and Surgeon (AAPS). (2023). Transgenderism: The

new medical standard? [Link]

standard/

Ayad, S., Marchiano, L., and O’Malley, S. (2023). When Kids Say They’re Trans.

Pitchstone Publishing.
 181

Baxendale, S. (2023). The impact of suppressing puberty on neuropsychological

function: A review. Acta Paedeatrica Foundation, 113,1156-1167.

[Link]

Bell, D. (2020). First do no harm. The International Journal of Psychoanalysis, 101(5),

1031-1038. [Link]

Bell, D. (2023). First do no harm. In Busch, F. (Ed.). Psychoanalysis at the Crossroads

(1st ed., pp. 182-198). Rutledge. [Link]

Benjamin, H. (1999). The Transsexual Phenomenon. Symposium Publishing.

Bhinder, J., and Upadhyaya, P. (2021). Brief history of gender affirmation medicine and

surgery in Nikolavsky, D., Blakely, S.A. (Eds). Urological Care for the

Transgender Patient: A Comprehensive Guide. Springer Cham.

[Link]

Bibi, H., Khan, S., and Shabir, M. (2022). A critique of research paradigms and their

implications for qualitative, quantitative, and mixed research methods. Webology

19. Downloaded from [Link]

Biggs, M. (2022). The Dutch protocol for juvenile transsexuals: origins and evidence.

Journal of Sex & Marital Therapy.

[Link]

Biggs, M. (2022). Suicide by clinic-referred transgender adolescents in the United States.

Archives of Sexual Behavior, 51, 685-690. [Link]

02287-7
 182

Bingham, A. J. (2023). From data management to actionable findings: A five-phase

process of qualitative data analysis. International Journal of Qualitative Methods,

22, 1-11. [Link]

Blake, N. (2021). Responding to the allure and incoherency of transgenderism:

Transgender ideology has powerful supporters, such as [Link], but it is also

weak. The Dispatch. The Catholic World Report. Downloaded from

[Link]

incoherency-of-transgenderism/

Block, J. (2024). Gender medicine in the US: How the Cass review failed to land. BMJ

Publishing Group. [Link]

Block, J. (2023). Gender dysphoria in young people is rising – and so is professional

disagreement. BMJ Publishing Group. [Link]

Boston Children’s Hospital. [Link]

Bradley, G.V. (2021). Catholic schools and transgender students, religion, and the public

sq. Journal of the Witherspoon Institute. Downloaded from

[Link]

Branstrom, R., & Pachankis, J. E. (2020). Reduction in mental health treatment

utilization among transgender individuals after gender-affirming surgeries: A total

population study. American Journal of Psychiatry, 177(8), 727-734.

[Link]

British Psychological Society (BPS). [Link]

Brunskell-Evans, H. (2019). The medico-legal ‘making’ of ‘the transgender child’.

Medical Law Review, 27(4), 640-657. [Link]

 183

Butler, C., & Hutchinson, A. (2020). Debate: The pressing need for research and services

for gender desisters/detransitioners. Child and Adolescent Mental Health, 25(1),

45-47. [Link]

Cantor, J. M. (2019). Transgender and gender diverse children and adolescents: Fact-

checking of AAP policy. Journal of Sex & Marital Therapy, 46(4), 307-313.

[Link]

Cass Review. The Independent Review of Gender Identity Services for Children and

Young People (aka The Cass Review). [Link]

Catholic Medical Association (CMA). [Link]

Children’s Hospital Los Angeles. [Link]

Chen, D., Strang, J. F., Kolbuck, V. D., Rosenthal, S. M., Wallen, K., Waber, D. P.,

Steinberg, L., Sisk, C. L., Ross, J., Paus, T., Mueller, S. C., McCarthy, M. M.,

Micevych, P. E., Martin, C. L., Kreukels, B. P. C., Kenworthy, L., Herting, M.

M., Herlitz, A., Hebold Haraldsen, I. R. J., Dahl, R., Crone, E. A., Chelune, G. J.,

Burke, S. M., Berenbaum, S. A., Beltz, A. M., Bakker, J., Eliot, L., Vilain, E.,

Wallace, G. L., Nelson, E. E., & Garofalo, R. (2020). Consensus Parameter:

Research methodologies to evaluate neuro developmental effects of pubertal

suppression in transgender youth. Transgender Health, 5(4), 246-257.

[Link]

Christian Medical and Dental Associations (CMDA). [Link]

Clarke, A. C., & Spiliadis, A. (2019). ‘Taking the lid off the box’: The value of extended

clinical assessment for adolescents presenting with gender identity difficulties.

 184

Clinical Child Psychology and Psychiatry, 24(2), 338-352.

[Link]

Clayton, A. (2023). Gender-affirming treatment of gender dysphoria in youth: A perfect

storm environment for the placebo effect – The implications for research and

clinical practice. Archives of Sexual Behavior, 52, 483-494.

[Link]

Clayton, A. (2022). The gender affirmative treatment model for youth with gender

dysphoria: A medical advance or dangerous medicine? Archives of Sexual

Behavior, 51, 691-698. [Link]

Cleveland Clinic. [Link]

Cohen, D., & Barnes, H. (2019). Gender dysphoria in children: Puberty blockers study

draws further criticism. The BMJ. [Link]

Cohn, J. (2023). The detransition rate is unknown. Archives of Sexual Behavior, 52,

1937-1952. [Link]

Creswell, J. W. and Poth, C. N. (2018). Qualitative Inquiry & Research Design:

Choosing Among Five Approaches (4th ed.). SAGE Publications, Inc.

Cypress, B. S. (2019). Qualitative research: Challenges and dilemmas. Dimensions of

Critical Care Nursing, 38(5). [Link]

D’Abrera, J. C., D’Angelo, R., Halasz, G., Prager, S., Morris, P. (2020). Informed

consent and childhood gender dysphoria: emerging complexities in diagnosis and

treatment. Australasian Psychiatry, 28(5), 536-538.

[Link]
 185

Daly, T. T. W. (2016). Gender dysphoria and the ethics of transsexual (i.e., gender

reassignment) surgery. Ethics and Medicine, 32(1), 39-54. Downloaded from

[Link]

D’Angelo, R. (2020). The complexity of childhood gender dysphoria. Australasian

Psychiatry, 28(5), 530-532. [Link]

D’Angelo, R. (2018). Psychiatry’s ethical involvement in gender-affirming care.

Australasian Psychiatry, 26(5), 460-463.

[Link]

D’Angelo, R. (2020). The man I am trying to be is not me. The International Journal of

Psychoanalysis, 101(5), 951-970.

[Link]

D’Angelo, R., Syrulnik, E., Ayad, S., Marchiano, L., Kenny, D. T., & Clarke, P. (2020).

One size does not fit all: In support of psychotherapy for gender dysphoria.

Archives of Sexual Behavior, 50, 7-16.

[Link]

da Silva, L. M. B., Freire, S. N. D., Moretti, E., & Barbosa, L. (2023). Pelvic floor

dysfunction in transgender men on gender-affirming hormone therapy: A

descriptive cross-sectional study. International Urogynecology Journal.

[Link]

Davies-Arai, S. (2020). “Gender identity”: The rise of ideology in the treatment and

education of children and young people. In Moore, M., and Brunskill-Evans, H.

(Eds.). Inventing transgender children and young people, (pp. 154-170).

Cambridge Scholars Publishing.

 186

De Jong, D. H. (2017). The truth behind “gender ideology”. Social Work & Christianity,

44(3), 135-140. Downloaded from

[Link]

Detransinfo. [Link]

de Vries, A. L. C., Steensma, T. D., Doreleijers, T. A. H., & Cohen‐Kettenis, P. T.

(2011). Puberty suppression in adolescents with gender identity disorder: A

prospective follow‐up study. The Journal of Sexual Medicine, 8(8), 2276–2283.

[Link]

de Vries, A. L. C., & Cohen-Kettenis, P. T. (2012). Clinical management of gender

dysphoria in children and adolescents: The Dutch approach. Journal of

Homosexuality, 59(3), 301–320. [Link]

de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T.

A. H., & Cohen- Kettenis, P. T. (2014). Young adult psychological outcome after

puberty suppression and gender reassignment. Pediatrics, 134(4), 696–704.

[Link]

Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. l. V., Langstrom, N., & Landen,

M. (2011). Long-term follow-up of transsexual persons undergoing sex

reassignment surgery: Cohort study in Sweden. PLoS ONE, 6(2): e16885.

[Link]

Dignitas Infinita, (04/08/2024). Declaration of the Dicastery for the Doctrine of the Faith

“Dignitas Infinita” on Human Dignity.

Doctors Protecting Children. [Link]

Do No Harm. [Link]
 187

Douay-Rheims Holy Bible, 5th Printing (2009). Loreto Publications. (Original translation

1568).

Drag Queen Story Hour. [Link]

Drescher, J. (2020). Queer diagnoses parallels and contrasts in the history of

homosexuality, gender variance, and the Diagnostic and Statistical Manual

(DSM) review and recommendations prepared for the DSM-V sexual and gender

identity disorders workgroup. Focus, 18(3), 308-335.

[Link]

Ehrensaft, D., Giammattei, S. V., Storck, K., Tishelman, A. C., & St. Amand. C. (2018).

Prepubertal social gender transitions: What we know; what we can learn – A view

from a gender affirmative lens. International Journal of Transgenderism, 19(2),

251-268. [Link]

Eisenberg, A. (2023). The plight of the detransitioners. National Review, 35-38.

[Link]

Endocrine Society. [Link]

medicine-and-research

Engelhardt, H. T., Jr. (2000). The Foundations of Christian Bioethics. M&M Scrivener

Publishing.

Entwistle, K., (2021). Debate: reality check – Detransitioners’ testimonies require us to

rethink gender dysphoria. Child and Adolescent Mental Health, 26(1), 15–16.

[Link]

Ethics and Public Policy Center (EPPC). [Link]

European Society for Child and Adolescent Psychiatry (ESCAP). [Link]

 188

Evans, M. (2020). Why I resigned from Tavistock: Trans-identified children need

therapy, not just “affirmation” and drugs. Quillette. Downloaded from

[Link]

children-need-therapy-not-just-affirmation-and-drugs/

Evans, M. (2020). Freedom to think: The need for thorough assessment and treatment for

gender dysphoric children. BJPsych Bulletin, 45, 285-290.

[Link]

Evans, M. (2022). ‘If only I were a boy…’: Psychotherapeutic explorations of

transgender in children and adolescents. British Journal of Psychotherapy, 38(2),

269-285. [Link]

Exposito-Campos, P. (2021). A typology gender detransition and its implications for

healthcare providers. Journal of Sex & Marital Therapy, 47(3), 270-280.

[Link]

Exposito-Campos, P., Gomez-Balaguer, M., Hurtado-Murillo, F., Garcia-Moreno, R. M.,

Morillas-Aririo, C. (2021). Medical transition following transgender identity

reaffirmation: Two case reports. Sexual Health, 18(6), 498-501.

[Link]

Exposito-Campos, P., Salaberria, K., Perez-Fernandez, J. I., & Gomez-Gil, E. (2023).

Gender detransition: A critical review of the literature. Actas Esp Psiquiatr, 51(3),

98-118. Downloaded from [Link]

Exulansic, T. T. (2022). Double vision on testosterone: The trans lobby lies about the

harmful effects of steroids on human development. The American Mind, A

 189

Publication of the Claremont Institute. Downloaded from

[Link]

Exulansic, T. T. (2023). Genital mutilation for the masses: The gory details and

irreversible horrors of “gender affirming” surgery laid bare. The American Mind,

A Publication of the Claremont Institute. Downloaded from

[Link]

Frechette, J., Bitzas, V., Aubry, M., Kilpatrick, K., & Lavoie-Tremblay, M. (2020).

Capturing lived experience: Methodological considerations for interpretive

phenomenological inquiry. International Journal of Qualitative Methods, 19, 1-

12. [Link]

French Academy of Medicine (FEAM). [Link]

Fry-Bowers, E. K. (2020). A matter of conscience: Examining the law and policy of

conscientious objection in health care. Policy, Politics, & Nursing Practice, 21(2),

120-126. [Link]

Gendered Intelligence. [Link]

Genspect. [Link]

Giordano, S. (2019). Importance of being persistent. Should transgender children be

allowed to transition socially? Medical Ethics, 45, 654-661.

[Link]

GIRES - Gender Identity Research and Education Society. [Link]

Gonzalez, M. R. (2023). Why we return to Augustine. The Catholic Thing. Downloaded

from [Link]
 190

Gould, W. A., MacKinnon, K. R., Lam, J. S. H., Enxuga, G., Abramovich, A. & Ross, L.

E. (2023). Detransition narratives trouble the simple attribution of madness in

transantagonistic contexts: A qualitative analysis of 16 Canadians’ experiences.

Culture, Medicine, and Psychiatry. [Link]

Grabowski, J. S. (2022). Unraveling Gender: The Battle Over Sexual Difference.

TANBooks.

Gribble, K. D., Bewley, S., & Dahlen, H. G. (2023). Breastfeeding grief after chest

masculinization mastectomy and detransition: A case report with lessons about

unanticipated harm. Frontiers in Global Women’s Health, 4(1073053).

[Link]

Griffin, L., Clyde, K., Byng, R., & Bewley, S. (2020). Sex, gender and gender identity: A

re-evaluation of the evidence. BJPsych Bulletin, 45, 291-299.

[Link]

Grijseels, D. M. (2024). Biological and psychosocial evidence in the Cass Review: A

critical commentary. International Journal of Transgender Health.

[Link]

Groenewald, T. (2004). A phenomenological research design illustrated. International

Journal of Qualitative Methods, 42-54.

[Link]

Hakeem, A., (2008). Changing sex or changing minds: specialist psychotherapy and

transsexuality. The Group Analytic Society (London), 41(2), 182-196.

[Link]
 191

Hakeem, A. (Ed.) (2018a). TRANS: Exploring Gender Identity and Gender Dysphoria.

Tiger Press.

Hall, H., (2021). Gender dysphoria in adolescents, SkepDocs. Downloaded from

[Link]

Haltigan, J. D., Pringsheim, T. M., & Rajkumar, G. (2022). Social media as an incubator

of personality and behavioral psychopathology: Symptom disorder authenticity or

psychosomatic social contagion? Comprehensive Psychiatry, 121(152362).

[Link]

Hanley, K. MD; Wittenberg, H. MD; Gurjala, D. MD, MS; Safir, M.H. MD; Chen, E.H.

MD (2021). Caring for transgender patients: Complications of gender-affirming

genital surgeries. Gender and Sexuality.

[Link]

Harness, J., & Getzen, H. (2022). TikTok’s sick-role subculture and what to do about it.

Journal of the American Academy of Child & Adolescent Psychiatry, 61(3).

[Link]

Hildebrand-Chupp, R. (2020). More than ‘canaries in the gender coal mine’: A

transfeminist approach to research on detransition. The Sociological Review

Monographs, 68(4), 800-816. [Link]

Hookway, N. (2008). ‘Entering the blogosphere’: Some strategies for using blogs in

social research. Qualitative Research, 8(1), 91–113.

[Link]
 192

Horton, C. (2024). The Cass review: Cis-supremacy in the UK’s approach to healthcare

for trans children. International Journal of Transgender Health.

[Link]

Hruz P.W. (2020). Deficiencies in scientific evidence for medical management of gender

dysphoria. Linacre Q. 87(1):34-42.

[Link]

Instagram. [Link]

Irwig, M. S. (2022). Detransition among transgender and gender-diverse people – An

increasing and increasingly complex phenomenon. The Journal of Clinical

Endocrinology & Metabolism, 107(10). [Link]

James, E., Lioi, J., & Yang, F. (2021). Conscientious objection and the impact on

transgender patients: a response to “Identifying and Addressing Barriers to

Transgender Healthcare”. Journal of General Internal Medicine, 37(3), 971.

[Link]

Jedrzejewski, B. Y., Marsiglio, M. C., Guerriero, J., Penkin, A., & Connelly, K. J. (2023).

Regret after gender-affirming surgery: A multidisciplinary approach to a

multifaceted patient experience. American Society of Plastic Surgeons.

[Link]

Jelsma, T. (2022). An attempt to understand the biology of gender and gender dysphoria:

A Christian approach. Perspectives on Science and Christian Faith, 74(3), 130-

148. Downloaded from [Link]

[Link]

Johns Hopkins Hospital. [Link]

 193

Jones, D. A. (2018). Gender reassignment surgery: A Catholic bioethical analysis.

Theological Studies, 79(2), 314-338. [Link]

Jorgensen, S. C. J. (2023). Transition regret and detransition: Meanings and uncertainties.

Archives of Sexual Behavior, 52, 2173-2184.

[Link]

Jorgensen, S. J. (2023). Iatrogenic harm in gender medicine. Journal of Sex & Marital

Therapy, [Link]

Joyce, H. (2021). Trans: When Ideology Meets Reality. Oneworld Publications.

Kaczor, C. (2018). Philosophy and theology: Sex reassignment surgery. Philosophy

Faculty Works. © The National Catholic Bioethics Center. Downloaded from

[Link]

Kalin, N.H. (2020). Correction to Branstrom and Pachankis. American Journal of

Psychiatry, 177(8), 734-734.

[Link]

Kaltiala-Heino, R. (2018, November 18). Endocrine Perspective- Pubertal development,

sexual behaviour, gender identity and mental health in adolescence. Paper

presented at The Science of Gender Conference, Tavistock Clinic, London.

Klavan, S. (2020). Children and transgenderism. The American Mind, A Publication of

the Claremont Institute. Downloaded from

[Link]

Labuschagne, P.H. (2021). Science in service of theology: Gender and sexual orientation.

In die Skriflig/In Luce Verbi 55(1), a2665. [Link]

 194

Lawler, L. M. (2023). Beware church use of transgender language. The Catholic Thing.

Downloaded from [Link]

use-of-transgender-language

Lester, J.N., Cho, Y., & Lochmiller, C. R. (2020). Learning to do qualitative data

analysis: A starting point. Human Resource Development Review, 19(1), 94-106.

[Link]

Levine, S. B., Abbruzzese, E., & Mason, J. W. (2022). Reconsidering informed consent

for trans-identified children, adolescents, and young adults. Journal of Sex &

Marital Therapy. [Link]

Levine, S. B. (2018). Ethical concerns about emerging treatment paradigms for gender

dysphoria. Journal of Sex & Marital Therapy, 44(1), 29–44.

[Link]

Levine, S. B. (2021). Reflections on the clinician’s role with individuals who self-identify

as transgender. Archives of Sexual Behavior, 50, 3527-3536.

[Link]

Levine, S. B. (2018). Transitioning back to maleness. Archives of Sexual Behavior, 47,

1295-1300. [Link]

Littman, L. (2021). Individuals treated for gender dysphoria with medical and/or surgical

transition who subsequently detransitioned: A survey of 100 detransitioners.

Archives of Sexual Behavior, 50, 3353–3369. [Link]

02163-w
 195

Littman, L. (2018). Parent reports of adolescents and young adults perceived to show

signs of a rapid onset of gender dysphoria. PLoS ONE, 13(8).

[Link]

Littman, L. (2019). Correction: Parent reports of adolescents and young adults perceived

to show signs of a rapid onset of gender dysphoria. PLoS ONE 14(3): e0214157.

[Link]

Littman, L. (2020). The use of methodologies in Littman (2018) is consistent with the use

of methodologies in other studies contributing to the field of gender dysphoria

research: Response to Restar (2019). Archives of Sexual Behavior, 49, 67-77.

[Link]

Littman, L., O’Malley, S., Kerschner, H., & Bailey, J. M. (2022). Detransition and

desistance among previously trans-identified young adults. Archives of Sexual

Behavior. [Link]

Mack, N., Woodsong, C., MacQueen, K. M., Guest, G., and Namey, E. (2005).

Qualitative research methods: A data collector’s field guide. Family Health

International. [Link]

MacKinnon, K. R, Newman, K. M., Sansfacon, A. P., Kia, H., Salway, T., Lam, J. S. H.,

Gould, W. A., Marshal, G., Khan, N. (2024). Sampling with Sisyphus:

Introducing a community-driven study designed to reach hidden sexual and

gender minority populations with experiences of gender detransition. Journal of

Medical Internet Research. [Link]

MacKinnon, K, R., Exposito-Campos, P., & Gould, W. A. (2023). Detransition needs

further understanding not controversy. BMJ 2023;381:e073584.

 196

[Link]

MacKinnon, K. R., Kia, H., Salway, T., Ashley, F., Lacombe-Duncan, A., Abramovich,

A., Enxuga, G., & Ross, L. (2022). Health care experiences of patients

discontinuing or reversing prior gender-affirming treatments. JAMA Network

Open, 5(7). [Link]

Malone, W. J., Wright, C. M., Robertson, J. D., (2019). No child is born in the wrong

body…and other thoughts on the concept of gender identity. 4thWaveNow.

Downloaded from [Link]

wrong-body-and-other-thoughts-on-the-concept-of-gender-identity/

Malone, W. J., (2021). Time to hit pause on “pausing” puberty in gender-dysphoric

youth. Medscape. Downloaded from [Link]

Marchiano, L. (2021). Transgender children: The making of a modern hysteria.

Psychological Perspectives, 64(3), 346-359.

[Link]

Marchiano, L. (2021). Gender transition: A case study. Journal of Analytical Psychology,

66(4), 813-832. [Link]

Marchiano, L. (2017). Outbreak: On transgender teens and psychic epidemics.

Psychological Perspectives, 60(3), 345-366.

Https://[Link]/10.1080/00332925.2017.1350804

Marchiano, L. (2020). The ranks of detransitioners are growing. We need to understand

why. Quillette. Downloaded from [Link]

gender-detransitioners-are-growing-we-need-to-understand-why/
 197

Matthews, S. (2020). Gender guides and workbooks: Understanding the work of a new

disciplinary genre. In Moore, M., and Brunskill-Evans, H. (Eds.). Inventing

Transgender Children and Young People, (pp. 240-281). Cambridge Scholars

Publishing.

Maxwell, J., Clyde, K., & Griffin, L. (2019). Gender dysphoria: A question of informed

consent. BMJ, 367. [Link]

Mayo Clinic. [Link]

Mermaids. [Link]

Milionis, C., & Toska, A. (2023). Conscientious objection to caring for transgender

people: An ethical right or a discriminatory attitude? International Journal of

Nursing Practice, 2023:e13180. [Link]

Moore, M., & Brunskell-Evans, H. (Eds.) (2019). Inventing Transgender Children and

Young People. Cambridge Scholars Publishing.

Mcloed, S. (2023). John Money gender experiment: Reimer twins. Downloaded from:

[Link]

Moreton, K. L. (2021). A backwards-step for Gillick: Trans children’s inability to

consent to treatment for gender dysphoria – Quincy Bell & Mrs. A v The Tavistock

and Portman NHS Foundation Trust and Ors [2020] EWHC 3274 (Admin.).

Medical Law Review, 29(4), 699-715. [Link]

Moschella, M. (2021). Trapped in the wrong body? Transgender identity claims, body

self-dualism, and the false promise of gender reassignment therapy. The Journal

of Medicine and Philosophy, 46, 782-804. [Link]

 198

Mul, D., Versluis-den Bieman, H. J. M., Slijper, F. M. E., Oostdijk, W., Drop, S. L. S.

(2007). Psychological assessments before and after treatment of early puberty in

adopted children. Acta Paediatrica: Nurturing the Child, 90(9), 965-971.

[Link]

Muller-Vahl, K., Pisarenko, A., Jakubovski, E., & Fremer, C. (2021). Stop that! It’s not

Tourette’s but a new type of mass sociogenic illness. Brain, 145, 476-480.

[Link]

National Catholic Bioethics Center (NCBC). [Link]

National Public Radio (NPR). [Link]

Newton, W. (2020). Why Aquinas’s Metaphysics of Gender is fundamentally correct: A

response to John Finley. The Linacre Quarterly, 87(2), 198-205.

[Link]

Noble, H., & Smith, J. (2015). Issues of validity and reliability in qualitative research.

Evid Based Nurs, 18(2). [Link]

Norwegian Healthcare Investigation Board (NHIB).

[Link]

O’Donovan, O. (1983). Transsexualism and Christian marriage. The Journal of Religious

Ethics, 11(1), 135-162. Downloaded from [Link]

Olson-Kennedy, J., Warus, J., Okonta, V., Belzer, M., & Clark, L. F. Chest

reconstruction and chest dysphoria in transmasculine minors and young adults:

Comparisons of nonsurgical and postsurgical cohorts. JAMA Pediatr. 172(5),

431–436. [Link]
 199

O’Shea, S. C. (2021). If I knew then what I know now. Gender Work Organ, 29, 626-

638. [Link]

Partners For Ethical Care. [Link]

Pediatric Endocrine Society (PES). [Link]

Pilgrim, D. & Entwistle, K. (2020). GnRHa (‘puberty blockers’) and cross sex hormones

for children and adolescents: Informed consent, personhood, and freedom of

expression. The New Bioethics, 26(3), 224-237.

[Link]

Planned Parenthood. [Link]

Plastic Surgery Foundation (PSF). [Link]

Post Trans. [Link]

Proferes, N., Jones, N., Gilbert, S., Fiesler, C., & Zimmer, M. (2021). Social Media +

Society, April-June, 1-14. [Link]

Pullen Sansfacon, A., Gelly, M. A., Gravel, R., Medico, D., Baril, A., Susset, F., &

Paradis, A. (2023). A nuanced look into youth journeys of gender transition and

detransition. Infant and Child Development. [Link]

Rawee, P., Rosmalen, J. G. M., Kalverdijk, L, & Burke, A. M. (2024). Development of

gender non-contentedness during adolescence and early adulthood. Archives of

Sexual Behavior, 53, 1813-1825. [Link]

Reagle, J. (2023). Even pseudonyms and throwaways delete their Reddit posts. First

Monday: Peer Reviewed Journal on the Internet, 28(6). Downloaded from

[Link]

[Link]. [Link]
 200

[Link]/r/detrains. [Link]

[Link]/r/actual_detrans. [Link]

[Link]/r/ask_detrans. [Link]

Respaut, R., Terhune, C., & Conlin, M. (2022). Youth in transition. Reuters.

Downloaded from [Link]

Ristori, J., Cochetti, C., Romani, A., Mazzoli, F., Vignozzi, L., Maggi, M., & Fisher, A.

D. (2020). Brain sex differences related to gender identity development: Genes or

hormones? International Journal of Molecular Sciences, 21.

[Link]

Roberts, C. M., Klein, D. A., Adirim, T. A., Schvey, N. A., & Hisle-Gorman, E. (2022).

Continuation of gender-affirming hormones among transgender adolescents and

adults. The Journal of Clinical Endocrinology & Metabolism, 107(9), e3937-

e3943. [Link]

Robles, M. (2021). The bioethical dilemma of gender-affirming therapy in children and

adolescents. The Linacre Quarterly, 88(3), 259-271.

[Link]

Roy, S. (2020). Christian bioethical approaches to gender reassignment surgery:

Understanding opposition and retrieving the body-soul complex. Say Something

Theological: The Student Journal of Theological Studies, 2(2), article 5.

Downloaded from [Link]

theological/vol2/iss2/5

Ruuska, S. M., Tuisku, K., Holttinen, T., & Kaltiala, R. (2024). All-cause and suicide

mortalities among adolescents and young adults who contacted specialized gender
 201

identity services in Finland in 1996-2019: A register study. BMJ Mental Health,

27, 1-6. [Link]

Saad, T. C., Rodger, D., & Blackshaw, B. P. (2019). Responding to objections to

gatekeeping for hormone replacement therapy. Journal of Medical Ethics, 45(12),

828-829. [Link]

Saad, T. C., Blackshaw, B. P., & Rodger, D. (2019). Hormone replacement therapy:

informed consent without assessment? Journal of Medical Ethics, 45(12), 824-

825. [Link]

Safer, J. D. (2021). Research gaps in medical treatment of transgender/nonbinary people.

The Journal of Clinical Investigation, 131(4). [Link]

Sanders, T., du Plessis, C., Mullens, A. B., & Bromdal, A. (2023). Navigating

detransition borders: An exploration of social media narratives. Archives of

Sexual Behavior, 52, 1061-1072. [Link]

Schwartz, D. (2021). Clinical and ethical considerations in the treatment of gender

dysphoric children and adolescents: When doing less is helping more. Journal of

Infant, Child, and Adolescent Psychotherapy, 20(4), 439-449.

[Link]

Science Based Medicine. [Link]

Scientific American. [Link]

Shrier, A. (2020). Irreversible Damage: The Transgender Craze Seducing Our

Daughters. Regnery Publishing.

Shrier, A. (2022). A transgender controversy. SkepDocs. Downloaded from

[Link]
 202

Shuster, S. M. (2019). Performing informed consent in transgender medicine. Social

Science & Medicine, 226, 190-197.

[Link]

Silverman, D. Qualitative Methods. e-Source, Behavioral & Social Sciences Research.

Slothouber, V. (2020). (De)trans visibility: Moral panic in mainstream media reports on

de/retransition. European Journal of English Studies, 24(1), 89-99.

[Link]

Society for Evidence-Based Gender Medicine (SEGM). [Link]

Soh, D. (2020). The End of Gender: Debunking the Myths about Sex and Identity in Our

Society. Threshold Editions.

Song, R. (2007). Genetic manipulation and the body of Christ. Studies in Christian

Ethics, 20(3), 399-420. [Link]

Song, R. (2013). Body integrity identity disorder and the ethics of mutilation. Studies in

Christian Ethics, 26(4), 487-503. [Link]

Soriano, V., & Montero, B. (2023). Current challenges for conscientious objection by

physicians in Spain. The Linacre Quarterly, 1(10).

[Link]

Steensma, T. D., Biemond, R., de Boer, F., & Cohen-Kettenis, P. T. (2010). Desisting

and persisting gender dysphoria after childhood: A qualitative follow-up study.

Clinical Child Psychology and Psychiatry, 16(4), 499-516.

[Link]

Stella, C. (2016c, September 03). Female detransition and reidentification: Survey results

and interpretation. Guide on Raging Stars. Downloaded from

 203

[Link]

and-reidentification-survey

Swedish Agency for Health Technology Assessment and Assessment of Social Services

(SBU). [Link]

Symons, X. (2022). Conscientious objection in health care: Why the professional duty

argument is unconvincing. The Journal of Medicine and Philosophy, 47, 549-557.

[Link]

Symons, X. (2023). Why conscience matters: a theory of conscience and its relevance to

conscientious objection in medicine. Res Publica, 29, 1-21.

[Link]

Thoughtful Therapists. [Link]

TikTok. [Link]

Transgender Heaven. [Link]

Transition Justice. [Link]

[Link]. [Link]

detransition-and-reidentification-survey

Turban, J. L., Loo, S. S., Almazan, A. N., & Keuroghlian, A. S. (2021). Factors leading

to “detransition” among transgender and gender diverse people in the United

States: A mixed-methods analysis. LGBT Health, 8, 272-280.

[Link]

Turban, J. L., Brady, C., & Olson-Kennedy, J. (2022). Understanding and supporting

patients with dynamic desires for gender-affirming medical interventions. JAMA

 204

Network Open,5(7):e22247222.

[Link]

Turban, J.L. & Ehrensaft, D. (2018). Research Review: Gender identity in youth:

treatments paradigms and controversies. The Journal of Child Psychology and

Psychiatry, 59(12), 1228-1243. [Link]

United States Professional Association for Transgender Health (USPATH).

[Link]

Valdes, D., & MacKinnon, K. (2023). Take detransitioners seriously. The Atlantic.

Downloaded from

[Link]

nonbinary-gender-affirming-care/672745

Valenstein, E. S., (1986). Great and Desperate Cures: The Rise and Decline of

Psychosurgery and Other Radical Treatments for Mental Illness. Basic Books.

Vandenbussche, E. (2021). Detransition-related needs and support: A cross-sectional

online survey. Journal of Homosexuality, 69(9), 1602-1620.

[Link]

van der Loos, M., Klink, D. t., Hannema, S. E., Bruinsma, S., Steensma, T. D., Kreukels,

B., Cohen-Kettenis, P. T., de Vries, A., den Heijer, M., & Wiepjes, C. M. (2023).

Children and adolescents in the Amsterdam Cohort of Gender dysphoria: Trends

in diagnostic and treatment trajectories during the first 20 years of the Dutch

Protocol. The Journal of Sexual Medicine, 20, 398-409.

[Link]
 205

Von Benzon, N. (2018). Informed consent and secondary data: Reflections on the use of

mothers’ blogs in social media research. Ethics in/of Geographical Research,

Area 51, 182-189. [Link]

Vrouenraets, L. J. J. J., De Vries, A. L. C., Arnoldussen, M., Hannema, S. E., Lindauer,

R. J. L., de Vries, M. C., & Hein, I. M. (2022). Medical decision-making

competence regarding puberty suppression: Perceptions of transgender

adolescents, their parents, and clinicians. European Child & Adolescent

Psychiatry, 32, 2343-2361. [Link]

Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M,, Allison, C.,

& Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental

and psychiatric diagnoses, and autistic traits in transgender and gender-diverse

individuals. Nature Communications, 11, 3959. [Link]

020-17794-1

Watt, H. (2019). Gender transition: The moral meaning of bodily and social presentation.

New Blackfriars Journal, 101(1094), 456-477. [Link]

Watt, H. (2020). Social and medical gender transition and acceptance of biological sex.

Christian Bioethics, 26(3), 243-268. [Link]

Whitehall, J. (2018). Experimenting on children with gender dysphoria. Does the “Dutch

protocol” offend the Nuremberg code? Quadrant, July-August, 74-82.

Downloaded from [Link]

children-gender-dysphoria/
 206

Whitehall, J. (2020). Banning alternatives to child gender experiments. Quadrant, Jan-

Feb, 36-41. Downloaded from [Link]

alternatives-to-child-gender-experiments/

Withers, R. (2020). Transgender medicalization and the attempt to evade psychological

distress. Journal of Analytical Psychology, 65(5), 865-889.

[Link]

World Medical Association (WMA). [Link]

World Professional Association for Transgender Health (WPATH). Standards of Care

(SOC) for the Health of Transgender and Gender Diverse People, Version 8

(2022). [Link]

YouTube. [Link]

Zucker, K. L. (2019). Adolescents with gender dysphoria: Reflections on some

contemporary clinical research issues. Archives of Sexual Behavior, 48, 1983-

1992. [Link]
207