Embarrassed by Low Detrans Rate, Right-Wing Claims Irreversible Damage Via Nickname

As medical evidence fails to support anti-trans ideas anti-trans propagandists are getting creative with a theory that even the purely social aspects of transition are irreversible interventions.

by Evan Urquhart

An article in the Washington Free Beacon this morning took aim at efforts by the LGBTQ+ nonprofit Human Rights Campaign to promote better healthcare experiences for people in the queer community. The Free Beacon’s piece objects to HRC’s promotion of staff trainings asking hospital personnel to use the name and pronouns trans people request as one of these best practices, and to their use of a scoring system based on voluntarily provided data from medical providers. The Free Beacon uses this discussion to present a topsy-turvy rationale for opposing common courtesy towards trans people in medical settings: Because detransition and regret is so rare among trans people, purely cosmetic and social measures to transition constitute an irreversible medical intervention.

The Free Beacon attempts to suggest that social transition leads to medical interventions such as hormone therapy, using an interview with a nurse who quit her job rather than use the pronouns trans people requested. This, like everything else in the piece which posits a vast conspiracy by big pharma, is not supported by any of the data collected on trans people’s reality. In fact, a representative survey by the Washington Post conducted late last year found that only about a third of people who identify as transgender have also accessed some form of medical transition. The majority have simply changed things like their clothing and hairstyle, the sorts of measures associated with making a social transition.

In addition to the Post’s polling, there’s evidence that even clinics specializing in treating gender dysphoria in youth don’t offer medical transition routinely. An internal investigation into one gender clinic in Missouri found barely over one half of the youth seen by the clinic had recieved these interventions. None of this is reflected by the Free Beacon, who present the use of nicknames and pronouns as inextricably linked with puberty blockers and hormone therapy.

screenshot from the Washington Free Beacon

Opposing social transition amounts to opposing treating trans people with dignity and respect as human beings, particularly in a medical setting where setting a patient at ease and establishing trust forms the basis of all other treatment. It’s not a medical treatment, and it’s certainly not an irreversible step towards anything.

Until recently the moral panic over trans people has largely centered on medical transition, not social measures, and success seems to be breeding innovation as conservatives search for new vistas of repression and discriminatory treatment. The success of bans on gender-affirming care is whetting conservatives’ appetite for ever harsher restrictions, now seemingly targeting the ways trans people express themselves and treating them with common courtesy.

According to data tracked by Movement Advancement Project seventeen states have acted thus far to ban gender affirming care for youth, despite the fact having such measures as an option for those who need them represents the best practices in treatment of gender dysphoria according to all major US medical associations. Including these options are considered best practices because abundant medical evidence has shown that gender-affirming care is safe and effective for trans people.

One of the many findings that has led to the understanding that gender-affirming care is overwhelmingly positive for the trans people who access it is the low rate of detransition. The low rate of trans people choosing to resume a cisgender identity has recently been found to apply to youth as well as adults. In fact, the most recent study of youth who socially transition found only 2.5 percent returned to identifying as cisgender after five years. Most of this 2.5 percent had socially transitioned at a very young age, suggesting that the older a child is the more you can trust that their expression of a transgender identity is genuine.

This is an extremely inconvenient finding for opponents of medical transition, who have long relied on the belief that many, of not most, trans people will come to regret their medical transitions. However, because opposition to transgender rights is ideological, not based in evidence or medicine, opponents of trans rights are shiftin their narrative to meet the data. Since so few youth desist after a social transition conservatives, as represented by the conservative Free Beacon, are now attempting to claim that affirmation and socially transitioning is what causes people to be transgender. (The fact that this would require the use of a time machine is never mentioned).

In order to find support for this counterintuitive conclusion, propagandists reach back into old, outdated studies, when the precursor to gender dysphoria, Gender Identity Disorder, was diagnosed primarily based on outward behavior. Instead of asking a child if they wanted to be or live as a member of another gender, old-school clinicians diagnosed any child with gender nonconforming interests, clothing, or friendships with this precursor diagnosis. These studies found a large percentage of the children diagnosed in this way were not trans, but did grow up to be gay or lesbian. The Free Beacon and others omit this context, describing the older studies as if they were more recent and ignoring the trend, which has shown a steadily improving diagnostic process and confusing cause-and-effect in the newer, more accurate results.

screenshot from the Free Beacon

As gender dysphoria has come to be better understood, non-conforming interests, behavior, and friendships have been de-pathologized and removed from the diagnostic criteria, leading to vastly fewer misdiagnoses. In the newer process, children are asked to describe what they think and feel about their gender, their bodies, and what they hope to happen as they grow, and this has become the basis of both the diagnosis and of any interventons. Small social steps are taken at home first, and for children who consistently seem happier in another gender, a broader social transition (encompassing school and other public settings) is recommended. Medical treatments are considered later, not for all patients, but only for children who need them. This has been vastly more effective, and the rates of children who grow up to identfy as cisgender have plummeted. The rate of regret for medical interventions has remained low throughout, likely because there have always been multiple checks and barriers preventing youth from accessing such treatments unnecessarily.

The impressive achievements in the area of gender-affirming care have been continually misrepresented by anti-trans activists and by the right wing press, but the effort to go after social-only measures like nicknames and haircuts is truly chilling. Conservatives are demonstrating that their true intent is to enforce more rigid gender roles on everyone. Trans people, and trans youth, are just the canary in the coal mine.