Can't say I recommend it
On a specific medical intervention and on airing my grievances
Primum non nocere
I have grievances with a specific medical intervention.1 I have personal experience undergoing this specific medical intervention. I believe this specific medical intervention is being wrongly applied to thousands of people. In fact, I believe there is a possibility it is never being applied correctly.
The people who are convinced this specific medical intervention is "lifesaving" (reminder that we're not talking about a physical condition where we can empirically judge whether someone was prevented from dying) think I want them all to die because I don’t agree that the benefits are worth the risks.2
Despite the ideologue claim that this specific medical intervention isn't experimental, it has not been widely available for very long. It was relatively rare to undergo this specific medical intervention until about 30 years ago (you know...after Internet access became widespread). Demand started to spike suddenly about 10 years ago (you know...after social media became widespread).
When it wasn't widely available, it was also a lot more stigmatized than it is today. Undergoing this specific medical intervention was something to be hidden at all costs. So obviously, you didn't kick up a fuss when it didn't turn out to be what you were led to believe it was. You kept your head down and restarted your life quietly, or you got placed on the TDOR list.
(Quite different than regretting knee surgery, you see...)
There was very little long-term data about this specific medical intervention when it wasn't widely available. There continues to be little long-term data now. We are waiting for the data.
(And we all know I’m talking about this specific medical intervention as a whole, and not just the pediatric version of it, right? Cool, just reminding you.)
I began undergoing this specific medical intervention 14 years ago. That makes me one of those data points. In the grand scheme of things, I was early, a few years before demand surged. My breasts were removed 12 years ago and my uterus, 6 years ago. I took testosterone on and off for the better part of five years. I was fully bought in for ten years.
Something went wrong here.
This is the point I’ve tried to begin from for the past couple of years. If we can’t at least agree that something went wrong — even if my case was a rare occurrence, even if I’m a complete idiot, whatever it is you want to think — if we can agree that this is some kind of health care failure, then we can move forward somewhere. If we can’t agree on that, there’s no point talking about this topic with me.
What I’ve really found shocking is the fervour with which people have tried to shut others down from talking about their own experiences of what seems to be medical negligence.
Nil nisi bonum
Every person in my position, who underwent this specific medical intervention and has grievances with the way it was applied, has been vilified for speaking about it, regardless of what our opinions are outside of how the specific medical intervention was applied to us personally.
Speaking about this particular medical intervention disparagingly is usually not allowed. On the off chance it is allowed, it must always be accompanied by a disclaimer that grievances are rare and this experience is exclusive to the speaker. If it sounds at all like a warning, you're bigoted. If you think other people should avoid this specific medical intervention, you're bigoted. You cannot say "I do not recommend."
I understand ideologues won't like me outside of my personal experience, though. That's because I think the way this specific medical intervention was applied to me was part of a systemic failure of the health care system. I think this specific medical intervention is one massive medical scandal, and not only when applied to children (though it is certainly most shocking to see it applied to them).
By publicly calling this specific medical intervention into question, I risk the possibility of being extremely publicly wrong in my larger assessment of it. But people have been raising red flags about it for years, and the emerging evidence continues to vindicate them. This specific medical intervention irreversibly harms, at the very least, 1 in 100 of the patients it is meant to treat — and I really do think it’s a lot more than that.
A lot of ideologues seem to think that detransitioners didn't fully commit to the intervention. But the thing that really spurred me to go public with my grievances was precisely how completely insane it felt to have been so committed that you'd give body parts, just to realize that it was bullshit.
If it happened to me, it could happen to anyone. I can't shake that feeling.
After that experience — and personally meeting dozens with the same experience — how could I ever believe someone when they say this specific medical intervention is lifesaving? They all sound exactly like we used to.
While deprogramming, I struggled a lot with how I was going to present my feelings about this specific medical intervention. I had been hurt, but I felt like I wasn't allowed to be sad or angry about it. I didn't have space to grieve my life with any of the people who actually knew my life.
Twitter was the platform I used to speak freely without feeling scrutinized by them, but eventually, I started to feel repressed in a different way.
Ad meliora
Speaking publicly about my grievances meant inducting myself into a "movement" of people discussing grievances that have sprung up around this specific medical intervention. The intent was for my words to change things for the better. My story had a purpose as a cautionary tale.
Many who go public with transition grief think some version of "I've been hurt by this, and I don't want someone else to experience that same hurt." We understood that we were presenting ourselves as people who were harmed. I didn’t predict how much our lives would get flattened in the process, though. We became no more than symbols of an outcome to be avoided. And it's so personal. Our use is in giving testimony about how terrible it is to live in our altered bodies (which we then have to live in).
I’ve noticed there's a fine line between "I don't want this to happen to you" and "I don't want you to be me." It's also one thing for me to say it, and another for complete strangers to be pointing at me as the thing to avoid becoming.
It's not a comfortable position to be in. I stopped feeling like a person a lot of the time. And hey, I consented to it. I said it myself: I'm the data point. I'm part of the early warning system kicking in. But I'm also a useful idiot and a story to weaponize. Celebrity, even niche Internet microcelebrity, means your life becomes public domain. I can't control who speaks about me or how.
In the past year, I've focused less on criticism of that specific medical intervention and more on how to improve things for those of us who are on the other side of it. I wrote something of a "guide" to talking about it, which I don't think has seen much use, but at least it was cathartic to write.
My concern when I wrote it—but really at all times—was the mental wellness of people like myself (and of people who might have grievances in the future). I worry about the effect of calling people's lives "ruined" and their bodies "mutilated." I worry that repeatedly witnessing images of altered bodies alongside words of pity, disgust, and scorn will forever cement negative connotations in our minds (when we could perhaps have arrived somewhere more neutral about our own bodies). I worry that the discourse around being post-transition will lead people who are post-transition to feel like their lives no longer have worth.
I also know people won't stop doing these things that I worry about because emotional manipulation inspires action. This is where detransitioners get exploited. Our "job" within the movement comes with abuse built into it: be the victim, including letting yourself be victimized even more, or else you don't really care about saving the kids.
In my work collaborating with others, I also feel sort of torn. I come only with my lived experience and nothing else. I have lived experience with this specific medical intervention because I have mental health and neurodevelopmental disabilities. I don't want too much to be expected of me, but I want to be taken seriously. I'm still recovering from what happened, but I'm not entirely incapable. I was wrong about something quite big, but I think the skills I learned in the process are valuable.
Like other people who had their truth-telling moment, I made sacrifices. I risked my reputation. I lost relationships. You'll find my psychiatric history every time you Google my name from now until the end of time. I permanently branded myself a freak show because I thought it would help change the world. I gave everything I was capable of giving.
Sometimes I haven't felt respected as an individual, though. I haven't felt like my insight was valued. I felt like I was being tokenized.
Many of the people who came into my life during advocacy correctly recognized that I would need mental health support. Some of them genuinely helped me hold feelings that were burdening me, but the eventual realization that these people were going to be transient in my life was crushing. I don't need crisis workers. I need people I see regularly, who make me feel like a person and who aren't going to leave me when the movement's goals are met.
Maybe that was always the hard truth, though. I don't have expertise. I don't have credentials. My value does lie entirely within my lived experience. I genuinely don't have any use outside of sharing that. Not for making change in this specific arena, anyway.
Protegimus invicem
At times, I've had sort of an unelected leadership position for the aggrieved. I'm not a great direct-support person, but I have been a point of contact for a lot of people and organizations. I took my unofficial duties pretty seriously. If people were going to put their trust in me, then I didn't want to stand for anything that would harm us, especially since we'd all already been harmed before. I didn't want to vouch for people I wasn't certain would care for every one of my friends the way I would care for them.
The problem, I’ve discovered, is that no one will.
We were never meant to be the priority. We're the lost causes—for now, anyway. There's no long-term plan for us. Our stories are needed, but we aren't. I've seen people get asked to do things completely out of the range of things they should ever be asked to do (and then proceed to do that thing free of charge). I've seen them be pursued for media participation when they've already refused. I don't think very many people understand the personal cost, and so many push too hard.
Other times, the help we were offered fell short of expectations. Criticisms were dismissed. After all, beggars can’t be choosers.
I've been slowly pulling away for a long time. I'm not sure that it's possible to vouch for anyone in this movement at all when it comes to properly caring for someone post-transition. Most just can't meet my standard, and I can't deal with feeling betrayed over and over.
The mantra that guides my advocacy means "we protect each other." My motives for speaking out were not only that I didn't want anyone else to experience medical negligence. They were also that I didn't want anyone else who had experienced medical negligence to go through speaking about it publicly and begging to be taken seriously.
I can't change the discourse. Protecting the harmed is not the priority; protecting the unharmed is. It's a values clash. Nothing I can do about that. I can tell other people with grievances to avoid public advocacy because, in my view, it hampers personal recovery. Tried it. Can’t say I recommend it. Like a specific medical intervention. But I can't stop you from doing it if you think differently. I can also emphasize once more that most people will choose not to prioritize us, including people who do otherwise mean us well.
My advice for every person who is thinking about publicly airing their grievances about this specific medical intervention is still "don't." But if you're going to anyway: always remember that you are worth more than the larger movement. Put yourself first every single time.
Per aspera ad astra
I guess there's a question to be answered here. If we aren't helping aggrieved transitioners, then what do they need that will actually help them? And you're going to get varied responses depending on who you ask, but this is mine.
Bare necessities: access to food and water, permanent shelter, uninterrupted sleep, gainful employment, physical safety
Health care: some are reliant on exogenous hormones, some have complications from surgery, some have chronic pain as a result of the intervention. We don't want to be referred to the gender clinic; we want non-ideological physical and mental health care.
Connection: a sense of belonging or feeling of normalcy: feeling understood and appreciated for who we are; able to express ourselves without feeling out of place or alienated.
Aspirations: something to look forward to; examples of the type of things we could be doing or the type of person we could be. It's hard to imagine what a successful life will look like when it has been changed so dramatically.
This isn't much different from the well-known hierarchy of needs proposed by Maslow. Desistence can sometimes feel like your life is starting over, and when you feel like you have absolutely nothing, I think it's helpful to begin with foundational needs.
I think there is also a fifth need, but I'm not sure what to call it yet. Maybe "resolution"? After you've been wronged, you want to feel a sense of justice. It tends to be a pretty desperate feeling, especially when you realize how many times it's happened. People can't just keep acting this way without any pushback. And then you get sucked into advocacy work.
But we shouldn't have had to do it. Harmed people shouldn't have to publicly force a discussion. I hope the bravery of the recent bunch of people in the NYT marks the end of it. I hope people start coming to their senses. Based on the response from organizations like GLAAD, it certainly doesn't sound like it, but I don't think we need one single more cautionary tale. Can we be done now?
My ideal outcome is the medical profession properly self-regulates. It takes complaints seriously. It disciplines doctors who provide inadequate care. There have been and continue to be whistleblowers from within health care fields trying to put out the fire around this specific medical intervention (usually as applied to minors, though). To me, that looks like the beginning of self-regulation. Does that mean I can be done, at least?
What would have been better, though, would have been to feel resolved without relying on external forces to act. Some people never get closure after harm. We still need to move forward.
A couple of months ago, I spoke with friends about what we thought we really needed, and the fourth need came up a lot. It's important to convey the gravity of our experiences, but at the same time, our lives didn't end at the point of desistence. We aren't exactly selling how much better off we are now when the narratives surrounding us are about misery all of the time.
This can't define us. We need to have fun. We need to thrive. There has to be life left after this.
Everyone needed something to look forward to. We planned to meet up a few weeks after that and then spent a few nights together, laughing until we couldn't breathe, about things of no consequence whatsoever. It was worth more than 100 therapy sessions.
Some of the most beautiful places I've seen in my lifetime, I've seen in the last couple years. The bravest, funniest, smartest, kindest, most generous, most attractive, most impressive people I've met in my lifetime, I've met in the last couple years. Transient in my life as they may be, I will remember many of these moments and these people until the day I die.
However, continuing to talk about my grievances no longer feels like a recovery process. Every moment in which I feel alive is one in which I have managed to forget I had any in the first place. Those moments are getting closer together than they used to be.
I like to call it "medical transition." Ideologues like to call it "gender-affirming care." I'm talking about a process facilitated by health care professionals in which one's sex traits are modified via the use of exogenous hormones and surgical procedures. When I underwent this specific medical intervention, it was meant to be a treatment for "gender identity disorder" (which became "gender dysphoria" a few years later).
Systematic reviews suggest the available evidence is of low quality. Sample sizes are often small. The methodology challenges the validity of the conclusions. Researchers frequently profit from the specific medical intervention they're studying the efficacy of. Objectively, the health risks outweigh the benefits because of the low certainty. The benefits are largely subjective, though, and how someone weighs those benefits will vary from person to person and likely won’t be static through their lifetime.