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The End of Transition: Protecting Our Children From an Induced Mental Health Crisis

 Consider these mostly factual statements that were uncontroversial just a few years ago:

  • Puberty is an important, if difficult, developmental stage for human development.
  • There are two sexes.
  • Men cannot change their sex.
  • Only women can get pregnant.
  • Men have a penis.
  • Women have a vagina.
  • Males don't belong in spaces and programs set aside for women.
That these statements are now contested might lead one to believe that there has been something observed in a subset of humans which means these statements don't apply to them. This explains why they are so poorly contested, precisely because nothing has changed. Like all multi-cell species, humans still come in two sexes. The assertions of gender ideology are so absurd-- some women have a penis-- that it seems impossible for rational people to adopt them. Yet, they do. In part, it is imposed top down by brute force with threat to employment and parental rights. It also employs a powerful tool which does the cognitive work that allows people to impose a new reality on themselves: the concept of transition.

It should be understood that the concept of transition is predicated on an impossibility. It rests on the idea that people have an attribute which may negate their sex, a gender. As a result, they may transition to the opposite sex. This bears no connection to material reality. No one can change their sex. At most, they can change their appearance to attempt to cosmetically mimic the opposite sex through hormones and cosmetic surgery. Historically, transition has been something done by a vanishingly small portion of the population, much less than 1%, predominantly men. Trans has since become an opt in identity which means that individuals should be recognized as having transitioned to the opposite sex or out of sex entirely to be non-binary because they say so. According to this ideology children as young as 6 months may be trans, despite having no understanding of the concept of sex or their relationship to their own sex. 

Learning of the impact of this ideology on increasingly younger people is what led me to further research this topic. There has been an exponential increase in adolescents engaging gender clinics in the last decade. This cohort is overwhelmingly made up of girls. Historically those seeking treatment at gender clinics have been diagnosed with pervasive gender dysphoria. Researcher Lisa Littman coined a term, Rapid Onset Gender Dysphoria (ROGD), to describe many of those currently entering gender clinics. Rather than presenting long term gender dysphoria, many seem to self diagnose after extensive time on social media or influenced by peers undergoing transition. Like eating disorders and cutting, it seems to spread as a social contagion. While that describes those presenting at gender clinics in recent years, it's safe to say this might possibly change. Gender affirmation for adolescents has been repeatedly endorsed and promoted by the Biden administration and gender identity is taught in schools.

Gender affirmation is a euphemism for preparing adolescents for sexual reassignment surgery. The gender affirmation medical protocol for adolescents starts by stopping puberty at Tanner stage 2 with Gonadatropin-releasing hormone agonists (GnRH). This is done ostensibly to prevent the maturation of secondary sexual characteristics like breasts and facial hair to make transition more convincing. This is followed by cross sex hormones at 16. Cosmetic surgery may follow after 18, although girls as young as 12 are getting double mastectomies right now. Children undergoing this protocol will be infertile and unlikely to ever reach orgasm as adults. These outcomes are accompanied by an increased risk of heart attack, cancer, stroke, osteoporosis and other bone ailments, and early onset menopause. It's a protocol for removing healthy bodily function and decreasing bodily health for an aesthetic effect, to "pass" as the opposite sex.

Dishonest people respond to the objection of sterilizing children by asserting that children are not engaged in this protocol. It's absurd to pretend that 12 year olds are not children, but it's worse than that. People ignore that social transition, non-surgical change of name and sexual presentation, is a psychological intervention rather than a means for light experimentation. They also assert that blocking puberty is just a "pause on development" to allow the child to reason through transition. This is medical nonsense. Both social transitioning and puberty blockers act as initial steps to transition, not alternatives. They both lead to the preservation of what may be a transient socially mediated identity. There are at least 11 studies that show that the majority of children with gender dysphoria desist through puberty. It is alarming that rather than seek to understand what about cognitive and sexual maturation "cures" gender dysphoria for adolescents, gender affirmation starts by assuring the dysphoria persists. What is more alarming is that there is no strong evidence that any aspect of gender affirmation offers lasting benefit to the adolescent, but much evidence of lasting harm. This is the reason that where comprehensive reviews of the evidence have been conducted the practice of pediatric medical transition has been highly limited.

I initially thought that if people were better informed of the facts around pediatric medical transition they would oppose it as I did. This may have been naivete, but I prefer to think of it as an optimistic faith in humanity that may be entirely unwarranted. There is a growing political coalition opposing pediatric medical transition. My experience has led me to believe that it will ultimately fail by focusing solely on stopping pediatric medical transition. What I have found is that people are convinced that medical transition has meaning and is inherently good, regardless of the consequences. It is almost held up as an achievement, like a great job, which may require sacrifice, instead of a medical process which needs to balance risk of harm. 

Dr. Marci Bowers provides a somewhat extreme example of this mindset. Bowers is a post transition surgeon who specializes in sex reassignment surgery. Bowers is a true believer who has become increasingly vocal about the consequences of the pediatric transition protocol. At a symposium at Duke University, Bowers said, "Every single child who was truly blocked at Tanner stage 2 has never experienced orgasm...I mean, it's really about zero."


The fact that no child is capable of giving informed consent to losing bodily functions never experienced should be enough to end pediatric medical transition. Instead, true believers like Bowers consider the consequences for their patients acceptable for the fulfilment of transition. There is always another experimental solution for addressing short-sighted negative consequences. In addition to never experiencing orgasm, males in this protocol face additional problems when considering surgery. Sex reassignment surgery for them involves inverting the penis to create a cavity. A patient with insufficient penile growth from puberty blockers may have part of their colon used in vaginoplasty. This may be accompanied by a pervasive fecal odor. An entry on Bowers blog suggests that tilapia skin might be used instead. The way the issue is framed is concerning. "The maturation of a large number of children, genitalia growth blocked prior to onset of puberty, now coming to age of surgery, is putting an enormous strain on Dr. Bowers and those who care for these adolescents and young adults as they seek functional genitalia." Remember: this process is entirely cosmetic. It is impossible to surgically create functional genitalia. It is not clear if there is any line Bowers won't cross in pursuit of promoting transition.

Recognizing that there is no evidence of medical transition benefitting adolescents and much evidence of harm, who is the transition for? People like Bowers seem to have a personal investment in adolescent  transition that extends beyond the professional. Some of the loudest advocates of pediatric medical transition are adult males who have chosen to identify as trans unlikely to undergo any surgical interventions. In part, they believe they would be happier had they not experienced the development of secondary sexual characteristics in puberty. They are willing to sacrifice the future sexual fulfillment of a generation to prove it. Beyond that, they seem to be using these adolescents as self validation. The only way to be trans is by choosing to identify as trans. Younger people being called trans allows them to claim to have been trans since birth. Pediatric medical transition supports the self-serving desires of adults more than it could possibly serve the needs of adolescents. 
Gender affirming care is an invention of activists that ignores any medical precedent for care. Gender affirmed patients are not externally evaluated. Psychiatrists in at least 20 states are prohibited by law from exploring the gender confusion of the patient. They accept the prognosis of the adolescent instead. No area of medicine rests on the subjective self diagnosis of the patient, especially for a psychiatric condition. Nor does medicine start with the most invasive low evidence treatment offering short term satisfaction over long term health. Medicine also does not utilize a treatment that does not address the condition for which it has been engaged. Gender affirming care isn't medicine. It is wish fulfillment, but only in the most shallow way possible.

The process is often reinforced by a cynical claim to increased risk of suicide for children not allowed to transition. While studies have found increased suicidal ideation in gender dysphoric adolescents, a study from Sweden found the suicide rate to be .6%. However, another long term study from Sweden found that the post transition rate dramatically increased at the 10 year mark. It was 20 times the rate of the general population. Despite the numerous studies based on surveys claiming overall satisfaction for transition, clearly the satisfaction from cosmetic bodily changes eventually wanes.

In a nutshell, transition is a consumer choice. It offers patients a temporary escape from their emotional pain without addressing it. In so doing it creates erroneous expectations of the process. Once considered, it seems to become the source of obsessive ideation, a goal unto itself instead of a solution for a pervasive disorder. One procedure leads to the next for precisely that reason. A number of detransitioners have said that each step of transition created a stronger sense of dysphoria, leading to further intervention. The realization that these interventions might not be a solution for distress often comes after irrevocable changes to the body. Doctors are ignoring the Hippocratic Oath to allow disordered patients to harm themselves for their own good. As one detransitioner stated, "doctors treated me as if I had a hardware problem and forgot about the software problem."


In many ways, transition acts like the advertising of a new pharmaceutical you're encouraged to ask for from your doctor. It similarly suggests that you determine the best course of action for yourself, whether the doctor knows if it is fit for purpose or not. After all, gender dysphoria is whatever the patient says it is, even if it is a desire to transition to fulfill a paraphilia. On an episode of Gender: A Wider Lens, Debbie Hayton, who underwent transition in 2012, made the point that it was the possibility of transition that made him want to transition. It acted as a powerful attractor for his autogynephilia (AGP). AGP is a male's sexual attraction for himself as a woman. Theorists believe that a high majority of males identifying as trans transition because of their autogynephilic desires. It is as important to that desire that they are validated externally as women as it is to dress or act as they think women do. We participate in their kink publicly without our consent. Would as many men with AGP perseverate over transition without the possibility of being accepted as women? I don't think so.

I have suggested to activists working against pediatric medical transition that it is a stronger political argument to oppose transition for everyone. After all, if it is unfit for adults how can it be fit for adolescents? The push back is that we should not attempt to tell adults what to do. I think this is shortsighted. It is not about telling adults what they can or cannot do with their bodies. It is saying that we will not transition society because of what they do with their bodies. A man taking estrogen, getting breast implants, and surgery to invert his penis does not actually transition to the opposite sex. A woman cannot become a man. The transition is in legal designation of sex and in the social willingness to accept a person as the opposite sex. Because adolescent transition exists more to validate adults than to serve the needs of adolescents, it won't end until we end transition. We need to sever the connection between the concept and the consumer choice for chemical and surgical body modification.

Paraphilias are not inherently healthy or unhealthy, but the false promise of transition creates an unhealthy relationship between a man and his autogynephilia. It is based on the cruel optimism that not only will he become a woman, he will be accepted as one. The concept of transition allows men to convince themselves that their AGP represents their true self rather than their sexual desire. As Hayton has suggested for himself, transition acts as a form of propaganda. We are beginning to recognize the social contagion for adolescent girls. We should also recognize that men promoting their kink in this public way is a social contagion for men who share that kink. I would suggest that no one, including the man with autogynephilia, believes that he has become a woman. This is why their rhetoric is so extreme. It is not that they are angry at internet strangers for stopping them from being women. It is that the internet strangers say exactly what the voices in their heads say when they are looking in the mirror.

Severing the relationship between the concept of transition and surgical and pharmaceutical body modification forces these men to be honest about their paraphilia. If there are healthy ways to engage AGP, they start with the men being honest about it rather than deflecting with fantasy. This is ultimately not about those men, but opposing the political goals of the billionaires funding the spread of gender propaganda internationally and the downstream impacts. Without transition there is not even the pretense at a rationale for including men in women's sports, prisons, rape crisis centers, domestic violence shelters, awards, bathrooms, locker rooms, changing rooms, or spaces.

The greatest downstream benefit is the increased likelihood of accurate individualized mental health diagnoses and intervention for young people. They are being conditioned to view any internal distress through the same poorly defined narrow lens of gender. What one adolescent may call gender dysphoria in herself may stem from entirely different sources in another adolescent claiming to have gender dysphoria. Cancer in one patient is created by the same biological process that causes cancerous cells in another. Unlike cancer, gender dysphoria is less descriptive of a defined illness than a means of grouping symptoms. The diagnosis does not contain the reason for the illness. A study on detransitioners found that a majority felt misdiagnosed or that the doctor failed to examine underlying trauma or comorbid mental health conditions.    

According to detransitioners, gender dysphoria may be a stand in for internalized homophobia, internalized misogyny, PTSD from physical or sexual abuse, or autism. A number of women felt extreme distress from being sexualized in puberty and wished to opt out of being women. As I've written about previously, in a podcast interview, the Dutch practitioners who initiated the use of puberty blockers in adolescent transition seemed to just be treating puberty, rather than fulfilling a gender identity. There is strong evidence that the gender affirmation protocol is an effective treatment for puberty. However, there is no evidence that puberty should be treated like a disease, or that doing so is anything other than harmful. If we had the type of society moved to action by harm to children, then informing of the harms of pediatric medical transition would be enough. We must politically destroy the concept of transition because we lack such a society. If we had that sort of society, pediatric medical transition would not have become a problem.

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