A reader named Joe sent me this article, Trouble in Transtopia, about regretting transition and, well, never let it be said that I do not listen to the will of my readers.
First, I would like to highlight my points of agreement with the article. The trans community as a whole is shitty to detransitioners. We need to acknowledge that identity is fluid over time and many people will identify as trans for a period and later not. We need to acknowledge that sometimes people will think transition is the right decision for them, and it turns out that it isn’t. It is morally repugnant to erase a vulnerable group of people in need of support because they don’t fit into our neat, political narratives. Detransitioners are part of the trans community too. Doubly so! They transitioned twice, they are clearly far more trans than a silly once-transitioner like myself.
Similarly, I agree that medical transition is a big step which should only be entered into after a lot of thought (depending on the permanence of the transition step, of course– it can be reasonable to experiment with estrogen to see if you like it but definitely not with SRS).
However, the evidence presented by the article that detransition is very common is, uh, shitty.
The article claims that trans people claim that only five percent of people detransition. It doesn’t have a source, but that seems like a reasonable estimate, so let’s go with that. If about .3% of the population is transgender, then there will be 45,000 detransitioners in the US alone. That is more than enough for as many anecdotes as you please.
Furthermore, the detransition stories presented in the article include the story of Rene Richards, a tennis star, who not only never detransitioned but does not actually regret her transition:
In the same interview, Dr. Richards talked about wishing for something that could have prevented the surgery.
“What I said was if there were a drug, some voodoo, any kind of mind-altering magic remedy to keep the man intact, that would have been preferable, but there wasn’t,” Dr. Richards says. “The pressure to change into a woman was so strong that if I had not been able to do it, I might have been a suicide.”
Does she regret having the surgery?
“The answer is no.”
It is a very remarkable twisting of the facts to consider a person who says “if I hadn’t transitioned I would have killed myself” to be a trans failure story. She had a bunch of bad options and she picked the best available option. Not letting people transition would not actually improve the situation. “All your options are terrible! I will remove the best available option! I am helping! It is a good decision I have made here today!”
Furthermore, this includes the story of Ria Cooper, Britain’s youngest trans woman. As Natalie Reed wrote when the story initially broke:
Even some of the articles that most directly presented the story as one of how Ria’s “sex change hormones” had “caused” her depression, and that she was clearly “too young” to have made such a choice, nonetheless included quotes from Ria about how she had been treated by her family and friends in the wake of her transition. I can’t help but wonder if this is because the cis bias of the reporters was so thick they didn’t even realize they were including evidence of how they’d distorted the story and glossed over highly significant details. Ria described how her mother no longer permitted her to live at home or come by, unless she did so “as a boy”, how her father openly described her as an “embarrassment” and disappointment, how she ended up alienated from almost all of her friends, and how she considered detransition the only option for having interpersonal connections again, how she considered detransition her only chance to be happy. And that she herself tied this not to the mood swings “caused” by her HRT, but because detransition would allow her to regain her family and connections and support systems.
This wasn’t simply an issue of medical transition, and the physical changes, being something that Ria didn’t want (perhaps tellingly, perhaps not, I wasn’t able to find any statements by Ria on how she felt about her body, its changes, and what changes detransition will sacrifice). I don’t feel comfortable speculating on Ria’s feelings and whether or not she experiences dysphoria about male or female physical characteristics, or how intensely, but what’s clear is that this is very largely an issue of her being unable to cope with the intense pressures and alienation of being trans in a transphobic world. Which is to say nothing of the pressure, stress, transphobia, and lack of privacy or ability to adapt to a relatively “normal” life as female, she must have faced transitioning under such public scrutiny as “Britain’s youngest sex change patient!”.
I don’t know about you, but if I were seventeen years old, and my parents made it clear that they would only accept me if I were cis, and I no longer had friends, and I believed these situations would never change unless I detransitioned… I am pretty sure I would detransition. And I’m definitely dysphoric and have never regretted my social transition for a moment! Humans are social animals. As Natalie Reed says, we cannot know why Ria Cooper chose to detransition. However, it is simply bad journalism to report about it without mentioning that social rejection could be a factor.
Fortunately, the article Trouble in Transtopia does not purely rely on misrepresented anecdotes. It also cites two studies. So, let’s look at the studies!
First, they discussed the National Transgender Discrimination Survey, which among other startling results found that 41% of trans people have attempted suicide. (We Are The 41%!) Trouble in Transtopia says, “One need look no further for compelling evidence of widespread transgender and sex change regret.” I think they probably should have looked a bit further. Perhaps to the second half of the sentence?
with rates rising for those who lost a job due to bias (55%), were harassed/bullied in school (51%), had low household income, or were the victim of physical assault (61%) or sexual assault (64%).
I dunno, I’m just blueskying here, but it seems maybe plausible that the reason the trans suicide rate is so high is that people keep raping, harassing, firing, and trying to kill us.
The second study is a 2003 Swedish study which found that trans people are more likely to die, particularly from suicide, than demographic-matched cis controls of the same birth sex are.
I assume the sequel to Trouble in Transtopia will be Trouble in Depressedtopia. First paragraph: “Depressed people after treatment are more likely to kill themselves than people who have never been depressed are. This is undeniable evidence of therapy regret. Therapists are taking advantage of vulnerable people and making them want to kill themselves. We must ban therapy immediately.”
Threequel: “Trouble in Cancertopia! After chemo, cancer patients are still much more likely to die than people who have never gotten cancer! Look at all the side effects of chemo. It’s probably all the side effects of chemo killing everyone, we should just never treat cancer and there would be no problems anymore.”
It is true that trans people, even post-transition, are more likely to die than cis people. But “be cis” is not actually an option I have. My options are to be a non-transitioning gender dysphoric person or a transitioning gender dysphoric person. As far as I am aware, not a single study has been conducted on which option is better, possibly because gender dysphorics as a whole are extremely stubborn and going to respond to “you can’t transition” with doctor-shopping and/or illegally buying hormones and transitioning anyway. In the absence of such a study, we merely have to use our best judgment when figuring out whether transition is the right choice for us.
Finally: I have noticed a recurring trend through this article, which is that it treats the results of transphobia as the results of being trans. This is literally schoolyard bully logic: “it’s your fault I hit you, you were just standing there looking so hittable.” This is not to say that transphobia isn’t a factor people should take into account when considering whether to transition– they definitely should. But in terms of whether transition is an effective treatment for gender dysphoria, the fact that people are constantly assholes to us for no reason is not actually relevant. Transition is fine! Transition works great! The solution to the problems you’re decrying is not eliminating transition, it’s getting people to stop being assholes to us for no reason– that is, exactly the sort of trans activism you wish wouldn’t exist.
queenshulamit, the sad fat weird girl with incredible boobs said:
I would comment on your posts more but all I can say is “Ozy is very smart.”
LOOK AT ME I AM DATING A SMART PERSON! THEY ARE DATING OTHER SMART PEOPLE BUT ALSO WANT TO DATE ME FOR SOME REASON. 🙂
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veronica d said:
What bugs me is these counter points are so freaking obvious that I cannot help but assume bad faith on folks who publish this stuff. Which is probably actually incorrect — or maybe not. I mean, seriously!
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Benja Fallenstein said:
> possibly because gender dysphorics as a whole are extremely stubborn and going to respond to “you can’t transition” with doctor-shopping and/or illegally buying hormones and transitioning anyway
It seems like this should be qualified to “gender dysphorics who go see a doctor in the first place” or something, since it seems like if being stubborn in this way is an observed property of gender dysphorics, the screamingly obvious explanation is “selection effect” (even more so than with the correlation of gender dysphoria with intelligence I’ve heard anecdatally claimed & seen explained in this way).
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Joe said:
Hey Ozy
Thanks for blogging about this article. You bring up some really good points but I think one of us is misunderstanding why the author of the article brought up the 41% in the Swedish study. I from what I understand the 41% doesn’t include trans people that have experienced sexual assault, job loss and bullying. The percentage goes up with those issues but I think the 41% is just unmolested suicidal trans people in tran friendly Sweden. Its probably me misreading things. It might be overly simplistic to blame all suicidal ideation on societal abuse. Some of the people you don’t mention really seemed distraught after their surgery.
I really enjoyed reading the full article you linked on Renee Richards(a male to female trans traditional marriage advocate!) but I think you have to admit things are a little less than clear. If she does not regret the surgery, as she clearly says, then why does she discourage everyone that asks her if its a good idea?
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ozymandias said:
No, 41% is the rate for the entire sample. If you look deeper into the survey it has numbers for other groups (for instance, 37% of currently employed trans people have attempted suicide at some point).
Presumably she discourages it because she thinks it’s a bad idea unless you absolutely have to transition.
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Emily said:
That individual trans people cannot choose to be cisgender does not mean that if we had a different discourse regarding gender, fewer people would be transgender. A generation ago, if you were a young female-bodied masculine person who was attracted to other female-bodied people, you could go to various big cities, meet other queer people, and learn that there was a category of people that included you called “butch lesbians.” For a lot of people, that category felt right. Now if you’re a young female-bodied masculine person who is attracted to other female-bodied people — someone with that same personal history — you’re much more likely to wind up identifying as a trans guy. It’s a startling thing that’s happened to the queer female community: the shrinking of what was once a pretty major category of women. I don’t think there’s something in the water that’s making there be more trans guys and I don’t think that the older butch lesbians are actually unhappy being butch lesbians and really are trans. What changed was our ideas, and therefore the ideas we presented people with, particularly people who were at very formative stages regarding the development of their gender and sexuality. We made there be more trans people.
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Audrey said:
Yes, this comes back to things like the cis by default idea and similar. In the Swedish study, the trans individuals were not compared to cis individuals. They were compared to the general population, who mostly don’t know what cis means and haven’t been asked if they are cis. Unless an individual has very strong feelings of sex dysphoria, people with issues around gender tend to be filtered into different roles depending on generational solutions. And even of those with sex dysphoria, some (and I mean just some) of the people with eating disorders from forty years ago (and sexist theories around them – they’re starving themselves because they don’t want breasts or womanhood and are repressed about the possibility of penetration etc etc etc) sound like dysphoria about the sexed body.
Just as Emily points out where did all the young butch lesbians go when the category of trans guys appeared, I can ask where did all the maiden aunts go when the category of butch lesbian appeared? And now perhaps some of that maiden aunt category is now being replaced with the asexual category.
As for the Swedish study, there conclusion was that sex reassignment surgery was inadequate on its own and many trans people would need additional support. I don’t think that is supposed to be an argument against the surgery.
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Audrey said:
Sorry, I’m probably using incorrect and confusing terminology. I mean strong feelings of sex dysphoria to mean dysphoria about the physical body, as compared to somebody who is not unhappy or not hugely unhappy with their physical body, but would still, if they were aware of what trans was, consider themselves to be trans.
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bem said:
Can I ask if there’s a reason why you’ve qualified your argument about eating disorders as applying only to people a generation ago? Because I actually find this idea very persuasive for at least some ED cases (admittedly, it’s possibly not the determining factor for many/most).
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ozymandias said:
I know a couple of assigned female at birth trans people with disordered eating issues that are explicitly connected to “the thinner I am, the less obvious it is that my fat is female-distributed.” So anecdotally that is a thing.
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Audrey said:
I think I was just trying to be concise. It is really only the eating disorder= repressed=doesn’t want to be penetrated/pregnant with penetration being seen as a norm that hopefully no longer exists as a credible theory. The rest could apply to now.
I read Susie Orbach’s Hunger Strike which covers a lot on gender, the body and anorexia. She doesn’t talk about trans people at all (it is a fairly old book now). I think I’d want to make a distinction between what she is saying about women being uncomfortable with society’s attitudes to women and so developing anorexia, and trans masculine leaning people who would have sex dysphoria anyway developing anorexia as a coping mechanism. Otherwise it gets conflated back to ‘but if there was no sexism/patriarchy/objectification there would be no trans people.’ Or actually I’d like someone more capable than me to make this into a cogent argument which didn’t conflate the two issues.
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veronica d said:
Well, I cannot speak to the FtM spectrum, but gender dysphoria on the MtF spectrum has a long history. For example, from the first moments that “sex change” was even hinted at in the broad culture, sexology magazines were flooded by letters from AMAB people begging for more information. After her initial media blitz, Christine Jorgensen was herself flooded with letters from AMAB people wanting to know more.
Denmark, where Jorgensen had received surgery, changed their laws to disallow visitors get receive SRS, given the overwhelming number of Americans who came seeking surgery.
Similarly, as the “gender identity clinics” began to open, they were flooded with applications, most of which were denied for various terrible reasons.
I don’t know why trans women were then more common than trans men. Both certainly existed. Nor do I know why these frequencies have changed.
[All cites from http://www.amazon.com/How-Sex-Changed-History-Transsexuality/dp/0674013794%5D
Of course, there is nothing wrong with being trans. There is nothing wrong with transition. It is not a “regrettable necessity.” Instead, it is a lovely thing that our technology now allows.
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veronica d said:
Uh, better link:
Ozy, edit function! Please!
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bem said:
Hm. I think that the gender situation of a generation (or two or three generations ago) may have been a bit more complicated? I mean, I think that the availability of hormones and other technologies that make it possible to physical transition probably has had an effect on the number of people who identify as trans, but even generations ago, you definitely have people like Radclyffe Hall, who’s usually called a butch lesbian but wrote extensively about feeling like one had “male soul,” and also preferred John to her birth name. Maybe some of these people would have transitioned if the technology had been available. Maybe not.
From what I’ve heard from butch lesbians, though, it seems like there is at least some pressure to identify as trans if you’re very far on the masculine end of the gender presentation spectrum. So there’s that, too.
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Emily said:
Yeah, I didn’t mean to suggest that transgender people were invented during the last thirty years. For some people, having the category of trans and hormones/other technology as an option is (or would have been) a godsend compared to the previously available things. And I’m sure that’s true of some people who identified as butch lesbians. And maybe more true of trans men than trans women, I don’t really know. But I think it’s not true for some trans people – even though they are really and truly trans now, they would have been something else (and maybe happier and less in need of medical interventions) if that something else were more available and trans were less available.
I don’t know entirely what the implications of that are, because maybe what’s good for those people is different for what’s good for the people for whom trans really is the best category, and you can’t necessarily tell who is going to be who.
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Emily said:
Sorry, I meant to say “more true of trans women than trans men”
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veronica d said:
You might be right. You might be wrong. But what do we do with this?
Is there a problem that too many people are willing to believe trans people, such that they need all kinds of extra scrutiny and skepticism? Cuz to me it seem the exact opposite is the case. There seems to be no shortage of people eager to interrogate and invalidate trans people. In fact, among trans people I see a deep desire for this to become a settled question.
How often do trans people have to hear, “Okay, so now I want to once again bring your entire identity in question based on a crap article written by hostile jerks”?
It gets old.
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veronica d said:
That link should be: http://www.imatyfa.org/resources/healthcare-practitioners/american-medical-association-transgender-resolution/
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Benja Fallenstein said:
Veronica, I agree that a world with even more scrunity and skepticism of trans people would be worse, and I don’t see any obvious things to change in society based on Emily’s comments that seem like they would make the world better. (Based on her comments, I don’t think Emily does, either.)
But I’m happy to see Emily’s comment (read as “this evidence suggests that there’s a significant subset of masculine people born in female bodies who could end up happily identifying as either women or men”, which is how I read it, not as “this is true of all masculine people born in female bodies and gender dysphoria didn’t exist until recently”, which is clearly wrong), because it points out evidence that gender is more nuanced than you might otherwise think, and it seems better to have better models of how people actually work even if this doesn’t immediately translate into different policies.
And yes, I realize this is in the context of a discussion of a trans-negative article. But, like, I like Ozy’s article for explicitly acknowledging that gender identity can be fluid over time, and that this is important. You can sort of imagine an alternate version of the article that would be all like, “sure, I agree that some people are mistaken about what their true gender is, but most people who identify as transgendered are actually transgendered, so it’s clearly better to give them care”; and while I’d agree with the policy conclusions of that hypothetical article, I’d be unhappy about its assumption that all people have a permanent real gender which is either male or female (but may disagree with gender assigned at birth), and the only reason somebody would detransition is because of a mistake about what their true gender is, because that is in fact not how the real world works, and I would be happy for there to be discussion which points this out, even if there’s no disagreement about the policy conclusion of “don’t make it more difficult for trans people to get care”.
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Emily said:
I’m not sure exactly what we do with this.
The one thing that I do have specific ideas about is how we deal with young children who are not gender-normative. There are a lot of them. I don’t want to say there have always been a lot of them because always is a long time, but there have certainly been a lot of them for awhile. I believe that many grew up to be cisgender adults and that worked pretty well for them. These are not people who are saying “I am transgender”, but rather they are doing things which are consistent with being transgender but also with other stuff. As the concept of being transgender gains prominence, it’s crowding out these other alternatives, like just being a little boy who likes sometimes wearing dresses. So I guess that would be my rather small suggestion: small children who are non-gender normative should be given some room to be non gender-normative. Adults should be chill about that, not make a big deal of it, and treat it like a phase because it probably is (and because maybe it is more likely to actually be a phase if it’s treated as not a big deal). We should be reluctant not just to start hormones or do surgery but even to raise the concept of transgenderism with the child unless they are self-reporting a whole lot of gender dysphoria.
By the time an adult (or a 15-year-old) is saying “I’m transgender”, that’s a different thing.
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ozymandias said:
I think it’s important to note that most children with gender dysphoria will not remain gender dysphoric after puberty. Many will grow up to be cisgender LGB people. I am not necessarily opposed to social transition and delaying puberty to give the child a better chance to decide– after all, dysphoric children have, what, a hundred times the prevalence of transness that the general population has– but I think parents should be aware that social detransition is likely and explicitly affirm to their child that their parents will not be angry or upset if they decide they want to go back to their assigned gender.
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veronica d said:
According to the SoC, HRT cannot being until the child is age 16. However, the child and the parents have the option to begin puberty blockers before that.
Which, keep in mind, puberty is irreversible, and many children are quite certain, even at that age, that they do not want the bodily changes that come with their assigned-gender puberty. And if the child changes their mind, they can go off the blockers and puberty begins.
This is not without cost. Delaying puberty does put them behind their peers regarding development. For AMAB people, they may not gain the stature they otherwise would have. This should not be taken lightly. But no one is taking it lightly not even close OMG.
Forcing a trans child through puberty should not be taken lightly either. Cuz it’s torture. And it takes from them so much they could have had: a real adolescence as their real gender, plus gender-appropriate physical development. This is life changing stuff. Seriously life changing. Immeasurable.
Every single interaction with every single other person for their entire life in every way will be shaped by these choices.
Currently there is zero evidence that these treatments are over prescribed. In fact, we are not within ten thousand miles of over prescribing this. Your concerns are wildly misplaced.
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MugaSofer said:
Veronica, if there’s significant evidence that child!trans is a different condition to adult!trans, then it’s entirely plausible that treatments for adult!trans might be overperscribed to children – even though they’re not commonly perscribed.
Then again, I must admit that going through puberty doesn’t strike me as “torture”, so maybe I’m underestimating the potential costs of underperscribing.
Still. If I understand this correctly, accidentally transitioning a child to the wrong gender is exactly as harmful as accidentally not transitioning a child to the right gender. So it’s entirely a question of what percentage of chil!trans people are actually adult!trans people, right?
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veronica d said:
Mugasofer — I’ve heard (but cannot cite) that there are about equal odds that a gender variant child will turn out 1) cis-gay, 2) trans, or 3) cis-straight. But we are not talking about child!trans, we are talking about adolescent!trans. For which, the irreversible stuff is not available before age 16. Before that puberty blockers are available. They are not without risks, but those risks are rather small compared to the potential gain.
The medications typically prescribed are these: http://en.wikipedia.org/wiki/Gonadotropin-releasing_hormone_agonist
The reason I am prickly on this subject is trans people are targeted with pretty relentless misinformation, which hurts them. In fact I’ll say blunty, random cis speculation about trans stuff is nearly always completely wrong.
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Princess Stargirl said:
@mugasofer
If you already feel your body is wrong and it now starts becoming much more wrong this is horrifying. Imagine something strange about your body getting worse and worse until it is completely terrible.
Also the effects of puberty are not always fully reversible. So the damage that is being done to your body everyday may never be repaired. And you have to live with the knowledge that your body might never fully recover from these changes.
The social effects are also very serious. An explicit view of a trans-female friend of mine whose parents did not allow her either social or medical transition was that her childhood and adolescence were stolen from her. She barely even wants to talk about those years.
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veronica d said:
It seems very difficult for cis people to understand the magnitude of this. Which, look, many people are born with terribly deformities or disabilities, which diminish their lives, but who go on to thrive. Trans people can do likewise. However, when there exists such an easy fix, but only for the young, and only with a brief time window, that if missed will never appear again — until perhaps some blissful transhuman future — but trans teens live now! This is the fierce urgency of now!
To see this opportunity missed, again and again, without sound justification — it’s infuriating. I can barely stand thinking about it.
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Zorgon said:
I can’t really shake the feeling that surgery should be considered an option of last resort. As you mention above, identity is fluid and a trans person that identifies as a man this decade may identify as a woman or some other nonbinary identity next decade and what the fuck then?
Of course there are going to be numerous individuals for whom the last resort is the required resort, because dysphoria is a complete shit. But hormones are kind of awesome and can do a whole lot on their own and I’m so, so happy that we’re finally getting to the point as a society where women with penises and men with vaginas are a thing that people understand as *OK*.
And I think that if we can separate this issue from the whole idea of “trans regret” the whole issue will look a lot simpler and less fraught with shit. That term alone is awful – do we call the phenomenon of gay people who develop bisexuality later in life “gay regret”? Like fuck we do.
Bah. TL;DR – nanosurgery for perfect transition and retransition NAOW.
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veronica d said:
“I’m so, so happy that we’re finally getting to the point as a society where women with penises and men with vaginas are a thing that people understand as *OK*.”
We’re reaching a point where people pay lip service to this idea. We are pretty fucking far from a place where it is an active reality.
Regarding surgery as a last resort: we are so far from a place where SRS is too easy to get that it’s kinda callous to talk that way.
I think the average wait time to start HRT is six months to a year. The average wait time for genital surgery is mumble mumble pretends to Google but actually doesn’t bother — well something far longer.
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ramendik said:
I understand this is an old article, and I got here by a link from a Star Slate Codex article that is also old.
But I need to correct a factual statement here about Ria Cooper. She simply did not detransition, this was a canard, as I understand she went along with the canard to get some cash. She is still trans, still a woman, a glamour model, and gets controversial press from time to time: https://www.hulldailymail.co.uk/news/hull-east-yorkshire-news/hull-glamour-model-ria-cooper-3431923
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איתי אבו-אלה إيتاي ابو-اله (@realitaigreif) said:
I have a question, I hope it’s OK.
If the two options are suffering from dysphoria, or suffering from transphobia, it’s obvious to me why someone would choose to transition, though they will continue to suffer in some form. It’s the lesser of two evils. If those are the only two options, then obviously the best world would be if we eliminate transphobia, and then the choice would be between dysphoria, and no dysphoria, which would be ideal.
What if there was a third option; dysphoria, transition (then potentially suffering from transphobia), or removing the dysphoria? If we live in a crappy world, where transgenders suffer from transphobia, it seems this would at least be considered? Perhaps a particular transgender person would still prefer transition, to removing the dysphoria, but another might prefer removing the dysphoria. And it’s not presented as an alternative.
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