The Econmist - USA (2021-11-06)

The Economist November 6th 2021 United States 27

Medicineandidentity

Portrait of a detransitioner

C

arolhadlongsuspectedhereveryday

lifeinruralCaliforniawouldbeeasier

ifshewerea man.Yetshewasstunnedby

howtruethisturnedouttobe.Asa “butch”

woman(and“notabigsmiler”)shewas

routinelytreatedwithslightcontempt,she

says.Aftera doublemastectomyanda few

monthsontestosterone—whichgaveher

facialhairandagravellyvoice—“people,

cashiers,everyone, suddenly becameso

goddamfriendly”.

YetCarolsoonfeltwretchedasa trans

man.Atfirst,thetestosteroneshestarted

injectingat 34 liftedhermoodandenergy

levels.Butaftertwoyearsshebegantosuf­

ferawfulsideeffects.Vaginalanduterine

atrophy(whichcancausetissuetocrack

andbleed)was“extremely painful”. Her

cholesterollevelsroseandshehadpalpita­

tions. She also became so anxious she

startedhavingpanicattacks.

So shewentonantidepressants,and

theyworked.“Itwasa light­bulbmoment,”

shesays.“Iwaslike,I neededtheantide­

pressants;I didn’tneedtotransition.”She

realisedhergenderdysphoria,thepainful

feelingshewasinthewrongbody,didnot,

infact,makehera man.

Nearlythreeyearsago,afterfouryears

asa transman,Carolbecamea “detransi­

tioner”:someonewhohastakencross­sex

hormonesorhadsurgery,orboth,before

realisingthiswasamistake.Herexperi­

enceillustratesthedangersofa “gender­

affirmative”modelofcarethatacceptspa­

tients’self­diagnosisthattheyaretrans,

nowstandardpracticeinAmerica’strans­

gendermedicinefield.

Nooneknowshowmanydetransition­

ersthereare,butanecdotalevidence,and

swellingmembershipsofonlinegroups,

suggeststhenumberisgrowingfast.Are­

centsurveyof 100 detransitioners(69of

whomwerefemale)byLisaLittman,a doc­

torandresearcher,foundamajorityfelt

thatthey had notreceived an adequate

evaluation before treatment. Nearly a

quartersaidhomophobiaordifficultyac­

ceptingthattheyweregayhadledthemto

transition;38%reckonedtheirgenderdys­

phoriawascausedbytrauma,abuseora

mental­healthcondition.

Carolbelievestherootsofhergender

dysphorialay in her childhood. Anup­

bringing that was both fanatically reli­

gious and abusive rammed home two

harmful messages. One was the impor­

tanceof“rigidgenderroles...womenwere

theretoserve;theywerelessthanmen”.

Hermother’sendlessfurythatCarolwould

not bowto this notion ofwomanhood,

whichincludedwearingonlydresses  (“I

didn’teven‘walklikea girl’,whateverthat

meant”)meantshegrewupbelieving  her

way ofbeing female was somehow “all

wrong”.Theothermessagewasthathomo­

sexualitywas“anabomination”.

Carol’s“ohGodmoment”came,as  she

amusinglydescribes,whenshedeveloped

a “heavycrush”onhermother’sfemale es­

tateagentat16.Therealisationprompted a

breakdown(thoughshedidn’tcallit that at

thetime).Firstshe“fastedandprayed  to

Godto takethisaway”.Thenshe began

drinking heavily and having one­night

standswithmen“inthehopesomething

wouldclick”.Whenshecameoutatthe age

of20,manyofherrelativesexcluded  her

fromfamilygatherings.

Itwasinherearly20s,whenmany les­

biansinhersocialcircle(“almostalways

the butch ones”) started identifying  as

transmenthatshebegantothink,“This

mustbeit!Thisiswhatiswrongwithme!”

Butshewastoldshehadtoliveasa man for

six months before being approved for

treatment andthe thoughtofusing the

men’stoiletwasintolerable.Bythispoint,

shehadmetthewomanwhowould  be­

comeherwifeandfoundsomestability.

Butshewasstilldeeplyunhappy.“I just

felt...wrong,” she says. “I was disgusted

withmyself,andifaniceanswercomes

along and says, this is going to fix it, guess

what you’re going to do?” By her mid­30s,

she no longer needed to see a therapist to

be  prescribed  testosterone.  (Planned  Par­

enthood uses an “informed consent” mod­

el  in  35  states,  meaning  trans  patients  do

not  need  a  therapist’s  note.)  Yet  Carol  did

see a therapist, because she wanted to “do

it right”. The therapist did not explore her

childhood  trauma,  but  encouraged  her  to

try  testosterone.  Months  later  Carol  had

her breasts removed.

Detransitioning  was  the  hardest  thing

she has done, she says. She was so terrified

and ashamed that it took a year to come off

testosterone.  To  her  relief  her  cholesterol

levels  returned  to  normal  in  months.  She

still has some facial hair and a deep voice.

Her  mastectomy  “is  like  any  loss:  it  dissi­

pates but it never completely goes away”.

She now spends a lot of time campaign­

ing for other detransitioners’ stories to be

heard.  This  is  not  easy  work.  Outspoken

detransitioners  are  often  maligned.  One

gender­medicine doctor has criticised the

use  of  the  term  “detransitioner”,  saying,

with extraordinary cruelty, “it doesn’t real­

ly  mean  anything”.  Dr  Littman’s  study

found  that  only  24%  of  detransitioners

told  their  doctors  transitioning  had  not

worked  out.  This  may  help  explain  why

some dismiss the phenomenon.

Carol worries about girls who are taking

puberty blockers to avoid becoming wom­

en,  something  she  says  she  would  have

leapt at given the chance. And she worries

about  butch  lesbians  who  are  being  en­

couraged  to  consider  that  they  are  in  fact

straight  men.  She  now  considers  this  ho­

mophobic. “My wife told me recently that

when I was transitioning she was on board

for two months before realising, this is cra­

zy. And she was right. Shewasbeing told,

your wife is really a man soyouare bisexu­

al or straight. It was bullshit.”n

WASHINGTON, DC

Carol was born a woman, thought she was a man, then realised she wasn’t.

Her story has lessons for the way doctors treat transgender people

Carol, contented