When Harry Became Sally: Responding to the Transgender Moment

by Ryan T. Anderson

The transgender movement has hit breakneck speed. In the space of a year, it's gone from something that most Americans had never heard of to a cause claiming the mantle of civil rights.

But can a boy truly be "trapped" in a girl's body? Can modern medicine really "reassign" sex? Is sex something "assigned" in the first place? What's the loving response to a friend or child experiencing a gender-identity conflict? What should our law say on these issues?

When Harry Became Sally: Responding to the Transgender Moment provides thoughtful answers to all of these questions. Drawing on the best insights from biology, psychology, and philosophy, Ryan T. Anderson offers a balanced approach to the policy issues, a nuanced vision of human embodiment, and a sober and honest survey of the human costs of getting human nature wrong.

He reveals a grim contrast between the media's sunny depiction and the often sad realities of gender-identity struggles. He introduces readers to people who tried to "transition" but found themselves no better off. Especially troubling is the suffering felt by adults who were encouraged to transition as children but later came to regret it.

And there is a reason that many do regret it. As Anderson shows, the most helpful therapies focus not on achieving the impossible--changing bodies to conform to thoughts and feelings--but on helping people accept and even embrace the truth about their bodies and reality. This discussion will be of particular interest to parents who fear how an ideological school counselor might try to steer their child. The best evidence shows that the vast majority of children naturally grow out of any gender-conflicted phase. But no one knows how new school policies might affect children indoctrinated to believe that they really are trapped in the "wrong" body.

Throughout the book, Anderson highlights the various contradictions at the heart of this moment: How it embraces the gnostic idea that the real self is something other than the body, while also embracing the idea that nothing but the physical exists. How it relies on rigid sex stereotypes--in which dolls are for girls and trucks are for boys--while also insisting that gender is purely a social construct, and that there are no meaningful differences between women and men. How it assumes that feelings of identity deserve absolute respect, while the facts of our embodiment do not. How it preaches that people should be free to do as they please and define their own truth--while enforcing a ruthless campaign to coerce anyone who dares to dissent.

Everyone has something at stake in today's debates about gender identity. Analyzing education and employment policies, Obama-era bathroom and locker-room mandates, politically correct speech codes and religious-freedom violations, Anderson shows how the law is being used to coerce and penalize those who believe the truth about human nature. And he shows how Americans can begin to push back with principle and prudence, compassion and grace.

Genres: Nonfiction, Politics, Psychology, Cultural, Gender, Science, Sexuality

251 pages, Hardcover

First published January 1, 2018

About the author

Ryan T. Anderson researches and writes about marriage and religious liberty as the William E. Simon Fellow in Religion and a Free Society at The Heritage Foundation. He also focuses on justice and moral principles in economic thought, health care and education, and has expertise in bioethics and natural law theory.

Anderson, who joined Heritage’s DeVos Center for Religion and Civil Society in 2012, also is the editor of Public Discourse, the online journal of the Witherspoon Institute of Princeton, N.J.
Anderson’s recent work focuses on the moral and constitutional questions surrounding same-sex “marriage.” He is the co-author with Princeton’s Robert P. George and Sherif Girgis of “What Is Marriage? Man and Woman: A Defense” (Encounter Books, December 2012). The three also co-wrote the article “What is Marriage?” in the winter 2011 issue of Harvard Journal of Law and Public Policy.

Anderson, George and Girgis filed amicus briefs with the 9th Circuit Court on the appeal of Perry v. Schwarzenegger, the case reviewing the constitutionality of California’s Proposition 8, and with the 1st Circuit Court on the challenge to the federal Defense of Marriage Act. In January 2013, the co-authors filed a brief with the U.S. Supreme Court after it agreed to hear the cases.

Anderson’s previous positions include assistant editor of First Things; journalism fellow of the Phillips Foundation; and executive director of the Witherspoon Institute, where he was research assistant to Robert P. George and Jean Bethke Elshtain.
His articles have appeared in The Wall Street Journal, First Things, Weekly Standard, National Review, Ricochet.com, New Atlantis, Claremont Review of Books, Touchstone, Books and Culture, Christianity Today, The City and Human Life Review.

Anderson received his bachelor of arts degree from Princeton University, graduating Phi Beta Kappa and magna cum laude. He is a doctoral candidate in political philosophy at the University of Notre Dame, where he received his master’s degree. His research spans the natural law tradition in conversation with classical and contemporary liberalism. The tentative title of his dissertation: “Beyond Private Property and Social Welfare: Economic Justice and Economic Rights.”

Anderson, who was born in Baltimore, Md., currently resides in Washington, D.C
(from Heritage Foundation Website)

Reviews

[Brynn Tannehill · Rating 1 out of 5]

Note: Page numbers in this review refer to the advanced reader copy of the book that I acquired.)

I have written elsewhere on how to detect and debunk anti-transgender propaganda in science and the media previously. I described fifteen tests, and Anderson’s book fails at every level. I cannot address all of the issues in this book, but fundamentally it is deliberately misleading and designed to push transgender people into the closet.

This book was not science. It is apologetics to support a religious viewpoint and a set of policies that would cause great harm to a vulnerable minority community already suffering from significant stigma and economic disparities.

So, how does this book look when you ask the 15 questions I wrote about in the link above?

1. Who Wrote It?
Ryan Anderson works for the Heritage Foundation, and is a conservative Catholic. Anywhere that science conflicts with his Catholic faith, he defaults to the position of the Catholic Church, and interprets the science in such a way that it conforms with his religious beliefs. At other times, he ignores scientific evidence that is contrary to his (and the Church’s) religious beliefs.

Fundamentally, this is not science. This is religious apologetics.

2. Who Does The Author Hang Out With?
Ryan Anderson works for the Heritage Foundation, and has strong ties with the Family Research Council, which is designated as an anti-LGBT hate group by the Southern Poverty Law Center for making “claim(s) that LGBT people are threats to home and society. Others in these hate groups disseminate disparaging “facts” about LGBT people that are simply untrue — an approach no different to how white supremacists and nativist extremists propagate lies about black people and immigrants to make these communities seem like a danger to society.”

3. Where Is It Published?
The book is published by Encounter Books, which is a publisher of conservative religious tracts. This affects the quality and objectivity of the book with a rather slipshod editing process. For example, on page 21 Anderson asserts that no one on the left has been able to specify any errors or flaws in an article written by Mayer and McHugh. This is patently untrue, as can be found in the enclosed links, including an article by McHugh’s colleagues at Johns Hopkins University.

On page 19, Anderson claims that the decision to reopen the Johns Hopkins gender clinic “was not a consequence of any new scientific evidence” since the study commissioned by McHugh in 1977. Again, this is patently untrue: there have literally been hundreds of studies on transgender health care since 1977, and over the past 20 years the wide majority of them have shown improvements in quality of life for transgender people.

A competent, unbiased editor would have challenged these rather sweeping assertions, but did not.

4. Does It Blatantly Misuse (Or Cherry Pick) Real Research?
One of the quickest ways to spot biased and unreliable articles about transgender people is when they misuse actual research. Most commonly this occurs when they cite a 2011 study by Dr. Cecillia Dhejne to argue that medical care for transgender people is ineffective, or that it makes them suicidal. The problem is, the research actually says no such thing, and Dhejne has gone on the record saying that attempts to use it to make these points are both wrong and unethical.

As such, articles which deliberately misrepresent (lie) about the findings of actual academic work to support anti-transgender positions aren’t just wrong, they are unethical from the get go. I’ve met Dr. Dhejne, and she finds the use of her work to these ends disgusting.

Anderson’s book does just this, repeatedly.

Anderson misuses her research by saying that it shows that health care may not improve outcomes, when the study explicitly says you cannot use it this way because there was no transgender control group which received no treatment, so one cannot make any inferences as to the efficacy of treatment.

He also omits the crucial part of Dhejne’s research that found that after 1989, the suicide rate for transgender people was mathematically similar to the general population. Dhejne looked at this data, and posited that as society became more accepting, mental health outcomes for transgender people improved.

5. Does It Blatantly Misrepresent The Actual Positions Of People?
I have already discussed how Anderson misrepresents Dr. Dhejne’s positions and research above. But let’s discuss Dr. Kenneth Zucker.

Dr. Kenneth Zucker is a problematic figure. He has been the biggest proponent of the 80% Desistance Myth, and been completely opposed to supporting pre-pubescent kids in any gender variant behavior whatsoever, even if the kids are otherwise emotionally healthy and happy. This is why he is frequently cited by people and organizations opposed to letting transgender and gender variant kids be themselves.

However, what Anderson never acknowledges is that even Zucker supports the use of puberty blockers for adolescents (i.e. those who have started puberty) who are gender dysphoric, because in an interview with a conservative outlet he conceded that, “By age 11 or 12, trans kids are typically “locked in” to their gender identity” and for them, “I very much support that pathway, because I think that is going to help them have a better quality of life.” (i.e. even Dr. Zucker thinks that kids older than 11 or 12 are unlikely to desist)

Indeed, Zucker wrote a considerable portion of the DMS 5, and the WPATH Standards of Care for Transgender Adolescents. While Anderson is happy to hold Zucker up as someone who agrees with him on one thing, he ignores all the other areas where he doesn’t.

6. Does It Misrepresent The Positions Of Mainstream Organizations?
This book does not so much misrepresent mainstream organizations as ignore them altogether. He spends almost no time exploring the positions of the American Psychological Association, American Psychiatric Association, American Medical Association, and other major professional organizations. He spends no time exploring how these organizations arrived at their conclusions on transgender care, or the research they examined. He doesn’t look at the evidence they examined to arrive at their conclusions.

He simply dismisses them as wrong, and defaults to the viewpoints of people with similar religious views, such as Michelle Cretella and Paul McHugh. Neither has produced clinical research on transgender people (McHugh commissioned someone else to do the study at Jon’s Hopkins in the 1970’s)

You can read actual position statements at the following links, and read the reports of the task forces that looked at transgender health care as well. These position statement provide copious peer reviewed references to why they support health care for transgender people.

7. What Organizations Does The Author Represent?
As discussed above, Mr. Anderson is an employee of the Heritage Foundation and a conservative Catholic. His views must represent the political and religious views of the organizations he represents, and cannot represent anything close to an impartial, scientific review.

Within the book itself, he includes the views of many people with strongly anti-LGBT views, such as Michelle Cretella of ACPeds (a fake medical organization and SPLC certified hate group for deliberately spreading falsehoods and misinformation about LGBT people), Leon Kass (who was a conservative opponent of same sex marriage),

Ask what organizations the writer belongs to, or is representing. Do they belong to a hate group, as defined by the Southern Poverty Law Center?[1] Or speak for fake medical organizations that are routinely produce recommendations driven by religious beliefs rather than peer-reviewed science and medical consensus?[2] If they do, they cannot credibly claim to be unbiased, or acting in the best interests of transgender people.

(Seriously, if someone is a spokesperson for the Klan, you can’t take their claims that they’re acting on behalf of the best interests of black people. Why should we think about it differently when the group being targeted is transgender people?)



8. Who Does The Article Cite?
Many of the primary people used to support Anderson’s assertions have long histories of anti-LGBT animus, such as Michelle Cretella of ACPeds (a fake medical organization and SPLC certified hate group for deliberately spreading falsehoods and misinformation about LGBT people), Leon Kass (who was a conservative opponent of same sex marriage), Ray Blanchard and Michael Bailey (who routinely post at anti-transgender websites and push theories designed to denigrate the identities and dignity of transgender people), Paul McHugh (long history of anti-LGBT nastiness and defender of pedophile priests)



9. Does The Article Go Against The Scientific Consensus?
There is currently an overwhelming consensus by professional organizations for mental and medical care providers on the necessity and efficacy of health care for transgender individuals. These organizations include the American Medical Association, the American Psychological Association, and the American Psychiatric Association. These organizations studied the matter in detail before taking these positions.

Ryan attempts to contradict all of these organizations, while relying primarily on a pair of non-peer reviewed articles in a religious publication written by people with a long history of religious based hostility towards LGBT people to support his assertions that everyone else got it wrong.

Mr. Anderson must adequately explain why he’s more qualified or smarter than the vast majority of experts who have studied the issue based on peer-reviewed evidence. Alternately, he must explain why all the peer-reviewed evidence is wrong in a way that would survive peer review.

Ryan Anderson does neither, meaning that this book is much more of an opinion piece than a work based on science.

10. Does It Substitute Anecdotes For Research?
The entire chapter on detransitioners chooses anecdote over research. The actual peer reviewed evidence shows that regret rates tend to be very low (1-2%), and regrets are frequently over being treated poorly after transition by others, and not about being transgender.

Worse, Anderson did not even interview at least 4 out of the 6 people he cites, and they were not happy about how their stories were being used.

Another example of anecdote over research in this book is the claim that public accommodations laws endanger women based on a small number of anecdotes and people who fear (and sometimes hate) transgender people, when there is no peer-reviewed quantitative evidence to support this assertion.

11. Are Crucial Details Deliberately Left Out Or Ignored?
This occurs frequently in Anderson’s book, and is deliberately done to mislead the reader. For example:
* On page 191-192 Anderson leaves out the crucial fact that the transgender boy (Mack) wrestling in the girls’ division in Texas tried to wrestle with the boys, but was not allowed to because Texas law required him to use his birth certificate to determine which division he should be in. In Texas, it is almost impossible to change your birth certificate. As such, Mack was left only two options: quit the sport or wrestle in the girls division. He tried to do the right thing, but people with positions like Anderson’s prevented him from doing so.

* Leaves out all of the current research showing positive psychological outcomes for transgender youth with supportive environments

* Leaves out all of the studies showing that transgender youth in unsupportive environments (like the ones proposed by Anderson) have worse mental health outcomes

* Leaves out all of the previous research showing that attempts to change the gender identity of adults have failed, just as they did when trying to make gay people straight

* Omits discussion of epigenetics and other biological factors in human development. For example, studies of identical twins show that while autism, sexual orientation, and gender identity are correlated (i.e. if your twin is autistic/gay/transgender, you’re more likely to be as well). However, it’s not a 100% correlation (if your twin is autistic/gay/transgender, you might not be).

* Omits the fact that transgender people exist across cultures throughout human history, and it didn’t cause cultural collapse or people to forget how to procreate or have families. Indeed, the Hijra of India have been around for 2500 years, and there are 1.3 billion people in the country.

* Fails to note that transgender unemployment runs at twice the national rate due to discrimination, similar to the figure for African-Americans.

* The book did not discuss the fact that transgender people can be, and often are, happy and successful in their daily lives and careers

* Omits the entirety of the research into biological origins of gender identity. You can read some of it at these links; there’s actually quite a bit.

Anderson fails to explore any of these, and a lot more, in order to present the reader with a distorted picture of the state of the research.

12. Does It Make Unsupportable Assumptions?
A prime example of an unsupportable assumption is that transgender people can (and should) just stop being transgender because of higher health risks, as if it was like quitting smoking or eating carb-loaded snacks before bedtime. This assumption first ignores that the medical and mental health care communities regard efforts to change sexual orientation and gender identity as ineffectual and unethical. It also ignores the fact that the only people promising to “fix” someone’s gender identity are the same people who failed so miserably at “curing” gay people while using the same “embrace your God-given masculinity” snake oil.

Anderson’s book implies that “clinicians need to be trained in these methods.” (p. 211) The problem is, Anderson doesn’t actually acknowledge that there are NO clinically tested, peer reviewed treatment methods to change a persons’ gender identity. They tried all the same things they did on gay men (praying, electric shocks, aversion therapy using castor oil and chemical tear agents, cognitive behavioral therapy, anti-psychotics, anti-depressants, psychic driving, hypnosis, Jungian theory, you name it) without success.

In short, Anderson assumes that there is a method that works (there isn’t), and that the reader won’t question whether there is (you should). Anderson makes the unsupportable (and no, 14 people in Europe does not constitute a need for a nationwide network of doctors) assumption that there are lots and lots of transgender people out there who cannot wait to have their surgeries reversed, if only activists would let them.

Or, conversely, it’s a lot easier to reasonably assume based on the peer reviewed evidence that if transgender people weren’t ostracized, abused, and legally marginalized they’d have better mental health outcomes. This has been borne out in numerous studies (i.e. transgender people have much better mental health outcomes when they’re not abused, ostracized, and discriminated against)

Go figure.

13. Does It Make Unsupportable Conclusions? (And Ignore The Supported Ones?)
Examples of unsupportable conclusions in this book are myriad.

Many of the anecdotes about detransitioners essentially conclude that no one should ever be allowed to transition (which ignores the peer reviewed evidence showing the vast majority of transgender people report improvement in quality of life after transition). A far more logical conclusion would be that people should have better (more) access to competent mental health care providers, which is something the APA is recommending anyway. A common thread among the people Anderson cited was that they either had limited access to mental health care providers, or in the case of Walt Heyer, deliberately deceived them.

It essentially concludes that stigmatizing and abusing transgender people until they go back into the closet is good for transgender people.

It concludes that the best thing for transgender people is to undergo some sort of unspecified reparative therapy, when no such therapy has ever been demonstrated to be effective (but there is plenty evidence of harm.)

It concludes that all transgender people are, by definition, mentally ill, even if they are happy, well adjusted, successful, and highly successful in their careers. In other words, in order to conclude that transgender people are mentally ill, Mr. Anderson has taken upon himself to re-write the very definition of mental illness as defined by psychiatrists and psychologist (which he is not).

It concludes that transgender people should be banned from bathrooms because someone might pretend to be transgender and do bad things. Sort of like banning Sikhs from entering the US because most people don’t know the difference between Muslims and Sikhs anyway.

14. Does The Article Make Wild Accusations And Predict Ludicrous Outcomes?
Strange ideas and accusations in this book include:

* Accepting transgender people will destroy our entire cultural concept of gender and sex,
* Transgender people destroy women’s rights
* Transgender people are somehow contributing to the decline of family / marriage in the US
* Transgender people cause people to forget how to procreate
* Support for transgender health care is part of a conspiracy by “politically correct” medical and mental health organizations
* Transgender activists are stealing kids and forcing them to transition with therapists who railroad them.

When your positions require a conspiracy theory where thousands of medical professionals are in on it in order to be true, the positions are on pretty weak ground.

15. Does The Article Imply Religion Is A Cure For Gender Dysphoria?
While Anderson does not explicitly state what the “cure” for gender dysphoria should be, he does not rule out the religious based programs recommended by the Family Research Council (with which he is affiliated and cites). Indeed, every one of the “ex-trans” programs recommended by the FRC is religious based. Since Anderson cannot cite a secular methodology for curing gender dysphoria, all that remains are religious ones.

And using religion to establish public health policy is not scientific.



****************************************************************************

While Anderson claims “we must not be careful to stigmatize those who are suffering”, the book alleges the following about transgender people:

Transgender people are all mentally ill
Transgender women are gay men who want to trick straight men into sleeping with them OR
Transgender women are straight men who are all sexual perverts
Transgender activists are stealing children and conducting medical experiments on them
Acceptance and inclusion of transgender people is unacceptable because of bathrooms
Transgender people are destroying the American family (somehow)
The goal of convincing readers transgender people are deranged perverts who steal children while destroying America is to get them to discriminate against transgender people. Anderson then advocates for eliminating all civil rights protections for transgender people to ensure that people are able to do just that.

On page 27, Ryan makes it clear that this book isn’t really about what’s best for transgender people, it’s what he sees as best for everyone else. “The topic at issue that day was not whether people who identify as transgender have a right to their lives; it was what sort of policies best respect the lives of students who identify as transgender and the lives of all the other students,” where he italicizes “all the other students,” for emphasis on who really matters.

This book was not science. It was propaganda to support a religious viewpoint and a set of policies that would cause great harm to a vulnerable minori

[George P. · Rating 5 out of 5]

“America is in the midst of what has been called a ‘transgender moment,’” writes Ryan T. Anderson in When Harry Became Sally. “Not long ago, most Americans had never heard of transgender identity, but within the space of a year it became a cause claiming the mantle of civil rights.”

The inflection point was probably Diane Sawyer’s April 2015 interview with Bruce Jenner, in which he said, “for all intents and purposes I’m a woman,” taking the name Caitlyn a few months later. A judge legally approved Jenner’s name and gender change in September of that year. In October, Glamour magazine named Jenner a “Woman of the Year.”

Jenner’s transition put a well-known face on America’s transgender moment, but actions by the Obama administration gave the moment legal muscle. In a series of “Dear Colleague” letters, first the Department of Education (2010) and then the Department of Justice and Department of Education jointly (2016) redefined the word sex — i.e., biological sex — to include “gender identity.”

The Department of Health and Human Services (2016) similarly proposed expanding the meaning of sex to include “gender identity.” Various federal laws ban discrimination based on sex (e.g., Title IX), but Obama administration actions required schools and hospitals to act as if there were no legal difference between a biological female and a biological male who identifies as a woman. (The Trump administration reversed many of these executive actions.)

Popular culture and political action may have normalized transgender identity, but Anderson reminds readers how radical it is. “At the heart of the transgender moment are radical ideas about the human person — in particular, that people are what they claim to be, regardless of contrary evidence. A transgender boy is a boy, not merely a girl who identifies as a boy.” This is a metaphysical claim, one that needs to be subjected to more scrutiny than it has been. When Harry Became Sally offers a multidisciplinary critique of transgender identity.

Chapters 1 and 2 describe our transgender moment and the ideology of transgender activists, respectively.

Chapter 3 then turns to the personal narratives of transgender people who subsequently detransitioned to their birth sex. Anderson argues that these stories “tell us, at minimum, that transitioning is not the ‘only solution’ to gender dysphoria.”

Chapter 4 examines “what science tells us about the biological basis of sex.” Anderson writes, “The fundamental conceptual distinction between a male and a female is the organism’s organization for sexual reproduction.” Indeed, he argues that “sex is a coherent concept only on the basis of that organization.”

Chapter 5 then explores the nature and treatment of gender dysphoria. Anderson understands it as “incongruence between biological sex and experienced gender.” How one defines gender dysphoria determines how one treats it. “The central debate in treating people with gender dysphoria is whether therapies should focus primarily on the mind or on the body.” Anderson argues that treating the feeling of incongruity between biological sex and gender identity has better therapeutic outcomes than gender reassignment.

Chapter 6 examines gender dysphoria among children. Experts agree that between 80 and 95 percent of kids who experience gender dysphoria naturally resolve those feelings in favor of their biological sex. Because of this, Anderson argues, “We need medical professionals who will help them mature in harmony with their bodies, rather than deploy experimental treatments to refashion their bodies.”

Chapter 7 outlines a view of gender that Anderson believes is preferable to transgender identity theory. It is a “nuanced view of gender.” It avoids rigid gender stereotypes, even as it acknowledges that “gender norms” are not merely “social constructs.”

Chapter 8 concludes the book by examining transgender identity from the standpoint of public policy. Anderson’s primary concern is that “commonsense policies regarding bodily privacy and sound medicine are now being labeled discriminatory.”

In my judgment, When Harry Became Sally makes a persuasive case against the idea of transgender identity, as well as the medical and public policy practices that flow from that idea. Five or ten years ago, Anderson’s arguments would have been noncontroversial. Today, however, as popular culture and presidential politics have mainstreamed transgender identity, those arguments have become a matter of great controversy.

The value of When Harry Became Sally lies in its multidisciplinary arguments. If you’re looking for a book about what to do if you personally experience gender dysphoria, or how to help a friend or family member who experiences it, this is not the book to read.

Similarly, it is not a religious book. I read it from the perspective of a Christian minister interested in how the Church should respond to transgender persons. Though Anderson is Catholic, his arguments are secular in character, depending on biology, psychology and philosophy, not Scripture and theology. He helped me understand the nature of transgender identity, but he didn’t outline a uniquely pastoral response to it.

In sum, When Harry Became Sally is the reasoned judgment of a public intellectual on an important matter of current controversy, well worth reading.

 

Book Reviewed
Ryan T. Anderson, When Harry Became Sally: Responding to the Transgender Moment (New York: Encounter, 2018).

P.S. I wrote this review for InfluenceMagazine.com. It appears here by permission.

P.P.S. If you found my review helpful, please vote "Yes" on my Amazon.com review page.

[emily · Rating 1 out of 5]

Ryan Anderson has managed to, in the grand tradition of oppressors, write about a marginalized group of people without asking them to tell their own stories. No trans writers, no doctors who treat trans people, no leaders in the trans community, have stepped up to lend their voices to the book or even go so far as to give a quote for its cover. I wonder why that is?

Also, any reference to trans lives and experiences as something that's just cropped up in the past few years is woefully ignorant of hundreds, if not thousands, of years of history. This book isn't just bigotry, it's misinformation. Should find a huge readership among Republicans, but as for me, I'll be giving it a hard pass.

[Breck Wightman · Rating 4 out of 5]

It seems like there are a lot of troll reviews for this book. Anderson takes the issue on with class and respect. Consider this a holistic approach...he covers gender, culture, politics and policy, law, biology, medical practice, psychology, metaphysics, and more. Highly recommend for social conservatives or for someone wanting to understand the social conservative argument.

[Juanita · Rating 5 out of 5]

Well researched and thought provoking. It was kind of refreshing to hear a different take on the issues, yet i didn't find it transphobic or hateful. It questions some of the science or lack thereof behind what we hear in the media. Some of the issues it touches on are whether the approach to helping a a transgender/gender dysphoric child become their best self should be the same as with and adult? And is transitioning always the best solution or are there other approaches that work for some people? I would highly recommend this book to anyone thinking about transgender issues.

[Todd Miles · Rating 5 out of 5]

Anderson's contribution to the transgender issue is primarily from the policy (state, education, community, science, etc.) standpoint. Of particular interest is his chapter giving voice to the experiences of those who have "detransitioned." It was heartbreaking. Anderson's book demonstrates how void of scientific basis this entire issue actually is and how purely ideological it is. This is a must read for any who are confused by the current state of things or are involved in developing policies at churches, civic organizations, or schools.

[Amber · Rating 5 out of 5]

This is an important read. There is nothing hateful in this in the slightest. Anderson emphasizes respect for the afflicted, caution for the confused, and common sense protections for women and children. Must read if you're not afraid of nuanced though on the subject.

[Gabriella Hoffman · Rating 5 out of 5]

This is a very timely book on this controversial matter. Ryan Anderson take a very level-headed, respectful tone towards those advocating for transgenderism. He cites numerous individuals with empathetic intentions to show how failed transitions or those who detransitioned need to be heard rather than coerced into dire situations. He offers constructive criticism without demeaning his opponents and offers a scientific sound argument to pose questions of this transgender moment—one that actually has drawn bipartisan support from radical feminists and ChrisTian conservative women who sound the alarm on conflating biological sex with gender. I’ll have a more thorough review for The Resurgent in the coming days, but I highly recommend this book to be read to better understand the nuances surrounding this cultural issue, and to be cautious with it.

[Kaethe]

This would be extremely silly if it weren't so cruel. If you want to know about people who are transgender read a book by a transgender writer. There are quite a few. This book is only fair and reasonable if you are looking for someone to tell you that there is no such thing really. The idea that guidance counselors are trying to convince children that they're a different gender? That a good place to commit rape is a public restroom full of women?

In NC the Bathroom bill gave people an opportunity to attack women who didn't look feminine enough. Oh, and cost the state billions. Didn't stop any rapists though.

Edited to add on March 7, 2021: Folks, don't bother posting comments attempting to rationalize your efforts or support for denying other people the most basic human rights. I am not here for that nonsense. And while random all caps and lots of exclamation points may be popular among your set on Facebook or whatever, I also have zero tolerance for that.

[Tanja Berg · Rating 4 out of 5]

A few years ago I was on a road trip with my sister and her children. We had stopped at a gas station to use the restrooms. As we are washing our hands, a tall person with short hair and trucker overalls walks in. Unthinkingly, I opened the door to the restroom and asked "did we walk into the wrong one?". My sister, furious, "Tanja - she had BOOBS! If you ever question whether it is a man or a woman, look at the chest!"

A few weeks later I was on a horseback-riding holiday in the Norwegian mountains. I walked into the common room and greeted the guests that had already arrived. One of them was the ugliest woman I had EVER seen. A wrinkled, long face. Frizzy black hair. Blue nail polish. Boobs. Hmm. Well, thinking back to my sister's advise, I categorized this person as "woman". Later in the evening, walking on a gravel path, down to the horses, I got talking with this person. She worked with train wagon maintenance, and had for 30 years. "That's an unusual job for a woman", I thought. Then again, I've worked in male-dominated field for most of my career, so I shrugged and let it pass. During the first break, after a couple of hours on horseback, this woman strode down the field where the horses had been let loose to graze, spread her legs and took a piss standing. So much for listening to my sister's advise!

Every evening during this holiday, this transgender person, would make a spectacular entrance for dinner in full evening gowns and gloves and make-up. The rest of us sat there in our jeans and t-shirts.

The author of this book is conservative. I am very liberal and, according to a recent test, have pretty much exactly the same opinions as Bernie Sanders. If I had read about the author beforehand, I would not have bought the book. I am glad I did though, because it addresses issues that I have been concerned about since the transgender moment - movement - took full force: how is body mutilation a good thing? Why on earth are we letting children make life-altering decisions with consequences that they cannot possibly fathom or understand?

I've also been mulling over the story of the botched circumcision that led one boy in a pair of twins without a penis, and being raised as a girl. In my high school psychology book this was presented as a success, as "nature over nurture". A few years later, I read " As Nature Made Him: The Boy Who Was Raised as a Girl" by John Colapinto and that story was quite different. The poor boy was uncomfortable with the gender he had been assigned all his life. You cannot make a boy into a girl. There are fundamental biological differences.

With this is in mind, why is there such a positive focus around trying to help people who feel "trapped in the wrong body"? Is mutilating the physical sex attributes of the gender you were born with and putting some cosmetic, ill-functioning ones in its place, really going to help anything in the long run? If it would, go ahead. It does not. The suicide attempt rate of people with dysphoria is 41% over a life time. After sex-reassignment surgery, this does not decrease. In fact, the rate of death by suicide after this is 19 times higher than in the general population. Hormone therapy and sex reassignment does not permanently alleviate their despair.

In Norway I've read many recent articles on children wanting sex-reassignment. In Norway at least, you need to pass through quite a rigorous set of therapy sessions - unlike in the United States where some people are put on hormones after just two or three sessions. However, assigning puberty blockers and hormones to children - I cannot wrap my head around this being right. Children aren't allowed to drink or drive, but it's perfectly okay for an 8-year old to decide on puberty blockers? It's okay to let children make decisions that will make them infertile, at a time where they cannot possible know what this means? The damage done by the chemicals and hormones is in many cases irreversible. Children who are put on puberty blockers do not grow out of their body dysphoria in the same way most other children do. Up to 95% of children who identify with the other sex will grow out of it during puberty.

Treating gender dysphoria with sex reassignment and hormones is like offering liposuction to anorexia nervosa patients. A cosmetic fix to deep-rooted psychological problems that are not helped by this severe and irreversible mutilation of their bodies. A woman on testosterone will have a deeper voice and a hair growth in unusual places even after she stops. These people need help, but for most, hormones and surgery are not the right the answers.

It's also a little odd how this trans-gender movement has been mixed up with LGB, which is about sexual orientation rather than sexual confusion. Love whomever you want, marry whomever you want, be anywhere on the scale from feminine to androgynous to masculine. Don't let yourself be hemmed by stereotypes. Accept yourself as you are. Cross dress if you like. However, if you think you are trapped in the wrong kind of body compared to your biological sex - go see a psychiatrist, not a surgeon.

[David Robertson · Rating 5 out of 5]

his is a stunning book – the best I have read on the subject of Transgender. But it is about so much more than that. It covers issues such as gender fluidity, the difference and connection between biological sex and gender; feminism, politics, government, law and media. Although it is written from and into the American situation (which seems especially nuts) it is certainly applicable to the UK and other areas of the Western world – or indeed any part of the world where Western liberal imperialists seek to impose their ideology

It is well researched and written, with a great mixture of theory and practice. I was particularly moved by the personal testimonies of those who have been harmed by the current trans fad amongst the governing elites. They are heartbreaking.

Before any lawmakers, just following the fashion, pass any further laws on changing gender and adopting the whole concept of gender fluidity – they should read this book. (In my own country I hope every MSP will read this before passing the Scottish Governments mad gender self-identity proposals – if you baulk at my description of it being ‘state sponsored child abuse’, then read this book for the evidence. Of course the way the militant trans activists conduct themselves I wouldn’t be surprised if they tried to get it banned – so get your copy now. It will enlighten, inform and sadden you. It will also make you glad that someone with brains and sanity has their finger on the pulse of what is going on!

I have written a more extended review with quotes here - https://theweeflea.com/2018/05/16/whe...

[Amora · Rating 4 out of 5]

A controversial book that deals with a very difficult subject in a very sympathetic way. I’m convinced virtually nobody that reviewed this book negatively actually read it. If they did, they would’ve know the author doesn’t have any animus towards trans individuals or people going through gender dysphoria. This is a great resource for responding to claims that transitioning is evidence-based medicine or that gender is simply (or largely) a societal construct. I hope more conservative authors and pundits take the approach Anderson does

[Jeremy]

Related post here. CT review here. Recommended here.

In Feb. 2021, Amazon scrubbed the book in all its forms. Anderson talks with WORLD about the incident here. More information here. Alan Jacobs has some helpful thoughts here, here, and here.

In March 2021, I inquired at B&N, but they did not carry (and could not order) hard copies; only an e-copy was available. the book is available at the publisher's website.

Fascinating interview with Ryan (May 2021).

Now might be a good time for people to read Milton's treatise on censorship.

[Alicia · Rating 5 out of 5]

Amazing, well-researched book. Ryan T. Andersen thoroughly examines this "transgender moment" as he quotes several people who detransitioned, reports on scientific studies, and discusses laws based on gender or gender identity. I too support the approach of seeing “medicine as a practice aimed at restoring healthy functioning, not simply satisfying the desires of patients.” (p.5) It is heartbreaking to read about many people who detransitioned back to their biological sex after operations and hormone treatments. Everyone who undergoes transition is left sterile for life, which can be so disappointing for many of them later in life when they wish they could bear a child. Because the pressure to transition is very strong, often people with gender dysphoria aren’t told about other options, such as counseling to deal with the childhood trauma behind their confusion. It is especially sad to hear of children being encouraged to live as the opposite sex, when “All competent authorities agree that between 80 and 95 percent of children who say that they are transgender naturally come to accept their sex and to enjoy emotional health by late adolescence.” (p. 123) Because of this, Anderson argues, “We need medical professionals who will help them mature in harmony with their bodies, rather than deploy experimental treatments to refashion their bodies.” Andersen writes with clarity and charity and digs deep into this controversial issue. Highly recommended!

“Drawing on the best insights from biology, psychology, and philosophy, Ryan T. Anderson offers a balanced approach to the policy issues, a nuanced vision of human embodiment, and a sober and honest survey of the human costs of getting human nature wrong.” -inside front cover

“The best biology, psychology, and philosophy all support an understanding of sex as a bodily reality, and of gender as a social manifestation of bodily sex. Biology isn’t bigotry.” -p. 2

“Activists tend to be uncompromising in their demands, yet their worldview is fraught with contradictions. It holds that the real self is fundamentally separate from the material body, yet insists that transforming the body is crucial for personal wholeness. It attaches a notion of authentic gender identity to stereotypical activities and dispositions, yet it grows from a philosophy holding that gender is an artificial construct. It promotes a radical subjectivity in which individuals should be free to do whatever they wish and to define the truth as they choose, yet it calls for enforced conformity of belief in transgender dogma.” -p. 4

“Many psychologists and psychiatrists think of gender dysphoria as being much like other kinds of dysphoria, or serous discomfort with one’s body, such as anorexia. These feelings can lead to mistaken and harmful beliefs. The most helpful therapies do not try to remake the body to conform with thoughts and feelings - which is impossible- but rather to help people find healthy ways to manage this tension and move toward accepting the reality of their bodily selves.” -p. 5

Protesting NC’s “bathroom bill” (which says people need to use the public restroom that corresponds with their biological sex): “The NBA moved the 2017 All-Star Game out of Charlotte, a decision that was particularly amusing given that the NBA and its sister organization, the WNBA, determine participation in their leagues according to biology….That they boycotted a state in an effort to force a policy they haven’t voluntarily adopted for themselves was the height of hypocrisy.” -p. 15

“It’s hard to see how these contradictory positions can be combined. If you pull too hard on any one thread of transgender ideology, the whole tapestry comes unraveled. But here are some questions we can pose: If gender is a social construct, how can gender identity be innate and immutable?...Why should feeling like a man- whatever that means- MAKE someone a man?...The challenge for activists is to explain why a person’s “real” sex is determined by an inner “gender identity”, but age and height and race and species are not determined by an inner sense of identity.” -pp. 46-7

“I want to ask you, how many other medical conditions are there where you can walk into the doctor’s office, tell them you have a certain condition, which has no objective test, which can be caused by trauma or mental health issues or societal factors, and receive life-altering medications on your say-so?” -p. 53

“A strain of radical feminism intersects with transgender ideology in the shared premise that gender has no real connection to biology and can be nullified or changed at will.” -p. 172

“Whereas the law forbids discrimination on the basis of sex, HHS redefined the word ‘sex’ to mean ‘gender identity,’ without legal authority to do so. Medical professionals and health-care organizations would thus be penalized for believing -as a matter of faith, moral conviction, or professional judgment- that maleness and femaleness are biological realities to be respected, not defects to be corrected.” -p. 175

What we see happening in schools: “The aim of protecting students who identify as transgender from bullying and respecting their dignity is reasonable in itself, but that’s not what these policies are about. They’re about a larger program of indoctrination in gender ideology… ‘Antibullying’ programs can turn into 'antidisagreement’ programs. Dissent is equated with bigotry and hate, so no dissent will be tolerated. All students must accept gender ideology, and their parents will have no say in the matter.” -p. 178

“Gender identity claims are manifested in action, and actions are subject to moral evaluation, while one’s race and sex are not. Existing and proposed gender identity laws...aren’t deployed as shields to protect people from unjust discrimination, but as swords to impose a new sexual orthodoxy on private citizens...It is one thing for the government to allow or even endorse conduct that many citizens consider immoral, but quite another thing for the government to force others to condone and facilitate such conduct in violation of their convictions.” -p. 196 (e.g. forcing doctors to prescribe hormones and perform hysterectomies or mastectomies on healthy bodies)

From Cari, who detransitioned after having a mastectomy and taking testosterone: “Transition didn’t really make my dysphoria better, it just kind of kept moving the goalposts, so I felt like I was making progress, but I never got any closer to where I wanted to be or where I thought I wanted to be...This is a real outcome of transition. I’m a real live 22 year old woman with a scarred chest and a broken voice and 5 o’clock shadow because I couldn’t face the idea of growing up to be a woman. That’s my reality.’” -pp. 54, 56

From Crash, who detransitioned: “Being supported in my trans identity didn’t help me, letting go of it and accepting myself as a woman did. Changing my body didn’t help me find lasting peace. I helped myself by tracing back my trans identity and dysphoria to trauma and working through how I’d been hurt… And when I look back I’m horrified and creeped out. There’s something disturbing about doing something you think is good for yourself but that turns out to be really self-destructive and it’s even worse when so many other people were helping you and making it easier for you to do it.” -pp. 59, 60

[Christopher Humphrey · Rating 5 out of 5]

I just completed “When Harry Became Sally: Responding to the Transgender Moment” by Ryan T. Anderson. Every thinking person needs to read this book. Before proceeding please re-read my last sentence. By that I mean this is an important book. The very essence of our culture is at stake. The transgender movement is based on bad “science”, bad philosophy, bad public policy and irrational ontology.

Although Anderson writes about a controversial topic, he writes in a logical and winsome manner. Rather than attacking those who identify as transgender, Anderson carefully and thoughtfully addresses the topic. If you think this book does not pertain to you, think again! The transgender moment is a freight train careening down the tracks of our culture. This moment produces harm to our culture and, more importantly, to those individuals who are led into the mythical land of transitioning from one gender to another (it is not possible and Anderson explains why). Transitioning causes great harm to individuals who suffer from gender dysphoria. Most of these individuals, if properly treated, would go on to lead happy, healthy and productive lives consistent with their biological sex.

Anderson explains how transgender activists are using intimidation to cow society into accepting, accommodating and cheering their cause. Anderson’s book will arm you with the intellectual arguments you will need to combat our culture from a further “slouching toward Gomorrah”

Take my word for it—you need to read this book and then you need to educate those with whom you are influential. Stop wringing your hands and do something! Happy reading.

[Gigi · Rating 5 out of 5]

I am not crazy about the harry and sally part of the title of this book, but to call what we are going through the transgender “moment” does make a very important and encouraging point, ie, that the trans issue, like same sex marriage, are temporary phenomena. The culture will return to truth on these issues. Both were made possible and are sustained only by massive propaganda campaigns, eg, via a sympathetic media. It astounds me when people in media use biologically incorrect pronouns; do they not realize that in lying on this issue, they are undermining their credibility on every issue?

I am constantly amazed by Ryan T Anderson’s ability to write and with great clarity and charity on difficult topics. (Although I suppose in a sane culture, Ryan’s positions would be taken for granted as truth and common sense, as they were until about a nanosecond ago.) Would recommend this book or the book he co-authored on marriage, or any videos of Ryan speaking that have been posted on YouTube.

[David Haines · Rating 5 out of 5]

This is a well-written, balanced, and sober analysis of the current cultural discussion concerning Gender Identity and Transgender sexuality. The author devotes an entire chapter (ch. 2) to presenting the claims, arguments, and expressed intentions of the activists which are pushing the transgender and gender identification agenda forward. In chapter 3 he gives a voice to those who transitioned from their biological sex to their felt "internal gender", and who then detransitioned. These people identified as a gender other than their biological sex and transitioned in order to bring their body into conformity with their internal sense of gender. They discovered, however, that transitioning did not solve the psychological and social problems that they experienced prior to transitioning. Anderson goes on to discuss just what it means to be a man and a woman (ch. 4), what is involved in sex reassignment (ch. 5), how this affects children (ch. 6), the relationship between sex, gender, and culture (ch. 7), and how that he covers in the earlier chapters has affected, and should affect, public policy (ch. 8).
I highly recommend this book.

[Paul Herriott · Rating 4 out of 5]

The hype is real. Anderson has written the best book to date critiquing the transgender moment we are experiencing as a culture right now. Using a broad range of testimony, research, and pop culture, he explains the movement as the fruit of the sexual revolution, one that has ignored the results of studies and the victims it has created.

[Audrey · Rating 4 out of 5]

This has been banned by Amazon, and I don’t believe in banning books. I don’t care if it’s Mein Kampf or the Bible or what. Naturally, this has made many more people want to read it.

I didn’t see anything here that was particularly controversial. It’s not hateful; it’s compassionate. It just asks a lot of questions: Why do we push surgical transition on people with gender dysphoria so much, especially when the long-term effects are largely unknown? In other areas of medicine, surgery is usually a treatment of last resort. Why do we insist young kids need to change their gender? Even teens’ brains aren’t done developing, and the vast majority of those with gender dysphoria grow out of it and accept that they’re gay instead. What about the harm to women in general as a result of male predators exploiting trans-friendly policies? Should trans women have more rights than natural women? If gender is a social construct, why do people have to have surgery to change it? Why are we forcing people to conform to gender stereotypes after trying to dismantle those stereotypes over the last fifty years? What about the body positivity movement? What’s wrong with wanting people to be comfortable in their bodies?

There’s this cult-like ideology out there that considers questions heresay and declares that the ideology trumps science and truth. Those caught up in this cult will find the book offensive.

Gender isn’t “assigned at birth.” It’s part of one’s genetic makeup at conception and dictates how the body grows, before birth and after. You can’t change your genetic makeup. You can only make cosmetic changes, which involve removing or mutilating healthy body parts. We can’t create real breasts that can breastfeed, only a facsimile. Same with the other organs. Then there’s sterility and other complications and unforeseen consequences. So why isn’t social transitioning good enough if you can’t change your DNA anyway?

My husband doesn’t like sports, and I don’t like romance novels or chick flicks. We’re gender nonconforming. Just because we don’t fit all the stereotypes doesn’t mean we’re a different gender. Likewise, I refused to affirm my son’s belief that he was Superman and let him jump off the roof. Yet now, I could lose custody of him for that.

Gender dysphoria is the only condition where medical professionals are not allowed to find the root cause of it. With one visit, a patient will be declared trans and given hormones and surgery. (Children don’t need parental permission or even knowledge for this, yet my child can’t have a cavity fixed without my permission.) But when the dysphoria is a side effect of something else, usually a severe trauma or abuse, transitioning doesn’t help. It’s only treating a symptom. If the root trauma is addressed, the dysphoria often goes away on its own. There are way too many detransitioners to continue this course of surgery as the only treatment. It should only be recommended to people it will actually help and to full adults who can make informed decisions for themselves. We should be trying to get more information, not blocking research. If you demand tolerance, you should try showing some.

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Activists tend to be uncompromising in their demands, yet their world-view is fraught with contradictions. It holds that the real self is fundamentally separate from the material body, yet insists that transforming the body is crucial for wholeness. It attaches a notion of authentic gender identity to stereotypical activities and dispositions, yet it grows from a philosophy holding that gender is an artificial construct. It promotes a radical subjectivity in which individuals should be free to whatever they wish and to define the truth as they choose, yet it calls for enforced conformity of belief in transgender dogma.

While activists have attacked the Mayer-McHugh review … they haven’t been able to specify any errors or flaws. As Last observes, “It’s an extremely cautious document that relies entirely on published research and presents both sides of all arguments. If you had to boil Mayer and McHugh’s conclusions down to a single sentence, it would go something like this: Human sexuality and gender are incredibly complicated, a lot of what’s been presented as ‘fact’ has no sturdy basis in scientific research, and we really ought to study the entire subject more rigorously.” But even this modest, empirically based view is regarded as blasphemy against the LGBTQ orthodoxy.

Simply accepting the self-declaration of a gender-dysphoric child and encouraging persistence in a transgender identity does not constitute sound, science-based medicine. But politics now rules the debate. If one of the world’s leading experts on gender dysphoria can be railroaded in this way, it means that medical practice is seriously compromised by an ideological agenda. Far from being a stable and coherent set of beliefs, it is an ideology that changes with political expediency, but what is lacking in logical coherence is more than compensated by the uncompromising zeal of its advocates.

Three realities about transgender activists will become clear. First, they are always changing their creed and expanding their demands: yesterday’s mandatory vocabulary will become tomorrow’s epithets; yesterday’s enlightenment will be tomorrow’s benighted bigotry; yesterday’s requirements of Science and Medicine and Justice are tomorrow’s suicide-inducing oppression. Second, even as their own position shifts, the activists are absolutely closed off to contrary evidence: they call for the censure of honest researchers; they refuse to give any consideration to competing interests of privacy or safety; they reject alternative therapies that may be favored by parents or doctors. Third, because the transgender moment is so close-minded, it inclines toward coercion. All of this suggests a posture of defensiveness—that activists know their claims can’t stand up to scrutiny.

Regardless of whether they identify as “cisgender” or “transgender,” the activists promote a highly subjective and incoherent worldview. On the one hand, they claim that the real self is something other than the physical body, in a new form of Gnostic dualism, yet at the same time they embrace a materialistic philosophy in which only the material world exists. They say that gender is purely a social construct, while asserting that a person can be “trapped” in the wrong body. They say there are no meaningful distinctions between man and woman, yet they rely on rigid sex stereotypes to argue that “gender identity” is real while human embodiment is not. They claim that truth is whatever a person says it is, yet they believe there’s a real self to be discovered inside that person. They promote a radical expressive individualism in which people are free to do whatever they want and define the truth however they wish, yet they try to enforce acceptance of transgender ideology in a paternalistic way.

Many people report feeling pressured into transitioning, as if it were the only real option. They regret that medical professionals never explored the underlying psychological issues. They detransitioned because they didn’t find the peace and wholeness they desired by changing their bodies, but did find it when they were able to address past trauma in their lives and come to a better understanding of gender. Many of these people regret the damage done to their bodies and their lost fertility. They feel they were too young to be making such life-altering decisions. They blame a society that was hostile to people like them—particularly to people with same-sex attraction and other gender-nonconforming people—as they believe this hostility contributed to their thinking that transition was the only option. This charge should prompt social conservatives (like myself) to be careful not to attack or marginalize people as we advocate for the truth. By the same token, we should insist that trans activists cease attacking and marginalizing detransitioners.

Cari Stella: The truth is that a lot of women don’t feel like they have options. There isn’t a whole lot of place in society for women who look like this, women who don’t fit, women who don’t comply. When you go to a therapist and tell them you have those kinds of feelings, they don’t tell you that it’s okay to be butch, to be gender nonconforming, to not like men, to not like the way men treat you. They don’t tell you there are other women who feel like they don’t belong, that they don’t feel like they know how to be women. They don’t tell you any of that. They tell you about testosterone.

It’s dismaying that people who found more problems after transitioning would be ignored or even attacked by transgender activists. Women who transition and then detransition can be special targets for hate.

The first observation to make about the outcome of sex reassignment surgery is that it doesn’t actually reassign sex. Cosmetic surgery and cross-sex hormones don’t change the deeper biological reality, which begins with our DNA and fetal development, unfolding in every bodily system. ... People who have sex reassignment surgery do not become the opposite sex … ; they merely acquire the outward appearance of a change in bodily organization. As the philosopher Robert P. George puts it, “Changing sexes is a metaphysical impossibility because it is a biological impossibility.” Surgeons are becoming more skillful in building and attaching artificial genitalia, but they do not change a person’s biological sex with those “add-ons.” No matter how technically advanced the plastic surgery becomes, it doesn’t create an actual sex organ, but a mere simulacrum.

Things are even more opaque when people claim a gender identity at odds with their biological sex. This raises metaphysical questions concerning what it could mean to “be” a man in a women’s body, and epistemological questions concerning how a man could know what it is to “feel” like a woman. ... The claim of a biological male that he is “a woman stuck in a man’s body” presupposes that someone who has a man’s body, a man’s brain, a man’s sexual capacities, and a man’s DNA can know what is like to be a woman. As many feminists have pointed out, no biological male can really experience what it is like to be a woman, for males can have no embodied female experiences. Many of the claims made by transgender activists seem therefore to rely on stereotypes of what “real” men and women are like, of male versus female preferences and interests.

Beneath the debates over therapies for people with gender dysphoria are two related questions: How do we define mental health and human flourishing? What is the purpose of medicine, particularly psychiatry? Those general questions encompass more specific ones: If a man has an internal sense that he is a woman, is that just a variety of normal human functioning, or is it a psychopathology? Should we be concerned about the disconnection between feeling and reality, or only about the emotional distress or functional difficulties it may cause? What is the best way to help people with gender dysphoria manage their symptoms: by accepting their insistence that they are the opposite sex and supporting a surgical transition, or rather by encouraging them to recognize that their feelings are out of line with reality and learn how to identify with their bodies? All of these questions require philosophical analysis and worldview judgments about what “normal human functioning” looks like and what the purpose of medicine is.

The reality of desistance in children is slighted or ignored in the dominant media narrative about gender dysphoria. So are the stories of detransitioners, who found that transitioning was not the remedy for their distress. The desisters and detransitioners refute the theory that “gender dysphoria is always a mark of a stable, deep-seated identity,” as Singal remarks. He calls out his liberal colleagues for their shoddy journalism on this subject: “Unfortunately, many progressive media outlets have done a poor job covering desistance and detransition. Vice and Vox and ThinkProgress have all written misleading articles falsely claiming that desistance is a ‘myth’ (or close to it), that detransitioners are nothing more than pawns for transphobic bigots to make it harder for people to transition, or both.”

Gender identity is shaped during puberty and adolescence as young people’s bodies become more sexually differentiated and mature,” say Hruz and colleagues. How it normally happens is not well understood, so it’s imperative to be cautious about interfering with the process. But far from being cautious and prudent by using puberty blockers to treat gender dysphoria, doctors are conducting a giant experiment that does not come close to the ethical standards demanded in other areas of medicine.

Neuroscientists often tell us that “the adolescent brain is too immature to make reliably rational decisions,” Hruz and colleagues observe, yet “we are supposed to expect emotionally troubled adolescents to make decisions about their gender identities and about serious medical treatments at the age of 12 or younger.”

Adjusting the body through hormones and surgery doesn’t fix the real problem any more than liposuction cures anorexia nervosa. An effective treatment strategy would “strive to correct the false, problematic nature of the assumption and to resolve the psychosocial conflicts provoking it,” McHugh says. In the case of gender dysphoria, unfortunately, the mistaken belief is often encouraged by school counselors who, “rather like cult leaders, may encourage these young people to distance themselves from their families and offer advice on rebutting arguments against having transgender surgery.

A doctor who helps a young boy socially and hormonally transition into a “girl” does not violate the law, but a doctor who helps a young boy identify with and accept his body might be acting unlawfully. It’s an Orwellian abuse of language to say that helping a child be comfortable in hi own body is “conversion therapy,” but transforming a boy into a “girl” is simply allowing the child to be “her” true self. Of course, the doctors who use the former approach don’t think they’re doing “conversion” at all, but activists believe it’s an effort to suppress the child’s “real” gender identity.

A healthy culture fosters an atmosphere in which boys and girls come to understand themselves, in significant part, in terms of their potential to be husbands and wives, fathers and mothers. This means replacing the hookup culture with a revived marriage culture. It means cultivating modesty and self-respect in girls as they grow to womanhood, and it means teaching boys to respect women and to discipline their impulses.

When it was passed in 1972, Title IX of the Education Amendments was intended to protect women and girls from harassment and discrimination, to ensure that they have equal opportunities in education, but forty-four years later the Obama administration was unlawfully rewriting it to say that schools must allow boys unfettered access to girls’ bathrooms, locker rooms, dorm rooms, hotel rooms, and shower facilities, if they claim to identify as girls. Anything less than full access to the sex-specific intimate facility of one’s choice would be deemed a transphobic denial of civil rights and equality.

Gender identity politics can quickly generate politically correct speech codes in schools and workplaces. “Antibullying” programs can turn into antidisagreement programs. Dissent is equated with bigotry and hate, so no dissent will be tolerated. All students must accept gender ideology, and their parents will have no say in the matter.

The larger question is whether children are helped or harmed by a school’s “gender-inclusive” policies. The danger may be greatest to the children with gender dysphoria themselves, since affirming young children in a transgender identity may prolong and solidify their dysphoria when they might otherwise have come to accept their bodies naturally as they matured. Drs. Paul McHugh, Paul Hruz, and Lawrence Mayer made this point in the amicus brief they submitted to the Supreme Court concerning “gender identity” policies in schools. Their brief describes the “well-recognized” phenomenon of neuroplasticity, where repetition affects brain structure and function. ... This means that transgender-affirmative policies may prevent some gender-confused children from coming to accept their true sex.

The Obama administration instructed schools that they may not even notify students (or their parents) about whether they will have to share a bedroom, shower, or locker room with a student of the opposite biological sex. The privacy of transgender students is held to be paramount; the privacy of all other students is irrelevant. Such a skewed notion of privacy rights has drawn ire from both sides of the political spectrum. The Women’s Liberation Front and the Family Policy Alliance jointly submitted an amicus brief to the Supreme Court in which they said, “It is truly mind-boggling that informing women as to which men have the ‘right’ to share a bedroom with them is an ‘invasion of privacy,’ but it is not an invasion of privacy to invite those men into women’s bedrooms in the first place.”

Bodily privacy is a great concern to young people as they develop into adults. It is also highly important to women who have been victims of sexual abuse. For these women, seeing a naked male body can be a traumatic trigger. Whether the naked male body they suddenly see in front of them belongs to a man who “identifies as” a woman is of no moment to survivors of sexual abuse.

In addition to guarding privacy, sex-specific intimate facilities exist to serve the related purpose of protecting girls and women from male predators. The concern is not that people who identify as transgender will engage in inappropriate acts (as some activists have mockingly said), but that predators will abuse gender identity policies to gain easier access to victims. ... [Kenneth V Lanning says] that males who are not transgender will “exploit the entirely subjective provisions of a GIBAP [gender-identity-based access policies] ... to facilitate their sexual behavior or offenses.” If a man can have unlimited access to women’s facilities simply by claiming to be a transgender woman, this creates “an additional risk for potential victims in a previously protected setting and a new defense for a wide variety of sexual victimization.”

CONTINUED IN COMMENTS

[Joshua Reichard · Rating 5 out of 5]

I have been reading books on transgenderism to really see what is going on in this movement. And this book by Ryan Anderson is a must read. He give solid advice, facts, and truths about how this movement is actually hurting the world. How those who are extremists miss understand transgenderism and try to push their false ideas on everyone! He compared this movement to the movement to remove racism and said the removing racism was bringing a shield to those who were being attacked and mistreated whereas transgenderism is bringing a sword and cutting everyone down in their way. This is a must read for everyone regardless of background or belief this book will help you truly think long and hard about why we should or should not encourage the transgenderism movement.

[Sharad Pandian · Rating 2 out of 5]

In the beginning of his book, Anderson claims "this book is an effort to provide a nuanced view of our sexed embodiment, a balanced approach to policy issues involving transgender identity and gender more broadly, and a sober and honest survey of the human costs of getting human nature wrong."

He does not quite deliver on any of this.

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1. What I think is basically going on, overall:

The default assumption that everyone is cisgender, comfortable with their birth assignment of gender, turns out to be false in many cases and so trans people fight for a different world where:

1) Those not cis are not pressured into hiding and don't have violence done to them because they're trans
2) Trans people get medical resources required
3) It is easier for people to come out to others as trans

The problem is that traditional society doesn't see sex/gender as assigned, as much as identified and nurtured, much like a plant. Sure, there can be deviations in a particular plant's nature and nurture, but this shouldn't change the way we think of normalcy in plant growth.

The battle between the two sides is a complex one of conceptual interventions, being selective of which cases to focus on, , etc...because that's how any social debate happens. Anyone who's unreflectvely in either camp is going to end up with a bunch of half-truths, with which they can point and laugh at the other's half-baked opinions, only to open themselves up to similar criticism.

For example, Anderson successfully points out the hypocrisy of many trans-allies quite well: he points out that Andrew Cuomo denounced North Carolina's bathroom bill...while visiting Cuba. Many companies boycotted North Carolina, while being completely cool working in far more repressive nations. Hardline stances just don't seem possible in any comprehensive way.

In addition, against the background of how these are novel conceptual innovations in the way we think about gender/sex, the fact that some cis people might still be uncomfortable with different sex bodies in their changing rooms doesn't sound crazy. Anderson points out that if people actually thought different changing rooms for boys and girls were acceptable, body-based differences seem just as compelling as identity-based ones as a criterion. So the federal government punishing schools for their varying policies is probably questionable, especially if it is done sneakily through the reinterpretation of older statutes with "sex" as gender identity. Like ok, this isn't a terrible argument.

But when Anderson presents his actual substantive views, it becomes clear that his claims to care about trans people are like Cinderella's step-mother who thinks her cruelty is care - it's either a lie or delusional. And that's not even mentioning the pretty weird metaphysics he adheres to, which I'll try to indicate below.

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2. On development

Before I go on to what doesn't work, I thought I would highlight the strongest part of Anderson's argument. This is the claim that the opposition has no serious account of child development, in particular, an account of the acquisition of gender. They basically seem to be assuming children are just miniature adults, already exposed to enough content and mature enough to sift through their role amidst these.

I remember a story about how Dan Savage's son, who he raised with his male partner, simply could not accept that idea of same-sex marriage because in his mind marriage was just between a man and a woman. He wasn't some kind of miniature bigot, it's just that children have very limited conceptual vocabularies and are quite fixed in their narrow usages. So the teaching of gender and how it might be navigated is probably quite dicey, and I think it probable that a lot of children who might identify as other genders might be relying on rigid stereotypes. To therefore get rid of the slow teaching of norms to children in favour of solely a choice-first approach is probably a mistake, as Anderson claims (even if a bit too harshly):

For children, developing into a healthy understanding of their bodies and their sexuality is a delicate enterprise, fraught with difficulties even in the best circumstances. Transgender ideology makes the process much more difficult by destabilizing what David Cloutier calls the “sexual ecology.” It challenges the normality of congruence between sex and gender simply because a small number of people have trouble reconciling themselves with their bodily sex. “To destabilize [the] default position of body/soul congruence,” writes Cloutier, “is to allow exceptional cases to reshape the entire ecology.” We should be tolerant—indeed, loving—toward those who struggle with their gender identity, but also be aware of the harm done to the common good, particularly to children, when transgender identity is normalized. Transgender activists are not merely asking for tolerance or kindness; they are demanding affirmation, not just from adults but from children and adolescents who are already challenged by the normal process of sexual development. Cloutier observes that “affirming and accommodating the transgender identity of one child will affect other children, in much the same way that gender stereotypes about alpha males and compliant females affect them.” In a culture where transgender identities are not only affirmed but celebrated, everyone will be compelled to construct their own gender identity, unaided by a common understanding of sex differences and why they matter.

Anderson has a section on de-transitioners who loosely corroborate this criticism by claiming that a big part of what made them want to transition is rigid stereotypes they held as children (eg: people assigned as girls at birth who believed that if they had been boys, then they could have protected their mothers).

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3. Anderson's problems

While I think this is a decent argument, the problem is that Anderson has some pretty wacky ideas about gender and sex himself:

Sex is a bodily, biological reality, and gender is how we give social expression to that reality. Gender properly understood is a social manifestation of human nature, springing forth from biological realities, though shaped by rational and moral choice. Human beings are creatures of nature and of culture, but a healthy culture does not attempt to erase our nature as male or female embodied beings. Instead, it promotes the integrity of persons, in part by cultivating manifestations of sex differences that correspond to biological facts.

It sounds very nice, but if you examine its parts it strikes you as a bunch of vapid words designed to claim that the gender norms of a few decades ago are the "natural" ones. This puts him in a fix - after all, the stories of detransitioners impel him to claim that trans kids are wrongly over-relying on stereotypes:

Acknowledging the richly diverse ways of being male and female can help children more readily identify with and accept their own embodiment.

But on the other hand, he also thinks there are real differences between men and women, as when he approvingly quotes David Popenoe:

Men and women are different to the core, and each is necessary— culturally and biologically—for the optimal development of a human being.

This dig at same-sex parents and single parents, unfortunately makes him claim that men are women are "different to the core". But if this is so, maybe those trans kids are actually onto something because they could have powerful internal tendencies to act like the other gender from which their current one is "different to the core". Anderson tries to paper over this by claiming there needs to be a balance, but these two approaches- that stereotypes are real and valid, and that stereotypes are not- are approaches that are..."different to the core". Once you admit there are real differences, and given the plausible empirical assumption that there exist people with persistent and immutable need to identify with the other different-to-the-core gender, Anderson's whole argument about detransitioners and stereotypes gets shaky really fast.

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4. More problems

As I mentioned at the start, its easy enough to kick up enough dust to make the opposition seem less solid that it portrays itself to be. Let's say Anderson does this well. However, he also seems to think that showing that there isn't as much scientific consensus on the other side's claims automatically means the status quo is the right one:

If science doesn’t support this course of treatment for children, why are these “drastic and experimental measures” now being promoted as the norm?

In essence, an eight-year-old child was treated as an authority on whether and how to block puberty. A third-grader was “definitely” sure that the implant was right.

Sure these don't sounds ideal, but what's the alternative, especially since at least a big chunk of kinds with dysphoria will turn out to actually be trans? Allow parents to make all the decisions anyway? Including parents who might be dumb enough to think this book is some kind of comprehensive guide?

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5. Deceit

But worst of all is Anderson's complete lack of academic integrity. There might have been good reason to highlight the stories of de-transitioners, as I've indicated above...but he doesn't interview any other trans people. Not one. This allows him to say stuff like:

For an individual to look female while living as a male, or vice versa, “creates difficult barriers with enormous lifelong disadvantages.” No doubt. But it isn’t clear why the remedy would be to change the body rather than address the disconnection at the psychological level.

Well it's not clear because you didn't talk to any trans person who also didn't de-transition, you dingus. The rhetorical move here is so infuriating, because obviously such a statement would be completely implausible if he had also conceded the existence of trans people who swear that transition really helped out their lives (He repeated brings up a study to show that suicide attempts over the lifetime doesn't diminish for people who transitioned, but this is attempts OVER THEIR LIFETIMES, so even if they tried to kill themselves as teens, this would be included)

I somewhat respect the anti same-sex marriage views of other Natural Lawyers like Robert P. George because they were at least honest and had integrity, they engaged. This book's complete absence of any actual opposition views or figures makes it quite clear that Anderson is an intellectual charlatan through and through. Would any serious intellectual write a whole book without seriously engaging with any arguments, let alone the strongest arguments, from the other side?

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6. The lack of philosophical subtlety

For my own part, I actually do think that there is (for now, at least) a kind of primacy to cisgender heterosexuality. But this is a primacy about intelligibility, according to which deviations from this can only be understood against its background. It isn't some kind of moral primacy, where everyone needs to be forced to adhere to it. That's the argument I'd like to see conservatives engage with or even challenge. But following his metaphysics, Anderson keeps running these two kinds of primacies together, creating a stance which is bound to be unappealing to the vast majority of people, if only they read him closely enough.

[Josh · Rating 4 out of 5]

For a legal, medical/biological, and cultural analysis of the transgender moment, Ryan Anderson's book can't be beat. He relies heavily on natural law or teleology as the basis of his argument, and as a Christian presuppositionalist I think more has to be said to completely buttress the argument (eventually, the "why" of human nature must rest upon the foundation of "In the beginning God"). But Anderson's book is in every other way superb: cogent, compassionate, and comprehensive.

[Josh Bishop · Rating 5 out of 5]

A thoughtful, thorough, clear critique. I can't recommend this book highly enough.

[Neil R. Coulter · Rating 3 out of 5]

This is not a perfect book, but I learned a lot from reading it, and I found a number of Ryan Anderson’s points very thought-provoking. It’s helpful first to understand what the book is meant to be: it’s not the final word on the issues Anderson raises, nor is it a comprehensive scientific or scholarly (or even journalistic) consideration of the topic. It really is just what the subtitle says: one person responding to a complex current issue. It’s not an unbiased, neutral response (it’s totally clear from the first pages that this is written by a social conservative), but the early chapters raise some issues beneath the surface of public discourse, asking intriguing questions that I hadn’t considered before. (The last couple of chapters work less well; in addressing culture and policy, Anderson overreaches what he’s capable of covering in such a brief space. His arguments in those chapters are often flawed, as he mischaracterizes some positions in order to make his point. Even where I agreed with the point he was making, I sometimes felt that his method of argument was inadequate, inviting easy contradiction rather than deep discussion.)

The reason I say that it’s not a perfect book, even given what it is intended to be, is the research method Anderson applies. The book is a demonstration of the limits of document-based, secondary-source research. Anderson looks entirely at material that’s publicly available in print, and the questions this leads him to are valuable and fascinating. But what’s missing from the book is any connection between the author and a living, breathing person, and for this issue, that’s a big shortcoming. It doesn’t nullify the good research that’s here, but it feels like just one part of what should have been a larger, richer research project. Because I teach ethnographic fieldwork, when I read a book like this I feel the significant lack in the research method. Where are the people? Where is the information the author received through talking, interviewing, observing?

Another shortcoming is that Anderson relies very heavily on one person: Dr. Paul McHugh, retired professor of psychiatry at Johns Hopkins. The quotes Anderson presents from McHugh often seemed completely apt in the context of the book, but this dependence on one voice means the argument rises or falls based on what the reader thinks about that person. It’s at least risky, if not outright problematic.

One of the main reasons I appreciated this book, despite the flaws, is that I feel too often in public conversation now (and especially in online conversation), discussions of important, complex topics begin and end with the surface-level feelings of individuals. It seems sometimes that there is no other consideration than what each individual feels at any given moment, and to ask questions or disagree (or to seek some deeper level of truth and objectivity than just individual feelings) is taken as a sign of disrespect, hostility, or hatred. What I long for is a way to talk together where everyone can feel certain that they are valued and respected, and then we can move on to deeper questions, without fear of personal insult or offense. This fear of causing offense prevents us from considering the very intriguing questions that the “transgender moment” raises, from the epistemological and ontological to the biological and psychological.

For that reason, I’m glad for the ways that this book, in spite of its imperfections, pushes the conversation into a number of areas that deserve contemplation. It helped me slow down and think better about a “moment” that pushes us to make quick, emotion-based decisions instead of considering the full scope of history, culture, and science. I came away from the book with a viewpoint that sees more “shades of gray,” not black-and-white. The book did not make me scorn or disrespect transgender people. On the contrary, it made me more sympathetic and understanding, more invested in ensuring that people are receiving all the help they need to be mentally and physically whole, that major decisions about lifestyle and body are made with the best information and the most compassionate intentions. It’s given me much to continue thinking about.

[NinaB · Rating 4 out of 5]

4.5*
I just recently saw a HuffPost article encouraging parents to affirm their children’s transgender wishes, while another article on the same site warning about not being too quick to neuter our beloved pets. It is insane that we are told to care more about our dog’s genitalia than our kids’! This reality is why When Harry Became Sally (clever title, by the way) is such a timely read.

What an enlightening, frustrating, and helpful book. It’s enlightening because it introduced me to the issues, examples, dangers and politics of transgenderism. I read about real people with real problems that forced me to come face to face with transgenderism, that it isn’t just someone else’s problem. Our society is in a transgender “moment” that is most likely headed toward “war,” at least for us who affirm only two genders as God intended.

This book is frustrating because it highlights our society’s headlong support of the transgender ideology without any hesitation. If one voices any opposition, he/she is immediately labeled “transphobic.” People have politicized it, thus ignoring truly helping those who struggle with it. Instead of figuring out and dealing with the underlying issues why a child would want to change genders, those in authority are subjecting these poor kids to therapies that would leave them infertile and mutilated. Transforming their outside appearance doesn’t change the fact that every cell in their body affirms the gender they’re born with.

The government is making policies in myopic ignorance, without considering the broad implications and dangerous consequences their policies may cause. By legitimizing the demands of the transgender community, our government is stomping on the rights and desires of others, mainly women. I don’t know why the leftist feminists are not fighting against transgenderism more vehemently.

Finally, I found this book helpful because it made me become more aware that transgenderism is an ideology that is here and now. It goes against my Christian worldview, but it’s a reality I need to adjust to. Understanding it will help me better educate my kids on how to form their convictions on it based on biblical principles, to prepare all of us for the coming influx of transgender people in our midst, to know how to love and minister to them who struggle with it, and to lead them to the true solution to their identity problem.

[Hillary · Rating 1 out of 5]

A cursory glance at the synopsis of this book might make you think, “ah, ok, so this is a different take on transgender issues,” and your assumption would be correct. But, an unbalanced, unbiased, responsible take, it is not.

Anderson hails from conservative think tank the Heritage Foundation, and has written a couple of titles arguing against legalized same-sex marriage, which he feels is a violation of religious liberty. Once you realize where this text is going, it’s easy to see that his crusade against the gays didn’t work out, so he had to switch gears and find another minority to go after—the transgender community. The book opens with generous accolades from lots of folks with letters behind their names, but figures in the transgender community, prominent or otherwise, are conspicuously absent.

From chapter 1, Anderson deliberately misgenders well-known celebrities such as Caitlyn Jenner and Chaz Bono. Some readers will be discouraged by this disrespectful decision alone, and for good reason. It soon becomes clear that this is not a scientific text seeking to discredit the idea that medical transition is necessary for those who are transgender. It seeks to discredit the whole notion that people are transgender. You might question how Anderson can ignore the APA’s official position on transgender individuals. Well, he does not—he simply rejects it. He argues that activists coerced the organization into supporting the transgender community. This might sound familiar, because when the APA declared homosexuality to be a natural variation in human sexuality rather than a mental illness in 1973, critics claimed activists pressured them into changing their position. Another parallel is Anderson’s contention that we should not blame transgender people for a movement (or “moment”) he feels activists have perpetuated, but instead feel sympathetic toward them because they are mentally ill. This is just a secular reworking of the endlessly frustrating “hate the sin and not the sinner” argument against homosexuality.

There is a chapter dedicated to those he called “detransitioners,” or people who have transitioned to the other sex socially and/or medically, regretted the decision, and returned to the sex they were assigned at birth. It should be noted that Anderson didn’t interview these people, but instead just transcribed their YouTube videos, reproduced portions of their blog posts, or quoted news articles. (And if you conduct some further research into some of these individuals, you'll find that their identities are not as cut-and-dried as Anderson would have us believe). It’s mostly, but not entirely an exercise in futility. If there’s nothing else to be learned from this book, we can gather that there are always ignorant or simply bad therapists out there, and their recommendations can cause harm. Some of the “detransitioners” had mental issues their therapists failed to address, and they mistakenly thought transitioning was the answer. Notably, most of these individuals acknowledged that for many who are transgender, socially and medically transitioning *is* beneficial, undermining Anderson’s thesis that transitioning is an unnecessary medical decision altogether. Anderson’s decision to use the voices of six or seven “destransitioners” but failure to cite (or speak to) those who have transitioned successfully and are leading happier lives is a major weakness in his argument.

He also cherry-picks some feminist works of literature, spends an entire chapter on X and Y chromosomes, and tries to reach across the aisle because he’s under the impression that cis queer folks and other leftists secretly agree with him. He describes the transgender movement as something relatively new, kicked off by the rise of Caitlyn Jenner, ignoring its rich history and figures like Christine Jorgenson, Renee Richards, Sylvia Rivera, Billy Tipton, Jan Morris, and many, many others. He oversimplifies the matter of transitioning, presuming that all transgender people have the desire to transition both socially and medically, and that therapists offer them no alternatives and fail to educate them on the health risks involved.

TL; DR this is trash.

[Daniel · Rating 4 out of 5]

A well-written, thoughtful, and compassionate critique of transgender ideology.

[Steve · Rating 5 out of 5]

Superb.

[Evan · Rating 5 out of 5]

This is a timely and well researched book. Ryan Anderson covers the issue from many angles with sympathy and compassion for those suffering from gender dysphoria.

[Carl Di-Palma · Rating 5 out of 5]

an excellent book that exposes the ideology ( and lack of science) behind the transgender movement, but also acknowledges the deep distress of those who struggle with Gender Dysphoria, especially concerning de-transition.