Irreversible Damage: The Transgender Craze Seducing Our Daughters

by Abigail Shrier

Her distress is real. But her self-diagnosis, in each case, is flawed—more the result of encouragement and suggestion than psychological necessity.

In October 2017, my own state, California, enacted a law that threatened jail time for healthcare workers who refuse to use patients’ requested gender pronouns.6 New York had adopted a similar law, which applied to employers, landlords, and business owners.7 Both laws are facially and thoroughly unconstitutional.

The First Amendment has long protected the right to say unpopular things without government interference. It also guarantees our right to refuse to say things the government wants said.

Gender dysphoria—formerly known as “gender identity disorder”—is characterized by a severe and persistent discomfort in one’s biological sex.8 It typically begins in early childhood—ages two to four—though it may grow more severe in adolescence. But in most cases—nearly 70 percent—childhood gender dysphoria resolves.9 Historically, it afflicted a tiny sliver of the population (roughly .01 percent) and almost exclusively boys. Before 2012, in fact, there was no scientific literature on girls ages eleven to twenty-one ever having developed gender dysphoria at all.

In the last decade that has changed, and dramatically. The Western world has seen a sudden surge of adolescents claiming to have gender dysphoria and self-identifying as “transgender.” For the first time in medical history, natal girls are not only present among those so identifying—they constitute the majority.10

This is a story Americans need to hear. Whether or not you have an adolescent daughter, whether or not your child has fallen for this transgender craze, America has become fertile ground for this mass enthusiasm for reasons that have everything to do with our cultural frailty: parents are undermined; experts are over–relied upon; dissenters in science and medicine are intimidated; free speech truckles under renewed attack; government healthcare laws harbor hidden consequences; and an intersectional era has arisen in which the desire to escape a dominant identity encourages individuals to take cover in victim groups.

But the phenomenon sweeping teenage girls is different. It originates not in traditional gender dysphoria but in videos found on the internet. It represents mimicry inspired by internet gurus, a pledge taken with girlfriends—hands and breath held, eyes squeezed shut. For these girls, trans identification offers freedom from anxiety’s relentless pursuit; it satisfies the deepest need for acceptance, the thrill of transgression, the seductive lilt of belonging.

Teens of my era who came of age in the early 1990s set the high watermark in the U.S. for teenage pregnancy.2 It’s been plummeting ever since—as have rates of teenage sex—recently reaching multi-decade lows.3 This is at least partly the result of lack of opportunity: Today’s adolescents spend far less time in person with friends—up to an hour less per day—than did members of Gen X.4 And dear God, they are lonely. They report greater loneliness than any generation on record.5

Between 2009 and 2017, the number of high schoolers who contemplated suicide increased 25 percent.8 The number of teens diagnosed with clinical depression grew 37 percent between 2005 and 2014. And the worst hit—experiencing depression at a rate three times that of boys—were teenage girls.9

As Twenge wrote for The Atlantic, “It’s not an exaggeration to describe iGen as being on the brink of the worst mental-health crisis in decades. Much of this deterioration can be traced to their phones.”12

The iPhone was released in 2007. By 2018—a decade later—95 percent of teens had access to a smartphone and 45 percent reported being online “almost constantly.”13 Tumblr, Instagram, TikTok, and YouTube—all very popular with teens—host a wide array of visual tutorials and pictorial inspiration to self-harm: anorexia (“thinspiration” or “thinspo”), cutting, and suicide. Posting one’s experiences with any of these afflictions offers the chance to win hundreds—even thousands—of followers.14 Anorexia, cutting, and suicide have all spiked dramatically since the arrival of the smartphone.15

They are far less likely to suffer the wounds brought on by adolescent heedlessness—but they’ve also failed to be toughened by the scars. Plunge into the furnace of adolescent experimentation, and you may suffer harm. Survive, and you are likely to emerge steelier, so much fragility having been banged out.

Only 12 percent of natal females who identify as transgender have undergone or even desire phalloplasty.23 They have no plans to obtain the male appendage that most people would consider a defining feature of manhood. As Sasha Ayad put it to me, “A common response that I get from female clients is something along these lines: ‘I don’t know exactly that I want to be a guy. I just know I don’t want to be a girl.’ ”

The therapist began the session by asking Julie her preferred name and pronouns. Julie supplied a male name and pronouns, which is how the therapist referred to her from then on. But rather than satisfying Julie, all this affirmation seemed to make her more anxious and unhappy. “Every time our daughter came out of that session, when that therapist was affirming her… she was angry, and detached and cocky.”

Two patterns stood out: First, the clear majority (65 percent) of the adolescent girls who had discovered transgender identity in adolescence—“out of the blue”5—had done so after a period of prolonged social media immersion. Second, the prevalence of transgender identification within some of the girls’ friend groups was more than seventy times the expected rate.6 Why?

The most recent Diagnostic and Statistical Manual (DSM-5) reports an expected incidence of gender dysphoria at .005–.014 percent for natal males, and a much lower .002–.003 percent for natal females, based on the numbers of those who, a decade ago, sought medical intervention.22 This is an incidence of fewer than 1 in 10,000 people.

Psychologists who study peer influence ask what it is about teenage girls that makes them so susceptible to peer contagion and so good at spreading it. Many believe it has something to do with the way girls tend to socialize.35 “When we listen to girls versus boys talk to each other, girls are much more likely to reply with statements that are validating and supportive than questioning,” Amanda Rose, professor of psychology at the University of Missouri, told me. “They’re willing to suspend reality to get into their friends’ worlds more. For this reason, adolescent girls are more likely to take on, for instance, the depression their friends are going through and become depressed themselves.”

While all this sexual identity politics marches through the front door, a large-scale robbery is taking place: the theft of women’s achievement. The more incredible a woman is, the more barriers she busts through, the more “gender nonconforming” she is deemed to be. In this perverse schema, by definition, the more amazing a woman is, the less she counts as a woman.

Indeed, the school calendars at so many schools insist that LGBTQ students be not merely treated equally and fairly, but revered for their bravery. The year-long Pride Parade often begins in October with “Coming Out Day,” “International Pronouns Day,” and LGBTQ History Month; November brings “Transgender Awareness Week,” capped off by “Transgender Day of Remembrance,” a vigil for transgender individuals killed for this identity. March is “Transgender Visibility Month.” April contributes “Day of Silence / Day of Action” to spread awareness of bullying and harassment of LGBTQ students. May offers “Harvey Milk Day,” dedicated to mourning the prominent gay rights activist; and June, of course, is Pride Month—thirty days dedicated to celebrating LGBTQ identities and decrying anti-LGBTQ oppression.

anti-bullying effort is only a pretext for gender identity education:

“When we construe normal feelings as illness, we offer people an understanding of themselves as disordered.”

By the time they reached adolescence, self-focus and self-diagnosis had become an ingrained habit, a way to handle feelings that confused them. With the rest of the culture, they had been reared to participate in a therapy language game, in which everyone has some mental illness and the only question is what code to offer insurance.

But this is, roughly, the scenario created by “affirmative care,” the prevailing medical standard for the treatment of transgender patients. The standard asks—against much evidence, and sometimes contrary to their beliefs on the matter—that mental health professionals “affirm” not only the patient’s self-diagnosis of dysphoria but also the accuracy of the patients’ perception. The therapist must agree, in other words, that a male patient with gender dysphoria who identifies as a woman really is a woman.

It’s worth noting how different this is from being the parent of a gay adolescent. An adolescent who comes out as gay asks her parents to accept her for what she is. An adolescent who is transgender-identified asks to be accepted for what she is not. Even the most loving parent might be forgiven for failing this mind-bending test.

For the U.S. population as a whole the rate of attempted suicide is 0.6 percent, and 10 to 20 percent for lesbian, gay, and bisexual individuals.

In order to justify the peculiar mandate that therapists immediately accept patients’ self-diagnosis when presented with someone claiming gender dysphoria, we must answer two questions: 1) Is the gender dysphoria causing the suicidal ideation? And 2) Do we have any evidence that affirmation ameliorates mental health problems? The answer to both questions, it seems, is no. In a recent academic study, Kenneth Zucker found that the mental health outcomes for adolescents with gender dysphoria were very similar to those with the same mental health issues who did not have gender dypshoria. In other words, we have no proof that the gender dysphoria was responsible for the suicidal ideation or tendency to self-harm. It may have been the many other mental health problems that gender dysphoric adolescents so often bear. Still, even if the gender dysphoria were not responsible for the suicidal ideation, it might be worth “affirming” these youths if doing so would cure their depression and lift their suicidal fantasies. Unfortunately for proponents of affirmative therapy, there is no evidence that this is the case. There are a few important studies on point, though none is definitive here, since the current craze is so new. One is a long-term study of adult transsexuals (the term in use at the time) showing a rise in suicidality after sex reassignment surgery.18 Another, more relevant to today’s gender-crazed girls, comes from a leaked 2019 report from the Tavistock and Portman Trust ...

Several studies indicate that nearly 70 percent of kids who experience childhood gender dysphoria—and are not affirmed or socially transitioned—eventually outgrow it.23

Finally, many affirmative therapists argue, as Dr. Kaufman did to me, that we know gender identity is immutable because of the famous case of David Reimer.24 David Reimer was an identical twin (born “Bruce Reimer”) whose badly botched circumcision at seven months left him without a functioning penis. Under great pressure by Johns Hopkins psychologist John Money, David’s parents renamed him “Brenda” and acquiesced to full sex reassignment surgery to “transform” David into a girl. On the strict advice of John Money, the parents never told Brenda she had been born a boy. For years, many hailed this experiment as a triumph of nurture over nature: unlike his identical twin, Brenda Reimer had actually become a girl. But John Money’s experiment failed miserably, as later follow-up studies and reports showed. David never felt comfortable as a girl, was unalterably boyish for all of his life, aggressive and unhappy. By adolescence he was so troubled and depressed that his parents reluctantly told him the truth. He abruptly renamed himself “David,” underwent masculinizing hormone treatments and surgery and presented himself, once more, as a boy, then a man. David went on to marry a woman. But David, who was never able to fully regain physical functionality as a man or to escape the tortured years he spent treated as a girl, eventually committed suicide in 2004.

But of course, this case just as readily proves the opposite. After all, David’s biological sex was also male. It was arguably David’s biology that he couldn’t escape—that not-so-minor detail stamped on every cell of his body—not the ethereal concept “gender,” for which there is no scientific evidence.

A therapist needed to question the patient’s understanding of gender in order to determine why the patient might have fixated on that as a source of their problems. What beliefs did the patient have about boys or girls? Why did the child or adolescent come to believe changing gender would lead to a happier life? The goal of the questioning was often to challenge the notion that biological sex was the source of the patient’s problem and, wherever possible, to alleviate the dysphoria.

In fact, Blanchard does not believe the adolescent girls who suddenly identify as trans in adolescence necessarily have gender dysphoria at all. He believes they are likely a mixed bag of at least three groups: (1) some kids who are going to be transgender no matter what therapy they’re given; (2) kids who would naturally have outgrown their dysphoria on their own and proceeded to live as gay adults; and (3) “some contingent of teenage girls who just have borderline personality disorders and who have a kind of faux gender dysphoria, which they have identified as the locus of their unhappiness.”

Blanchard emphasizes that in the entire diagnostic history of gender dysphoria—dating back to the 1910s—there is no record of genuine transsexualism or well-established syndromes of gender dysphoria ever passing from one person to another. “People developed gender dysphoria in isolation from models.” They didn’t need prompting from a friend, a school assembly, or a YouTube influencer to realize their dysphoria; it simply was.

But what is gender identity? It has no diagnostic markers, no measurable signs, no blood test to confirm it. It is a feeling—an attitude. That does not mean that it does not exist. But it does mean that, like many psychiatric ailments, it poses challenges to diagnosis and treatment. When the prospective treatment is an irreversible surgery, the slippery nature of the condition would seem to justify measured and careful evaluation.

Affirmation is the exact opposite of curiosity. It’s saying, I already know what this is. It’s taking things at face value.”

But there’s something else she’s even more worried about: Insisting that an adolescent who doesn’t transition is likely to kill herself—that notion can also easily fall into the symptom pool, too. It may have already. “When you tell a group of highly suggestible adolescent females that if they don’t get a certain thing, they’re going to feel suicidal,” she says, “that’s suggestion, and then you’re actually spreading suicide contagion.”

Johns Hopkins University distinguished professor of psychiatry and behavioral sciences Paul McHugh has an answer. Gender dysphoria is an “overvalued idea” or ruling passion. This is “an idea held by many people in the world, but held intensely by the patient or the person, who is making a life of that idea,” Dr. McHugh told me. Many people believe that it is good to be thin, for instance. Many adolescent girls believe it’s better to be a boy. But for anorexics and those with gender dysphoria, those ideas become all-consuming.

“Policy makers and the media are doing no favors to the public or the transgendered by treating their confusions as a right in need of defending rather than as a mental disorder that deserves understanding, treatment and prevention,”

But Dr. McHugh believes the transgender craze will likely end as the multiple personality craze did: in the courts, with patients suing their doctors. Some of these teenage girls, he says, “will wake up at age twenty-three, twenty-four, and say, ‘Here I am. I’ve got a five-o’clock shadow, I’m mutilated and I’m sterile, and I’m not what I ought to be. How did this happen?’ ”

As any biologist will tell you, sex in humans is much more than a few spare parts. Long after our organs have liquefied, skin begun to recede, our cells converted to nitrogen, and ligament casings have surrendered our teeth—when everything that made us identifiable to those who knew us is gone—maleness or femaleness remains.

“There is no other cosmetic operation where it is considered morally acceptable to destroy a human function. None,” he told me. “There is no cosmetic operation that I could propose in front of a room full of my colleagues where I could say, ‘Hey, listen, I’m going to improve this guy’s nose but take away his ability to smell.’ Or, ‘I’m going to improve the appearance of this boy’s ears but he’s going to be deaf.’ They’d say, ‘Sir, we’d like to see your credentials.’ But in the case of an adolescent girl, surrendering her capacity to breastfeed so that she can appear to be a boy, that’s considered morally correct. Forgive me for my skepticism.”

Relatively few female-to-male transgender people pursue “bottom surgery”—which probably is a good thing. I have talked to enough transgender-identified people who have suffered a botched phalloplasty (or had friends who did) to fuel a lifetime of nightmares. Whereas 36 percent of biological females identifying as “trans men” have had top surgery and another 61 percent desire it, according to the U.S. Transgender Survey of 2015, only 3 percent have had phalloplasty and only 13 percent even want it.26

Part of the answer lies with the Affordable Care Act of 2010, which indirectly forced health insurance companies to cover hormones and surgeries by barring health insurance companies from discriminating based on sexual orientation and gender identity. This meant that if insurance companies provided hormones (like birth control) to the non-transgendered, it had to also provide the expensive cross-sex version to the transgender-identified. If health insurance companies were going to cover breast reductions for anyone, they had also to cover double mastectomies for the gender dysphoric; anti-discrimination law all but required it.29

Benji offers this thought experiment: “Imagine if there was a cult, and every single member of that cult wanted a gastric bypass because they needed to be skinnier because of the tenets of their cult. It wouldn’t be ethical for a doctor to give all these women gastric bypass just because it’s their religion. So when I see these people who have like spent years on Tumblr, indoctrinating themselves, and then they go to the doctor—it’s like, the doctor is the one who has the responsibility to be like, ‘Can this person tell what is reality? Is this person making a decision that’s good for them?’ ”