[The full post is ~5300 words and way way too long for the Motte's 20k character limit but I'm posting as much as I can fit.]
If you've ever been curious about the etymology of cis and trans as prefixes, just know they're Latin for "the same side of" and "the other side of", respectively. These prefixes are widely used in organic chemistry to distinguish between molecules that have the exact same atoms with a different spatial arrangement. Notice, for example, how in the cis isomer below on the left, chlorine atoms are oriented toward the "same side" as each other, but on the "other side" of each other in the trans isomer.
[chlorine on hydrogen action too hot for the motte]
The dashed line is just me simplifying the geometric comparison plane (the E-Z convention is much more precise in this respect), but regardless, this is meant only to illustrate how talk of cis or trans is necessarily one of *relative positioning. *A single solitary point floating in space cannot be described as the same or other "side" of anything when there is nothing else to contrast it against.
Now this is just organic chemistry, not real life, but the cis/trans convention is applied consistently elsewhere. In the context relevant to this post, "sex" and "gender" are the two anchor points --- the two chlorine atoms in the dichloroethene molecule of life --- and their relative resonance/dissonance relative to each other is the very definition of cis/trans gender identity. To avoid any ambiguity, I use sex to refer to one's biological role in reproduction (strictly binary), while gender is the fuzzy spectrum of sex-based societal expectations about how one is supposed to act. If your sex and gender identity "align", then you are considered cis; if they don't, then you are trans. Same side versus other side.
But what does it mean for sex and gender identity to "align"? There is an obvious answer to this question, but it is peculiarly difficult to encounter it transparently out in the wild. For reasons outlined below, I will argue that the elusiveness is completely intentional.
More than two years ago I wrote a post that got me put on a watch list, called Do Trans People Exist?. The question mark was barely a hedge and the theory I outlined remains straightforward:
I'm starting to think that trans people do not exist. What I mean by this is that I'm finding myself drawn towards an alternative theory that when someone identifies as trans, they've fallen prey to a gender conformity system that is too rigid.
Two years on and I maintain my assertion remains trivially true. One change I would make is avoiding the "fallen prey" language because I have no idea whether the rigidity is nascent to and incubated by the trans community (for whatever reasons), or if it's just an enduring consequence of society's extant gender conformity system (no matter how much liberal society tells itself otherwise). If you disagree with my assertion, it's actually super-duper easy to refute it; all anyone needs to do is offer up a coherent description of either cis or trans gender identity void of any reference to gender stereotypes. But I'd be asking for the impossible here, because the essence of these concepts is to describe the resonance or dissonance that exists between one's biological reality (sex) and the accordant societal expectations imposed (gender). Unless you internalize or assimilate society's gender expectations, unless you accede to them and capitulate that they're worth respecting and paying attention to as a guiding lodestar, concepts like "gender dysphoria" are fundamentally moot. A single point cannot resonate or clash with itself, as these dynamics necessitate interaction between distinct elements.
The position I'm arguing is nothing new. The Oxford philosopher Rebecca Reilly-Cooper had already established the incoherencies inherent within this framework conclusively and with impeccable clarity in this lecture she gave way back in 2016 (website form). It's wild how her arguments remain perfectly relevant today, and if anyone has attempted a refutation I have not encountered it. And yet this remains a controversial position to stake, but not because it's wrong. Rather, I believe, it's because of how insulting it is to be accused of reifying any system of stereotypes nowadays.
In case it needs to be said, stereotypes can occasionally offer useful shortcuts, but their inherent overgeneralization risks flattening reality into inaccuracy. The major risk relevant to this discussion is when stereotypes crystallize into concrete expectations, suffocating individual expression with either forced conformity due to perceived group membership, or feelings of alienation due to perceived incongruence. The indignation to my position is also understandable given how the foundational ethos of the queer liberation movement was a rejection of gender normativity's constraints.
You're not obligated to take my word for this, but I do tend to feel an immense discomfort whenever I hold a position that is purportedly controversial, and yet I'm unable to steelman any plausible refutations --- a sense of "I must be missing something, it can't be this obvious" type deal. I did try to bridge the chasm of inscrutability when I wrote What Boston Can Teach Us About What a Woman Is. My plea to everyone was to jettison the ambiguous semantic topography within this topic and replace it with concrete specifics:
To the extent that woman is a cluster of traits, I struggle to contemplate a scenario where communicating the cluster is a more efficient or more thoughtful method of communication than just communicating the specific pertinent trait. Just tell me what you want me to know directly. Use other words if need be.
Because right now it's a complete fucking riddle to me if someone discloses that they "identify as a woman" or whatever. What, exactly, am I supposed to do with this new information? Suggesting that stereotypes are the referent is met with umbrage and steadfast denials, but if not that, then what? Over the years I've tried earnestly to learn by asking questions and seeking out resources, and what I've repeatedly experienced is a marked reluctance to offer up anything more than the vaguest of details.
The ambiguity I'm referring to isn't absolute, however, and there are two notable exceptions worth briefly addressing: body modifications and preferred pronouns.
Sex does not only determine whether an individual produces large or small gametes --- an entire armory of secondary characteristics comes along for the ride, whether you like it or not. If a female happens to be distressed by their breasts and wants them removed, you could describe this scenario in two very different ways. One is that this person "identifies as a man" and their (very obviously female) breasts serve as a distressing monument that something is "off". The other way is that this person is simply distressed by their breasts, full stop, without any of the gender-related accoutrements. [These two options are not necessarily exhaustive, and I'm open to other potential interpretations.]
Is there any difference between these two approaches? The first framework adds a multitude of vexing, unanswerable questions (Does comfort with one's secondary sex characteristics require some sort of "affirmation gene" that trans people unfortunately lack? Is the problem some sort of mind/body misalignment? If so, why address one side of that equation only? Etc.) within an already overcomplicated framework. The other concern here is if the gender identity becomes prescriptive, where an individual pursues a body modification not for whatever inherent qualities it may have, but rather because of some felt obligation to "complete the set" for what their particular identity is supposed to look like.
The second framework (the one eschewing the gender identity component) would not dismiss the individual's concerns and would be part of a panoply of well-established phenomena of individuals inconsolably distressed with their body, such as body integrity dysphoria (BID), anorexia, or muscle dysphoria. The general remedies here tend to be a combination of counseling and medication to deal with the distress directly, and only in rare circumstances is permanent alteration even considered. I imagine there is some consternation that I've compared gender dysphoria with BID, but I see no reason to believe they are qualitatively different and welcome anyone to demonstrate otherwise. Regardless, I subscribe to maximum individual autonomy on these matters, and so it's not any of my business what people choose to do with their bodies. The point here is that preferences about one's body (either aesthetic or functional) exist without a reliance on paradigm shifts of one's "internal sense of self". If someone wants to, for example, bulk up and build muscle, they can just do it; it's nonsensical to say they first need to "identify" as their chosen aspiration before any changes can occur.
The other exception to the ambiguity around what gender identity* means* is pronoun preference. Chalk it up to [whatever]-privilege, but I concede I do not understand the fixation on pronouns. The closest parallel I can think of are nickname preferences, but unlike nicknames, pronouns almost never come up in two-party conversations, so it's difficult to see why they would be any more consequential. I personally accommodate pronoun preferences out of politeness (and I suspect almost everyone else does as well), the exact same way I would accommodate nicknames out of politeness. If I happen to refer to my friend using frog/frogs pronouns, it's not because I believe they're actually a frog; I'm just trying to be nice and avoid getting yelled at. Regardless of the intent behind them, pronoun preferences are a facile and woefully incomplete account for what we're warned are suicidal levels of distress around one's incongruent gender identity, so this can't be the whole story.
So on one extreme you have potentially invasive body modifications that are at least commensurate with the seriousness of the distress expressed, and on the other side you have the equivalent of a nickname preference that is relatively facile to accommodate. In between these two pillars, however, is a conspicuous vacuum of silence. My conclusion is that this missing middle is really just gendered stereotypes, but nobody wants to admit something so laughably antiquated out loud.
Well, almost nobody.
I've had this post sitting in my drafts for months largely because of an ever-present concern that I was unfairly shining a spotlight on the craziest examples from the trans-affirming community. My perennial goal with any subject is to avoid weakmanning, but with this issue I have no idea how to draw the contours and discern what arguments are representative and thus fair game to critique.
The lack of contours means I can't prove this next part conclusively, but I noticed a shift over time regarding which talking points were most common. The perennial challenge for this camp remains the logical impossibility of harmonizing the twin snakes of "trans people don't owe you passing" and "trans people will literally kill themselves if they don't pass". At least as late as 2018, there was more of an apparent comfort with leaning more toward openly reifying gendered roles and expectations. For example, in this Aeon magazine dialogue between trans philosopher Sophie Grace Chappell and gender-critical feminist Holly Lawford-Smith, Chappell uses the word script in her responses a whopping forty-one times.
But by far the most jaw-dropping example of this comfort comes from a lecture by Dr. Diane Ehrensaft, currently the head psychologist for the UCSF Benioff Children's Hospitals' gender clinic. When a parent asked how to know if a baby is trans, Dr. Ehrensaft literally said that a baby throwing out a barrette is a "gender signal" the baby might not really be a girl, the same way another baby opening their onesie is a signal they might be a girl. Seriously, watch this shit.
This is such a blatantly asinine thing to say that it depresses me to no end that the auditorium didn't erupt in raucous laughter at her answer. I don't even know how to respond to it. Maybe it bears repeating that babies are dumb. At any given moment, the entirety of a baby's cognitive load is already stressed over having to decide between shitting and vomiting. Dr. Ehrensaft conjures up this tale about how dumb babies are able to divinate the eternal message that "dresses are for women" out of thin air (or maybe directly from Allah), and that same dumb baby also has the ingenuity to cleverly repurpose their onesie into a jury-rigged "dress". I'm not claiming that it's impossible for young children to notice and even mirror societal expectations, including gender-related ones. Indeed, research indicates wisps of this awareness can start manifesting very early on, with children reaching "peak rigidity in their gender stereotypes at age 5 to 6" followed by a dramatic and continuing increase in flexibility. But it remains a jaw-dropping level of projection and tea leaf--reading on display here by Dr. Ehrensaft; the simple explanation that a baby might open their onesie because they're a dumb baby is apparently not worth consideration.
Dr. Ehrensaft is illustrative of the intellectual rigor that is apparently expected from the lead mental health professional in charge of the well-being of an entire clinic's worth of young patients. Matt Osborne wrote a devastating piece about her very long history of dangerous quackery. My mind was blown when I found out that Dr. Ehrensaft happened to be at the scene in 1992 desperately trying to whitewash the Daycare Satanic Panic and the unconscionable misery the "recovered memory" movement caused. In response to some highly suggestive interviews by therapists, preschool children alleged bizarre and horrific sexual abuse by staff involving drills, flying witches, underground tunnels, and hot-air balloons. The notorious McMartin case resulted in no convictions, with all charges finally dropped in 1990 after seven years of prosecutions. Two years later in an aftermath report of the similar Presidio case, Dr. Ehrensaft notes how the children's abuse narratives often contained fantasy elements, such as devilish pranks and hidden skeletons. This should normally be grounds for skepticism, but Dr. Ehrensaft stridently refuses to question the veracity of the accounts, and explains away the outlandish aspects as simply the result of trauma management --- the kids were using imaginative fears as a protective barrier for their (according to Dr. Ehrensaft) unquestionably real trauma. Given her general credulity, it's no surprise why her writing on the topic of gender identity is a murky soup of pseudo-religious nonsense about "gender ghosts" and "gender angels".
What exactly is the explanation for trans-affirming professionals like Chappell and Ehrensaft explicitly encouraging the necessity of adhering to gender scripts? Were they misled? Did they get the wrong bulletin? How? Why aren't their professional peers correcting them on such an elementary and foundational error? So many questions.
You can't keep drawing from the well of gender stereotypes so blatantly without anyone noticing. My general impression of the field is people realized how idiotic they sounded when their talking points were solidly anchored upon the veneration of (purportedly antiquated) gender roles and gender scripts. The response to this inescapable criticism has largely been to subtly pivot into the realm of empty rhetoric. But because of the necessity to cling onto strands of the initial assertions (for reasons I'll explain further), the result is a strenuous ballet of either constantly leaping between the two positions, or uncomfortably trying to straddle both.
Dr. Ehrensaft gives us an example of the vacuous. Her onesie/barrette poem of an answer above is from a video uploaded in 2018, but here's how her website explains gender nowadays, except with one particular word switched out:
This core aspect of one's identity comes from within each of us. Flibberdibber identity is an inherent aspect of a person's make-up. Individuals do not choose their flibberdibber, nor can they be made to change it. However, the words someone uses to communicate their flibberdibber identity may change over time; naming one's flibberdibber can be a complex and evolving matter. Because we are provided with limited language for flibberdibber, it may take a person quite some time to discover, or create, the language that best communicates their internal experience. Likewise, as language evolves, a person's name for their flibberdibber may also evolve. This does not mean their flibberdibber has changed, but rather that the words for it are shifting.
Can anyone reading this tell me what flibberdibber is beyond that it's something inexplicably very important?
It's probably too much to expect philosophy to throw us a lifeline here, but even with those low standards, the response from the trans-inclusionary philosophers has been a complete fucking mess and followed a similarly strenuous pivot. For example, in the 2018 paper Real Talk on the Metaphysics of Gender, Yale philosopher Robin Dembroff argues for a more "inclusive" understanding of gender. But in doing so, Dembroff explicitly acknowledges the glaring contradiction between decrying a category as oppressively exclusionary while simultaneously petitioning to be included within it. The apparent solution on page 44 to this conundrum is rather. . . something:
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Notes -
Apologies for the late reply.
I agree that social contagion/ROGD is a real thing. The denial of this phenomenon by trans activists is one of their more ridiculous stances: they are essentially asserting that teenagers are not susceptible to fads and peer pressure and general social reinforcement, which is of course absurd. Though I want to note that, as with other mass psychogenic disorders, those with ROGD are not faking it or doing it for attention, etc.
I think there exist some people who are, for lack of a better term, "really" trans. They experience intense dysphoria which is alleviated by transitioning. These are the sorts of people who identified as trans long before it became fashionable. The Institut für Sexualwissenschaft in interwar Germany performed experimental sex reassignment surgery "in response to the ardent requests of patients". I vaguely recall reading about a trans woman who requested a legal sex change from the German emperor (before the war) and was obliged. I couldn't find any sources on that, but I did find this.
The distinction I draw here is similar to, but IMO not quite the same as, transmedicalists/truscum vs transtrenders/tucutes.
Ideally, we would identify who is really-trans and who is suffering from social contagion/ROGD. The latter would be made to wait it out and the former would be given treatment as soon as possible. Some people on this website have expressed the view that they are fine with adults doing what they want but that they object to any kind of treatment for minors. But if you accept that really-trans adults exist, then it naturally follows that really-trans minors exist too. Going through the puberty of their birth sex is extremely distressing for them and it also makes it permanently harder to pass, so we would want to provide them with treatment sooner rather than later.
Here's my practical policy proposal. There should be paediatric psychiatrists who specialize in treating trans patients, to whom any children or adolescents claiming dysphoria would be referred. They would approach the case with a degree of scepticism, acknowledging that really-trans people exist but so does ROGD, and with their experience, they should be able to tell the two apart. I think this is feasible. After all, wasn't the existence of ROGD first postulated by a psychiatrist?
My proposal is not a compromise between two sides, rather, it is the policy that maximizes everyone's welfare, derived from first principles. I think it would have been arrived at eventually by the medical profession had trans stuff not become so politicized. As is, anything may happen, though I still hope it will become the standard. In any case, I am very annoyed by the politicization and the dishonesty coming from both sides of the transgender debate.
(Aside: Why do those who disagree that really-trans people exist, those who believe everyone claiming to be trans is delusional or has an extreme fetish, etc., care about ROGD? Shouldn't they advocate treating all trans people the same – ostracizing them, forcing them to desist, or what have you? Why does the aetiology or time of onset of the perversion matter?)
So I agree that there should be some restrictions, especially relating to children and adolescents, and I fully support debate on what the optimal policy is. My comment about "metaphysical discussion" was in reference to, for example, the incessant questioning of "what is a woman?" by anti-trans activists. The question has no practical implications, it is pure posturing.
Thanks for your response and no worries about delay. My response is rather long and a bit ranty. Apologies if it seems didactic but was exploring some ideas.
I actually agree with quite a lot of your framing. In terms of treatment I view it largely as a medical issue, or more broadly, public health. I accept there is a proportion of people with gender dysphoria who very persistently want to identify as the opposite sex and that one of the options available for such people will be transitioning.
But although I agree with the open-ended treatment model you propose I am skeptical that it's possible to reliably identify 'true-trans', especially when you shift the diagnosis to younger people. I just don't think it's possible to reliably determine prior to puberty, or even in adolescence for that matter, what the life outcomes of that child are, and the ethical bar for early puberty intervention is so high (infertility and loss of sexual function) that I favour a ban (with exceptions in rare cases) on puberty blockers in the interests of public health. They are after all being used experimentally as an off label treatment. Broadly it might be possible to score for transition suitability on a risk-based assessment but there also needs to be enough history to determine that transition is the best option and so it can't be rushed in my view.
The argument to push treatment to pre-puberty would make sense if it were definitively diagnosible like heart disease but it's actually a poor idea with our current lack of understanding because it doubles down on treatment consequences while at the same time forestalling the window for diagnosis and therapeutic alternatives.
Also, the rationale to aid passing is an implicit acknowledgement that people who transition and don't pass don't actually resolve their dysphoria. I have a speculative suspicion that part of the drive towards early use of puberty blockers are reports from those who transitioned but still haven't resolved their dysphoria--"If only I had passed, then I wouldn't be dysphoric still"?
Anyway aside from this suspicion, the limited research on treatment with puberty blockers shows mixed outcomes so I don't think it's the silver bullet. I think this end of treatment under a passing rationale also segues from a medicalist to a trans-humanist paradigm.
Overall there needs to be much greater research into this issue. As you've alluded it's actually a grouping of different types under the umbrella 'trans' yet we talk as if it's all the same. As you acknowledge the transcum/ transtrender split isn't sufficient. Transvestites, transsexuals prominent in the past is a different thing than the modern gender dysphoria (as we've seen with the change in gender ratio). Transexuals as studied by Blanchard, which included autogynephiles (undeniable fetishism at play here in my view, whether you like the term) and androphilic men are a different beast to a young girl feeling gender dysphoric or a vulnerable, terminally online person imbibing trans messaging from a young age.
In addition to the medical frame and trying to identify any biological differences around gender non-conformity (being an effeminate gay male for example), we need to have two other frames to understand this issue in my view.
The first (articulated by Helen Joyce) is that trans is best thought of as a culture bound syndrome, that is, the experience of a set of internal experiences and suffering is mediated and interpreted within the current cultural settings. Gender dysphoria is at heart the description of an internal sense, but unavoidably the way we describe our experiences has cultural input. You can chart the rise and fall of many conditions (not just psychological), where what changed wasn't the underlying aetiology but the cultural setting where 'symptoms' are expressed. So hysteria was a notable condition of the past but doesn't exist now, carpal tunnel syndrome seems to have been largely a fad. It's possible that for some people the underlying cognitive complex of conditions like anorexia and ocd (to be sure longstanding behaviors over history) are being reinterpreted within the lens of gender dysphoria. It's clear that there is some overlap in these conditions for people who present at gender clinics. Similarly generalized anxiety around puberty may manifest as GD. Many different mental health indicators (self harm, depression) have shown a sharp rise for young people in recent years, particularly young women. Is it really hard to believe that this isn't some manifestation of a social unease of the moment but exhibiting in different forms due to the complex of interactive effects?
This brings us to the second frame which is really just a wider view of the previous point. This is trans as a sociogenic meme, or social contagion. This is where we are now. Culture has created an idea of trans, as a progressive, transcendent human rights issue and the cultural forces now permeate sufficiently that we may just be sending kids down the trans train without there needing to be any careful medical scrutiny. Some people may start choose trans, ie a lifestyle option. Parents may influence their child to actualise themselves as progressives
Anyway Ive blathered long enough. I only put in the more general, speculative points to show that trans may indicate a particular cultural moment, as part of a broader meaning crisis and so solutions will have to be at that level also.
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