Return to previous section (part 1): Nature Versus Nurture: What Other Factors Besides “Innate Gender Identity” Contribute to Trans Identification in Young People

D. Social Contagion

School System Employee Bay Area, CA. (2:50:44-2:50:50):

Oh my gosh, all of the sudden we are having all of these transgender kids here? Is this a fad?

Alexa Dunn, school official who teaches gender fluidity to children:


Gender is very fluid now,” said Dunn. “When we were growing up, it wasn’t as fluid.

Even with increasing awareness, 10 years ago trans identification was very rare. One of the more recent higher estimates from the Williams Institute, puts the number at .6% in the United States.

Now:

3% of Minnesota teenagers identify as transgender
2% of students in a CDC study identify as transgender

The number of adults and young people identifying as transgender is definitely increasing. Referrals at youth gender clinics are going up drastically, as the below graphs demonstrate. Many affirmative model advocates view these increases as healthy and positive (see here and here). Others view what is happening as a socially contagious body dysmorphia, similar to what happened with the spread of bulimia. Whichever viewpoint someone holds, or if they think it is a combination of both, people are declaring trans identities because they are hearing more about trans issues. This points to a strong social influence on people’s decision to transition.

Even in the 1990’s, when medical transition was available to adults and surgery techniques had improved, individuals who wanted to transition were rare. The numbers of people transitioning have increased significantly in congruence with more visibility of trans issues in the media, and the proliferation of social media. Estimates of trans identified young people vary:

“The Detransitioners: They Were Transgender, Until They Weren't,” provides a specific example of the reality that there is a huge increase of trans identified children.

Jesse, a 16-year-old in Portland who prefers the pronoun "they," told me that five kids in their eighth-grade class came out as trans that year.

Transgenderism used to be considered very rare, but there are increasing numbers of stories about parents with not one but two transgender children (here and here and here). There is even an example of an entire family coming out as trans. The trans parents have two children who have already transitioned.

Harrott's son, 11-year-old Mason, was assigned female gender at birth and is a transgender boy. He has dark brown hair, shaved up on the sides that falls slight over his eyes if he's not careful to keep it swept back.

Harrott's daughter, Joshua, age 13, was assigned male gender at birth and is a transgender girl. She has sandy-brown hair that falls just to her shoulders as she sits in her wheelchair.

'I think I was only, like 6 or 7,' Joshua said, of when she knew she was trans. 

The statistical likelihood of an entire family being trans, without some environmental influence or social contagion, seems extremely unlikely. 

There has been almost no interest (as of early 2019) expressed among the mental health and medical community, to reflect on these huge increases in trans identified youth. The mental health community in the West, appears content to validate the increasing numbers of youth for medical transition, and interpret it as young people being allowed to be their “true selves” in a more trans accepting environment. Many mental health professionals, and even universities, appear motivated to bury information if not transition-positive (see here and here). Some individuals in Britain have been an exception. Government officials have called for a review to explain why there are so many more youth who are dysphoric and seeking medical treatment. In addition, 5 clinicians have resigned form the Tavistock clinic because they fear what they are doing is unethical and that children are being medically over-treated..

The numbers of bisexual identified young people are going up in a more LGBT accepting environment. Some of the increase in both trans (not all trans identified youth are seeking medical treatment) and bisexual identities, may be due to a youth culture that prizes being a member of an oppressed minority group. This carries social cachet in an intense identity politics environment. However, one could consider the lack of expressed concern, and lack of intellectual curiosity among the top professional organizations (such as the APA or the AAP), as odd. Medical transition has permanent effects, may sterilize the person, has a serious impact on a youth’s life, and possibly their health. Large portions of the mental health and medical community appear very comfortable with the idea that social acceptance and increased visibility are what’s driving this trend. There are also many mental health professionals and doctors who are extremely alarmed by these increases. Many are afraid to speak out in a heavily politicized environment, since the tactics of activists may even be considered abusive.

Another commentator also expresses wonder at this seeming lack of any concern or calls for more research. They wonder if all of these young people are best served by hormones and surgery. 

Imagine a pathology or pathway that involved sterilization, lifelong medicalization, and surgical removal of functioning, healthy body parts of young adults increasing from 10 patients a year to 1600, or from 40 patients a year to 6400. I would argue that even the current rise (20x) virtually demands a social-contagion explanation, let alone a 160-fold one. A social contagion explanation is the result of an adherence to the “desistence-myth” theory without arguing for extreme gate-keeping.

Is the explosion in gender dysphoria, whose increase is promulgated by media & social media, following a pattern of other socially contagious mental illnesses? 

ftm_transition_increase_new_zealand.jpg

What is interesting about these graphs is that medical transition has been available to dysphoric people for decades. It became fairly socially acceptable in the gay and lesbian community in the nineties, when more same-sex attracted individuals sought medical treatment. The numbers of people who have transitioned, increased somewhat from the nineties through the early 2000’s. This was likely due to people in LGBT communities observing others transitioning. The big changes in numbers, coincide with the increase in social media use, as well as the increase in media attention on trans issues. This is especially apparent with the rise of smartphones. The rise in numbers also coincide with a media focus on trans issues. Trans issues began getting more attention, after same-sex marriage was legalized by the Supreme Court of the United States. It was viewed as the next big civil rights movement.

graphs created from  Aitken 2015 , and  4thwavenow.now

graphs created from Aitken 2015, and 4thwavenow.now

Gender dysphoria is often described as a life-threatening condition, where drastic body modifications are said to be “medically necessary.” So where were all of the trans people desperate for medical attention, prior to the large increases in media attention and communication? Organizations such as PFLAG, were not reporting high rates of dysphoric children that needed immediate medical attention. Were there a major issue, PFLAG, as an organization set up for supportive parents, would’ve had something to report, since they would’ve served the highest number of gender nonconforming same-sex attracted youth. 

It would be difficult to argue that “innate gender identity” is the only important factor, and that it drives people to suicide, if they aren’t able to medically transition. One could argue that this is all fueled by social tolerance, and it’s allowing people to be their “true selves,” which would be a good thing. That explanation may be satisfactory, if there weren’t multiple studies that show mental health, even in these younger populations, appears to remain poor, post transition. Only a control studywould answer if these increases are a good thing for all involved—A study that compares the quality of life, of these increasing populations of trans individuals, to that of a group in a similar culture, not offered medical transition.

Some mental/medical health professionals, parents, detransitioners, teachers, and LGBT people are expressing worry that there is an unhealthy social contagion factor fueling the huge rise in gender dysphoria beyond an increase in social acceptance. The social tolerance argument is valid. An increase of social tolerance has allowed many more people to come out as homosexual or bisexual and is certainly a factor in more trans people coming out. But there are major distinctions between these movements. The increase of trans identified people…

1) is causing more people to feel the need to use hormones and surgeries with health risks and monetary costs to the individual and society

2) is an identity dependent on modern medical technology 

3) is a movement that is reaching out to school children in order to affirm a path towards permanent medicalization of that identity 

4) requires that society alter their view of reality and change their language to accommodate a plethora of new genders and the concept that biological sex is based on self-perception. 

These reasons are also why it isn’t necessary to describe homosexuality or bisexuality as a “mental illness” and why it is not in the DSM. The term is appropriate for transgenderism, not because of gender nonconformity or even identifying with the opposite sex. It is because of a dependence on drugs, surgeries, and others perceptions of reality to feel ok. And in the interest of the safety of all gender nonconforming young people, for researchers, and society in general, it is essential to understand exactly why so many more people are gender dysphoric than 20 years ago when medical transition was an option, fairly acceptable in LGBT circles, but was not nearly as popular a choice.

Parents and people from many backgrounds are wondering in gender dysphoria is “socially contagious” for some individuals, as there is such a large recent rise in trans identification. Many other mental health and body dysmorphia issues appear to be socially, peer, and culturally influenced? In the section below and and in regards specifically to females here, we cover many mental health issues and body perception issues that have social contagion properties. It’s logical to consider these factors in GD. 

From a review study on gender dysphoria, a researcher states, 

Some informants wondered in what way the increasing media attention affects the way gender-variant behavior is perceived by the child or adolescent with GD and by the society he or she lives in. They speculated that television shows and information on the Internet may have a negative effect and, for example, lead to medicalization of gender-variant behavior. “They [adolescents] are living in their rooms, on the Internet during night-time, and thinking about this [gender dysphoria]. Then they come to the clinic and they are convinced that this [gender dysphoria] explains all their problems and now they have to be made a boy. I think these kinds of adolescents also take the idea from the media. But of course you cannot prevent this in the current area of free information spreading.”

This article, “An epidemic of transgender children is Safe Schools’ legacy” discusses the rise in children experiencing gender dysphoria post school trainings on gender identity.

One consequence has been an epidemic in “transgender” children presenting to medical clinics since the advent of Safe Schools in June 2014.

Referrals for gender services to The Children’s Hospital at Westmead, have tripled. Melbourne Royal Children’s Hospital had 250 children last year presenting with “gender dysphoria”, distress experienced because you feel you were born the wrong sex. The NSW Education Department reports a “spike” in transgender students, including a four-year old in kindergarten this year “who has identified as transgender”.

Official statistics are tightly held but, anecdotally: one public school in Sydney’s eastern suburbs has five transgender children, according to the relative of a student; a regional NSW government Safe School had five transgender students at the start of last year, according to a former teacher; a Safe School in outer Sydney had 5 or 6 “transgender” children last year in Year 8, all girls, according to a concerned teacher. “Safe Schools definitely had something to do with all this,” he says. “We are losing this fight… very badly”.

Some gender dysphoria experts are worried that social contagion of psychological issues fueled by media are fomenting more gender dysphoria in young people. Polly Carmichael, had this to say when asked about the influences of social media and “transtrending” that include intense rules around what you can think, what words you should use, and how you should ask and dress. 

 I think there are lots of reasons for the rise but that is definitely a concern that’s been talked about by some people. There’s a group called Transgendertrend and that started because there were a group of mothers who had kids with a diagnosis of Asperger’s, and they feel very concerned that their children are getting caught up in something…I have been so shocked by some of the things that are swirling around the internet, that young people have access to. There are numerous groups on Reddit and Tumblr that many of the young people who are attending our service are going onto…maybe it’s also the dissing of expertise in a way. So, there is a feeling that this is about who I’m, so what does anyone else know. It’s a very odd situation in some ways. And without a doubt you know there are some young people who are finding a community, friends, and all sorts of things through joining a group who have an interest around gender. And I think for some of those we would be very foolish not to acknowledge that it is probably the case that they are caught up in something rather than it being an expression of something that has arisen from within. So that there is a lot of concern. (30:55-32-29)

Dianna Kenny, professor of psychology at the University of Sydney, believes there is an unhealthy social contagion to increases in trans identification, going so far as to call her paper, “Transgender hysteria.”

What can possibly account for these alarming increases in transgenderism and other categories of gender? Here are some possible explanations:

1. 1.Social contagion and groupthink

 Contagion is a biological concept originating in the field of epidemiology. It describes the pattern of dissemination across networks of a disease, allowing patterns and causes of contagion to be identified and tracked. The concept has been borrowed by the social sciences to understand fads, politics, financial behaviour, and the popularity of new theories. A related concept is groupthink. Groupthink, a term coined by social psychologist Irving Janis (1972), is an extreme form of conformity in which people are prepared to keep the peace at all costs. It tends to occur more in homogenous groups, when a powerful and charismatic group leader is insistent on the preferred course of action, when the group is under severe stress, where significant moral dilemmas are part of the decision matrix and where objective outside experts are not called upon. The consequences of group think include the illusion of invulnerability, collective rationalization, stereotyping of out-groups, self-censorship, belief in the inherent morality of the group, poor information search, incomplete survey of alternatives, failure to appraise the risks of the preferred solution, selective information processing, and conflation of ethics and expedience (Kenny, 2015; Turner & Pratkanis, 1998).

Transgenderism is primarily a sociocultural and political phenomenon, not a psychological or medical phenomenon, that has been fuelled by both social contagion and groupthink social processes. You will observe all the features described above in the conduct of transgender advocacy individuals and groups.

Thirdwaytrans is a detransitioned male and psychology student. He has this to say:

I definitely think that there are benefits to having more social acceptance because a lot of the issues to do with being trans have to do with lack of social acceptance and all of the stigma. That will help trans people to live better lives but at the same time I think there’s also some elements of social contagion. People who would have not transitioned in other times but in this time consider it, are probably the ones who maybe have better ways to deal with their issues and so I think there’s definitely a problem going on. I think it’s a problem with therapists that rubber-stamp people’s transitions. For example, seeing them once and approving them for hormones which I think is pretty bad practice. Especially because I have training as a therapist. I have a master’s degree in psychology and I am now in a PhD program in clinical psychology. I worked in three different clinics seeing a lot of clients including trans clients.

The above examples do not look that different to some other historical examples.

This article discusses socially contagious “conversion disorder” and mass hysterias stating,

For an episode of mass hysteria to begin, all that is necessary is troubled times in the culture, a shared set of beliefs and a final, fearful, anxiety-provoking trigger to set the phenomenon into motion…

The phenomena of conversion disorder and mass hysteria have likely been around since the beginning of human history. Though we have advanced as a species, the thin veneers of modern science, technology and instantaneous communications have not altered the underlying nature of the human mind. Episodes of conversion disorder and mass hysteria will almost certainly continue to erupt in our country and around the world, and they will increase in frequency when times are trying. They need to be addressed with sensitivity, understanding and authority, and not by allowing fanciful notions to proliferate.

There is a known pattern of increasing and decreasing diagnoses of multiple personality disorder, now called dissociative identity disorder. Some mental health professionals do not even believe it is a true disorder but sporadically presents itself as a fad due to societal contagion and/or suggestibility due to the influence of therapists promoting it. The below quote is from a Psychology Today article. 

Multiple Personality Disorder has always been controversial and contagious. We are lucky that MPD is now in one of its quiescent phases, but it will almost certainly make a comeback before very long. Recurrent false epidemics have occurred several different times during the last century. The trigger is usually either the widespread copy-catting of a popular movie or book, or the fevered preachings of a charismatic MPD guru, or both

There is actually more trans identified people who also claim to have multiple personalities. They congregate in social media groups. This subject is also discussed here.

Recently there has been more awareness around body integrity disorder. Some of these individuals call themselves “transabled.” There is apparently an increase of people who want to amputate their limbs, blind themselves, or intentionally disable themselves in some other way. While people may have had these feelings in the past, greater awareness may be fueling this type of body dysmorphia and/or an obsession to seek surgery. In The Atlantic, Carl Elliott ponders whether more people are just comfortable “coming out” as desiring limb amputation or blindness, or if the condition is socially contagious. Can it be acquired (or at least worsened) by drawing attention to it. 

I am simplifying a very complex and subtle argument, but the basic idea should be clear. By regarding a phenomenon as a psychiatric diagnosis—treating it, reifying it in psychiatric diagnostic manuals, developing instruments to measure it, inventing scales to rate its severity, establishing ways to reimburse the costs of its treatment, encouraging pharmaceutical companies to search for effective drugs, directing patients to support groups, writing about possible causes in journals—psychiatrists may be unwittingly colluding with broader cultural forces to contribute to the spread of a mental disorder.

Here is an especially strange example of a socially contagious panic,

Given the right conditions, mass hysteria can happen in any culture. One of the most peculiar outbreaks of conversion disorder and mass hysteria occurred on the island of Singapore in 1967. After an outbreak of swine fever, Chinese men on the island began to flood into Singapore’s hospitals with the terrifying fear that their penises were shrinking. The belief was that if the penis withdrew all the way up into their abdomen, they would die. Nearly 500 men and a handful of women fell victim to the fear. They rushed terror-stricken to Singapore’s emergency rooms, penises in hand or tied down with string, begging for help. This was an epidemic of the culture-bound illness known as koro.

Charles Mackay, a Scottish journalist recounted multiple mass hysterias, mass delusions and other social contagions in Memoirs of Extraordinary Popular Delusions: The Madness of Crowds, published in 1841. These included financial bubbles, alchemy crazes, astrology fads, and the Crusades. The witch trials in the United States and Europe are particularly poignant examples of mental illness and hysteria and suggestibility and its effect on the human psyche. Witch hysteria incidents in Europe and the United States killed tens of thousands of people and spanned several hundred years,

A passion of tears seized upon the multitude; men, women, and children began to weep and sob, and all promised to divulge what they had heard or knew. In this frame of mind they were dismissed to their homes. On the following day they were again called together, when the depositions of several persons were taken publicly before them all. The result was that seventy persons including fifteen children were taken into custody.

In New England, about the same time, the colonists were scared by similar stories of the antics of the devil. All at once a fear seized upon the multitude, and supposed to criminals were arrested day after day in such numbers, that the prisons were found too small to contain them… All at once, the colonists were convinced of their error. The judges put a stop to the prosecution, even of those who had confessed their guilt. The latter were no sooner at liberty and they retracted all they had said, and the greater number hardly remembered the avowals which agony had extorted from them. Eight persons, who had been tried and condemned, we’re set free; and gradually girls ceased to have fits and to talk of persecutions of the devil. The judge who had condemn the judge you had condemned the first criminal executed on this charge, was so smitten with sorrow and humiliation at his folly, that he set apart the anniversary of that solemn day as one of solemn penitence and fasting.

Other examples of people’s vulnerabilities to suggestibility and social contagion can be found in this Atlantic articleon mass delusions and mass hysterias. A sociologist who is an expert in this area discusses several cases in the past. He provides a case of unusual behavior at a college,

“Eerie and remarkable.”Those are the words that Robert Bartholomew used to describe this past winter’s outbreak of mass hysteria in Danvers, Massachusetts, a town also known as “Old Salem” and “Salem Village… 

About two dozen teenagers at the Essex Agricultural and Technical School began having “mysterious” hiccups and vocal tics.

“The Massachusetts State Health Department refuses to say publicly,” Bartholomew wrote in an email in late August, “but I have heard from some of the parents privately who say that the symptoms are still persisting.

Robert Bartholomew describes one way phenomenon like this can unfold.

It starts with conversion disorder, when psychological stressors, such as trauma or anxiety, manifest in physical symptoms. The conversion disorder becomes “contagious” due to a phenomenon called mass psychogenic illness (MPI), historically known as “mass hysteria,” in which exposure to cases of conversion disorder cause other people—who unconsciously believe they've been exposed to the same harmful toxin—to experience the same symptoms.

There was another socially contagious mental illness that began in the late middle ages and lasted a couple of hundred years called “the glass delusion.”

The "glass delusion" is an extraordinary psychiatric phenomenon in which people believe themselves to be made of glass and thus liable to shatter. It peaked centuries ago but there are still isolated cases today, writes Victoria Shepherd.

Lameijn's research while director of the Endegeest Psychiatric Hospital in Leiden had led him to lost cases recorded after the 1830s. A lecture of 1883 from the archives in a Edinburgh mental hospital cited the symptoms of 300 female patients, one of whom thought her legs were made of glass.

There are reasons why someone with mental illness in the Middle Ages - or indeed the 17th Century - might manifest glass delusion. That was a time when clear glass was a new material on the scene, seen as magical, alchemical even.

The article also states that later in the 19thcentury when cement became a new material, a “cement delusion” appeared.

Also commenting on “the glass delusions” this author writes, “Do mental illnesses have certain eras? When we look at history, it seems like they do… It wasn't just known (the glass delusion), it was famous… And then it stopped.

That article also references another mental illness outbreak in the middle ages called “dancing plague”, where people would dance for days until they dropped from exhaustion, even dying in some cases.

These events seem to happen periodically throughout history and can manifest in actual physical symptoms.

Doctors have recorded cases for hundreds of years and fresh incidents crop up around the world most weeks. “This is incredibly common and happens to completely normal people,” says Simon Wessely at the institute of psychiatry, at King’s College London, who wrote his first paper on the subject in 1987. Gatherings on hot days of people who know each other well – marching bands, cheerleaders, school groups – are particularly prone…

Not all episodes of MPI are benign and easily resolved. Complex cases occur when stress builds up and becomes chronic in a population. In these instances, the effects can be explosive. In regions where people live in fear of being gassed, or bombed with nerve agents, or struck down by witchcraft, mass psychogenic events can affect hundreds, even thousands of people at a time. They can suffer muscular tics, twitching or shaking for weeks and months.

Moral panics are also socially contagious and can intersect with false memories of Satanic ritual abuse and other recovered memories that resulted in wide spread accusations of sexual abuse even of one’s own innocent parents (in most cases, fathers). This was often fueled by therapists themselves

Katie Herzog wrote in The Stranger:

All over the country, and then the world, people reported stories of just-recalled abuse. Some said they were kidnapped, tortured, and raped by cult members who stole into their childhood bedrooms at night and whisked them away to secret locations. Others claimed their parents and teachers were involved. In one case, documented in the recently published memoir Now I Can See the Moon: A Story of a Social Panic, False Memories and a Life Cut Short by Alice Tallmadge, Tallmadge’s niece—a troubled teenage girl also named Michelle from Logan, Utah—claimed she had been raped, impregnated, given birth, and forced to eat her own child. A counselor at the Utah State Hospital where Michelle was a patient believed that a satanic cult was clandestinely operating throughout the country, and that Michelle had developed multiple personality disorder as a result of her trauma. The counselor helped Michelle access her “alters,” or other personalities, through hypnosis. Increasingly tortured by the memories of her abuse, Michelle killed herself. Afterward, her mother, who believed her daughter entirely, began to think that it wasn’t suicide at all—the cult finally got to her.

There are many forces to blame for the recovered memory and ritual abuse craze: therapists who encouraged their clients’ delusions, police and prosecutors who relied on recovered memories rather than hard evidence, religious groups that were all too eager to see Satan’s work above ground, and the media, which pushed these fantastic narratives into the public eye.

While not all media coverage of satanic ritual abuse and recovered memories was blindly accepting, much of it was, according Tallmadge. "In that era, journalism helped the panic to spread," she says. “Journalists initially abandoned objectivity and wrote as if the accusations—particularly of grievous child abuse in daycare centers—were based on truth, and they weren’t.” 

Body dysmorphias are socially contagious. This can include anorexiabulimiamuscle dysphoria, and desire for cosmetic surgery.

The below quote ties much of this (seeking cosmetic surgery in this case) to media,

They are so popular, young people are now seeking the help of cosmetic surgeons to make them look like their favorite filters.

Boston University’s Dr. Neelam Vashi told FOX Business’ “Mornings with Mara” on Thursday that a new sensation called “Snapchat dysmorphia” is occurring where patients are “seeking out cosmetic procedures to not only improve their look in selfies, but also to look like filtered and altered versions of themselves with perfect hair and unblemished skin, smaller noses, fuller lips, bigger eyes.”

According to a recent study by the JAMA Network, filtered images are leading some people to body dysmorphic disorder, where they might feel the need to take extreme measures to change their looks.

The desire to self-mutilate is also socially contagious:

While it seems that self-harm has always been an issue, its presentation as something that affects young people is a fairly recent development. Perhaps 90s goth and grunge culture created a sheen of "cool" around self-mutilation, but that doesn't seem to account for the most recent reports of a sharp rise in cases of self-harm among teenagers.

There is a well-established connection between social contagion and suicide, particularly in young people. This is also why it is important not to push suicide contagion when reporting on transgender youth issues, which happens a lot (link XIV)). Suicide contagion is also called “the Werther effect,” because there was a series of suicides following the popularity of The Sorrows of Young Werther, by Goethe, which caused the book to be banned in some places. There has been a recent suicide cluster happening to teenagers and young adults in the Silicone Valley area.

As a result of the reality of suicide contagion, organizations such as Samaratans.org and Reportingsuicide.org publish guidelines in reporting suicide to reduce copycat cat cases that can cluster around these events.

Suicide is a public health issue. Media and online coverage of suicide should be informed by using best practices. Some suicide deaths may be newsworthy. However, the way media cover suicide can influence behavior negatively by contributing to contagion, or positively by encouraging help-seeking.

Other evidence shows negative rumination can be socially contagious. Gender dysphoria can almost be viewed as a negative rumination issue, as there is nothing wrong with the person’s physical body, or anything wrong with living as a feminine male or masculine female.

“Co-Rumination Mediates Contagion of Internalizing Symptoms within Youths’ Friendships”

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Demographics of gay, lesbian, bisexual youth & youth with GD have changed, more homosexuals, & bisexual & heterosexual females, are identifying as trans

Some youth who likely would have identified as lesbian, gay, or bisexual appear to be adopting transgender identities. LGBT youth support groups that used to have very few trans youth in some cases have a majority of trans youth now. This is only of concern because children and teens are being enthusiastically affirmed for medical treatment by many in the therapy and medical community (see here and here). And they are being affirmed immediately by school systems who insert themselves in between parents and their children to promote the child’s trans identity. Then youths can access hormone blockers, cross-sex hormones, and surgery as minors in United States.

It appears youth who lived as gays or lesbians twenty years ago are transitioning more now at very young ages. Susan Bradley is a psychiatrist with years of experience working with both gender dysphoria and autism. She believes that the culture is becoming more pro-trans than gay and this is particularly influencing lesbian youth. Many of these same-sex attracted females are also on the autism spectrum, and may be internalizing the pro-trans environment. 

There are trans support groups that don't understand people are leaping into it too quickly...don't understand the vulnerability [of these teens]...we would want them to also talk to people who are gay or lesbian.

"If you have a culture where trans has a high profile and is more respectable, wouldn't you rather be trans than an ordinary homosexual?"

Many trans activists resent the idea that trans men and trans women are “gays with internalized homophobia.” But it is worth asking why there were less trans identified homosexual youth, even until just recently, if trans identification is innate and not significantly influenced by culture. There is evidence that indicates internal and external anti-LGB feelings can fuel transition (see here and here and here). In addition, parents are reinforcing their young dysphoric children as transgender without attempts to help the youth adjust to their natal sex. It won’t be known how this may be affecting youths likely to grow up to be a gender nonconforming homosexual. A control group would be necessary for that.

The owner of an LGBT camp for youth observes: 

The biggest change was the amount of trans kids that we have," says camp founder Harry Stewart. "We've gone from just having a couple to last week, I'd say it was about 95 to 98 per cent trans.”

From a school resource pack from Transgendertrend:

I am a senior pastoral leader in a large comprehensive school. Un l 2015, we did not have a single child who identified as transgender during their me in school… Instead, children that I suspect might be LGB are most likely to come out as trans which is much more fashionable and means that they are far less likely to be victimised, as being trans carries so much power.  

Until recently the majority of people who would medically transition were homosexual males and females and autogynephilic males.

Graphics reviewing studies on desistance from this article confirm persisters in gender clinics who go on to medically transition are same sex attracted. 

It is well known that taking hormones may change someone’s sexual orientation, especially in FtMs who were often lesbian identified before they transitioned but start desire sex with men after taking high doses of testosterone. It’s also reported that some males will change to a bisexual orientation post transition. An article on Them reviews some of the studies on this topic. Many of these shifts are likely hormone prescription induced.

However, almost all teens who medically transitioned in the past had a history of childhood GD and a homosexual attraction based on natal sex. Currently, young people with other sexual orientations are transitioning at increasing amounts. This change has only been increasing since 2015 when Aitken et al. was published. Transresearchinfo.com sums up the results from a clinic in Canada:

Sexual orientation percentages have changed:

The Canadian clinic also looked at sexual orientation.
Sexual orientation of females:
-1976-2005 – 89% primarily attracted to females; 11% other
-2006-2013 – 64% primarily attracted to females; 36% other

Sexual orientation of males:
-1976-2005 – 67% primarily attracted to males, 33% other
-2006-2013 – 44% primarily attracted to males, 56% other
Other could mean primarily attracted to females, bisexual, or asexual.

To put it another way, in the past most of the teenagers would have been gay if they weren’t transgender. If they transitioned, they would live their lives as straight people.

Dr. Johanna Olson-Kennedy (Gender Odyssey, 2017) corroborates this by stating she has a significant amount of heterosexual female minors transitioning. This is a quote from a story of a youth with an unstable gender identity that she assumed would land on a “gay male” identity. 

Oh, this is going to be like among my myriad of gay trans boys, right?

This study in Finland shows higher rates of young females with non-same-sex attraction and no childhood history of gender dysphoria.

A further nine applicants (19%) had been tomboyish girls but had not questioned their gender or experienced dysphoria, and as to most of the applicants (30/47, 64%), neither the young person nor her/his parents recalled gender dysphoria or cross-gender behaviors during childhood.

Social Status & Peer Pressure

In her most recent paper promoting early social transition and medical transition for non-binary minors, Diane Ehrensaft states that there is little reason to worry that early social transitions will pressure children to go down a medical path. A potential desister child should experience no issues realigning with their natal sex after they, their parents, other children, teachers, and society has viewed and treated them as the opposite sex for some or most of the child’s formative years. This can all be easily remedied if society just adopts concepts “gender fluidity.”

Lastly, the reference in the SOC 7 to the problems of “desocial transitioning” for pubertal or postpubertal youth with an early social transition is based on the slimmest of evidence—a case study of two youths. 

Such stress is typically dependent on social stressors, in this case a social milieu, evident through- out the world, in which there is no acceptance for a child to be fluid in their gender expressions and one in which it is not understood that gender is an evolutionary process in which there may be several iterations throughout development. With that said, the more reasonable standard of care would not be to hold a child back from a social transition but instead ensure social supports for any child who may discover new aspects of their gender over time, including an alteration or shift in gender identity and expression of that identity, with no aspersion cast on their character. 

Here Johanne Olson-Kennedy (Gender Odyssey) echoes this lack of concern about social influences on young people and their trans identification. The below quote speaks to the comments she hears from the parents of her patients disturbed by the large numbers of youth’s identifying as trans in their children’s schools. 

…gender bending kids are not in distress. They are not talking about needing to go to the doctor. They are not talking about self-harm or experiencing it or practicing it. They are not talking about suicide. They are pushing the society to get rid of something that is no longer useful…Your kid is not going to be made accidentally trans by their friends. 

Is this total apathy about social influences on youth warranted? Multiple examples below demonstrate Diane Ehrensaft and Johanne Olson are wrong that the current culture and peers aren’t influencing the trans identification of some young people in unhealthy ways. This isn’t surprising given what is known about developmental psychology, and identity formation in young people, and all the other information provided in this section about influences beyond “innate gender.” This isn’t to blame people best served by transition for other people’s confusion. It just highlights peer pressure and culture do influence some people.

From “The Detransitioners: They Were Transgender, Until They Weren't”:

I really thought I was trans," Jane said. "I really believed it. One hundred percent. I was even fired from my job for coming out.

Jane now says that pressure from trans friends greatly influenced her decision to come out in the first place. She thinks it's an experience more common than people admit.

The idea that the perceived boom in the trans population is due to peer pressure or social contagion can be uncomfortable for trans people and their supporters; it's also a theory frequently pushed by the right. In reality, no one knows exactly why so many people seem to have recently come out as trans or some other form of genderqueer.

Here is a parent of a lesbian young adult who was trans identified for several years as a young person, including wanting breast amputation. This parent talks about the peer pressure her daughter felt to transition. 

penny_peer_pressure_desistance.png

This is a statement on the reality of peer pressure not only on teenagers, but on parents to socially and medically transition their children. 

People do not understand how hellish this is for parents. I used to put on a happy face and smile, faking “support” when I was dying inside. I didn’t want to”kill” my daughter by denying her “true gender.” The only other parents of ”trans” children I heard about were “wonderful people” who supported their trans children–not wretched mothers like myself who were heartsick and terrified that their children would mutilate their bodies and become life-long medical patients. My daughter very slowly outgrew her desire to transition. She has returned to claiming her female reality and it feels so good to call her my daughter again. I used to choke on the word ”son.” She is talking about a future in the medical field, having children with a female partner or alone, living a free powerful life without having her breasts cut off. She just turned 17 (she started talking about transitioning when she turned 13. This all lasted for about 3 years. But when she outgrew it she lost her peer group. Lots of pressure to transition once you’ve made that declaration). The longer you can postpone any medical transition the better. Encouraged her to claim her ”identity” without having to medically transition like those “true scum.

desistance_daughter_after_3_years.jpg

There is a research paper that indicates identity fusion with a trans group of friends moves a person more towards seeking medical treatment. This is a different dynamic then “group identification” which may be what is going on in the above examples, but still shows interesting social influences on decisions.

sex_reassignment_surgery_more_common_peers.jpg

The potency of the personal self and relational ties distinguish identity fusion from other forms of alignment with groups, such as “group identification”. In group identification, allegiance to the collective eclipses the personal self and relational ties to other group members. Because of this, the personal self and relational ties are not as involved in theories of group identification. Identity fusion theorizes that fusion measures should be more predictive of extreme pro-group behavior than previously proposed measures of identification. In fact, there is growing evidence of this. Measures of identity fusion are particularly powerful predictors of personally costly pro-group behaviors, including endorsement of extreme behaviors, such as fighting and dying for the group.[1][2][3][4][5][6][7][8][9][10][11]

Furthermore, whereas past researchers (Smith et al., 2005) have identified variables (e.g., gender dysphoria) that motivate transsexuals to eschew their natal sex, our findings identified a variable (identity fusion) that appears to motivate transsexuals to embrace the cross-gender sex.

Thirdwaytrans comments on the research:

I was excited to see this study, because I have been talking and thinking about identity fusion and its role in transsexualism. It was great to see that someone was studying this. Some in the reddit trans community even talk about the process of fusion, talking about how you go from “I sometimes fantasize about being a woman / have dysphoria” -> “I think I am trans” -> “I am a woman”. They talk about it as if it is inevitable, its not. That is fusion in action and can be reversed by the process of defusion.

Part of my own experience was similar to this. My dysphoria actually went away during my late teen years when I was dating and having some success socially. It came back when I went to college, and I still remember how powerful that feeling that there were other people like me when I encountered one of the early online forums for trans people. It was like “wow, people can really do this, and there are people like me!” That feeling of belonging after such long periods of not belonging was so powerful.

Also many people report that their dysphoria increases upon deciding they are trans. This process of fusion could be a mechanism for that. Identifying with the group itself can propel people along the path. Likewise taking a step back from the community can reduce dysphoria, here is an example of someone experiencing relief by taking a step back from the community.

I think it shows the importance of taking a step back and taking things slowly after the heady rush of first being exposed to the community, and reading as many different perspectives as possible.

An example of a teen who doesn’t seem to have serious dysphoria at first “fusing” or maybe “group identifying” with a trans community unfolds in this example:

Five days. That’s how fast he went from being fine with being male, to talking about testosterone killing him. Also note that he is going behind his family’s back with this.

Notice again how insanely fast it goes. From a male with some sexual fantasies to asking about sneaking hormones without parental consent or medical supervision, in one week.

There are gender dysphoria experts and doctors uneasy about these increases of trans identified youth and consider the role of social contagion and peer pressure. 

This article (Polly Charmichael quote) states:

Experts investigating why there's an increase in gender confused children believe it could be due to pressure to 'fit in'…

She explains: 'If we create a narrative which is it is the end of the world if you can't fully be seen to be a particular gender, or if there are things that don't quite fit, I wonder if that is the right sort of message we are giving.

How far are the physical changes one seeks motivated more around feeling that you fit in and are accepted by others?

A trans woman in the Bay area, in the United States worries that trans identities are actually becoming socially popular.

The controversy — whether gender dysphoria is permanent or ephemeral — has occasionally made its way into the UCSF clinic, with clinical psychologist Erica Anderson — herself a transgender woman — sometimes playing devil’s advocate. ‘I think a fair number of kids are getting into it because it’s trendy,’said Anderson, who was married for 30 years and fathered two children before transitioning seven years ago. …’I’m often the naysayer at our meetings. I’m not sure it’s always really trans. I think in our haste to be supportive, we’re missing that element. Kids are all about being accepted by their peers. It’s trendy for professionals, too.’

In an article in The Atlantic, Laura Edwards, an early promoter of the affirmative model, now seems concerned (along with an educator) about peer group and social contagion aspects of gender dysphoria.

But some anecdotal evidence suggests that social forces can play a role in a young person’s gender questioning. “I’ve been seeing this more frequently,” Laura Edwards-Leeper wrote in an email. Her young clients talk openly about peer influence, saying things like Oh, Steve is really trans, but Rachel is just doing it for attention. Scott Padberg did exactly this when we met for lunch: He said there are kids in his school who claim to be trans but who he believes are not. “They all flaunt it around, like: ‘I’m trans, I’m trans, I’m trans,’” he said. “They post it on social media.”

Given that humans are social creatures and that young people are in a search for their own identities, it’s important to look at how this may influence a youth to identify as trans in this current cultural climate. In the Western world, currently trans identity carries social status and self-righteous indignation in its activism. Being associated with certain oppressed groups can be intoxicating to young people. Johnathan Haidt, an academic psychologist, researchers the psychology behind this. Many trans and non-trans people believe a lot of young people are identifying as trans for social capitol in an environment where it is not “cool” to be a straight white man in general.

One expert in gender dysphoria in young people has validated this concern. This observation is from Australia,

MANY children and adolescents are identifying as transgender because they are confused about sexuality or think it will make them “different”.

He said he had seen a lot of adolescents “trying out being transgender” to stand out.

“One said to me, ‘Dr Steve ... I want to be transgender, it’s the new black’,” he said.

This appears to be an example related to social identity theory and other issues relating to self-esteem, the desire to be different, and the desire to belong. For anyone observing youth culture in the current climate, it is obvious that many young people want to be anything other than “white, cis, and heteronormative.” This is very apparent on social media sites like Tumblr where many trans identified minors congregate. For some young people, there is social status associated with being “queer.” For example, young people with same-sex attractions that appear to be quite weak or even non-existent are identifying as bisexual. 

A young woman who apparently doesn’t enjoy sex with women still identifies as bisexual.

But what 18-year-old Shannon isn’t as clear about is whether she actually enjoyed the experience. ‘It was disappointing because I think my feelings towards women are romantic, rather than sexual,’ she says. ‘But I am still attracted to both sexes and would describe myself as bi.’

As confusing as this might sound to some — and at times when discussing her sexuality Shannon herself sounds confused — she is far from alone. According to recent figures from the Office for National Statistics, the number of British people defining themselves as bisexual has risen 45 per cent in just three years.

This alleged increase is most notable in the young — for the first time, more 16 to 24-year-olds describe themselves as bisexual than those who say they are gay or lesbian combined. A survey by YouGov last year found that half of young people declared themselves as something other than 100 per cent heterosexual. 

So what has sparked this staggering shift in the sexual tastes of our younger generation? Can half of all young people really be sexually fluid? Or are they simply labelling themselves bisexual in order to fit in with what is undoubtedly a fashionable trend?

But “bi” or “pansexual” identity, unlike gender identity exploration, do not involve permanently altering oneself with hormones and surgery. And it’s worth asking the question whether a dysphoric person can be influenced by social status and peer pressure to seek transition.

A blogger from knowyourmeme.com points to a trendy, politicized “anti-cis” online culture.

Additionally, in certain social justice blogging circles, “cis” has been used as a negative slur [9] towards those who question or dislike the choices of people who identify with non-standard gender practices.

And a commentator on a skeptic believes trans is trendy, an opinion held by other people, including trans people

Transgender is the new Goth

Hey kids, need a new way to freak out your parents now that the Goth thing is over?

White, privileged, with no way to feel persecuted

Do we have just the thing for you! It's called Transgender! What was once a catchall for people who express cross-gender characteristics whether by choice or driven by innate compulsion can be co-opted by you. Now just dye your hair like a clown, get a few piercings, and be a protected minority! 

"I want to be the minority" -Green Day

Apply at Tumblr.com

A quote from this study on a rapid onset presentation of GD in teens corroborates that trans youth culture may at times express disgust with “cis” and non-LGBT people or even “cis” gay people.

The groups targeted for mocking by the friend groups are often heterosexual (straight) people and non-transgender people (called “cis” or “cisgender”). Sometimes animosity was also directed towards males, white people, gay and lesbian (non-transgender) people, aromantic and asexual people, and “terfs”. One participant explained, “They are constantly putting down straight, white people for being privileged, dumb and boring.” Another participant elaborated, “In general, cis-gendered people are considered evil and unsupportive, regardless of their actual views on the topic. To be heterosexual, comfortable with the gender you were assigned at birth, and non-minority places you in the ‘most evil’ of categories with this group of friends. Statement of opinions by the evil cis-gendered population are consider phobic and discriminatory and are generally discounted as unenlightened.”

It seems reasonable to ask if this may be attracting even a few individuals attracted to other rebellious groups of youth in the past.

Peer pressure can also apparently influence young homosexual effeminate males to transition. Conservative Youtuber and trans woman Blaire White (at 6:13), in a video titled “DE-TRANSITIONING. REGRET & GOING BACK” describes a young adult who seemed very enthusiastic about transitioning but ended up detransitioning. White is opposed to medicalizing children and cautions all young people to be very sure, take time, and seek proper therapy.

“And I was so shocked by that so obviously I asked him why the cold feet, you seemed so sure, this was something that you really needed and wanted to do.. And he basically said that he got up in sort of like the glamorous side of it. Watching trans celebrities on Youtubers, and looking at me and my transition thinking that it must be easy, it must be glamorous, it must be fun. Uuumm, that is the absolute wrong mindset. And so she was now detransitioning, like the other person dealing with breast growth and erectile dysfunction. Word of caution, don’t play with your life, don’t play with your body, don’t play with your future. 

We also discuss here and here the devaluing of an intact, non-medicalized body, and the social pressure on Trevor Moran to transition. It is interesting to note that in the current culture among young people, radical body modification, long-term hormone use, and dangerous genital surgeries are often not viewed as a big decision. It is even encouraged and celebrated. 

This historical account of Castrati is obviously a very different situation, as it involved the involuntary castration of young males. But there is a parallel in the type of fetishization Moran speaks of in his video.

Long live the knife, the blessed knife!” screamed ecstatic female fans at opera houses.

 And Moran in tears (4:43-4:55):

I get tons of comments on my Instagram and they’re just like, “Like yes you look so great as a girl like “Oh my god transition transition. “Go transgender like you’d ***ing kill it.”As if it’s like a ****ing sport.

Journalist Jessie Singal summarizes the situation well with trans youth who will maintain a stable identity and youth who may be socially influenced and endangering themselves.

It’s imperative to remember that Delta’s is a kind of story that can happen only in a place where trans people are accepted—and where parents, even skeptical ones like Jenny, are open-minded enough to take their kid to a clinician like Edwards-Leeper. In vast swaths of the United States, kids coming out as trans are much more likely to be met with hostility than with enhanced social status or recognition, and their parents are more likely to lack the willingness—or the resources—to find them care. But to deny the possibility of a connection between social influences and gender-identity exploration among adolescents would require ignoring a lot of what we know about the developing teenage brain—which is more susceptible to peer influence, more impulsive, and less adept at weighing long-term outcomes and consequences than fully developed adult brains—as well as individual stories like Delta’s.

Can porn use or anime fuel gender dysphoria?

Since there has been a recent proliferation of both cross-dressing males (sometimes who ID as non-binary) and heterosexual MtFs, a few MtFs themselves has posited that internet porn use may make a male with autogynephilic tendencies more dysphoric. These males can fall on a continuum. It can be a cross-dressing interest or serious GD.

The best-known examples of erotic target identity inversions occur in men who are sexually attracted to women and who are also sexually aroused by the idea of impersonating or becoming women; these paraphilic interests manifest as transvestic fetishism and as one type of male-to-female transsexualism.

To determine the effect porn use has on the increasing numbers of female identified males (up to 3% of the male population may be on an autogynephilic spectrum) is having on these increases numbers versus just general media attention and visibility would require more study. But trans activist Amy Chu wrote a whole paper on the subject, presented at a Columbia University conference title, “Did sissy porn make me trans.”(Warning; sexually graphic content in link)

Since this was a very small niche back then (I imagine there’s a large catalog for every fetish out there now), I absorbed whatever material I could find, and within a few months, this led me to the site of a woman who specialized in hypnotizing men and making them think they were women. Although the latter part just seemed gross, as I had no interest in being a woman, something about the power exchange appealed to me, even though it never did before. I have a theory that this is a pattern for frequent porn users: they may initially look for other things, but with enough exposure, they desire to be a passive sexual participant since it involves less effort on their part.

Chu is not the only one to engage in this discussion. Another example can be found here (Warning; sexually graphic content in link).

Many people who come to think of themselves as transgender, start out watching large amounts of pornography. Two of the most common types are called “sissy porn” and “forced feminization” or “forced sissification”. Some of these types of porn have “hypno” videos where the viewer is supposed to be “hypnotized” into becoming a woman. One popular site has the following text next to one of the video:

This bog post discusses gender dysphoria and anime from a feminist ideological perspective. But it is interesting to note the obsession with anime in the trans scene.

In the above section, it’s noted how there are more heterosexual females identifying as gay men. Some “gay” FtMs are heavily immersed in gay male anime on internet websites like Tumblr. Some of these cases may be autoandrophilia, the reverse of autogynephilia, even if this is rare. A discussion of that can be found in this article, “Gender Dysphoria is not One Thing.”

For the sake of completeness, we include two other kinds of gender dysphoria. We suspect that both are rare, even among persons with gender dysphoria. One of us (Blanchard) has seen cases of the first type, autohomoerotic gender dysphoria, which appears to be an erotically motivated gender dysphoria. In this case, sexually mature natal females (i.e., not biologically still children) become sexually preoccupied with the idea of becoming a gay man and interacting with other gay men.

And here is an anecdotal observation:

ftm_want_to_be_gay_men.png

Here is another thread that discusses a connection between online anime and porn imagery and gender dysphoria. These types of discussions aren’t rare in trans or LGBT online spaces.

None of this has been well studied and needs further research to prove any connection with anime and porn and trans identification.  

E. Can cultural attitudes about gender nonconformity reduce gender dysphoria?

Clearly some transgender youth are experience high levels of stress and unhappiness. Here is an example of just how serious that distress and body dysphoria can be,

The thought of touching their genitals is so abhorrent they don’t wash them and get infections.

Some youth will self-harm and seek hormones on the black market out of desperation. This is a testament to how serious GD can be for some individuals.

If there are any examples of cultures around the world where transgender youth are not experiencing the intense distress they appear to be experiencing in the West, it would require us to examine if medically transitioning youth is really“medically necessary.” The use of surgeries and hormones for treating gender dysphoria in our current western culture is increasing greatly. It is pertinent to ask how the culture influences gender nonconforming people to seek medical body modifications. 

If cultural changes towards acceptance of gender nonconforming individuals could reduce the need for drugs and surgery, that would be positive in terms of body health and social and financial cost. How would transgender youth feel if they were raised in an environment where they saw that extremely gender nonconforming males and females were represented and celebrated in the society?

Even Diane (Ehrensaft 2018), one of the most pro-early medical treatment affirmative model advocates, acknowledges cultural environments vary from country to country and may influence GD.

Let us now circle back to the statement made in the introduction that we can expect social environments to vary from country to country. 

Does this variation in “social environments” affect the need to medically transition? More individuals feel the need to medically transition now, despite the fact that these surgeries have been improved and available to the public since the 1990s and before. This is being supported, even celebrated in liberal quarters and in liberal media, by schools, and LGBT organizations. This would be an interesting question to ask Ehrensaft, who does not believe in providing any alternative ways of looking at or coping with GD, or waiting until the body matures to treat GD. 

There are some Pacific Island cultures that are actually very accepting of effeminate males. Fa'afafine culture has a rich history. 

In Samoa

…there is very seldom ridicule or displeasure towards a biologically male child who states that they are a girl.

Paul Vasey has done a lot of research on transgender and other gender nonconforming people in a multitude of cultures. He speaks to how our culture is medicalizing these individuals now.  

I would think that many of the feminine males in non-Western cultures would be transsexuals if they grew up in Western cultures.  But in their cultures, one can live as a feminine male. In the West, there is not much space for such individuals and, in any case, Western cultures view gender in a binary manner so at some point if you are a male and really feminine, you aren't perceived as really being a man (or at least a well functioning one) and there is only one other choice: woman.

In response to a question about dysphoric children self-harming do to body distress:

I have never heard of any Samoan fa'afafine or Istmo Zapotec muxe mutilating their bodies and I have interviewed many hundreds of them since 2003 in Samoa and since 2015 in the Istmo region of Oaxaca, Mexico.  In these cultures one can live has a highly feminine individual and having a male body (penis and all) is not incongruent with that, nor with a third gender identity.

Hijra castrate themselves as part of ritual religious devotion.  Their motivation is religious (and maybe partly economic...they make more money begging as castrated individuals), not necessarily body dysphoria.  So hijra body modification is probably very differently motivated than what we see among androphilic transsexuals in the West.  Gynephilic male transexuals, as I am sure you are well aware, are a different ballgame altogether.

The manner in which male androphilia (male sexual attraction to adult males) manifests varies cross-culturally. Regardless of cultural context, (pre)androphilic boys are feminine relative to (pre)gynephilic ones (i.e., those that are sexually attracted to women in adulthood).  In Euro-American cultures, feminine (pre)androphilic boys defeminize and masculinize the best that they can as they develop into adulthood.  In many non-Euro-American cultures, feminine (pre)androphilic boys grow up to be feminine adult males.  In many such cultures these feminine adult males are perceived to be neither men, nor women, but rather a third gender such as the fa'afafine of Samoa or the muxe of the Istmo Zapotec.  From a Western cultural perspective, we would categorize many of these feminine adult males as "transgender."  So, in terms of how male androphilia is publicly expressed and in terms of the identities male androphiles adopt, culture is an important determining factor. It is very important to note, however, that the vast majority of these Non-Western, feminine males do not desire any body modifications. So surgical or hormonal modification of the body is not seen as an appropriate cultural response to male femininity, even extreme forms of it.  It's also worth pointing out that in most countries outside the West, these individuals do not consider themselves women and the people around this don't believe it either.  Even if they get "sex change surgery" they remain third gender males.  They are not perceived by themselves or others as having changed their sex or their gender role.

"Samoan and Istmo Zapotec culture are among the most accepting of non-binary individuals in the world, yet they do not view medical interventions as an appropriate response to childhood gender non-conformity."

He also states in response to the current intense focus on pronouns:

There are no special pronouns used to refer to fa'afafine and muxe.

So, these cultures lack the intense rumination on pronouns that has taken over “queer” youth culture in the LGBT community now. We cover how new ideologies around trans/genderqueer identities appears to be having a negative affect on youth here with a section on pronoun usage specifically here

Detransitioned male, Thirdwaytrans, speaks to the pressure to pass as binary male or female in the West. He believes this has created a dynamic where trans people feel they must be viewed literally the opposite sex to be accepted. This may not be unhealthy and unliberating ultimately. It is definitely causing conflict within and without the LGBT community (see here and here).

I think this focus on taking gender thoughts literally is precisely what makes cross-gender roles in modern Western culture different from those of other cultures. Lots of cultures have cross-gender roles of some kind, but only in the West do we have the idea that one literally becomes the other sex, and that indeed the whole point of transition is to do just that. This also brings with it the idea of “passing”, proving your membership in the identified sex by becoming indistinguishable from natal members of that sex. This is also something that is not considered part of the gender-variant roles of other cultures.

Transition rates in populations in the United Sates may be different for different ethnic groups indicating cultural factors, not just innate biology, may affect gender transition. Demographics are those medically transitioning have changed drastically, so this may no longer be true, but in the past homosexual transsexuals (MtFs attracted to males) were over represented in black and Latino populations. Unless there is some biological reason why feminization of males in utero, or due to genetics, is more common in these populations this is because of culture. There’s so far little reason to believe trans innate biology is more common in some populations.

Professor Paul Vasey has done a lot of research on gender nonconforming people and believes that the issue of cultural influences is a very complex one. 

I am aware of studies indicating that androphilic male transsexualism is more common among the Latino and Black communities.  I don't know why.  I have no idea if this is related to ideas about masculinity.  My suspicion is that whatever is going on is a lot more complicated than that.  In any case, this suggests, once again, that culture is important in terms of whether a feminine male thinks of themselves as a transgender women and wants to transition.

This quote is from a New York Times article and is not the only one to point out there seems to be a higher number of African American and Latino homosexual transsexuals who medically transition in the United States. 

‘From prior research, we know that trans people are more likely to be from racial and ethnic minorities, particularly from Latino backgrounds,’ Jody L. Herman, a scholar of public policy at the institute, told the New York Times.

This MtF Latina believes a distaste for effeminate males can influence medical transition.

Alma is a 40-year-old Latina homosexual transsexual who got her sex change in her mid-30s — quite late for the homosexual type…

Alma has also noticed, as I have, the large number of Latina transsexuals. In Chicago, there are several bars that cater to Latina transsexuals. About 60 percent of the homosexual transsexuals and drag queens we studied were Latina or black. The proportion of nonwhite subjects in our studies of ordinary gay men is typically only about 20 percent. Alma says she thinks that Hispanic people might have more transsexual genes than other ethnic groups do. Another transsexual, remarking on the same phenomenon, attributed it to ethnic gender roles: “My culture is very macho and intolerant of female behavior in men. It is easier just to become a woman.” 

The above statement corroborates the numerous other examples of homophobia influencing gender transition in this section. A reverse effect may also be found. Pro-trans and pro-medical cultural attitudes among liberal whites may in the future result in more medically transitioned young people from that demographic. This study indicates leftist, educated, female Californians are more likely to transition their children, especially their female ones.

Until recently there were more males seeking medical transition than females. One exception was in Japan, a male dominated and anti-lesbian culture. It’s possible these factors influenced FtM versus MtF transition there.

The topic of the influence of culture on medical transition needs more research. Different rates of transition in different communities do seem to be attributable to attitudes about gender roles, masculinity, and homosexuality. If cultural factors influence medical transition, therapists, doctors, and people in the LGB community have an obligation to examine how gender nonconforming children could be over medicalized based on their environment.

F. Alternative coping strategies

The current consensus in the mental health profession is that medical treatment is the only cure for gender dysphoria. This assertion may be more accurate for those who medically transitioned in the 20thcentury, despite much social pressure not to be trans. 

In addition, there are newer psychological counseling approaches that were not really tried until recently. A wider discussion of these issues can be found in this blog post by a detransitioned MtF, who is skeptical that all mental health therapy is futile in treating GD. 

The effect of therapy on children is unknown. Dr Ken Zucker believes some children (not all) can be helped to adapt to their biological sex, thus avoiding dependence on the medical industry. He is hated by many trans activists for this position (link politicized climate). Affirmative model advocates don’t believe this should even be tried. Only a control group could determine the number of false positives the affirmative model approach will create. But it’s already proving not to be zero (link regret rates).

Cari Stella, a detransitioned woman, put together an informal survey about detransitioned females that addresses alternative coping strategies in dealing with GD: 

cari_transition_history.jpg
cari_dysphoria_management.jpg

There are a growing number of examples of desistance and detransition stories on social media. Some of these individuals have found less medically invasive ways to cope with gender dysphoria through physical activity, therapy, attitudes of body acceptance, feminism that critiques gender expectations, removing themselves from the trans community, and finding support with others in a similar situation. These alternative methods aren’t going to stop all trans people from medical transition. It merely demonstrates that dysphoria as simple, biological, and immutable is not a fact in all cases. Desistersand detransitioners may be a minority, but they are a reality. These individuals are living their lives without drugs and surgery, a measurable good.

Many desisting or detransitioned females report feminism helping them to cope with gender nonconformity. This woman who is on the autism spectrum has this to say 

Before I was trans I was confused and distressed alone. When I was trans I was confused and distressed in a group. And then I learned about gender abolition and second wave feminism. And I wasn’t confused. I realized that my initial aversion to gender as a thing and gender roles and gender roles and expectations, which I was never able to meet, wasn’t necessarily a sign that I was trans. (2:40-2:53)

Another example of feminism helping detransitioned females can be found here:

But some principles of radical feminism do resonate with Cass. Radfem ideology is about rejecting gender stereotypes, a philosophy that appeals to many detransitioned women who are reclaiming female identities. One of those is Jane, a 53-year-old woman in Southern California who lived as a trans man for nearly 20 years before discovering radfem forums online and, soon after, opting to transition back. "I really thought I was trans," Jane said. "I really believed it. One hundred percent. I was even fired from my job for coming out."

Interestingly, this article discusses a study that indicates feminist perspectives may help women with eating disorders

It concludes that the research "offers some support for the idea that focusing on broader gendered discourses – such as those relating to appetite for example – might be productive for participants in thinking about how often unquestioned (and potentially more ‘invisible’) gender inequities may shape the aetiology and maintenance of an ED [eating disorder]."

Here is another story of a male detransitioner who rediscovered his body through movement and therapy,

Over the years, Ryan tried different therapies, including yoga and massage, but the effects were always temporary. And then, a few years ago, he discovered Biodanza, a kind of ecstatic free dance created by a Chilean anthropologist in the 1960s. Biodanza required that Ryan listen to his instincts and connect physically with other people. "Gradually," he said, "my body began to thaw." He started going to therapy, and then he began experimenting with going off hormones, just to see how it felt. Soon his anxiety started to dissipate, and the fog he had felt since he was 19 began to lift. He started taking testosterone supplements and he felt, for a time, euphoric.

The euphoria wore off after a few months, but Ryan decided to continue his detransition. He'd come to the conclusion that dysphoria is normal—ordinary, even—and he'd found new ways to deal with it: movement, therapy, and accepting that he cannot control the way the world sees him. No one can.

Here is a quote from a Reddit comment of a young autogynephilic male who moved passed this phase of his life:

It took me until I was 21 to finally understand what I was doing to myself. What saved me was realizing that my depressive cycles led me to this escapism and dysmorphia, that I fueled my own dysmorphia with porn that reinforced it, building stable sexual confidence through comfortable confidence boosting hook-ups, and realizing it was a fetish built on insecurity and not an identity. Productive conversations with an amazing therapist that helped me unpack it all really cemented the progress I made. In the end I had to decide to be better. Cutting out behavior that reinforced it while building self confidence through exercise and a healthy relationship has led me to the clearest and happiest era of my life so far.

Thirdwaytrans on Jungian analysis helping him:

You might not hold much stock in Jungian psychology, and I’m not asking you to. But the techniques and ideas he parented have drastically changed a troublesome aspect of my mind that neither therapy nor meds were able to do anything with. So if you’re at your wits end with gender dysphoria or compulsive crossdreaming, consider taking your fantasies symbolically. I’m not guaranteeing that these methods will work in your case, but they have in mine, and so I feel obliged to share them here.

G. Conclusion Culture

While gender identity may be innate for some trans people the is a lot of evidence covered here that there is a grey area where mental illness, body dysmorphia, social contagion, anti-LGB attitudes, parents, and culture affect gender dysphoria. The view that affirmative model advocates have that trans people merely have a body defect that needs medical correction is an oversimplification of the issue. 

Asking questions about the environmental we are creating around raising gender nonconforming youth is necessary in insuring these young people are not being exposed to excessive drugs and surgeries that carry risks and social and financial costs. They are minors who can’t fully consent to theses consequences at young ages. Society should move towards normalizing gender atypical boys and girls as much as possible if this is shown to help the child be less body dysphoric. 

“The Myth of Persistence”:

Other co-factors in GD complexity:

From the childhood assessment, five variables were significantly associated with a composite Psycho- pathology Index (PI) at follow-up: a lower IQ, living in a non-two-parent or reconstituted family, a composite behavior problem index, and poor peer relations. 

Another quote on GD complexity: 

The intricacies of gender dysphoria:

Zucker was not available for discussion regarding how he and his clinic handled gender dysphoria but his concepts can be gleaned from his publications and statements attributed to him by his detractors. He described a Developmental, Biopsychosocial Model for treatment of gender dysphoria [45] based on the concept that gender identity was not “fixed” before birth but was “malleable” under the influences of external factors of varying strengths at varying stages of development. Biological factors would include innate chromosomal direction and the effects of antenatal hormones. Psychosocial factors would include attitudes and behaviour of siblings, parents, care-givers and other close associates. All the factors would combine to have particular relevance at varying ages. For example, a four-year-old girl might conclude she was a boy if she wore boys’ clothing and played their games, because until seven years of age gender identity may be confused by “surface expression of gender behaviour”.

 A comment criticizing oversimplifying the issue and its risks:

Dr Wren.... wondered how we can be sure of the authenticity of any young person’s choice of treatment when “some support groups and online sources widely communicate to young people their conviction that transition is essential.”

Increase of acceptance and possible negative factors for increases in medical treatment for GD: 

Dr Polly Carmichael, a Consultant Clinical Psychologist Director at Tavistock, said a key part of the treatment process is understanding why the numbers asking for a sex change are rising. 

She believes it could be down to the fact society is more accepting of transgender people today so there is no longer a fear or stigma attached to seeking help. 

Or she wonders, if, for some, it could be a misplaced sense of self, a belief that their unhappiness or ability to fit in is solely down to their gender, and if that was changed, their lives would be transformed.

 Dr Carmichael said this is something they always explore as, just with anyone undertaking plastic surgery, a change of appearance will not automatically make someone happier and more popular… 

…Polly Carmichael says: "We would be remiss if we weren't asking questions about whether some people are getting caught up in something".

A similar comment

“You might think that the experience of gender dysphoria is kind of a solution [for all their problems] that is culturally available for adolescents nowadays.[.] I think that the culture is kind of offering or allowing this idea that all problems are stemming from the gender problem. And then they stick to this fixated idea and [they] seek for assessment and we readily see that they have numerous and relatively serious psychological and developmental problems and mental health disorders.” -Psychiatrist

Words of caution from a detransitioned male and medical skeptic Jamie Shupe:

Based on my negative experiences with these hormones and anti-androgen medications, I’m of the opinion that we really need to consider the problems with these drugs before we set these transgender kids up for a lifetime of dependence on them. Because of the health effects and the treatment outcomes I’ve experienced, I’ve concluded that these children are better served by working to change society’s rigid gender norms rather than medically changing these kids to fit in. The kids are being medically “normalized.” But who gets to decide what’s normal?

While the “innate gender” argument may hold true for some individual the evidence is very strong that culture can influence a trans identification. 

Ironically, individuals are robbed of their personal identity and become anonymous members of the gender identity community—the “transgendered.” 

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