How Automatic Gender ‘Affirmation’ Hurts Girls and Women

Danish comedian Sofie Hagen, one of the founding members of The Guilty Feminist podcast, announced in 2019 that she was “non-binary,” giving as reasons that people in comedy paid a lot of attention to her sex, which felt wrong, and that wearing trousers “felt so right.” In societies that value males more, and that give opportunities to males that are not given to females, is it any surprise that women and girls would come to dis-identify with femaleness in this way, and identify more with maleness?

In a 1946 poll, a quarter of the women respondents said they wished they’d been born the opposite sex. Are we to believe that a full quarter of women were transgender then? Radical feminist Shulamith Firestone made this point in 1970 (in the section this passage comes from, she’s giving a feminist reinterpretation of Sigmund Freud):

As for the ‘penis envy,’ again it is safer to view this as a metaphor. Even when an actual preoccupation with genitals does occur, it is clear that anything that physically distinguishes the envied male will be envied. For the girl can’t really understand how it is that when she does exactly the same thing as her brother, his behaviour is approved and hers isn’t. She may or may not make a confused connection between his behaviour and the organ that differentiates him.

Firestone’s point is that what Freud called “penis envy” wasn’t literally envy of the penis, but rather envy of males’ superior social status. Simone de Beauvoir made the same point in 1949 when she said, “If the little girl feels penis envy, it is only as the symbol of privileges enjoyed by boys. The place the father holds in the family, the universal predominance of males, her own education—everything confirms her in her belief in masculine superiority.” Clara Thompson and Karen Horney made the point as early as 1939—summarized a little later by Thompson to the effect that “cultural factors can explain the tendency of women to feel inferior about their sex and their consequent tendency to envy men; that this state of affairs may well lead women to blame all their difficulties on the fact of their sex.”

Feminists have been making this point for a long time, but back then they were making it against insufferable male theorists such as Freud and Jean-Paul Sartre, not—as they must do today—against clinicians, mental-health professionals, counsellors, teachers, and all the other professionals who support the affirmation of any young girl’s claim that she is really a boy. Radical feminist Janice Raymond criticized the medicalization of what was, at her time of writing, “transsexualism” rather than “transgenderism” (the difference being whether mere self-identification, as opposed to having undergone sex reassignment surgery, was taken to be sufficient for trans status) as being an individual solution to a social problem.

Gender-critical feminists do not find it surprising that girls wouldn’t identify with their gender. On the contrary, that is exactly what a gender-critical understanding of gender predicts and explains. If all women were naturally inclined toward femininity, there wouldn’t need to be so much effort expended in policing conformity, in offering social and economic rewards for conformity and punishments for non-conformity.

Some women might get lucky, and happen to genuinely prefer what they would be pushed into even if they didn’t prefer it. But we can expect many women not to be in this position. Those women are not all transgender. Gender non-conforming women, that is, women who are not feminine in every or even any respect, are not a minority variation on the statistically normal feminine woman. Gender non-conforming women are normal.

We seem to have utterly lost sight of this basic feminist point today. Clinicians, school counsellors, mental-health providers, and other professionals are being increasingly encouraged to “affirm” the beliefs of children who claim to be the opposite gender. In Victoria, Australia, for instance, a law was recently introduced “to denounce and give statutory recognition to the serious harm caused by” the failure to “support or affirm” a person’s gender identity. But an affirmation-only approach makes it more difficult, when a female child claims to be a boy, to question them about other aspects of their life, in order to try to rule out other possible explanations than that they are transgender for why they might be thinking of themselves this way. There are high rates of mental health issues, family dysfunction, childhood sexual abuse, autism, and same-sex attraction within cohorts who identify as trans, any of which might be a better explanation of their wish to transition than that the individual is, in fact, trans.

One clinician, interviewed anonymously by Michele Moore, an honorary professor in Health and Social Care at the University of Essex, and Heather Brunskell-Evans, who was a senior research fellow at King’s College London, said:

You don’t just see one child and understand gender identity is not innate, but once you’ve seen a hundred you’ve seen ‘the Reddit kid,’ you’ve seen ‘the teenager with autism,’ ‘the one who might be gay,’ you’ve seen ‘the girl who was sexually abused and hates her body,’ or whose mother has been sexually abused and hates her body and doesn’t want the same for her child. We know that by not examining what is behind the onset of dysphoria, and going straight for ‘self-affirmation’ that the patient is transgender, we are subjugating children’s needs to an ideological position.

“The Reddit kid” here refers to the likelihood of a social contagion around identifying as transgender. In a 2018 paper, Lisa Littman introduced what she called “rapid onset gender dysphoria”—identification as trans that appears suddenly during or after puberty (rather than from a very young age), and generally after exposure to transgender-identifying peers or transgender social media content. In the friend groups reported in Littman’s study, the average number of friends in the same group who began to identify as transgender was 3.5, and about 61 percent of those adolescents and young adults who announced that they were transgender experienced increased popularity among their peers.

In the UK, there has been a 4,400 percent increase in girls being referred for transitioning treatment in 10 years, with drugs (specifically puberty blockers) being offered to children as young as 10. In the five years between 2015 and 2020, there was a 400 percent rise in referrals to the Tavistock centre in the UK, which is the country’s only public health clinic treating children with gender identity issues.

The majority are girls who identify as boys, generally without having shown signs of dysphoria in childhood. In Sweden, there’s been a 1,500 percent rise between 2008 and 2018 in the diagnosis of girls aged 13–17 years old as having gender dysphoria. This suggests we’re going to be seeing more and more “trans kids,” mostly identifying as boys. It is unlikely that these kids would have met older diagnostic criteria.

In February 2020, the well-known gay Australian writer Benjamin Law tweeted (from his account with more than 100,000 followers): “And even if there were more trans people in 2020, what would be the problem exactly? Let’s face it: so much of this conversation stems from an aversion to—and hatred of—the existence of transgender people.” This makes use of a familiar idea from the gay-rights movement, namely that when people worried about “social contagion,” or gay adults influencing children to be gay, there was no real explanation of why it should be objectionable that there are more gay people unless there’s something wrong with being gay.

But as we’ve just seen, there are a lot of different explanations for why people might wish to transition. Now imagine there’s a similar range of explanations available for why people claim to have feelings of attraction to the same sex, many of which suggest that they are not actually gay. Perhaps of all the people claiming to be gay, some of these were only bisexual, some were straight but just experimenting, some were rebelling against their parents, some were avoiding partners of the opposite sex because of past sexual abuse by people of that category, and so on. Imagine there were peer-group incentives to claim to be gay, and this was especially appealing to people who had no other marginalized identities and were sick of being accused of being “privileged.” Suppose there was a kind of social contagion where groups of kids were coming out as gay at the same time, in groups of friends, after exposure to online information about gay communities.

What’s the worst that can happen during a period of a person thinking they’re gay when they’re not? They experiment with some people of the same sex, who they will later end up ruling out as sexual or romantic partners. Is this a bad thing? It doesn’t seem so. Experimentation, sexual and otherwise, is commonplace. There’s no harm at all to affirming as gay people who are not gay. On the other hand, there is risk of serious harm in refusing to affirm such people. At worst, there is “conversion therapy,” where gay people are subject to attempts to make them straight. This has been linked to depression, suicidal ideation, suicide attempts, low self-esteem, sexual dysfunction, harm to interpersonal relationships in particular with partners and parents, alienation, loneliness, and social isolation.

Short of conversion therapy, refusal to affirm may cause a gay person to experience shame and self-loathing, to remain “in the closet” for a long period, to feel unconfident about trusting others—which can negatively impact the quality of their interpersonal relationships, and to miss out on caring romantic and sexual relationships. Ultimately, there is no reason at all to refuse to affirm claims about sexual orientation on the basis of wanting there to be fewer gays. More gays, fewer gays, it doesn’t matter. No one is harmed by being gay (except, of course, by people who don’t like gays and are willing to act on that).

But the idea doesn’t apply to trans people as straightforwardly as Law seems to assume. The potential harms of affirmation are very different when it comes to gender non-conforming kids who consider themselves trans.

First of all, they may fail to receive support for possible underlying issues of the kinds mentioned already, including autism, histories of childhood sexual abuse, mental health problems, family dysfunction, and same-sex attraction. Second of all, they may start taking harmful drugs. Kids who consider themselves trans may be prescribed puberty blockers (these do what they say, and block the onset of puberty) and later, cross-sex hormones.

In the UK, cross-sex hormones have been prescribed to kids as young as 12. Much of this medical treatment is experimental. Despite the World Professional Association for Transgender Health recommending the use of puberty blockers, there is disagreement among paediatric endocrinologists, psychologists, psychiatrists, and ethicists about whether they should be used. The UK National Health Service (NHS) website once described the effects of Gonadotropin-Releasing Hormone agonist (GnRHa) treatment as “fully reversible,” but this was changed in late May 2020 to say, “little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria,” “it is not known what the psychological effects may be,” and “it’s also not known whether hormone blockers affect the development of the teenage brain or children’s bones.”

What about the harms of refusing to affirm as trans people who are in fact trans? There is little data on this. Although legislation is being introduced in multiple countries to prevent “conversion therapy” on the basis of sexual orientation and gender identity, the legislation seems to be justified with reference to research that is disproportionately about sexual orientation.

Furthermore, refusal to affirm a gender identity is not equivalent to rejection or outright disbelief. The clinical alternative to the “gender-affirmative” model is the “watchful waiting” model, which explores with the child in therapy their other issues, and makes sure to affirm a trans identification only if and when other explanations are ruled out.

As Diane Ehrensaft—Associate Professor of Pediatrics at the University of California San Francisco (UCSF), and Director of Mental Health at the UCSF Benioff Children’s Hospital Child and Adolescent Gender Centre—explains, “Since a large majority of gender nonconforming young children seeking services at gender clinics desist in their gender dysphoria by adolescence, best practices would be to wait and see if the child persists into adolescence before making any significant changes in the child’s gender identity.” The harms of affirming kids who are not trans as trans are likely to far outweigh the harms of failing to affirm as trans kids who are trans, especially if the alternative is watchful waiting.

If being trans were just like being gay in that it didn’t impact a child’s health, then affirming everyone who considers themselves trans as trans might not be a problem. More trans people, fewer trans people, who cares. But it’s not like being gay, because it tends to involve medical interventions, invasive and painful surgeries, and uncertain long-term health impacts. Kids who consider themselves trans are at risk of being put on a conveyor belt to a lifetime of medical dependency.

And these negative outcomes are now disproportionately impacting girls. A 2017 UK government survey on 108,100 lesbian, gay, bisexual, and transgender (LGBT) or intersex individuals in the UK found 57 percent of trans respondents under the age of 35 to be non-binary, 26 percent to be transmen, and 17 percent to be transwomen. Other studies have found between two and five times more females than males identifying as non-binary. The authors note that the percentages are in line with referrals to gender-identity services, “where the majority of [UK] referrals in 2016–17 were for people assigned female at birth (1,400 of the 2,016 referrals—or 69 percent).” This reveals a generational shift in trans identification, with more girls than boys now considering themselves trans.

We also find disproportionate impacts when we look at sexual assault in trans communities. As we might have expected given what we know about the differential rates of sexual assault outside of trans communities, female people face disproportionate impacts. An Australian survey from 2018 showed that trans people experienced sexual violence at higher rates than the general public, but it was transmen and female non-binary people who experienced the highest rates, with 62 percent of those respondents answering “yes” to the question, “Have you ever been forced or frightened into doing something sexually that you did not want to do?” (Of the transwomen and male nonbinary participants, 39 percent answered “yes” to this question.) Female non-binary people were the most at risk (66 percent), followed by transmen (54 percent), then male non-binary people (44.5 percent), and finally transwomen (36 percent). Feminists who consider transmen to be men cannot consider this to be a specifically feminist issue, even though it is a rate of sexual coercion three times higher than that experienced by female people who are neither trans nor non-binary.

The UK government survey mentioned above found something similar, asking trans people about their experience of “incidents” including verbal harassment, coercive or controlling behaviour, physical harassment or violence, and sexual harassment or violence. They found that “trans men were notably more likely to have experienced an incident (58%) than trans women (40%) and non-binary respondents (47%).”

Accepting the redrawn boundaries of “woman”—and therefore the new constituency of feminism proposed by those feminists who think that gender is an identity or a performance—would therefore lead to the dismissal of significant harms at the intersection of being female and being trans-identified, as not being feminist issues. Gender-critical feminism accommodates the interests of the most vulnerable people in the trans community. Trans is a feminist issue, just not in the way that most feminists today think it is.

This essay has been adapted from the author’s newly published book, Gender-Critical Feminism.