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Psychology and gender dysphoria: Beyond queer ideology
Marino Pérez Álvarez and José Errasti
Universidad de Oviedo, Spain
ARTICLE INFO
RESUMEN
Received: June 3, 2022
Aceptado: June 20, 2022
Palabras clave
Disforia de género de comienzo
rápido
Ideología queer
Terapia armativa
Destransicionistas
Espera atenta
La disforia de género en la infancia y la adolescencia está hoy en día más bajo el domino de la ideología queer que
dentro de los conocimientos cientícos y profesionales. Este dominio de la ideología se traduce en importantes
consecuencias prácticas como la autodeterminación de la identidad de género con base en el sentimiento y la terapia
armativa de la identidad sentida como la única opción aceptable. Como resultado, quedan fuera de evaluación
los aspectos psicológicos y se emprenden transiciones fármaco-quirúrgicas que no resuelven el problema para
todos. En particular, surge el nuevo fenómeno de los arrepentidos de haber cambiado de género y destransicionistas
que quisieran volver atrás. Las profesiones sanitarias incluida la psicología, así como la psiquiatría y la pediatría,
debieran reclamar ante la disforia de género los mismos estándares cientícos y profesionales que aplican en los
demás problemas, empezando por la exploración, la evaluación, el análisis funcional, el diagnóstico, la prudencia,
la espera atenta, en vez de asumir sin más la terapia armativa.
Papeles del Psicólogo
Psychologist Papers
Papeles del Psicólogo (2022), 43(3), 185-199
ABSTRACT
Gender dysphoria in childhood and adolescence is currently more under the domain of queer ideology than within
scientic and professional knowledge. This dominance of ideology translates into important practical consequences
such as self-determination of gender identity based on sentiment and afrmative therapy of felt identity as the only
acceptable option. As a result, psychological aspects are left out of evaluation, and pharmaco-surgical transitions
are undertaken that do not solve the problem for everyone. In particular, there is the new phenomenon of those
who regret having changed their gender and detransitioners who would like to reverse the process. The health
professions, including psychology, as well as psychiatry and pediatrics, should demand the same scientic and
professional standards for gender dysphoria that they apply to other problems, starting with exploration, evaluation,
functional analysis, diagnosis, prudence, and attentive waiting, instead of simply adopting afrmative therapy
without question.
La psicología ante la disforia de género, más allá de la ideología queer
Article
Revista del Consejo General de la Psicología de España
https://www.papelesdelpsicologo.es/ • ISSN 0214–7823
Cite this article as: Pérez, M., and Errasti, J. (2022). Psychology and gender dysphoria: Beyond queer ideology. Papeles del Psicólogo, 43(3), 185-199.
https://doi.org/10.23923/pap.psicol.3001
Correspondence: marino.perezalvarez@gmail.com
Keywords
Rapid-onset gender dysphoria
Queer ideology
Afrmative therapy
Detransitioners
Watchful waiting
Pérez Álvarez et al. / Papeles del Psicólogo (2022), 43(3), 185-199
186
Gender dysphoria is today under the domain of an ideology,
rather than within scientic knowledge. Thus, psychology (and
psychiatry too) is practically excluded from being applied to
gender dysphoria—particularly in childhood and adolescence—
other than to afrm what the child feels and says. Psychological
exploration is excluded (Gómez-Gil et al, 2020; Rodríguez Magda,
2021a), and dysphoria becomes a matter for endocrinologists and
surgeons, for injections and scalpels.
The ideology in question is none other than transgender or
queer ideology. Transgender/queer ideology is an amalgam of
postmodern philosophy and political activism. While its philosophy
is characterized by the discrediting of scientic knowledge, reason
and truth, and the embracing of subjectivism and linguistic
constructivism, its activism awards itself a particular social justice
based on felt identities and not exactly on the universal rights of
individuals (Binetti, 2021; Errasti & Pérez-Álvarez, 2022; Malo,
2021; Pluckrose & Lindsay, 2020). It is an ideology, because the
term “theory,” insofar as it assumes an organized system of ideas
and knowledge, would be an oxymoron in this case due to its
hodgepodge of ideas. The denomination of “queer philosophy”
would also be excessive due to the disbelief of reason and the
contradictions within its doctrine. It would therefore be best
considered as an ideology, in the double sense of an amalgamation
of ideas and of functioning as a cover for interests such as the
“body market” (Binetti, 2021).
Queer ideology is powerful not in spite of being an ideology,
but precisely because it is an ideology in the way it is. It is an
ideology that is in tune with the spirit of the times, if it does not
itself dene the spirit of the times. Key aspects of this attunement
are the appeal to feelings, self-determination of identity, and wish
fulllment, all within the language of do-gooderism and social
justice (only you know how you feel, human rights). In fact,
transgender ideology constitutes a powerful lobby capable of
inuencing not only ordinary language by imposing a neolanguage,
but also institutions, corporations, and scientic and professional
societies, including the American Academy of Pediatrics (AAP),
the American Psychological Association, and the American
Psychiatric Association (APAs) (Ekman, 2022; Errasti & Pérez-
Álvarez, 2022). In particular, the APAs make ideological statements
in favor of afrmation as the only option, ignoring the scientic
knowledge and good professional practices that they themselves
support in relation to all other issues other than the aforementioned
dysphoria.
Queer ideology and the new orthodoxy that it is creating have
two major implications: on the one hand, for feminism, erasing
women as political subjects in the name of genderism (Ekman,
2022; Errasti & Pérez-Álvarez, 2022; Rodríguez Magda, 2021a),
and on the other, for gender dysphoria in childhood and
adolescence, the subject of this article.
Psychology has much to say about gender dysphoria. To begin
with, psychology offers knowledge about how people’s identity is
constituted in the context of culture, society, language, and the
vicissitudes of development. From Vygotsky to Skinner, to cite
only two references, it is known that self-knowledge is social
contact with oneself, not something that spontaneously arises.
Likewise, psychology offers knowledge about social inuence and
the formation of feelings, instead of, for example, assuming
essentialism.
In the face of gender dysphoria, psychology does not propose to
do anything other than what it does with any other subject and
problem: study it and see how best to offer the appropriate help.
On the other hand, psychology also examines the ideology and
implicit assumptions that may be part of its knowledge and
procedures. Thus, it is careful of essentialism, dualism, and
biomedical reductionism, aiming to see the problems and the help
or solutions available in the context of the person and his or her
circumstances, without skimping on social and institutional
criticism in order to change society and not merely adapt
individuals uncritically (González-Pardo & Pérez-Álvarez, 2007;
Pérez-Álvarez, 2021). The present article focuses on what is
known as rapid-onset gender dysphoria that occurs in childhood
and adolescence.
Rapid-onset gender dysphoria: the coal mine canary.
What is known as rapid-onset gender dysphoria (ROGD), refers
to a phenomenon, described in 2018 by gynecologist and researcher
Lisa Littman, according to which a girl suddenly feels and declares
herself to be a boy, or vice versa, although its occurrence is more
frequent (82.2%) in girls (Littman, 2018). The study consisted of a
90-question (open-ended, multiple-choice, Likert-type) survey of
256 parents recruited from three websites where they had reported
sudden or rapid onset of gender dysphoria occurring in their
adolescent or young adult children (mean age 15 years). Although
it came as a surprise to the parents, the sons’ or daughters’ reported
experience did not occur overnight. Of all the parents in the study,
86.7% report that their child recently maintained increased use of
social media, belonged to a group of friends in which one or more
friends identied as transgender, or both. According to the parent
report, 41% of the sons and daughters had expressed a non-
heterosexual sexual orientation prior to identifying as transgender.
Furthermore, many (62.5 %) had been diagnosed with at least one
mental health disorder or neurodevelopmental disability prior to
the onset of their gender dysphoria (Littman, 2018).
The controversy
The abovementioned author points to social contagion and
maladaptive coping mechanisms, as well as parent-child conict,
as possible explanations for the sudden dysphoria, which should be
explored. She adds, “The ndings of this study suggest that
clinicians should be cautious before relying solely on self-report
when youths seek social, medical, or surgical transition.
Adolescents and young adults are not trained clinicians. When kids
diagnose their own symptoms based on what they read on the
Internet and hear from their friends, they may well come to the
wrong conclusions. It is the duty of the clinician, when faced with
a patient seeking transition, to perform his or her own assessment
and differential diagnosis to determine whether or not the patient is
correct in his or her self-assessment of his or her symptoms and
conviction that he or she would benet from transition. This is not
to say that the patient’s convictions should be discounted or
ignored. Of course, some may benet from transition. However,
careful clinical examination should not be neglected either. The
fact that the patient’s history is signicantly different from the
parents’ account of the child’s history should serve as a red ag
Psychology and gender dysphoria: Beyond queer ideology
187
that further evaluation is needed and that other sources should
verify as much information as possible about the patient’s history”
(Littman, 2018, p. 37).
Littman’s paper proved controversial right from the start, to
the extent that her own university (Brown University) withdrew
it from the repository and the journal revised it a second time
including a correction the following year (Littman, 2019), in the
face of pressure from transgender activism. While its removal by
the University deserves all reproaches according to the former
dean of Harvard Medical School (Flier, 2018), the second
revision involved no substantive change other than improved
contextualization of the study (Bartlett, 2019; Littman, 2019).
Objections to the study focused on three aspects: the hypothesis
of social contagion and the role of associated psychological
problems, alleged methodological aws, and lack of clinical
evidence of ROGD. In relation to the rst, the objection is
surprising for proposing hypotheses about the ndings of an
exploratory study. These hypotheses are otherwise entirely
plausible and are in fact supported by the exponential growth of
the phenomenon, the concurrence of other previous disorders and
the new phenomenon of transition regret and detransitioners
(Entwistle, 2020; Littman, 2021; Vandenbussche, 2021). For
example, repentant individuals speak of inuences that led them to
a precipitous transition (Alsedo, 2022a; Bell, 2021; Dagny, 2019).
Regarding the alleged methodological aws, they in no way
invalidate the study, which, in fact, remained practically intact
(Bartlett, 2019; Littman, 2019), showing in the end that its
methodology is consistent with that used in the eld of gender
dysphoria, as demonstrated by the author in response to her critics
(Littman, 2020).
A social phenomenon
Regarding the lack of evidence of ROGD as a clinical entity,
the truth is that it has no clinical entity, nor does it claim to have
one. And, to put it bluntly, neither does the gender dysphoria/
incongruence included in the diagnostic systems DSM-5
(Diagnostic and Statistical Manual of Mental Disorders, 5th
edition) or ICD-11 (International Classication of Diseases, 11th
edition). (Nor should it claim to have a clinical entity). Not only
should ROGD not be included in future diagnostic systems, but
gender dysphoria/incongruence should be removed from the
current catalogs of mental disorders or illnesses. However, the so-
called ROGD is still a new social phenomenon in the context of
transsexual and transgender history, in view of its growth of
thousands per cent in a few years, the change in the female-to-male
ratio as opposed to the other way around as in the adult sphere and
the occurrence at increasingly younger ages (Bonfatto & Crasnow,
2018; Errasti & Pérez-Álvarez, 2022, p. 195; Kaltiala-Heino et al,
2018; Zucker, 2019).
The objections to Littman’s study, beyond the discussion that
all scientic work deserves, respond to ideological motivations
related to the hypotheses of social contagion and the role of other
problems. These hypotheses are in contradiction with the supposed
innate, natural, and unmodiable condition of felt identity as
queer ideology wants to present gender incongruence/dysphoria.
The truth is that what is known as ROGD is a new social
phenomenon.
The mother of the lamb
To see it from the perspective of the parents, it is understandable
that they may be disconcerted by the statement—undoubtedly
sincere, heartfelt, and long-suffering—of a girl who says she feels,
and is, in reality a boy (or the other way around) and who also
wants to be called by another name from now on, since she is no
longer who she was until then.
Parents will soon see that the change is neither sudden nor
lacking in rmness. The girl is clear, and well versed, about what
to say in the face of any parental reticence and remarks, including
saying that if they don’t support her, it is a sign that they don’t love
her, or that she may commit suicide. Parents will also see that the
change may have already been happening at school, in the peer
group, and in social networking communities, where the girl has
probably already chosen a new name and pronouns. The parents
will also see that in the health center, where they will most likely
go, the professionals (pediatricians, endocrinologists, psychiatrists,
psychologists) are already up to date on what to do in gender
dysphoria. Professionals will probably end up telling parents that
they have a son instead of a daughter or the other way around. And
the parents will eventually see that it is better to have a transgender
child than a dead one, as is often stated. Thus, we come to the
mother of the lamb.
Unlike how parents were at the beginning, schools and health
centers have an ofcial policy: self-determination of gender
identity by feeling (felt identity) and afrmative therapy consisting
of afrming the felt identity with no acceptable option other than
accompaniment for the purpose of gender transition.
The trans train
The transition can have four phases. Briey, these would be as
follows: social transition of changing name, pronouns, and
appearance, puberty blocking (around 11-12 years, depending on
development) with gonadatropin-releasing hormone analogs that
suppress the production of sex hormones (testosterone or estrogen),
cross-hormonal treatment (around 16 years) based on testosterone
for girls and estrogen for boys, and gender afrming surgery (from
18 years of age, but if done earlier it would not be the rst time).
Gender afrming surgery may include mastectomy, vaginectomy,
and phalloplasty for female-to-male (transgender male) change,
and vaginoplasty consisting of penile reconversion into a vaginal
cavity for male-to-female (transgender female) change, in addition
to other complementary plastic surgeries (Claahsen-van der
Grinten et al, 2021). Table 1 presents the surgical procedures for
natal males and females.
It is not necessary to go through all of the above phases to
consider oneself a transgender person. It may not even be necessary
to go through any of them, as the self-afrmation of feeling trans
may be enough for some. Social transition, however, is part of a
whole conveyor belt or train that takes the majority of people to the
next phase. This majority continuity of phases—starting with
social transition—does not necessarily occur because the feeling
was rm and denitive from the beginning (although this is not
ruled out). It may also occur because social transition itself
promotes hormonal blockade and orients the individual in that
direction, and from there to hormonal cross-treatment, and then on
Pérez Álvarez et al. / Papeles del Psicólogo (2022), 43(3), 185-199
188
to surgical interventions. All of this constitutes a psychosocial
process, as well as a biomedical one, which involves and commits
the person in a certain direction, rather than supposedly revealing
a crystalline feeling. It will be seen that before the afrmative
policy was established (as of 2013) most dysphoria remitted on its
own. However, since this policy has been in existence, the
likelihood of an individual who enters one phase moving on to the
next is almost one hundred percent, particularly from social
transition to puberty blocking and from puberty blocking to
hormone treatment. The newly emerging phenomenon of regretters
and detransitioners suggests that the policy of afrmation is going
too far for some, as will be seen.
In the end, even without being aware of the road ahead, parents
will realize that they have no choice but to afrm and accompany
their son or daughter. Thus, some parents become more afrming
than anyone else, while others feel abandoned by the system, if not
doomed to lose their “parental authority” or even to go to a
psychologist themselves (Alsedo, 2022b; Ekman, 2022, p. 280).
The self-determination and afrmation that are now obligatory
for all derive from the gender ideology that queer activism has
managed to impose on institutions as ofcial policy. They do not
derive from research or scientic consensus. Scientic consensuses
are actually ideological statements such as those of the AAP and the
APAs (Cantor, 2020; Errasti & Pérez-Álvarez, 2022, pp. 223-229).
The “Standards of Care for the Health Care of Trans and Gender
Variant People” (7th edition) of the World Professional Association
for Transgender Health (WPATH, 2012) are usually taken as a
reference. However, this guide, like the others that are inspired by
it, cannot be taken as a “gold standard” as it is considered, due to the
poor assessment of its quality in important domains (Dahlen et al,
2021, p. 8). Pending the 8th edition of the WPATH standards,
trusting that it will be more science-based than ideology-based,
there does not exist an ethically and scientically grounded
consensus as has been called for (Clayton, 2022; Gómez-Gil et al,
2020; Grifn et al, 2021; Levine, Abbruzzese, & Mason, 2022).
Clinicians on a knife’s edge
To the extent that ideology prevails over science, prudence, and
common sense, education and health professionals are failing not
only parents, but children and adolescents themselves. Schools are
failing to the extent that indoctrination prevails over knowledge.
Health professionals are failing as well, to the extent that children
and adolescents with gender dysphoria do not receive the same
standards of clinical care, assessment, and support as any other
child or adolescent accessing health services, due to the
constrictions imposed by afrmative therapy. Clinicians are on a
knife’s edge: either they risk being accused of transphobia if they
explore the case, or they remain silent while attending to the
uncontrolled experiment of afrmative therapy (Grifn et al, 2021,
p. 297).
Children and adolescents as a battleeld
What has happened? Where has trans childhood emerged from?
The ofcial version says that greater visibility and tolerance bring
to the surface gender dysphoria or incongruities that were already
there. However, this does not seem to be the explanation according
to what has been said and what will be said later. If scientic
research does not force us to think otherwise, it is possible to think
that trans childhood, more than an underlying reality that is now
uncovered, would be a battleeld where the war of genderism is
being waged. The problem is not in childhood or in the body, but
in society with its still stereotyped gender roles, and in the
transgender activism that naturalizes them, elevates them to a
political category, and turns them into law. In this sense, children
and adolescents become the canary in the old coal mines: a sign
that something is wrong with the system. What is wrong with the
system? The prevalence of ideology over science.
The prevalence of ideology over science and its consequences
Healthcare institutions starting with pediatrics, psychiatry, and
psychology, as well as educational institutions, are failing children
and adolescents, their parents, and society in general, to the extent
that they uncritically adopt gender identity self-determination and
afrmative therapy as the only acceptable option contrary to their
knowledge and practices in all other elds.
In this regard, it is worth highlighting the manifesto of the
professionals of the Gender Identity Units of the Spanish health
system, showing on the one hand the ideological pressure and on
the other hand claiming the knowledge of health experts (Gómez-
Table 1.
Surgical procedures for the treatment of gender dysphoria (Claahsen-van der Grinten et al, 2021).
Males at birth Females at birth
Breast surgery = augmentation mammoplasty with implants.
Genital surgery (sex reassignment surgery):
• Penectomy = removal of the penis.
• Orchiectomy = removal of testicles.
• Vulvoplasty = creation of female external genitalia including functional neoclitoris.
• Vaginoplasty = creation of female genitalia including a functional vaginal cavity
using the penis and scrotal skin, creation of a functional neoclitoris.
Other surgical interventions:
• Facial feminization surgery (including bone structure alteration surgery, rhinoplasty,
blepharoplasty, forehead lift, lipolling, use of llers).
• Liposuction or lipolling of body fat.
• Voice change surgery.
• Thyroid cartilage reduction.
• Buttock augmentation (implants/lipolling).
• Hair reconstruction (hair root, male type alopecia).
Breast surgery: subcutaneous mastectomy, creation of a male breast and nipple areola.
Genital surgery (sex reassignment surgery):
• Hysterectomy + salpingo-oophorectomy
• Urethral lengthening that can be combined with a metoidioplasty (creation of small
male genitalia with the use of local tissue) or with a phalloplasty (using for example
a microsurgical free ap of skin).
• Vaginectomy.
• Scrotoplasty.
• Implantation of erectile and/or testicular prosthesis.
Other surgical interventions:
• Voice surgery (rare).
• Liposuction or lipolling.
• Pectoral implants.
Psychology and gender dysphoria: Beyond queer ideology
189
Gil et al, 2020). Thus, for example, they raise a debate on the
“Legislative decisions on health issues not based on ideological
positions: professionals consider that health aspects are being
legislated based more on the pressure of associations, ideological
positions, or political interests, than on the recommendations of
the scientic literature or the knowledge that can be provided by
health experts working in the eld, and who, a posteriori, are the
ones that must respond and assume responsibility for care. “
(Gómez-Gil et al. 2020, p. 6).
What is the problem with transgender ideology? We will
highlight three issues: the dogmatic implantation of afrmative
therapy as the only acceptable option, the self-diagnosis that
assumes that children are wise, and the hasty transitions that give
rise to the new problem of detransitions.
Dogmatic implementation of afrmative therapy as the only
acceptable option
Ultimately, afrmative therapy is not as self-evident as it is
made out to be. The evidence reviewed by the National Institute
for Health and Care Excellence (NICE) on puberty blockers shows
that it is difcult to draw conclusions from the existing studies,
because they lack a control group, they are small, and they do not
describe what other physical and mental health problems a young
person may have in addition to gender dysphoria. Ultimately, the
review found no evidence of goodness of treatment (NICE, 2020a).
Although puberty blockers as a routine intervention for children
and young people are associated with few known medical risks,
Bernadette Wren, associate director of the British health system’s
Gender Identity Development Service (GIDS), is quick to
acknowledge potential unknown consequences, adding, “It is well
known that rigorous longitudinal trials are lacking and the available
evidence is of limited quality, although many leading doctors write
in favor of it.” (Wren, 2019, p. 208). In particular, one study
followed the evolution (at least one year) of 44 adolescents (aged
12-15 years) with persistent and severe gender dysphoria treated
with blockers. Although the participants generally reported a
positive experience, no improvements in psychological distress,
quality of life, or degree of gender dysphoria were observed
(Carmichael et al, 2021). A 2015 study had already shown that
puberty blockers were no better than psychological support in
reducing psychological distress (Biggs, 2019; Costa et al, 2015).
In relation to cross-hormonal treatment, a NICE review found
that the evidence for the clinical effectiveness and safety of gender-
afrming hormones was also of “very low” quality. As it points
out, any potential benet of gender-afrming hormones must be
weighed against a hitherto unknown long-term safety prole
(NICE, 2020b). A Cochrane Library systematic review concludes,
“We found insufcient evidence to determine the efcacy or safety
of hormonal treatment approaches (estradiol alone or in
combination with cyproterone acetate or spironolactone) for
transgender women in transition. The evidence is very incomplete,
demonstrating a gap between current clinical practice and research”
(Haupt et al, 2020, p. 11).
On the other hand, even though afrmative sex reassignment
surgery shows short-term (one or two year) benecial effects,
unfortunately, the long-term benets at ten-year follow-ups
disappear. A 10-year average follow-up study conducted in Sweden
on 324 transsexuals who, over a thirty-year period (1973-2003),
received afrmative surgery shows that they have considerably
higher risks of mortality, suicidal behavior, and psychiatric
morbidity than the general population. Compared to the general
population, patients who underwent surgery had a rate of completed
suicide that was 19 times higher, nearly three times the rate of all-
cause mortality, nearly three times the rate of psychiatric
hospitalization, and nearly ve times the rate of suicide attempts
(Dhejne et al, 2011). A recent Swedish study shows that afrmative
surgery does not actually improve the mental health of transgender
people compared to transgender people who did not undergo
surgery (Correction to Bränström & Pachankis, 2020; Van Mol et
al, 2020), contrary to the authors’ optimistic conclusions in an
early version of the article (Bränström & Panchankis, 2020) that
they had to correct.
A long-term retrospective study of 8,263 patients referred to the
gender clinic at the University of Amsterdam between 1972 and
2017 found that the annual rate of completed suicides among
transgender subjects was “three times higher” than the general
population. The incidence of suicide deaths was almost equally
distributed across the different stages of transition. In other words,
neither social nor medical transition reduced the suicide rate
(Wiepjes et al. 2020). Importantly, the mean time between
commencing hormones and suicide was 6.1 years for natal males
and 6.9 years for natal females (Wiepjes et al. 2020). An earlier
study had already shown this delayed effect. Thus, in a sample of
1,331 transsexuals followed for an average of 18 years, while there
were no suicides in the rst 2 years, there were 6 after 2 to 5 years,
7 after 5 to 10 years, and 4 after more than 10 years since cross-sex
hormone treatment (Asscheman et al. 2011). The results suggest
that short-term or even medium-term studies overlook the
phenomenon of suicide.
These ndings do not imply that hormonal or surgical
treatment causes suicide. This occurs because transgender people
suffer a high incidence of “comorbidities” that correlate with
suicide (depression, self-injurious behavior, anorexia, autism
spectrum, trauma), as well as discrimination, disrespect, and
violence (Biggs, 2020; Zucker, 2019). What these results show,
at least, is that neither hormonal nor surgical afrmation solve all
the initial problems, nor do they solve them completely.
Moreover, these individuals do not seem to be on the path to a
healthy life, contrary to the enthusiasm and haste with which the
transition is promoted.
From the perspective of these studies, the purported “new
evidence” supposedly supporting afrmation surgery—based on a
general survey that, incidentally, merely shows lower odds of
psychological distress in the past month, and of smoking and
suicidal ideation in the past year, compared to transgender people
without a history of afrmation surgery—is not justied (Almazan
& Keuroghlian, 2021). Also not justied is the emphasis in favor
of afrming medication based on short-term improvements, which,
on the other hand, also cannot be ruled out as being due to other
things, such as possible psychiatric medication and family support
that the authors themselves acknowledge (Tordoff et al, 2022). The
best help for children and adolescents does not start with getting
them directly into afrmative therapy (D’Angelo et al, 2021;
Grifn et al, 2021; Levine et al, 2022; Marchiano, 2021; Zucker,
2019).
Pérez Álvarez et al. / Papeles del Psicólogo (2022), 43(3), 185-199
190
Nor is the haste with which a pediatric clinical guideline
recommends afrmative therapies justied on the assumption that, if
“they are delayed excessively or there is no afrmative social
intervention to support these minors, there could be an overall
increase in psychopathology and other undesirable situations”
(Moral-Martos et al, 2022, p. 3). As the guideline itself acknowledges:
“Although experience in the management of hormonal and surgical
treatments is increasingly extensive, the scientic evidence is weak
and relatively scarce due to the lack of methodologically adequate
studies that assess long-term results, especially for treatments
initiated in the peripubertal stage; however—as the guideline
continues—there is evidence that demonstrates the benets of both
pubertal blocking and gender afrmation treatment on the health of
trans people” (Moral-Martos et al, 2022, p. 3). In this regard, the
guideline cites as evidence four studies (Chew et al, 2018; López de
Lara et al, 2020; T’Sjoen et al, 2019; Turban et al, 2020), which
themselves are, curiously, examples of studies that are
methodologically inadequate to assess long-term outcomes, due to
their acknowledged or readily demonstrable low quality and certainly
no long-term follow-up. Table 2 shows what these studies contribute.
Table 2.
Quality and conclusions of the purported evidence of the Clinical Guideline for the
care of transsexual minors (Moral-Martos et al, 2022).
Studies cited: Quality / Conclusions:
Chew et al, 2018 “Low-quality evidence suggests that hormone
treatments for transgender adolescents may achieve
their intended physical effects, but evidence on
their psychosocial and cognitive impact is generally
lacking.” (Abstract). “There is a medium to high risk
of bias in existing studies, given the small sample
sizes, retrospective nature, and lack of long-term
follow-up.” (p. 16).
López de Lara et al, 2020 Sample bias consisting of “simple volunteering”
from a “very favorable setting”; 1-year follow-up
after initiation of cross-sex hormone therapy; control
group of little relevance (recruited from pediatric
endocrinology practice), not for example gender
incongruent adolescents without, or awaiting,
hormone therapy.
T’Sjoen et al, 2019 “The current available research is based primarily
on cross-sectional studies, with limited longitudinal
data.” (p. 112). “Future studies should [...] provide
evidence on the effect of gender-afrming treatment
in the non-binary population.” (Abstract).
Turban et al, 2020 Despite its dissemination in the media, their nding
derives from low quality studies, as shown by Biggs,
2020, who concludes that “Turban et al (2020)
contribute nothing to our knowledge of the effects of
pubertal suppression in adolescents.”
It is inconceivable that a pediatric guideline would take the
supposed evidence for afrmative therapy so lightly, or be so
naïve, as will also be discussed below.
Self-diagnosis as if children were wise
Felt identity and afrmative therapy imply “self-diagnosis”
with no other options for the professional than accompaniment and
a “one-size-ts-all” approach (D’Angelo et al, 2021). On the other
hand, the presence of psychological disorders is well known in
adolescents with gender dysphoria, including depression, anxiety,
self-injurious behavior, suicidal ideation and behavior, eating
problems, and autism spectrum (Kaltiala-Heino et al, 2018).
It is understood that a professional knows more than a child or
adolescent. Children and adolescents are not wise, and—like other
people—their feelings are not exempt from social inuences. To
provide the best possible help, the professional needs—of course—
to study and understand the different aspects involved in people’s
suffering. Psychology has the knowledge and resources to
understand people in order to know what is happening to them and
to make the best decisions. The professional relationship is based
on respect and empathy, but respect does not necessarily consist of
afrming everything the client or patient says, as if he or she were
a customer in a department store. Nor does empathy consist of
merely agreeing, but rather it consists of taking seriously what we
are told in accordance with our professional knowledge. In fact,
agreeing to everything could be disrespectful, even more so in a
scientic, ethical, and professional context.
Consider these situations. In the context of psychotherapy for
depression, anxiety, autism spectrum, anorexia, or self-injurious
behavior, the client says she is a boy. Has the psychotherapy ended
here? Does the newly stated gender dysphoria/incongruence explain
everything? Should the practitioner focus on the initial problem
apart from the dysphoria? Should the practitioner include dysphoria
in the ongoing psychotherapy? By including it, does he/she not run
the risk of being accused of supposedly applying “conversion
therapy” instead of the mandatory afrmative therapy? In the
context of accompanying afrmative therapy, problems of
depression, anxiety, autism spectrum, anorexia, or self-injurious
behavior emerge. Should these problems be left aside and the
afrmative therapy continued? Should they be treated in parallel?
Should we simply assume that these problems derive from gender
dysphoria and expect that afrmative therapy will solve them?
What if these problems predate the dysphoria and everything seems
to indicate that the dysphoria derives from them? These are
dilemmas to which the policy on gender dysphoria leads, contrary
to the knowledge and procedure applicable to all other problems.
It is argued that the application of psychology to dysphoria
would be tantamount to pathologizing it. Apart from the fact that
no such connection—psychology-pathologizing—can be made at
all, the irony is that nothing amounts to greater pathologizing than
a pharmaceutical-surgical therapy such as afrmative therapy. If
gender dysphoria/incongruence is considered to be a psychosocial
discomfort with one’s own body (since no one is born in the wrong
body), afrmative therapy becomes a psychotherapy with a scalpel
that turns a healthy person into a patient for life.
Hasty transitions leading to the new problem of de-transitions
Whilst there is no denying that transition may be the best option
for someone, the new phenomenon is also true; that of individuals
who regret the transition undertaken and would like to de-transition
when there has already been irreversible damage (Shrier, 2021).
Although the transactivist movement attempts to deny or minimize
its existence, the fact is that the case of regretters who want to go
back is a new phenomenon that has been underestimated until now.
At present, there are no predictors that allow us to know in advance
for whom transition would be the best option. There is a dilemma
Psychology and gender dysphoria: Beyond queer ideology
191
here between the suffering of waiting if transition does not happen
now and the irreversible damage due to rushing into transition.
Transactivism seems to favor the rst option. However, waiting
may bring the solution or lead to the requested option from the age
of 18, while irreversible damage is forever. There are no predictors,
but there is a growing rate of regret and detransitioners. According
to a study conducted in the United Kingdom, 6.9% of people treated
with afrmative therapy were detransitioners within 16 months of
starting treatment, and another 3.4% had a pattern of medical care
suggestive of detransition (Hall, Mitchell, & Sachdeva, 2021, p. 6).
Another study also from the United Kingdom found that 12%
of those who had started hormone treatments either detransitioned
or required further evaluation, and 20% ceased treatment for a
variety of reasons. As the authors conclude, “The rate of
detransition found in this population is new and raises questions
about the phenomenon of overdiagnosis, overtreatment, or
iatrogenic harm as found in other medical elds.” (Boyd, Hackett,
& Bewley, 2022, p. 13).
A study conducted online, with the purpose of describing a
population of people who experienced gender dysphoria, chose to
undergo a drug-surgical transition, and then dropped out, recruited
one hundred participants, 69 natal females and 31 natal males
(Littman, 2021). The study was interested, among other things, in
the reasons for both transition and detransition. Table 3 shows
some of the reasons for transition and Table 4 for detransition.
Table 3.
Reasons for transition (Littman, 2021)
More than one answer is possible Female Male
69% 31%
I wanted to be perceived according to the desired gender 77% 77%
I thought transitioning was my only option to feel better 72% 68%
I felt bad in my body the way it was 72% 68%
I did not want to be associated with my native sex/gender 74% 61%
It made me uncomfortable to be perceived romantically/
sexually as a member of my birth sex/gender
71% 58%
I thought transitioning would eliminate my gender
dysphoria
39% 29%
I was not satised with the physical results of the transition
(insufcient)
62% 71%
I felt I would become the real me 61% 71%
Table 4.
Reasons for detransition (Littman, 2021)
More than one answer is possible Female Male
69% 31%
I felt more comfortable identifying with my native gender 65% 48%
I was concerned about possible medical complications
from the transition
58% 29%
My mental health did not improve during the transition 49% 35%
I was dissatised with the physical results of the transition/
feel that the change was too much
50% 16%
I found out that my dysphoria was due to something else
(trauma, abuse, mental health)
40% 32%
My mental health worsened during the transition 39% 29%
I was not satised with the physical results of the transition 32% 35%
I found more effective ways to help me with gender
dysphoria
36% 22%
My physical health worsened during the transition 30% 35%
Another online study, in this case with the purpose of
analyzing the specic needs of detransitioners, recruited 237
participants, of whom 217 (92%) were natal females and 20 (8%)
natal males (Vandenbussche, 2021). Table 5 shows excerpts from
experiences of exclusion from LGBT+ communities reported by
detransitioners.
Table 5.
Excerpts from experiences of exclusion of LGBT+ communities reported by
detransitioners (Vandenbussche, 2021).
— “The LGBT+ community does not support detransitioners and I lost all the
LGBT+ friends I had because I was considered transphobic/terf, only non-
LGBT+ friends supported me.”
— “Where I live, most of the LGBT community views detransitioners badly, so it’s
hard to talk about it freely.”
— “It is unacceptable that, at least in my experience, detransition is not something
that is allowed to be talked about in LGBT spaces.”
— “I was only helped by lesbians and feminists. The trans and queer community
demonized and marginalized me because of my reidentication.”
— “I lost a lot of support and attracted a lot of hostility from trans people when
I did social detransition.”
— “LGBT organizations don’t want to talk about detransition. I didn’t feel
welcome at LGBT events after I resigned from transition.”
— “Telling my trans friends that I desist is nearly impossible. The community is
too toxic to allow any kind of discussion about alternatives to transitioning,
sources of dysphoria beyond ‘that’s who you are,’ or stories about
detransitioners.”
— “I have been rejected by most of my friends who identify as trans. I had to leave
my former doctor, therapist, and LGBT group out of shame.”
— “I have several detrans friends who had permanent body alterations that they
regretted and that led to more dysphoria, and eventually their suicides. The
biggest factors were lack of medical support and outright rejection from LGBT
communities.”
— “I still have transgender friends who don’t want me to talk about
detransitioning. They’re ne with me, but they don’t want me to criticize
transition or discuss its negative effects.”
Similarly, the study shows negative medical experiences during
detransition (“When I rst mentioned to my doctor that I wanted to
get off testosterone, they were very dismissive and condescending
about it;” “As soon as I ‘detransitioned’ I was discharged from all
gender services, despite asking for help in dealing with sexual
dysphoria in case it resurfaced,” etc.) as well as difculties in
nding therapists that are friendly to detransitioners
(Vandenbussche, 2021, p. 11).
After the enthusiastic support for the transition, the abandonment
of people who repent and want to de-transition leads them to form
self-help groups, an initiative that is also undertaken by groups of
parents. Table 6 lists some of these self-help groups. Beyond these
aids, “clinical guidelines” are required for detransitioning
according to its typology if it is motivated by the cessation of
transgender identity or for other reasons (Boyd et al, 2022;
Expósito-Campos, 2021).
The prevailing narrative about detransitioning says that most
people who detransition will transition again and that the reasons
for detransitioning are discrimination, pressure from others, and
non-binary identication (Turban et al., 2021). Although that does
also occur, case studies shed light on a broader and more complex
range of experiences that include a variety of psychological
problems, worsening mental health after transition, reidentication
with natal sex, and difculty separating sexual orientation from
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192
gender identity (D’Angelo, 2020; De Celis Sierra, 2021; Expósito-
Campos et al, 2022; Levine, 2018; Pazos Guerra et al., 2020;
Withers, 2020). It is crucial to study each case if we want to
understand and recognize the reality of this suffering (which
involves multiple dimensions) and offer help and solutions tailored
to the individual beyond the “one-size-ts-all” approach imposed
by afrmative therapy.
What to do instead of afrmative therapy?
What all clinicians do in all cases: evaluation, exploration,
functional analysis, clarication, questions, confrontation,
common sense, prudence, attentive waiting, help according to
needs and problems. No “blanket approach”. The issue should
probably be not so much about diagnosing whether one is actually
transgender or not, but more about helping according to the issues,
including transition support. The drive to diagnose whether or not
someone is actually trans involves a double bias—essentialist and
biomedical—which does not correspond to the uid, nonlinear
dynamics of gender identity development (Pullen Sansfaçon et al,
2020), including desistance (Steensma et al, 2011). Properly
informed consent should be a process rather than an event (Levine
et al, 2022; Wren, 2019).
However—incredible as it may seem—everything that
clinicians do regarding the other problems is forbidden here, under
the accusation of “conversion therapy.” Fortunately, conversion
therapy is not applied today, even though it is used as a
disqualication for everything that is not afrmative therapy.
According to Roberto D’Angelo et al, exploratory psychotherapy,
which is neither afrmative nor conversion therapy, should be the
rst line of help for children and adolescents with gender dysphoria,
thus avoiding invasive and irreversible medical procedures
(D’Angelo et al, 2021, p.13). If only for the Hippocratic principle
“First, do no harm”, afrmative therapy should be the last resort,
not the rst.
What would happen without afrmative therapy?
Most children and adolescents would naturally resolve gender
incongruence, in the order of 60% to 90% according to studies
(Cantor, 2020; Levine et al, 2022; Ristori, & Steensma, 2016;
Singh, Bradley, & Zucker, 2021). This was the case before the
current afrmative policy that, in practice, begins with social
transition.
Thus, a follow-up study of an average of 20 years conducted in
Canada between 1975-2009 followed the evolution of children
(boys) with gender dysphoria with an average age of 7 years. Of
the 139 participants, 17 (12.2%) were classied as persistent and
the remaining 122 (87.8%) as desisters. Data on sexual orientation
in fantasy for 129 participants were: 82 (63.6%) were classied as
biphilic/androphilic, 43 (33.3%) as gynephilic, and 4 (3.1%)
reported having no sexual fantasies. Regarding the behavioral
sexual orientation of 108 participants: 51 (47.2%) were classied
as biphilic/androphilic, 29 (26.9%) were classied as gynephilic,
and 28 (25.9%) reported no sexual behaviors (Singh et al, 2021).
Similarly, a follow-up study (mean 23 years) of 25 girls with
gender dysphoria of a mean age of 9 also conducted in Canada
between 1975 and 2004 showed that 12% continued with dysphoria
and 88% had remitted. In terms of sexual orientation, 8 participants
(32%) were classied as bisexual/homosexual in fantasy, and 6
(24%) were classied as bisexual/homosexual in behavior
(Drummond et al, 2008).
A follow-up study of an average of 10 years conducted in the
Netherlands between 1989 and 2005 followed 77 children with
gender dysphoria (59 boys and 18 girls with an average age of 8
and 5 years respectively). Twenty-seven percent (12 boys and 9
girls) were still gender dysphoric and 43% (28 boys and 5 girls)
were no longer gender dysphoric. The other 30% (19 boys and 4
girls) did not return for follow-up. It is reasonable to assume that
those who did not return could be desisters, considering that in
the Netherlands treatment is accessible and free of charge and the
only place where it is provided is at the clinic where the study
was conducted (Wallien, & Cohen-Kettenis, 2008, p. 1430). In
another study also conducted in the Netherlands, of 127
adolescents (79 boys and 48 girls) who were 15 years or older
during the 4-year follow-up period between 2008 and 2012, 37%
(23 boys, 24 girls) were identied as persistent, requested
medical treatment, and were considered eligible to undertake it.
While the remaining 63% (56 boys and 24 girls) did not return to
the clinic, so it can be assumed that their dysphoria subsided, in
line with what was said above about services in the Netherlands
(Steensma et al, 2013, p. 583).
However, studies currently show low desistance and high
persistence. Thus, a study conducted in the USA between 2013
and 2017 on 317 transgender children with an average age of 8
years (208 transgender girls and 104 transgender boys) found
that 94% maintained transgender identity ve years after the
onset of social transition (Olson et al, 2022). Another study
consisting of a retrospective observational review of the medical
records of all children under 18 years of age who attended the
Gender Identity Unit of Catalonia between 1999 and 2016, found
a persistence of 97.6% at a follow-up of an average of 2.6 years
(De Castro et al, 2022). The high persistence found in these
studies, and not just these ones, contrasts with previous desistance
sometimes summarized in the controversial gure of “80%
desistance”, the subject of replications (Temple Newhook et al,
2018) and counter-replications (Steensma & Cohen-Kettenis,
2018; Zucker, 2018).
Among the reasons for this discrepancy is the greater visibility
and acceptance of gender dysphoria in our time, which may
facilitate its “expression” as well as family support (De Castro et
al, 2022; Olson et al, 2022). However, things are not so simple.
Table 6.
Some self-help groups for detransitioners and parents
Self-help groups for detransitioners:
— Detrans Voices. https://www.detransvoices.org/about/
— Detransition Advocacy Network. https://www.detransadv.com/about
— Pique Resilience Project: https://www.piqueresproject.com
— Post Trans. https://post-trans.com/About-Us
— r/detrans | Detransition Subreddit reddit.com/r/detrains
Parent support groups:
— Amanda (Agrupación de Madres de Adolescentes y Niñas con Disforia de
Género)
— Bayswater Support Group. https://www.bayswatersupport.org.uk/
— Cardinal Support Network. https://www.cardinalsupportnetwork.com/
— No Corpo Certo. https://nocorpocerto.com/
— Our Duty. https://ourduty.group/
Psychology and gender dysphoria: Beyond queer ideology
193
On the one hand, the supposed “expression” of dysphoria thanks
to visibility and acceptance implicitly carries the assumption that
gender dysphoria was already there inhabiting the wrong body, a
metaphysical and ideological explanation if ever there was one
(Errasti & Pérez-Álvarez, 2022; Moschella, 2021; Sadjadi,
2019).
On the other hand, visibility and acceptance themselves involve
modeling and shaping functions, according to well-known
processes in psychology. More specically, social transition is
already part of the treatment of gender dysphoria in current studies
(Olson et al, 2022; De Castro et al, 2022, p.7). Far from being a
neutral, spontaneous, natural expression, social transition already
implies a model, a ritual, an approval, a style, and a way of being,
not only acceptable but even particularly valued (hero, cool). This
is not to say that there are no extreme gender differences prior to
social transition (Rae et al, 2019), but in the current context, social
transition is already part of the afrmative therapy train or
conveyor belt.
Clinical settings take social transition very naturally and with
the best intentions in the world. However, clinicians are not being
neutral or allowing the free expression of who one is, as they may
believe. The uncritical, often enthusiastic, assumption of social
transition means conrming and validating a discourse and a state
of affairs that may still remain to be seen for what it is. In a clinical
context, social transition already implies psychosocial treatment
(Cass, 2022; Levine et al, 2022; Zucker, 2018).
The aforementioned pediatric guideline indicates: “Address the
child by the name he/she has chosen for him/herself, and according
to the gender identity expressed. If they have a non-binary identity,
ask with which pronoun and name they want to be addressed”
(Moral-Martos et al, 2022, p. 3). However, what the clinician does
is not a mere social treatment (however intentionally respectful),
but a psychosocial treatment, a kind of “wild psychotherapy”
(recalling Freud’s famous expression) that validates and orients in
a certain direction and not in another or in none. It orients towards
afrmative pharmaco-surgical therapy, and without delay, as the
aforementioned guideline continues the “psychological
accompaniment”, it says, “must not imply postponing a possible
afrmative therapy”. It is not proposed here to invalidate the
experience and suffering, which are undoubtedly real. The question
is how they have become real, without taking for granted that they
are the pristine expression of an inner essence or soul inscribed in
the body (Sadjadi, 2019). Far from desistance research being
irrelevant (Ashley, 2021), it is fundamental for a better
understanding of the natural course of dysphoria and the best help
for each individual, rather than “one size ts all” (D’Angelo et al,
2021).
It is a delicate matter to quibble about “family support” and
“afrmation”. But if parents want the best for their children, as
they undoubtedly do, and as clinicians do for their clients, then
they should think more about what they are doing, rather than
following mantras. What would the clinician do if, for example,
they received a cachectic anorexic teenager who sees herself as too
fat and wants to lose weight, or a suicidal teenager who is convinced
that life is meaningless and the best thing to do is to die? Support
and afrm? What would parents do if their children told them they
were happy staying at home playing on their cell phone instead of
going to school or high school?
How did we get here?
How has this ideology imposed itself on professional practice
over knowledge and standards in other elds? How has queer moved
from marginality to being the new orthodoxy? How has a small
number of organizations inuenced public bodies, institutions,
professional practices, as well as common language? How does an
intolerant minority impose itself on the majority? Perhaps this last
question is explained by Nassin Taleb’s rule of the intransigent
minority willing to gamble with its skin (Taleb, 2019). It is not
possible to answer the other questions satisfactorily here, but they
cannot be left unasked. Since neither scientic ndings nor evidence-
based practice justify the new orthodoxy that is being imposed, it is
necessary to look beyond it. A few threads will be pointed out that a
systematic investigation would surely have to unravel.
Like bamboo
There is an accumulation of proximate and ultimate conditions
intermingled. Nothing comes out of nowhere or suddenly. Like
bamboo, the ideology of queer/trans genderism has grown fast, but
it has taken its time to take root in the shade. The proximate
conditions in the shade are those roots that suddenly surprise us
with their growth. But it all depends on a propitious soil and
climate: its ultimate conditions.
In relation to ultimate conditions, we have to situate ourselves
in Western society, open, democratic, cosmopolitan, and afuent,
even though neither wealth nor well-being are equally distributed.
This open society is also a liquid society with a particular spirit of
the times characterized by subjectivist, expressive, and narcissistic
individualism, which is embodied in a oating (liquid, exible,
uid) individual. Fluid sex and gender are not alien to the liquid
society we live in. Felt gender identity is not something independent
of subjectivist individualism, no matter how much it may seem to
each one that it springs from his or her primal nature, his or her true
self, or something like that. Ideology is in charge of making people
believe it.
In this context, one would not fail to cite the declining birth rate
(Douthat, 2021), the decline of sexual relations (Herbenick et al,
2022; South, & Lei, 2021), or the irrelevance of biological sex
(Ekman, 2022; Miyares, 2022; Stock, 2022) as a breeding ground
for transgender ideology, which in turn feeds back into it. More
specically, subjectivist individualism—expressive and
narcissistic—is characteristic of neoliberal capitalism, which is
characterized precisely by the creation of desires as if they were
expressions of natural essences that one carries within oneself.
And here, to the astonishment of history, this subjectivist
individualism is the raison d’être of the identitarian left, which
turns desires into rights, such as gender dysphoria, which curiously
satises neoliberal capitalism with its pharmaceutical-surgical
industry. Unlike the classical universalist left that believed in
science, truth, and universal rights, and highlighted the
contradictions of capitalism, the identitarian left has become the
best ally of neoliberal capitalism. We are before an example of
“how theories or positions that at rst were thought to be
progressive and left-wing, have not only shown their political
ineffectiveness, but have been successfully assumed by
neoliberalism” (Rodríguez Magda, 2021a, p. 20).
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194
The queer/trans ideology has social justice and human rights as
its banner, so presumably it has the approval of everyone. It is
difcult to nd anyone who is not in favor of social justice and
human rights. However, not everything is as it seems. The social
justice of the queer movement has become a “new religion”, a
secular religion hostile to reason, to falsication and to any
disagreement other than its own truth, a truth based on the “lived
experience” of marginalized people and groups, who by the fact of
being marginalized are “enlightened” and declare others incapable
of understanding anything. We are no longer speaking of a
universal social justice capable of understanding the objective
conditions of reality, but of an experiential and tribal social justice,
according to the tribe to which one belongs (Errasti & Pérez-
Álvarez, 2022, ch. 6; Malo, 2021, ch. 6). With regard to human
rights, it is not easy to see whether they are taken seriously, or
whether they have a partisan (judging by the abandonment in
which the detransitioners are left, as has been seen) and strategic
use, as will be said. It is certainly easy to be on the queer side,
because it is supposed to be the good side and lends itself to virtue
signaling, a form of ethical posturing.
However, we would not get here without the proximate causes
- how the roots suddenly sprouted - referring in particular to the
trans lobby. Not to mention the social networks, without which
nothing would be the same. As far as we are concerned, sufce it
to recall the strategies of transgender activism, while still
“following the money”.
Activist strategies
The strategies of transgender activism are described in the
paper uncovered by James Kirkup (Kirkup, 2019; 2021) that was
produced by the law rm Dentons, the Thomson Reuters
Foundation, and the International Lesbian, Gay, Bisexual,
Transgender, Queer, and Intersex Youth and Student Organization
(IGLYO) entitled “Only Adults? Good practices in legal gender
recognition for young people” (Dentons, Thomson Reuters, &
IGLYO, 2019). Table 7 lists lobbying tactics to change laws so that
self-determination of gender identity with no age minimum
prevails over what parents and professionals say (Dentons et al,
2019, p. 15).
Table 7.
Strategies to promote gender self-determination in minors (Dentons et al, 2019).
1. Target young politicians.
2. De-medicalize the campaign, “so that gender recognition can be seen in the
eyes of the public as distinct from gender-conrming treatments” (p. 18).
3. Use case studies of real people.
4. Anonymize the narratives.
5. Get ahead of the political agenda of governments with legislative proposals
that will be accepted by the people (p. 19).
6. Use human rights as a campaign point, knowing that “human rights
arguments have been instrumental in several successful campaigns to
promote more progressive gender recognition laws” (p. 19).
7. Tie the campaign to a more popular reform, e.g., marriage equality, so that it
serves as a hook for harder-to-get support such as for gender identity.
8. Avoid excessive press coverage and exposure.
9. Carpe diem. “Activists need to capitalize on the political moment” (p. 20).
10. Work together (with other domestic organizations).
11. Be cautious with commitment (because it is a double-edged sword, don’t
commit too much).
With regards to “following the money,” there are corporations
and billionaire families funding queer genderism (Bilek, 2018;
2020; Contra el Borrado de las mujeres [Against the Erasure of
Women], 2020; Miyares, 2022, pp.113-115). Far from being
marginal, the queer movement is now a rich and powerful
lobby.
None of this denies the good intentions of the activists. But
intentions do not guarantee that the best is being done. According
to the well-known phrase of Nobel Prize-winning physicist Steven
Weinberg: “Religion or no religion, good people do good things
and bad people do bad things. But for good people to do bad things,
you need a religion”.
You might think of it as progressive
One might think that gender identity is a progressive and
liberating idea. But it is actually backward and oppressive. It is
backward because of the following:
1. It reintroduces sexual stereotypes on account of gender
identity; it cannot be assumed, for example, that a girl who
likes soccer is actually a boy according to gender identity
protocols (Ekman, 2022; Errasti & Pérez-Álvarez, 2022).
2. It denies that women exist as political subjects dened by
their biological bodies and, instead, offers a tautological
denition according to which “women are those who feel
themselves to be women” (Ekman, 2022; Rodríguez Magda,
2021b; Miyares, 2022; Stock, 2022).
3. It reintroduces the soul/body dualism, where now the soul is
the felt gender identity, trapped in the wrong body which
must be corrected (Moschella, 2021; Sadjadi, 2019).
4. While the de-medicalization of adult trans people is being
promoted, minors with gender dysphoria are increasingly
being medicated (Grup d’ètica CAMFiC, 2022).
It is oppressive because of the following:
1. It imposes afrmative therapy as the only acceptable option,
not only without support to justify it, but with evidence to
the contrary, as we have seen.
2. It imposes a neo-language that distorts the meaning of
things, such as “sex assigned at birth,” and circumlocutions
to avoid the word “woman” (“pregnant people,” etc.)
3. It prevents the debate on the transgender issue under the
pretext that it is a matter of human rights, used in reality as a
strategy, not to mention the well-worn accusation of
transphobia used as a wild card to cancel all debate.
4. It blackmails parents with the dilemma “transition or death,”
“a trans child is preferable to a dead child,” “if you don’t
support them, you don’t love them,” and “they will probably
commit suicide.”
What to do?
It is appropriate to consider the Statement on LGBTIQ+ issues
from the International Psychology Network on Lesbian, Gay,
Bisexual, Transgender, and Intersex Issues (IPsyNet, 2018). There
is agreement on a variety of proposals, including increasing
psychological knowledge of human diversity on issues of sexual
orientation, gender identities, gender expressions, and on applying
this knowledge in support of well-being and the full enjoyment of
Psychology and gender dysphoria: Beyond queer ideology
195
human rights; there is also agreement on depathologizing
LGBTIQ+ people, differentiating between sexual orientation and
gender identity, as well as rejecting both conversion therapy and
the reinforcement of gender stereotypes. However, the assumptions
that the IPsyNet Declaration adopts and the inconsistencies it
incurs cannot be ignored.
The Declaration adopts what are known as the Yogyakarta
principles, which are neither based on scientic knowledge, nor
should they have more relevance than the private proposal of a
pressure group. At the very least, their denition of gender
identity as a “deep inner feeling” is highly debatable, which, as
has been said, implies an essentialist conception that does not
correspond to the changing process and uidity of gender
identity. Not to mention the expression “sex assigned at birth,”
which is entirely ideological, as well as counterfactual. The
Declaration is blatantly inconsistent. If, on the one hand, it
states that identities and orientations “do not require therapeutic
interventions to be changed” (point 3), on the other hand, it
goes on to support “afrmative approaches” and, in point 4, it
calls for access to “available treatments”, again referring to
afrmative transition which, as is well known, includes
irreversible pharmaco-surgical interventions. In general, the
Declaration is oriented towards afrmative therapy. Its rejection
of conversion therapy, which, it seems, includes anything but
afrmation, overlooks the fact that between afrmation and
conversion there are a variety of alternatives. Given the
insistence on afrmation it might be suggested that the greatest
conversion therapy is in fact afrmative therapy, known to
leave no room for potential desisters that have always existed
and knowing the new phenomenon of repenters and
detransitioners.
Another inconsistency is found between the stated differentiation
between sexual orientation and gender identity and their continued
use as if they were on a par. It also states that “sexual orientation
and gender identity remain fairly constant throughout life,” only to
add that “changes in orientation and gender identity may occur
across developmental stages within the life course. Finally, the
Statement assumes that the psychological difculties associated
with gender incongruence occur solely because of stigma and
discrimination, without considering the possibility that the identity
distress itself may result from a variety of prior psychological
problems.
Given their more judicious and thoughtful consideration, four
ideas taken from the Ethics Group of the Catalan Society of Family
and Community Medicine (Grup d’ètica CAMFiC, 2022) are
proposed:
Start with the right of minors to the free development of their
identity, instead of prioritizing the right to transition. Take parents,
guardians, and teachers into account when making decisions that
involve important and irreversible consequences.
Demand professional evaluation. Self-determination in minors
cannot be unconditional and afrmative.
Implement watchful waiting as an alternative to afrmative
therapy, as well as psychological evaluation and exploration.
Accept that exploring and questioning the desire to transition is
not at all about being against people (parents or children). The
person presenting with gender dysphoria/gender incongruence
should be treated as an individual person, not as a collective.
Conclusions
Rapid-onset gender dysphoria (ROGD) is a social phenomenon,
not a clinical entity or a malaise to be pathologized. As a discomfort,
it involves a suffering that must be understood and addressed
according to the circumstances of each person.
The psychological study of gender dysphoria in no way implies
its pathologization as is erroneously and tendentiously assumed by
excluding psychological or psychiatric exploration for the sake of
afrmative therapy.
No one is trapped in the wrong body, if anyone is trapped at all
it is in erroneous discourses based on sexual stereotypes presented
as gender identities, under the protection of genderism that
naturalizes and essentializes them. Gender identity represents a
new version of the soul within the body, the revived dualism.
Self-determination of identity based on sentiment and
afrmative therapy as the only acceptable option constitute the
ideology that dominates the health professions, instead of scientic
knowledge, evidence-based practice, and prudence.
Afrmative therapy should be the last resort, not the rst as it
has been established.
Exploratory psychotherapy, functional behavior analysis,
psychological assessment, and attentive monitoring are examples
of practices by which to begin to understand gender dysphoria with
a view to the best help for each individual. None of these practices
is conversion therapy, nor is it afrmative therapy.
“Treating trans people with dignity, respecting their autonomy
and right to decide, does not mean uncritically acceding to their
demands for treatment. It means giving their suffering the same
concern, consideration, and value as given to other people.
Treating trans people equally does not mean treating them the
same but rather taking into account their unique needs so that
they have the same opportunities to achieve their fullest possible
life” (Esteva de Antonio, Expósito-Campos, & Gómez-Gil, 2021,
p. 150).
Conict of interest
The authors declare that there is no conict of interest.
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