Whether you regret a particular choice depends on the life you believe you would have had, should you have chosen differently. Since I turned fifty, I’ve become unhealthily obsessed with roads not taken. With more time behind than ahead of me, I rake over various turning points, analysing the fates of multiple imaginary selves. There are some who would have been super successful, and others who might not have made it past forty. Each performs a particular function (reassuring me that I would have been a genius, if only I hadn’t messed a few things up — or alternatively that I’m extraordinarily lucky, given how many more things I could have totally ruined).
Thankfully, I don’t believe I’ve done anything truly disastrous. Then again, had I done so I might persuade myself that an alternative path would have led somewhere even worse. If, for instance, I’d done irrevocably harmful things to my own body, but were offered a narrative which claimed I’d have suffered even worse psychological harm had I not done so, I might well take it. What would I have to lose? Easier to imagine your alternative, non-harmed self miserable than to think she’d simply be you, but without the pain.
Regret has become a common theme in the debate over paediatric gender medicine. Whether or not it is a good idea to give young people who hate their sexed bodies puberty blockers, cross-sex hormones and irreversible surgeries has been tied to the question of “—will they regret it later?”. The case of Fox Varian, a young woman who successfully sued her doctors for $2 million for giving her a double mastectomy at the age of 16, has convinced some critics that detransitioners will stop gender identity ideology in its tracks. Those who disagree argue that detransitioner numbers are small, and cannot be used as proof that gender medicine is harmful. I agree with the latter, albeit not for the same reasons. I don’t think you need a single person to regret transition to know that gender medicine does harm. It’s simply not the right way of looking at it.
Why would anyone regret choosing the least painful path, even if your choice still brings some pain? Supporters of gender identity ideology have long insisted that without so-called gender affirming care, gender dysphoric children would have lives that were not worth living (“would you rather a dead daughter or a living son?”). This imaginary disaster life has been treated as a certainty, despite the absence of any evidence that this happened to children in the past. On the contrary, it’s an argument that tends to come from adult trans activists who are very much alive (despite having been denied the treatments that would have given them the Barbie dream house pillow-fight teenage girlhoods they’re convinced should have been theirs by right).
That’s not to say that the current risk of suicide for young people denied puberty blockers is non-existent, even if it is exaggerated. The very existence of gender medicine functions to shape the alternative life that desperate children see before them, should such treatments be withheld. If credible institutions insist that some people — no matter how few — have feelings, personalities, desires, behaviours, ways of presenting, that are so incompatible with their sexed bodies that these bodies need changing, this reinforces the belief that sexed bodies must “match” gendered feelings. If you grow up in a conservative environment in which such beliefs are already held — which we know famous former “trans children” such as Jazz Jennings and Jackie Green did — then of course you might think that you can never be at home in the body you were born with. And perhaps you will be right. Gender medicine and its advocates do not just respond to a desire; they perpetuate it, by ensuring any acceptance of diversity remains out of reach.
At no point is it acknowledged that gender identity, as a concept, alienates people from their bodies to start with
The Pathways trial, which seeks to explore “the possible benefits or risks that young people with gender incongruence may experience when taking puberty suppressing hormones”, is not just an inadequate and harmful “solution” to a problem. It is part of the original problem. Benefits and risks can only be understood in relation to what one might have experienced without puberty blockers, yet the very prescription of blockers makes it impossible to imagine a life in which gender stereotypes are not imposed on the body. The trial literature describes puberty as difficult for “young people with gender incongruence […] because their body starts to change in ways that don’t match how they feel inside”. Are breasts, hips, facial hair etc. meant to “match” inner feelings? If someone believes that they should, shouldn’t we be challenging the forces that make them feel that way? We are told that puberty suppressing hormones “may help some young people with gender incongruence explore their gender identity more comfortably without feeling rushed or distressed about their body changing”. At no point is it acknowledged that gender identity, as a concept, alienates people from their bodies to start with.
You could discover that the lifelong physical costs of puberty blockers are enormous yet conclude that they are worth it on the basis that the psychological cost of not taking them is too high. You could even be right because you have played a role in ensuring the conflation of masculinity with maleness, and femininity with femaleness, is never challenged. Of course, others will have played a role too. Bog-standard conservative beliefs about how boys and girls should be have alienated people from their bodies for centuries (look at the history of female self-imposed starvation at the onset of puberty. There’s more than one way to stop your periods and make your breasts disappear). Misogyny and homophobia — wherever they come from — feed the view that the sexed body can be a trap, and in doing so they make it one.
In 1990’s The Beauty Myth, Naomi Wolf wrote that “women choose [cosmetic] surgery when we are convinced we cannot be who we really are without it”:
If all women could choose to live with themselves as themselves, most probably would. Women’s fears of loss of identity are legitimate. We ‘choose’ a little death over what is portrayed as an unliveable life; we ‘choose’ to die a bit in order to be born again.
I think this argument is a little overblown for facelifts and nose jobs (I don’t know of any woman who’s thought she’ll die without one); I think it’s far less so when applied to gender medicine. Children really are told they cannot be themselves without it. Trials such as Pathways do not seek to disprove this, merely to establish how much of a “little death” will be required in return. There are surely better possible lives than this.
