Women Are Human shares with our readers the following excerpts from Abigail Shrier’s Irreversible Damage: The Transgender Craze Seducing Our Daughters, published by Regnery Publishing. This book corresponds with Shrier’s piece for The Wall Street Journal titled “When Your Daughter Defies Biology,” published on January 6, 2019. She has written about attempts to silence and suppress her work in “Amazon Enforces Trans Orthodoxy” and, more recently, in “Does the ACLU Want to Ban My Book?.” For Shrier’s most recent work, see her piece for Newsweek titled “A British Court Breaks Gender Fever,” in which she discusses the recent, groundbreaking case involving Keira Bell. For the YouTube video and corresponding transcript of Shrier’s conversation with Benjamin A. Boyce about Irreversible Damage, see “What’s the Matter with Girls Today?,” posted at Uncommon Ground Media.
This is a story Americans need to hear. Whether or not you have an adolescent daughter, whether or not your child has fallen for this transgender craze, America has become fertile ground for this mass enthusiasm for reasons that have everything to do with our cultural frailty: parents are undermined; experts are over-relied upon; dissenters in science and medicine are intimidated; free speech truckles under renewed attack; government healthcare laws harbor hidden consequences; and an intersectional era has arisen in which the desire to escape a dominant identity encourages individuals to take cover in victim groups.
To tell the story of these adolescent girls, I conducted nearly two hundred interviews and spoke to over four dozen families of adolescents. I have relied in part on parent accounts. Since traditional dysphoria begins in early childhood and has long been marked by a “persistent, insistent, and consistent”1 sense of a child’s discomfort in his body (not something a young child can hide) parents are often in the best position to know whether the passionate dysphoria of adolescence began in early childhood. They are in the best position to know, in other words, whether the distress afflicting so many teenage girls represents traditional gender dysphoria or a different phenomenon altogether.
Parents cannot entirely be trusted to know how their adolescents feel about their transgender identities or the new lives forged in its name. But parents can report the facts of their kids’ academic or professional standing, their financial stability, and family formation or lack thereof, and even, sometimes, their social successes and failures. Are these transgender-identified adolescents still in school, or did they drop out? Do they maintain contact with old friends? Do they speak to any family members at all? Are they building toward a future with a romantic partner? Are they engaged in subsistence living on wages from the local coffee shop?
I do not pretend to capture these adolescents’ whole stories, much less the fullness of the transgender experience. Transgender success stories are everywhere told and celebrated. They march under the banner of civil rights. They promise to breach the next cultural frontier, to shatter one more basis of human division.
But the phenomenon sweeping teenage girls is different. It originates not in traditional gender dysphoria but in videos found on the internet. It represents mimicry inspired by internet gurus, a pledge taken with girlfriends—hands and breath held, eyes squeezed shut. For these girls, trans identification offers freedom from anxiety’s relentless pursuit; it satisfies the deepest need for acceptance, the thrill of transgression, the seductive lilt of belonging. As one transgender adolescent, “Kyle,” put it to me: “Arguably, the internet is half the reason I had the courage to come out. Chase Ross—a YouTuber. I was twelve. I followed him religiously.”
This is the story of the American family—decent, loving, hardworking, and kind. It wants to do the right thing. But it finds itself set in a society that increasingly regards parents as obstacles, bigots, and dupes. We cheer as teenage girls with no history of dysphoria steep themselves in a radical gender ideology taught in school or found on the internet. Peers and therapists and teachers and internet heroes egg these girls on. But here, the cost of so much youthful indiscretion is not a piercing or tattoo. It’s closer to a pound of flesh.
Some small proportion of the population will always be transgender. But perhaps the current craze will not always lure troubled young girls with no history of gender dysphoria, enlisting them in a lifetime of hormone dependency and disfiguring surgeries. If this is a social contagion, society—perhaps—can arrest it.
No adolescent should pay this high a price for having been, briefly, a follower.
In researching this transgender craze, I spoke with over four dozen parents. Again and again, I heard a variant on, “My daughter is seventeen, but if you met her, you’d think she was fourteen.”
Many of the adolescent girls who fall for the transgender craze lead upper-middle-class, Gen Z lives. Carefully tended by those for whom “parent” is an active verb, even a life’s work, they are often stellar students. Until the transgender craze strikes, these adolescents are notable for their agreeableness, companionability, and utter lack of rebellion. They’ve never smoked a cigarette; they don’t ever drink.
They’ve also never been sexually active. Many have never had a kiss—with boy or girl. According to Sasha Ayad, a therapist whose practice is largely devoted to trans-identifying adolescents, many have never masturbated. Their bodies are a mystery to them, their deepest desires under-explored and largely unknown.
But they are in pain—lots of it. They are anxious and depressed. They are awkward and afraid. Like the infant that learns to avoid the edge of a bed,2 they sense a dangerous chasm lies between the unsteady girls they are and the glamorous women social media tells them they should be. Bridging the gap feels hopeless.
The internet never gives them a day—or even an hour—of reprieve. They want to feel the highs and lows of teenage romance, but most of their life occurs on the iPhone. They try cutting. They dabble in anorexia. Parents rush them to psychiatrists who supply medications to pad their moods like so much cotton batting, which helps—unless feeling something is the point.
Where is all the raucous fun that should, by right, be theirs? They’ve heard their parents’ stories; they’ve seen the movies. That epic road trip is hard to recreate when few of your friends drive and parents prefer it that way. They could go to the mall, if it hadn’t closed down, and if teenagers still went to the mall (they don’t). Local environs can’t begin to compare with the labyrinthine corridors, ingeniously customized, supplied by their phones.
A decade ago, if it ever occurred to you that female-to-male transsexuals existed, you might have thought of Hilary Swank’s portrayal of Teena Brandon in the 1999 biopic Boys Don’t Cry. Swank’s characterization is captivating. Teena Brandon renames herself “Brandon Teena,” chases girls, swigs beer, and joyrides through rural Nebraska dressed as a boy, and mostly passing as one. Brandon chases a strikingly conservative vision of happiness. What Brandon wants is to find the right girl, win her, marry her, make her happy.
You spend the entire movie hoping like hell she’ll succeed. The abuse Brandon heroically endures, the knowledge that no one in her place and time is likely to offer the kindness or acceptance Brandon craves, the devastating certainty that this story can only end in tragedy—all of it registers in the viewer’s clenched gut.
The adolescent girls currently identifying as transgender have almost nothing in common with this picture. They don’t want to ‘pass’—not really. They typically reject the boy-girl dichotomy that Brandon Teena took for granted. They make little effort to adopt the stereotypical habits of men: They rarely buy a weight set, watch football, or ogle girls. If they cover themselves with tattoos, they prefer feminine ones—flowers or cartoon animals, the kind that mark them as something besides stereotypically male; they want to be seen as ‘queer,’ definitely not as ‘cis men.’ They flee womanhood like a house on fire, their minds fixed on escape, not on any particular destination.
Only 12 percent of natal females who identify as transgender have undergone or even desire phalloplasty.3 They have no plans to obtain the male appendage that most people would consider a defining feature of manhood. As Sasha Ayad put it to me, “A common response that I get from female clients is something along these lines: ‘I don’t know exactly that I want to be a guy. I just know I don’t want to be a girl.’”
In 2016, Lisa Littman, ob-gyn turned public health researcher and mother of two, was scrolling through social media when she noticed a statistical peculiarity: several adolescents, most of them girls, from her small town in Rhode Island had come out as transgender—all from within the same friend group. “With the first two announcements, I thought, ‘Wow, that’s great,’” Dr. Littman said, a light New Jersey accent tweaking her vowels. Then came announcements three, four, five, and six.
Dr. Littman knew almost nothing about gender dysphoria—her research interests had been confined to reproductive health: abortion stigma and contraception. But she knew enough to recognize that the numbers were much higher than extant prevalence data would have predicted. “I studied epidemiology . . . and when you see numbers that greatly exceed your expectations, it’s worth it to look at what might be causing it. Maybe it’s a difference of how you’re counting. It could be a lot of things. But you know, those were high numbers.”
In fact, they turned out to be unprecedented. In America and across the Western world, adolescents were reporting a sudden spike in gender dysphoria—the medical condition associated with the social designation ‘transgender.’ Between 2016 and 2017 the number of gender surgeries for natal females in the U.S. quadrupled, with biological women suddenly accounting for—as we have seen—70 percent of all gender surgeries.4 In 2018, the UK reported a 4,400 percent rise over the previous decade in teenage girls seeking gender treatments.5 In Canada, Sweden, Finland, and the UK, clinicians and gender therapists began reporting a sudden and dramatic shift in the demographics of those presenting with gender dysphoria—from predominately preschool-aged boys to predominately adolescent girls.6
Dr. Littman’s curiosity snagged on the social media posts she’d seen. Why would a psychological ailment that had been almost exclusively the province of boys suddenly befall teenage girls? And why would the incidence of gender dysphoria be so much higher in friend clusters?
Maybe she had missed something. She immersed herself in the scientific literature on gender dysphoria. She needed to understand the nature, presentation, and common treatment of this disorder.
Dr. Littman began preparing a study of her own, gathering data from parents of trans-identifying adolescents who had had no childhood history of gender dysphoria. The lack of childhood history was critical; as we have seen, traditional gender dysphoria typically begins in early childhood. That was true especially for the small number of natal girls who presented with it.7 Dr. Littman wanted to know whether what she was seeing was a new variant on an old affliction or something else entirely. She assembled 256 detailed parent reports and analyzed the data. Her results astonished her.
Two patterns stood out: First, the clear majority (65 percent) of the adolescent girls who had discovered transgender identity in adolescence—“out of the blue”8—had done so after a period of prolonged social media immersion. Second, the prevalence of transgender identification within some of the girls’ friend groups was more than seventy times the expected rate.9 Why?
Dr. Littman knew that a spike in transgender identification among adolescent girls might be explained by one of several causes. Increased societal acceptance of LGBTQ members might have allowed teenagers who would have been reluctant to ‘come out’ in earlier eras to do so today, for example. But this did not explain why transgender identification was sharply clustered in friend groups. Perhaps people with gender dysphoria naturally gravitated toward one another?
Then again, the rates were so high, the age of onset had increased from preschool-aged to adolescence, and the sex ratio had flipped. The atypical nature of this dysphoria—occurring in adolescents with no childhood history of it—nudged Dr. Littman toward a hypothesis everyone else had overlooked: peer contagion. Dr. Littman gave this atypical expression of gender dysphoria a name: “rapid-onset gender dysphoria” (“ROGD”).
There is nothing particularly outlandish in feeling discomfort in one’s own body or in suspecting that one might feel better in another. There are so many things about our physical forms that cause us distress and regret. We lug around bodies we would never have chosen. Anyone who has ever had the unpleasant sensation of looking in the mirror and being startled by the age of the woman staring back—the blanching, the slack, the lines that stole their way in while you slept—is well acquainted with our bodies’ ability to confuse and shock and disappoint.
For those with gender dysphoria, this unpleasantness must be excruciating, and we should expect mental health professionals to be respectful of it, sympathetic to those who bear it, and understanding of their pain—even perhaps by supporting medical transition. I have spoken to several transgender adults who are living good, productive lives, in stable relationships and flourishing in their careers. I believe there are instances in which gender-dysphoric people have been helped by gender transition.
But the new ‘affirmative-care’ standard of mental health professionals is a different matter entirely. It surpasses sympathy and leaps straight to demanding that mental health professionals adopt their patients’ beliefs of being in the ‘wrong body.’ Affirmative therapy compels therapists to endorse a falsehood: not that a teenage girl feels more comfortable presenting as a boy—but that she actually is a boy.
This is not a subtle distinction, and it isn’t just a matter of humoring a patient. The whole course of appropriate treatment hinges on whether doctors view the patient as a biological girl suffering mental distress or a boy in a girl’s body.
But the ‘affirmative-care’ standard, which chooses between these diagnoses before the patient is even examined, has been adopted by nearly every medical accrediting organization. The American Medical Association, the American Psychological Association, and the Pediatric Endocrine Society have all endorsed ‘gender-affirming care’ as the standard for treating patients who self-identify as ‘transgender’ or self-diagnose as ‘gender-dysphoric.’
As the World Professional Association for Transgender Health (WPATH) standards, consulted by nearly every field of medicine, advise, “Health professionals can assist gender-dysphoric individuals with affirming their gender identity, exploring different options for expressing that identity, and making decisions about medical treatment options for alleviating dysphoria.”10 Notice whose medical judgment is in the driver’s seat. Hint: it isn’t the doctor’s.
We are, by nature, social animals—as Aristotle once observed. We absorb ideas about ourselves from our surroundings more often than we realize and more deeply than we know. If we attend a school or live in a family in which we are made to feel stupid or told we are, some number of us will come to believe it. If a boy is placed in a school in which the other boys tease him for being gay, he may come to internalize their homophobia. He may turn his anger inward, at himself.
All of which is to suggest that social transition is not nothing; it is, in fact, an extremely potent and consequential act. It provides what world-renowned gender psychologist Kenneth Zucker—no fan of affirmative therapy—called an “experiment of nurture” when he spoke to me. It places a child or adolescent in an environment in which the entire school is asked to participate in affirming this child’s identity as the opposite sex. If the adolescent wasn’t entirely convinced of her new identity before the experiment, she may be much more so after it is underway.
In fact, a team of Dutch clinician-researchers who pioneered the use of puberty blockers found just that: Social transition is a significant intervention. In a 2011 journal article, they warned that early social transitions proved sticky. Given that girls who had been living as boys for years during childhood “experienced great trouble when they wanted to return to the female gender role,” they cautioned, “We believe that parents and caregivers should fully realize the unpredictability of their child’s psychosexual outcome.”11
Once you’ve been insisting to everyone that you’re one thing, it isn’t easy to announce to all your friends, classmates, acquaintances, teachers, and family that you might have made a mistake and change your mind. “You’re worried about losing face,” Lisa Marchiano explained. “First of all, you’re going to get treated like a traitor to the trans community if you step away, but also you’re going to look like an idiot. Like, you made all these people change your name and pronouns. You were up presenting at school for the Trans Day of Visibility—and now you’re not? Who can do that as a teenager?”
So ‘social transition’ and ‘affirmation’ are not without risk—for the patient or for the doctor. It’s worth wondering if a therapist who has adopted wholesale the perceptions of her patients is able to provide them with objective guidance. In the case of gender-dysphoric adolescents, the perception that a teen is ‘born in the wrong body’ is the very reason for seeking therapy in the first place. It is the cause of distress. One would think that if there were any aspect of the patients’ assessment about which a therapist should maintain objective detachment, it would be the nature of the ailment that led the patients to seek therapy in the first place.
Girls are different. They are not defective boys simply because they sometimes fail to be single-mindedly self-interested, especially in the face of their friends’ announced need or genuine suffering. They are possessed of a different set of inclinations and gifts—a whole range of emotions and capacities for understanding that boys, in general, are not. If only we didn’t make them feel so bad about this.
Adolescence is especially hard on girls. Effervescent with emotion, they buck and bray like wild horses. Parents might be forgiven for assuming that this can’t be right—that there is something wrong with them. Parents might even be forgiven for wishing to put their daughters on medication to flatten their moods and short-circuit these crazy teenage years. This is the fantasy of inducing a kind of Sleeping Beauty coma until your daughter is ready to awaken, calm and refreshed, having arrived gracefully at womanhood. (In fact, writing this book made me wonder if that wasn’t the actual origin of Snow White, Sleeping Beauty, and so many similar fairy tales: the fond wish to place your unmanageable teenage girl in a brief coma.)
Except that it isn’t possible. A young woman’s unruly emotions in her teenage years—the whirlwind fury and self-doubt of female adolescence—may be a feature, not a flaw. That doesn’t mean a parent shouldn’t set boundaries or punish bad behavior. But absent a serious mental health problem, neither should a parent strive to banish all her daughter’s ups and downs.
Your teenage girl may be driving you crazy. Though this be madness, there is method in it. She may just be beta testing. She’s flexing her muscles, discovering the power and extent of an intellectual and emotional prowess that will enable her to be the most compassionate of parents and supportive of friends.
Women feel things deeply. We empathize. For good reason, when asked to identify their best friend, most men name their wives; most women name another woman.12 Soldiers write home to mom. And in the dead of night, small children cry out for one person.
A woman’s emotional life is her strength. A key task of her adolescence must be to learn not to let it overwhelm her. A key task to maturity is to learn not to let it fade away.
We need to stop regarding men as the measure of all things—the language they use, the kind of careers they pursue, the apparent selfishness of which we are so endlessly envious. We blame men for this obsession, but really, it is our doing.
Excerpted from Irreversible Damage: The Transgender Craze Seducing Our Daughters, by Abigail Shrier, pp. xxiii-xxiv, 6-8, 25-27, 98-99, 114-115, 216-217. Copyright © 2020 by Abigail Shrier. Reprinted by permission of Regnery Publishing.
Women Are Human provides our readers with Shrier’s references below, numerically ordered to coincide with the above excerpts from Irreversible Damage.
1. Ranna Parekh, ed., “What Is Gender Dysphoria?” American Psychiatric Association, February 2016 (quoting the DSM-5 entry on “Gender Dysphoria,”), https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria.
[Since the publication of Shrier’s book, the original webpage that she cited has been edited by Jack Turban, M.D., M.H.S., as of November 2020, replacing Ranna Parekh, M.D., M.P.H. The original page, before Turban’s edits, can be seen at the following link to its PDF: http://www.lb7.uscourts.gov/documents/17-360URL1WhatIsGenderDysphoria_.pdf.]
2. See Megan Gannon, “How Babies Learn to Fear Heights,” Live Science, July 26, 2013, https://www.livescience.com/38432-how-babies-learn-to-fear-heights.html.
3. According to the National Center for Transgender Equality 2015 U.S. Transgender Survey, only 12 percent of natal females who identify as transgender either have had [1%] or even desire [11%] phalloplasty. National Center for Transgender Equality, https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf. [See p. 101, Table 7.4.]
[Significantly, also, 56% responded explicitly not desiring the procedure at all, while 31% were not sure if they desired it or would themselves feel comfortable with the potential surgical procedure.]
4. “2017 Plastic Surgery Statistics Report,” American Society of Plastic Surgeons, https://www.plasticsurgery.org/documents/News/Statistics/2017/body-contouring-gender-confirmation-2017.pdf. This point was made in a fantastic tweet by a mother who goes by the pseudonym “Emma Zane.” EZ, (@ZaneEmma), “Between 2016-2017, the # of sex reassignment surgeries in the US for natal females QUADRUPLED and the ratio flipped, with FTM now accounting for 70% of all SRS (1 year ago it was 46%) This is a public health EPIDEMIC disproportionately affecting young women!” Twitter, November 30, 2018, 4:22 p.m., https://twitter.com/ZaneEmma/status/1068616160218738688.
5. Gordon Rayer, “Minister Orders Inquiry into 4,400 Percent Rise in Children Wanting to Change Sex,” The Telegraph, September 16, 2018, https://www.telegraph.co.uk/politics/2018/09/16/minister-orders-inquiry-4000-per-cent-rise-children-wanting.
6. Natasja M. de Graaf et al., “Sex Ratio in Children and Adolescents Referred to the Gender Identity Development Service in the UK (2009-2016),” Archives of Sexual Behavior, vol. 47, no. 5, 2018: 1301-1304, https://www.researchgate.net/publication/324768316_Sex_Ratio_in_Children_and_Adolescents_Referred_to_the_Gender_Identity_Development_Service_in_the_UK_2009-2016; “Referrals to GIDS, 2014-15 to 2018-19,” Gender Identity Development Service, June 25, 2019, https://gids.nhs.uk/number-referrals; Madison Aitken et al., “Evidence for an Altered Sex Ratio in Clinic-Referred Adolescents with Gender Dysphoria,” Journal of Sexual Medicine, vol. 12, no. 3, 2015: 756-763.
7. See Kenneth J. Zucker et al., “Demographics, Behavior Problems, and Psychosexual Characteristics of Adolescents with Gender Identity Disorder or Transvestic Fetishism,” Journal of Sex and Marital Therapy, vol. 38, no. 2, 2012, pp. 151-189.
[This citation is edited to show the corrected reference to Zucker et al. 2012.]
8. Lisa Littman, “Parent Reports of Adolescents and Young Adults Perceived to Show Signs of a Rapid Onset of Gender Dysphoria,” PLoS ONE vol. 14, no. 3, 2018: 1-44, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330.
9. Littman, “Parent Reports of Adolescents and Young Adults,” 17. [“The expected prevalence of transgender young adult individuals is 0.7%.” (This, according to a 2016 estimate). “Yet more than a third of the friendship groups described in this study had 50% or more of the AYAs [adolescents and young adults] in the group becoming transgender-identified in a similar time frame, a localized increase to more than 70 times expected prevalence rate.”]
10. “Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People,” World Professional Association for Transgender Health, Version 7, 2012, 9, https://www.wpath.org/media/cms/Documents/SOC%20v7/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf.
11. T.D. Steensma et al., “Desisting and Persisting Gender Dysphoria after Childhood: A Qualitative Follow-Up Study,” Clinical Child Psychology and Psychiatry, vol. 16, no. 4, 2011, pp. 499-516, https://journals.sagepub.com/doi/abs/10.1177/1359104510378303; See also “Could Social Transition Increase Persistence Rates in ‘Trans’ Kids?” 4thWaveNow, November 28, 2016.
12. Deborah Tannen, “‘Put Down That Paper and Talk to Me!’: Rapport Talk and Report-Talk,” in A Cultural Approach to Interpersonal Communication: Essential Readings, Leila Monaghan, Jane E. Goodman, and Jennifer Meta Robinson, eds., 2nd ed, Oxford: Wiley-Blackwell, 2012, p. 191.
[This citation is edited to show the corrected book title as A Cultural Approach to Interpersonal Communication: Essential Readings instead of Interpersonal Communication: Putting Theory into Practice.]
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