Gender variance and camouflaging conversion therapy as care

Joanna Santos reveals how the advice and practice of Sasha Ayad of The Metaphor of Gender YouTube channel stop gender variant people from reaching an understanding of their true selves.

Guest post by Joanna Santos with Jack Molay

Recently I wrote a comment on the Metaphor of Gender YouTube channel regarding my objection to its dogmatic roots. The channel is run by Sasha Ayad. After having caught the gist of the approach, I realized the channel was about using a soft-pedaled and "kind" approach towards questioning gender variance and more specifically transitioning. 

I had looked up the author's previous appearances and discovered unsurprisingly that they subscribed to the gender critical school more broadly. More specifically they make use of  the Ray Blanchard two type taxonomy model where the variance is supposedly steeped in sexual dysfunction rather than in essence or a way of being.

The need for help

Sasha Ayad runs The Metaphor of Gender channel

Gender variant people have historically needed help from others, therapists included.  As undesirable members of society they save suffered from guilt and shame at one end of the spectrum to crippling dysphoria at the other. 

This angst has been used as confirmation of the idea that their dreams are sourced in mental illness rather than being primarily caused by the rejection from others. 

When gender variance is presented as a mental illness it is easier for gender critical "therapists" to present their "care" as a possible solution to their suffering.

All you need to know about transgender regret rates

We have collected a large number of articles and papers on to what extent trans people regret transitioning over at Transgender Report. There is only one possible conclusion to draw from all of this: The regret rates are extremely low.

Defining what "transgender regret" is, is not an easy task, as there are various ways of transitioning (legal, social, medical etc.) But if we look at what most people consider "transitioning", namely undergoing hormone replacement therapy and gender-affirming surgery as part of coming out as trans publicly, we end with regret rates around 1 percent.

A meta-study from 2021 ended up with the following conclusion:

“A total of 27 studies, pooling 7928 transgender patients who underwent any type of GAS [gender-affirmation surgeries], were included. The pooled prevalence of regret after GAS was 1% (95% CI <1%–2%). Overall, 33% underwent transmasculine procedures and 67% transfemenine [sic] procedures. The prevalence of regret among patients undergoing transmasculine and transfemenine surgeries was <1% (IC <1%–<1%) and 1% (CI <1%–2%), respectively.” 

In comparison, studies indicate that approximately 20% of cisgender plastic surgery patients report some degree of dissatisfaction post-surgery. Specific procedures have higher regret rates, with breast augmentation leading at 31%, followed by rhinoplasty at 27%, liposuction at 24%, and eyelid surgery at 16%. 

This does not mean that all gender-affirming surgery is perfect. What we see here is most likely that transgender patients are so relieved to be able to live as their true selves, that they are willing to live with some imperfections. They starting point is most often a jarring mismatch between body and gender, and not a cis person's desire to live up to some kind of esthetic perfection.

Go to Transgender Report for a large number of articles, news stories and papers looking at transgender regret and regret rates.

Photo: Gettys

What about non- and detransitioning transgender people?

I got the following anonymous question over at tumblr:

Why do you invalidate and devalue the experiences of detransitioners? Stop talking over them just bc they make you feel threatened. They're actually very lovely and they send an important message that we need to explore other options for dysphoria management. What about trans ppl with chronic illnesses that can't do HRT? They need our support but we just ignore them.

Here is my answer:

I do not devalue the experiences of detransitioners, nor do I feel threatened by them.

I have underlined repeatedly that the complexity and diversity of sex and gender lead to difficult choices for many transgender people (and I am using the word transgender in its wide “umbrella” sense here).

People with gender dysphoria may chose not to transition for many different and legitimate choices. I am a gender dysphoric transgender person and I have not transitioned.

Given the rampant transphobia and homophobia in our societies, I am also not surprised see that some who have transitioned find living and presenting as their target sex difficult, and detransition for that and other reasons.

Regretters used in anti-trans propaganda

However, right now the very existence of “regretters” is used by transphobic TERFs and right wing fundamentalists to invalidate the identities of all transgender people.

The argument is that if some are detransitioning, all those who transition are “fake” and that transitioning is a recipe for mental illness and suffering. This is why I over and over again underline the following:

1. Only a small minority of those who transition regret doing so (between 0.6 and 4 percent according to the studies I have read).

2. The great majority of those who transition report a much higher quality of life and health after transitioning. While the attempted suicide rate among all transgender people is around 40%, the similar rate for those that have transition is more or less the same as the general population.

I say this not in order to devalue the experience of detransitioners, but to ensure that their very existence is not not used to undermine the legitimacy of transitioning as an essential  tool in transgender health care.