It is hard to shock me these days — but as I moved around the World Professional Association for Transgender Health’s symposium in Montreal in September 2022, I often felt as if I’d slipped sideways into some strange universe that operated in accordance with other laws: where up is down and girls are boys and medicine has left its modest brief — healing — far behind in its breathless pursuit of transcendence.

I wasn’t really supposed to be there. I hadn’t misrepresented myself — I am what I claimed to be: a graduate student researching gender identity — but this was a convocation for believers and I’m a sceptic. When WPATH, the world’s most prestigious and influential gathering in transgender healthcare, came to Montreal, I couldn’t resist the opportunity to see up close the people and ideas I had pursued through so many articles and books.

I wanted to know what gender clinicians were saying behind closed doors. I wanted to see how they understand the work they do, the patients they serve, and the criticism they face. That’s why I began attending WPATH conferences, starting with the symposium in Montreal, followed by the European Professional Association for Transgender Health conference in Killarney, Ireland, in April, and the US Professional Association for Transgender Health conference in Denver, Colorado, just a few weeks ago.

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The Oxford kids are alright

By Kathleen Stock

After years of flying under the radar, the field of transgender health care is facing serious questions about whether minors can consent to life-altering interventions; what role factors like autism, sexual orientation, and social influence may play in the explosion of children and young people identifying as trans; and what to make of mounting evidence of medical harm, regret, and detransition. In response, the field of trans healthcare is becoming ever more secretive. There is a sharp demarcation between what gender clinicians say in public and what they say in private.

At these conferences, the big questions confronting transgender health care hardly feature. Instead, these conferences serve a different purpose: to shore up the faithful and cultivate a revolutionary vanguard within medicine. To this end, the proceedings revolve around a strange set of parables: that of the good gender clinician and the bad gender clinician.

In this world, being a good gender clinician means deferring to patients’ self-understandings and having the humility to serve even what one does not understand. The mark of a good gender clinician is her credulity in the face of brave new manifestations of gender.

“People outside this room get hung up on questions like ‘How can we make sure people are really trans and are not going to regret their transition later?’” one gender clinician in Denver mused. “I’m interested in giving the very best possible care to trans young people, the care that they need and deserve… it’s easy to roll down this pathway of ‘how do you know if somebody’s going to change their mind?’ or ‘how do you know if somebody’s really trans or not?’ and that’s not the conversation I’m really participating in.”

It’s difficult to imagine clinicians practising in other areas of medicine not asking such basic questions, especially when the basis for treatment is so murky. But a good gender clinician, looking at a patient, does not see what non-believers like you or I might see. A good clinician falls under the sway of the same fantasy as the patient and conspires with her to bring her transgender self into existence. Under this framework, there is no “really trans” or not. There is only what the patient says and the readiness of the clinician to put herself at the service of the patient’s vision.

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A bad gender clinician, by contrast, feels an “entitlement to know” why a patient feels the way she does or why she seeks a particular intervention. She clings to a traditional conception of her role as a “gatekeeper” who evaluates and prescribes. She thinks she can “discern a ‘true’ gender identity beyond what is articulated by the patient”. She may believe she can “identify the ‘root cause’ of a transgender identity”, which is seen as pathologising. She may try to leave the door open to desistance — the most common outcome before gender clinicians started interfering with normal development by deploying puberty-blocking drugs — in which case she is guilty of “valuing cis lives over trans lives”.

A bad gender clinician is easily “intimidated” by complicated patients, while a good gender clinician knows how to secure consent even in the trickiest cases. Mental health difficulties become “mental health differences”. Severe autism or thinking you have multiple personalities living inside your head become empowering forms of “neurodiversity”. When it comes to assessment, “careful” and “comprehensive” have become dirty words: “The answer always seems to be more assessment and more time. That’s gatekeeping.”

During the Denver conference, presenters role-played how to secure informed consent for a hysterectomy and phalloplasty in the case of a schizophrenic, borderline autistic, intellectually disabled “demiboy” with a recent psychiatric hospitalisation. At no point do the role-players encounter any real barriers. Instead, they persevere. At first, the patient struggled to understand why a phalloplasty might require multiple surgeries, but then the clinicians “explained everything” and the patient understood. This is called “lean[ing] into the nuance of capacity”.

The moral of this story is clear: failure to achieve informed consent is a failure on the part of the clinician, a failure of imagination and flexibility, not a recognition that some patients — whether because of age or mental illness or intellectual disability — will simply not be able to consent.

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On WPATH’s private forums, clinicians occasionally express reservations about what they’re being expected to do, such as the social worker who wondered whether she should write letters for surgery for “several trans clients with serious mental illness… Even though these clients have a well-established trans gender identity, their likely stability post initiation of HRT [hormone-replacement therapy] or surgery is difficult to predict. What criteria do other people use to determine whether or not they can write a letter supporting surgical transition for this population?”

Her colleagues quickly put her in her place: “My feeling is that, in general, mental illness is not a reason to withhold needed medical care from clients,” an “affirming, anti-oppressive” gender therapist responded. “My assumption is that you’re asking this question because you’re taking seriously your responsibility to care for and guide your clients. Unfortunately, though, I think the broader context in which this question even exists is one in which we, as mental health professionals, have been put inappropriately into gatekeeper roles. I’m not aware of any other medical procedure that requires the approval of a therapist. I think requiring this for trans clients is another way that our healthcare system positions gender-affirming care as ‘optional’ or only for those who can prove they deserve it.”

Another gender clinician referred dismissively to the recommendation that mental illness should be “well controlled” before initiating hormonal and surgical interventions: “I am personally not invested in the ‘well controlled’ criterion phrase unless absolutely necessary… in the last 15 years I had to regrettably decline writing only one letter, mainly [because] the person evaluated was in active psychosis and hallucinated during the assessment session. Other than that, everyone got their assessment letter, insurance approval, and are living [presumably] happily ever after.” Everything hinges on that “presumably”.

For years, gender clinicians have reassured patients and parents that the evidence would eventually bear out the lofty promises of transition: that transition is life-saving; that psychotherapeutic approaches to gender distress don’t work and instead constitute unethical “conversion therapy”. But as the data starts to come in, transition appears unlikely to live up to these high expectations.

During the Ireland conference, researchers bracketed discouraging findings with upbeat statements of belief such as: “We all know gender-affirming care is effective.” A Swedish researcher who found that psychiatric hospitalisation increased after patients initiated puberty blockers or cross-sex hormones told the audience that she was “really concerned”, not about the results themselves, but “about how results will be interpreted” because, “as you all know, there are improved mental health outcomes following puberty blockers and gender-affirming hormones” — even when the research can’t find those benefits.

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“There’s an expectation that gender-affirming hormones will improve somebody’s mental health problems,” Johanna Olson-Kennedy, one of the leading US gender clinicians, said on the opening night of the Denver conference. Why? Because “they improve gender congruence”. In other words, if a patient doesn’t want breasts and a surgeon removes her breasts, the treatment was a success, even if her mental health deteriorates and even if she experiences regret down the road. Clinicians dismiss detransition as one of multiple possible “attenuations” of gender identity, alongside “elf”, “fairy”, and “friendly non-intimidating woman”. If a patient changes her mind later, clinicians can simply treat this new manifestation of gender incongruence by the same means: no harm, no foul.

Meanwhile, gender clinicians speak with remarkable frankness about overcoming their reservations, including the plastic surgeon who recounted the alarm he felt the first time a patient requested gender nullification surgery: an intervention that involves removing all external genitalia to create a “smooth” Ken doll-like appearance. But this surgeon soon conquered his hang-ups: he now performs “a lot” of these surgeries and promotes the procedure to his more cautious colleagues. These kinds of stories frame doubt as something to be vanquished, not investigated.

And if doubts persist, there’s always emotional blackmail. In Denver, an obese patient berated the plastic surgeons in the audience, telling them “you wouldn’t be hearing from me today” had the patient not found a surgeon willing to bend the rules and perform a double mastectomy: “I had contacted over a dozen plastic surgeons in the state of Colorado, all of them telling me they refused to do surgery on me. The surgery I so, so desperately needed so as to not kill myself. Only because of my BMI.”

So if a clinician dares to enforce standard medical practices or exercise her professional judgment, she may drive her desperate patients to suicide. The most questionable sessions end with no questions at all.

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But what about the rest of us? What are we entitled to know about this bold new frontier in medicine? In Denver, public-relations specialists cautioned clinicians to spare reporters, policymakers, and parents the details of what “gender-affirming care” entails. In fact, even the use of the term “gender-affirming care” is discouraged: “When [people] hear it, they think ‘trans kids in the driver’s seat,’” health policy expert Kellan Baker said. “Many of us here, we all support trans kids in the driver’s seat because it’s their bodies, their lives. But when you think about folks who don’t know trans people, they are very scared by the idea that young people are making irreversible decisions and that nobody else has any oversight over these decisions. The term “medically-necessary care” is better, he said. “Essential medical care. Prescribed medical care.”

Presenters also recommended that gender clinicians avoid specifics. Avoid ages (“this care is highly individualised and age-appropriate”). Avoid giving information about the effects of puberty blockers and hormones. Avoid discussing the ins and outs of surgeries. In practice, “holding [the public’s] hands and helping [them] understand” looks more like covering their eyes and telling them whatever they need to hear to feel at ease. “The dinosaurs are scared,” Baker deadpanned.

This is how an entire field of medical practice became committed to virtuous obscurantism. Gender-affirming clinicians feel misunderstood by their critics. They don’t trust outsiders to put the work they do in the right light. There’s always a risk that someone will look at life-saving reconstructive chest surgeries for transmasculine minors and see the wrong thing: doctors performing breast amputations on troubled teen girls. Therefore, in order to defend the “life-saving” work they do, they must dissemble, obscure, or practise other forms of “heavenly deception”.

Critics of gender-affirming care fall somewhere along the spectrum of transphobia — with dinosaurs at one end, genocidaires at the other. In Ireland, a keynote speaker described “the gender-critical movement [as] a totalitarian and genocidal force that targets not just trans people but all institutions that uphold democracy and individual human rights”. In Denver, a state legislator announced that policymakers passing restrictions on youth gender transition “will kill children. Not with their own hands. But they will.”

The result of this Manichean worldview is that there is no possible dialogue with critics and no room for serious dissent within the movement itself: “If we are fighting amongst ourselves the forces of oppression have won,” as outgoing USPATH president Maddie Deutsch put it. No one, at any conference, discussed the risks and unknowns around puberty blockers and their possible effects on brain development, or the evidence that suggests blockers may change the course of a child’s life by turning what may have been a developmental phase into a permanent condition.

In one of the most extraordinary moments in Ireland, outgoing EPATH president Jan Motmans said: “We respect everyone’s freedom of speech, but we choose not to listen to it.” The auditorium burst into applause. But the speech they’re choosing not to listen to is the mounting evidence that something has gone wrong in the field of gender medicine.

The conviction of being on the right side of history is why criticism doesn’t stick. Clinicians don’t see themselves reflected in critiques. They are, for the most part, decent people, capable of feeling genuine horror when they accidentally say “hey guys” instead of “hey folks”. Their best impulses — their empathy, their humility in the face of what they don’t understand, their sincere desire to help distressed patients — have been hijacked by an ideological movement within medicine. In the process, they have lost sight of what they do.

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This blindness sets in more or less the moment a patient sets foot in a gender clinic — when a distressed girl transforms into a “boy” in need of affirmation. Gender clinicians see empowerment in overlooking a patient’s limitations. They have come to believe that medical responsibility to their patients requires them to dismantle the guardrails that stand between vulnerable patients and life-altering interventions.

Nothing illustrates this more clearly than a session on “neurodiversity-affirming gender-affirming care” in Denver, which overflowed with suggestions for clinicians working with autistic patients to achieve their surgical goals. To make autistic patients more comfortable, clinicians should dim the lights, keep an assortment of fidget toys on hand, drop the small talk, don’t try to make eye contact, avoid open-ended questions. If a patient won’t — or can’t — speak, the clinician should ask for a thumbs up or thumbs down. A good gender clinician helps patients anticipate the sensory reactions they might have to injections, surgeries, stitches, blood, and pain.

Over and over again, I’m struck by the realisation that these clinicians have thought of everything. Everything, that is, except: what if they’re wrong?

On this issue, the Democratic Party assumes the mantle of righteousness. Who could oppose “life-saving” “gender-affirming care”? Who supports “conversion therapy”, which the Biden administration described as “a discredited and dangerous practice that seeks to suppress or change the sexual orientation or gender identity of LGBTQI+ people”?

The reality diverges sharply from the loaded language the Biden Administration deploys, lifting terms directly from the most radical trans activists occupying positions at the outermost extreme of an ongoing debate between different factions of gender clinicians.

The dispute over how best to treat gender-questioning children that the Biden Administration seeks to resolve by enshrining “gender-affirming care” and stigmatising “conversion therapy” boils down to whether or not clinicians regard the children in their care as exceptions to everything we know about child development, human biology, sexual orientation, and more. Attending closely to the language of the activists with whom the Biden Administration has sided provides a masterclass in how to manipulate language to normalise risky and invasive medical intervention on a class of people — children — who are widely understood to be unable to provide consent in other contexts.

For exploratory providers, a child’s transgender identification is the beginning of a clinical inquiry that will travel through the individual patient’s biography, their social context, and the templates the culture at large offers that young patients use to make sense of suffering. Nothing magical or transformative happens when a patient experiences gender dysphoria or expresses a transgender identity. Children and adolescents remain children and adolescents. Clinical practice does not overthrow itself when a young patient changes her pronouns.

For affirmative clinicians, on the other hand, the declaration of a transgender identity and the desire for a particular gender presentation suffice. That’s what affirmation means: no further inquiry required. A transfer of loyalty takes place when affirmative clinicians are confronted with “trans” children and adolescents: clinicians’ sense of responsibility shifts from the patient in front of them to the patient’s transgender “alter”. Doctor and patient then collude to slice and drug the patient’s body into compliance with the new identity regime.

Across the Atlantic, countries such as Sweden, Finland, and the United Kingdom are stepping back and shifting away from hormones and surgeries and toward exploratory psychotherapy as evidence of harm mounts. It’s remarkable that the United States government has chosen this moment to double down, without reference to serious inquiries underway at home and abroad.

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Why should lesbians have sex with men?

By Eliza Mondegreen

Rather than bending the arc of history toward justice, the Biden administration has put the full force of the federal government behind a treatment model that amounts to little more than an unregulated medical experiment on vulnerable children and adolescents. Don’t let the language of civil rights fool you.

To understand gender affirmation and the people who push it, we need to take a closer look at their belief in the utterly exceptional “transgender” child. What do affirmative clinicians believe about such a patient, who arrives in their office with a label firmly affixed? Affirmative care starts not with a question or a clinical assessment but with a moral imperative: validate the patient’s transgender identity.

Presented with a “transgender” patient, what else matters? Does a patient’s age or developmental stage matter? What about his or her sex or sexual orientation? What parts of a patient’s life story — or medical history — stand out?

Gender clinicians such as Johanna Olson-Kennedy prefer to talk about gender-questioning three-year-olds as “people”. And they are people. But when we talk about three-year-olds as “people”, rather than toddlers, important information gets lost, with consequences. When we talk about “people”, we think adults. We think autonomy. When we talk about “toddlers,” we think: tiny humans who need constant care and guidance, who cannot be trusted to brush their teeth or cross an empty street, much less start down a medical pathway.

That’s the reason Olson-Kennedy talks about “people” when she’s referring to toddlers. The ideas that underpin gender-affirming care lose their moral force when translated from “people know who they are” to “toddlers know who they are”.

What about sex and sexual orientation? As recently as the mid-2000s, medical providers understood cross-sex identification in childhood and adolescence to be a normal stage of homosexual development, resolving in the majority of cases as the child moved through adolescence and became comfortable with his or her sexual development and sexual orientation. Long before the concept of gender identity took root, the idea of being “born in the wrong body” resonated with many young gays and lesbians — not to mention medical providers, who viewed homosexuals as “inverts” in need of psychological or surgical “correction”.

Affirmative providers overlook, downplay, or outright deny the overrepresentation of same-sex attracted youth among youth seeking transition. But clinicians who rate the “gender presentation” of “transgender” preschoolers on a scale from stereotypical girl (fitted, sparkly, frilly) to stereotypical boy (baggy, sporty) inevitably sweep up children whose rejection of gender stereotypes is rooted in their same-sex orientation. Affirmative providers such as Diane Ehrensaft argue that “prototransgender youth use [same-sex] sexual identity as a stepping-stone toward their transgender true gender self”, a rhetorical move that overwrites the connection between homosexual development and gender dysphoria, and equates accepting your same-sex sexual orientation with pursuing irreversible medical interventions.

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Much like their views on same-sex attraction as a “stepping stone” toward a young person’s “transgender true gender self”, affirmative providers treat just about any mental health comorbidities as secondary to gender dysphoria. Suicide attempts, psychotic episodes, anorexia nervosa, depression, anxiety, autism, obsessive-compulsive disorder, experiences of sexual abuse and trauma, and substance abuse aren’t taken as reasons to question or delay transition but instead are treated as evidence for the need to accelerate transition.

In order to grease the skids, affirmative providers have invented or adapted a wide range of new medical concepts, all of which operate to obscure what they do from the public and from providers themselves,  scrambling the complex clinical presentations they need to parse — and manipulating patients, parents, and policymakers. These concepts include “wrong puberty”, “sex assigned at birth”, “reconstructive surgeries”,  and “internalised transphobia”.

Reconceptualising patients as “wrongly sexed” (thus in need of reconstructive relief) and giving allegiance over to the patient’s transgender “alter” over the physical patient and her social and medical history skew clinical assessments and lower clinicians’ barriers to providing experimental medical interventions. Girls become “boys”, not in reality, but in the way gender clinicians talk about reality. Elective double mastectomies on girls become “reconstructive chest surgery” on “boys”. Exploratory therapy to understand where distress over sex and gender originates becomes “conversion therapy,” something no ethical clinician would practice. Drastic, life-altering medical interventions — such as “pausing” puberty and all the cognitive, physical, and emotional development that goes along with it — become conceptualised as non-interventions on the one hand, “life-saving” on the other. In any case, language becomes detached from reality, skewing risk analysis.

This language of determined identities and autonomous “people” speak to the way affirmative clinicians see their role: deferring to patient self-identification and facilitating hormonal and surgical interventions to bring patients’ bodies in line with how they want to “wear their gender”, Meanwhile, activists inside the medical profession push for policy changes to lower the age at which minors can consent to transition — a priority of the forthcoming guidelines from the World Professional Association for Transgender Health — and remove requirements for parental assent. California legislators are on the verge of passing a bill that would equate denial of “gender-affirming care” with child abuse, a move advocates say would turn California into a “sanctuary state” for trans-identifying children.

Ask for stronger evidence or stricter safeguarding measures and you’ll get an earful about suicide and self harm: affirmation is a “matter of life and death.” (Never mind that researchers had to cook bad survey data at extremely high temperatures in order to make such dire claims.)

Affirmative clinicians frequently compare gender dysphoria to endocrine conditions such as diabetes. Take Johanna Olson-Kennedy, dismissing the need to explore the causes of a young person’s distress over gender: “I don’t send someone to a therapist when I’m going to start them on insulin”. Never mind that medical providers can test for diabetes (and monitor whether the treatment is working), while relying on patient testimony to initiate medical transition. Never mind that untreated diabetes kills. Analogies to cancer also abound, especially when clinicians need to justify serious risks like permanent loss of fertility and the very real possibility that patients will lead shorter, sicker lives after medical transition. Ask clinicians and they’ll tell you that gender dysphoria, like cancer, is a life-threatening condition. In the absence of supporting evidence, this is emotional extortion, nothing more.

Affirmative clinicians evade the possibility of regret and detransition. They prefer to talk about “gender fluidity” or “gender journeys”— “journeys” that may include puberty blockers, cross-sex hormones, and elective double mastectomies. Journeys that could not and should not have been avoided, in other words.

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Affirmative providers also cleave to a narrow set of explanations about why patients experience regret and detransition, pinning regret and detransition on lack of social support for the patient’s transgender identification. By placing the blame on factors outside the medical system, providers avoid the suggestion that regret and detransition may be the result of inadequate evaluation or inappropriate medical interventions. This interpretation also keeps patients firmly within the ideological framework that underlies affirmative care. Under this framework, a patient remains “really transgender”, even if external factors conspire to keep the patient from living out that identity. Even if the patient disavows their transgender identity entirely.

***

If affirmative providers’ belief in the exceptional “transgender” child bears out, we can make a strong case for affirmation. But if this belief is merely an article of faith, nothing more, clinicians risk doing serious harm to their patients under the banner of affirmation. In other words, if gender-dysphoric children and adolescents are truly exceptions to everything we know about identity formation, child and adolescent development, how humans make sense of distress and their susceptibility to social influence, the role of sexual orientation in gender dysphoria, and more, then affirmation may be the right approach.

But what if supporters of gender-affirming care are wrong?

What if children who identify as transgender are just that: children? What if they hurt, like other children? What if they’re trying to figure themselves out and learn how to navigate the strange world they live in, like other children?

What’s changed are the ideas and expectations that we’ve raised children on and the way we’ve turned them loose in an online world whose terrain no one has mapped. Many of these children have grown up with extended experiences of online disembodiment. They may not be free to run around outside with their friends but they’re free to roam the darkest corners of the Internet. Who knows what strangers and strange ideas they encounter there.

These children have grown up hearing a very new and confusing set of fairy tales about gendered souls that can end up in the ‘wrong bodies’. Adults who should know better — adults who do know better — have made these children impossible promises.

Children who identify as trans aren’t sages. They aren’t sacred. They haven’t been endowed with wisdom beyond their years. It’s not fair to treat them as exceptions to the safeguards we place around children, so that when they grow up and change their minds and ask why we let them do this, we say: You wanted it. You asked for it. You were so sure. What else could we have done?

There’s a way in which everything that touches trans must be exceptional — the children, the stakes, the feelings, the possibility of knowing anything for sure — because if these kids aren’t exceptional, then we threw everything we knew out the window. We didn’t ‘help’ exceptional children but harmed ordinary ones, struggling with ordinary challenges of development, sexual orientation, identity, meaning, and direction.

This month, media organisations and mega corporations will bend over backwards to find an LGBTQ angle to cover. But what you won’t see or hear is the underside of Pride: a culture of intense social and sexual pressure that’s pushing some lesbians back into the closet and encouraging others to identify out of womanhood altogether. 

It started with the push to redefine “lesbian” to be inclusive of heterosexual males who identify as women. But it didn’t stop there. Now same-sex attraction is out, redefined as a problematic “genital preference”. A surprising number of hardline activists vilify lesbians as “genital fetishists” and accuse them of practising “sexual apartheid”.

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Meanwhile, lesbians are bombarded with suggestions on “how to have lesbian sex with a trans woman”. Safe-sex guides for lesbians provide information on avoiding pregnancy and performing blowjobs. Healthline’s “How Do Lesbians Have Sex?” guide, which targets sexually inexperienced women and girls, reminds readers that “any person can have any type of sex”. “[D]on’t apply assumptions you apply to cis men to us, our body works in different ways,” a columnist for Allure scolded readers: “Keep an open mind, and remember you’re having sex with a woman who knows more about her body than you do about hers.”

Not convinced yet? “Estrogenized dicks are… a lot like if a vagina was shaped like a dick and testes… Sex with an estrogenized dick is its own experience, but it’s MUCH MORE like sex with a vagina than sex with a man’s dick!” This remarkable advertisement concludes with a denial of what’s being pushed and why: 

“Don’t have sex with anyone you don’t want to! You don’t ever have to give a reason why you don’t want to have sex with someone… But if you go out of your way to tell everyone that you won’t have sex with trans women, and your reasoning is that you think trans women are men, and that sex with us is like sex with men, don’t be surprised when people call you out as an uninformed bigot!” 

Or, as one “trans lesbian” put it: “Being shut off from the very idea of it, not even considering that having my penis inside you is different from having a man’s penis inside you? That hurts.”

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Somehow, telling lesbians that they “just haven’t tried the right dick yet” went woke.

Young lesbians get the message — from their peers in the “queer” community, their role models in arts and culture, the media, and medical providers — that their discomfort with any of this means that they may really be straight men trapped in gay women’s bodies. Sometimes, adopting an idiosyncratic gender identity — like “transmasc non-binary who’s attracted to women” or “feminamoric” — may be the only way a young woman can set boundaries around her sex life.

Last year, two friends and I launched Unspeakable LGBTQ. We asked: What do you wish you could say about your experiences as a woman in the LGBTQ community? 

Some women talked about intense pressure to identify out of womanhood. When femininity — not sex — makes someone a “woman”, women who don’t conform to stereotypes come under scrutiny: “I wish I could talk about how non-conforming women are being pressured to identify as a different gender to validate transwomen’s ‘femininity,’” wrote one respondent. “Feeling alienated by femininity is a near-universal female experience, especially for gay and bisexual women — not something that means you’re not a woman at all,” wrote another. Another respondent confessed that she now feels “​more comfortable around my conservative neighbors than I do in ‘queer’ liberal circles because my neighbors call me a lesbian and a woman… [in the LGBTQ community] I’ve had people ask me if I am truly non-binary or a trans man because I have short hair and don’t wear makeup or dresses.” 

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Relentless policing of lesbians’ sexual orientation and self-expression run through these stories. One woman compared the LGBTQ community today to her experience growing up in the Mormon religion, “where women are subservient in every way that matters”:

“We are allowed to have no leadership positions without the permission or surveillance of men, even in our own organizations… I was excited to join LGBT spaces and meet people like me. But it wasn’t like that. I left one cult and found out that what awaited me was another. In LGBT and other “progressive” circles, women don’t have the right to assemble without the presence of males who, by nature of being male, have no ability to relate to the experiences of female people. Just like my old religion, you aren’t allowed to question the ideology (in this case transgenderism) without being ostracized… Just like my old religion, men’s feelings and sensibilities must be taken into account in everything that women do.”

Another recalled her evangelical upbringing, writing: “I’d really really like, as a lesbian woman, to no longer be surrounded by transwomen who parrot the same talking points and shame tactics used, nearly word for word, by the youth pastor that tried to help me ‘pull away from sin’,” one woman wrote. “I never thought I would have to defend my sexuality against people in the community”, said another. “I get to feel wrong for how I am and how I love all over again.”

One university student described her brief involvement with the LGBTQ community on campus: “I hoped to meet other same-sex attracted people in the ‘lgbtq+’ club at my new university. It was not a community. There were some gay men and some lesbians, but there were also men who told me to my face that they were lesbians. That I should ‘be open to penis’. That I was a bad person for being a lesbian. I didn’t stay.” Another respondent admitted, “I forced myself to date trans women because I was made to feel like I was a bigot for not being attracted to them as a lesbian. It was incredibly traumatic and I was treated like utter crap.”

Responding to a climate where women who dissent from gender identity ideology face threats of violence, one woman wrote: “I want to talk about the incredible setbacks we’ve made in both women’s rights and same-sex rights without people threatening to beat, rape, or kill me.” 

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For women who have firsthand experience identifying as transgender or transitioning — before deciding to desist or detransition — the LGBTQ community reinforces patterns of thinking that caused distress and harm. One detransitioned woman reflected: 

“I spent years running from being a butch lesbian. I transitioned in order to escape the shame & fear I had. When I finally came to terms with the fact that transition had not really helped & I was still the same me I detransitioned… I wanted community more then anything. But there isn’t a place for me anymore. Before I transitioned there were several lesbian groups in my area. They aren’t here anymore. As far as I can tell there is no lesbian space or group anywhere in my area… I can not express how painful it is to not have a place to belong.”

One of the most wrenching submissions was also the simplest and shortest — speaking to something the community at large seems to have forgotten: “there is nothing wrong with women who are only attracted to the female body.” An LGBTQ community in thrall to gender identity and “trans inclusivity” necessarily sacrifices belonging and acceptance for same-sex attracted women.  

For women who want to be part of the LGBTQ community, there’s no escaping gender identity ideology. “The problem with leaving the ‘trans cult’ as a lesbian is that you can never really leave,” one young desisted woman wrote. “The ideology is in every LGBT space, every LGBT charity, every dating site, on the front page of our news sites every single day.” 

In other words, you can accept yourself as a lesbian. You can desist or detransition from a trans identity. You can accept your sex and your sexual orientation. But if you want to stand under that rainbow flag, you’re not allowed to say so.