More people are identifying as transgender and seeking medical care for gender dysphoria than ever before. Between 2018 and 2022, gender-dysphoria diagnoses increased considerably in every state in the U.S. except for South Dakota, according to Definitive Healthcare. Children’s share of dysphoria diagnoses rose from 17.5 percent to 20.4 percent in that same period. A JAMA paper noted a threefold increase in “gender-affirming” surgeries between 2016 and 2019.
The story that the “gender-affirming” camp tells itself about these developments is equal parts illuminating and frustrating. Proponents typically claim that transgender people, as we understand them today, have always existed, and that more people identify as trans because the public has become more aware and accepting of transgender identities. In other words, these activists believe that apparent increases in the trans-identifying population are not really increases at all; they merely reflect that the language, tools, and cultural climate are now in place to gauge more accurately the trans population’s size.
In a recent reported piece for The Hill, for example, Russ Toomey, a transgender professor at the University of Arizona, claimed that the alleged rise of transgender young people “is not an increase . . . we are seeing the numbers of people disclosing nonbinary and trans identity on a survey because we are asking people in more inclusive ways about their gender.” Shoshana Goldberg of the Human Rights Campaign similarly argued, “It is not that there are more people. It is that there are more people who are open and who are out. . . . The reality is that when you talk to the average person on the street, they are going to be more accepting and more affirming than they have ever been.” Of course, this observation cannot be reconciled with the pro-affirming camp’s claim that half of U.S. states are “anti-trans” and create a hostile environment for trans-identifying minors. Moreover, it seems unlikely that these explanations can solely account for the sheer size and scope of the increase in referrals over the last decade. For example, England’s Gender Identity Development Service saw a twentyfold increase in referrals for dysphoria between 2011 and 2021.
The pro-affirming side is willing to grant that social and cultural forces contribute to the documented rise in trans identification, but only in a narrow way. They allow that greater cultural visibility and acceptance leads to more people being comfortable sharing their “real” identities—but they won’t entertain the possibility that greater cultural visibility and acceptance has created cases of gender dysphoria and trans identification.
When confronted with statistical reality, this thinking yields absurd conclusions. A Williams Institute study from 2021, for example, noted the presence of 1.2 million “nonbinary” people in the United States, 75 percent of whom were below age 30. According to the pro-affirming camp, nonbinary people have always existed. But why are young people more likely than older people to adopt this identity? Why are nonbinary identities more common among girls and young women, specifically? And why didn’t this phenomenon seem to exist 30 years ago?
“You can’t identify as something if you don’t know what the word is,” counters Kay Simon, a professor who studies “queer” youth and their families. “From a very young age,” he adds, “I kind of realized I was gay . . . at the time, I probably could have told you that I felt different about my gender, but I didn’t have a word for it.”
Simon is right that discovering new terminology can sometimes help people describe elements of reality that they couldn’t previously describe. But language, and culture more broadly, can also create new social realities.
Certain material facts—our embodiment as sexed beings is one—exist independent of our cultural discourse about them. When you move beyond these natural phenomena and into the social realm, however, nature and culture can become hard to disentangle. Gender dysphoria, as a psychiatric condition, might have biological roots and in that sense be a biological phenomenon, though researchers have yet to confirm this. The idea that a person who has gender dysphoria is a different sex, however, and must be treated with hormones and surgeries is another claim altogether. It assumes that a person’s mind is the only thing that counts toward whether the individual is male or female (or something else). This is a cultural argument, not a discovery of natural fact.
Consider how our understanding of sex-reassignment surgeries has evolved. For most of the twentieth century, an adult who had surgical genital modifications would have been described as “transsexual,” not “transgender.” The popular scientific understanding of this person’s situation would be that he was suffering from a mental-health disorder and was opting to live socially as the opposite sex. Significantly, however, neither the scientific nor cultural understandings of this person’s situation would have included a metaphysical belief that the person really was the opposite sex (or another sex entirely). No shared cultural understanding existed that a male undergoing a procedure to create an artificial vagina was somehow already a female even before the procedure, though the concept of gender identity had been introduced.
In the older paradigm, the language of sex reassignment suggests that sex can be changed through surgery. Filtered through the prism of the gender-affirming paradigm, though, sex reassignment is a misnomer, since the procedure simply confirms the patient’s true “sex” as reflected by his or her gender identity. Of course, a third possibility is that it is impossible to change sex, and that these procedures are simply cosmetic.
As the philosopher Tomas Bogardus pointed out in Quillette, our language used to maintain a sex-gender distinction that acknowledged sexual dimorphism. “Sex” referred to being biologically male or female, while “gender” stood in for qualities that we associate with the sexes —like wearing makeup for girls or playing sports for boys—that are not intrinsic, definitionally, to being male or female. These gender qualities are mostly “socially constructed,” though they may be biologically predisposed. Notably, gender was also used by feminists as a synonym for sex, while gender identity was used by sexologists to refer to a person’s perception of being male or female. “Queer theorists” would later argue that the entire sex-gender distinction was artificial and that both categories were socially constructed. In this way, the terms “man” and “woman” also came to be associated with gender, suggesting that a man or woman was a social role or position that one occupied.
According to Bogardus, the flaw in what he calls the social-role view of gender is that not every person who wants to be recognized socially as a man or woman is perceived as one. To rectify this, the social-role view of gender morphed into the self-identification view. In the process, the sex-gender distinction collapsed, and the survivor was gender, not sex. In this brave new world, men who identify as women are female, and women who identify as men are male.
Gender-identity theory, then, is a strange amalgam of ideas. The theory asserts that we are imbued with an innate gendered essence, but it defines that essence by time- and culture-bound masculine and feminine stereotypes. It divorces our sex from biology, and redefines it by how we dress, behave, and express ourselves.
Even the “queer theorists,” often credited with developing gender ideology, arguably would not understand its current incarnation. For the godmother of queer theory, Judith Butler, sex is subsumed under gender, and gender exists only as a performance made intelligible through repetition. The notion that there is a “real” gender—or gender identity—behind the performance is not only false but is the very idea that queer theory aims to challenge. Those who borrow Butler’s jargon and concepts to argue that all humans have an innate gender identity, and that this innate identity needs social and medical “affirmation,” seem scarcely aware of—or concerned with—the deep contradiction in their position.
Whether social scientists admit it or not, gender discourse has consequences. As the writer and researcher Eliza Mondegreen recently pointed out, growth in trans identification is not just fueled by interpreting various kinds of distress as gender dysphoria. Trans identification can come first, followed by the experience of gender dysphoria.
Imagine a shy, sensitive boy who likes to cook and draw, and is uninterested in sports and rough-and-tumble play. In a different time, this would be unremarkable. But now, ubiquitous cultural messaging suggests that this boy’s personality and preferences are evidence that he is a girl and always has been. The boy’s self-understanding is made increasingly unstable, and his sense of self is increasingly dependent on the opinion of others. Do I sound enough like a girl? Do I look enough like one? Do others see me as the girl I know I am inside? He becomes increasingly distressed about the reality of his male body and the ever-growing chasm between it and true female embodiment. Alternatively, a part of him may understand that he is in fact male, and yet this reality is routinely denied by the gender-affirming people in his orbit. Either way, he develops gender dysphoria.
Ironically, what some activists call “gender liberation” arguably reinforces the same pressures to conform. For example, the Gender Liberation Resource Center describes liberation as “people understand[ing] themselves free of pressures to conform or limit who they can be based on their assigned sex.” “Gender liberation” in this sense may free us from the limits imposed on us by our “assigned sex,” but significantly, it imposes new limits, pressures to conform, and understandings of who we can be based on personality, preferences, and gender expression. What the activist camp fails to grasp is that in practice they encourage the same rigid adherence to social norms, and intolerance of nonconformity, that their supposedly liberatory project rejects. Where some see liberation, others see a rainbow-colored cage.
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