Identity Crisis: ‘Gender-Affirming’ Surgery, Social Contagion, Detransitioners, and the Autism Overlap

Part 2: Complications of “Gender-Affirming” Surgery, Social Contagion, Detransitioners, and the Autism Overlap

What does the scientific data show regarding so-called gender-affirming surgery? Is there an argument for the rise in Trans individuals being part of a social contagion? And what about detransitioners and the Autism connection?

One of the other most controversial aspects of this debate is so-called “gender affirming surgeries”, such as mastectomies, and attempts to create “neo-vaginas” and “neo-penises” by using various parts of the patients body. While some trans-identifying individuals will never pursue surgery, an increasing number are. The argument made by some medical professionals is that by performing these surgeries and “affirming” a patient’s gender identity, they are more likely to live happier and healthier lives.

A 2004 review by the University of Birmingham’s aggressive research intelligence facility, or Arif, found the opposite. Arif conducts reviews of health care treatments for the National Health Service. The university conducted a review of more than 100 international medical studies of post-operative trans patients. The review was conducted after a request from The Guardian which said they spoke with several people who had regrets about gender surgeries or believe they were improperly prepared for their new lives.

The Aggressive Research Intelligence Facility concluded that none of the studies provided conclusive evidence that gender reassignment is beneficial for patients. It found that most research was poorly designed, which skewed the results in favor of physically changing sex. There was no evaluation of whether other treatments, such as long-term counseling, might help transsexuals, or whether their gender confusion might lessen over time.

Chris Hyde, the director of the facility at that time said there was huge uncertainty over whether changing someone’s sex is a good or a bad thing”. Hyde said even if surgeries were to be performed only on “appropriate patients” there would still likely be a “large number of people who have the surgery but remain traumatized”, some to the point of committing suicide.

Sometimes the surgeries themselves lead to death. For example, a 2016 medical article documents the death of one young adult who used puberty blockers and indicates that puberty suppression played a role in the young person’s death. In this case an 18-year-old trans-identified male whose puberty was blocked by Dutch researchers at a very early stage underwent surgery in an attempt to create a “neo-vagina”. However, due to a lack of tissue, surgeons attempted to use a section of the patient’s bowel, resulting in fatal necrotizing fasciitis.

Unfortunately, within 24 hours of surgery major complications began to arise. After treating the patient with large doses of intravenous antibiotics and repeatedly surgiclly removing dead flesh, the patient — who was initially described as “healthy” — went into multiple organ failure and died.

The researchers do their best to attempt to convince the reader that performing such surgeries are in the best interest of the patient because it MAY improve their standard of living. They write, “Transgender women with early-onset gender dysphoria, treated with puberty suppressing hormones, report fewer behavioral and emotional problems and an improvement of general functioning.”

While this example may seem extreme, the major concern is that these types of procedures are often being done without giving all the data to patients. For example, Swedish investigators involved in the Trans Train documentary acknowledged that despite that nation’s medical guidelines recommending top surgery, the procedures are happening despite a lack of long-term scientific data.

This lack of data, as well as the all-too common failure of medical professionals in divulging this lack of data, prevents patients from being given true informed consent.

The Question of Social Contagion

A 2022 report from the Williams Institute at UCLA’s School of Law shows transgender youth represent a higher portion of the overall transgender population in the United States. The report found that youth ages 13 to 17 are significantly more likely to identify as transgender (1.4%) than adults ages 65 or older (0.3%). The fact that younger children are identifying as trans at a higher rate than previous generations has some critics concerned that social media may be driving or at least reinforcing the concept to confused youth.

The rise in numbers of young adults pursuing gender transition treatment has caused alarm in parents and medical professionals who fear that the increase may not be a genuine reflection of more individuals feeling safe to come out as transgender — which is often the argument — but instead a representation of what is known as a social contagion.

A Social contagion involves behavior, emotions, or conditions spreading spontaneously through a group or network. Some critics point to historical examples of previously unknown conditions being given names and publicized in journals only to lead to an explosion of reported cases. For example, in 1979 British psychologist Gerald Russell first named the eating disorder bulimia nervosa. By the 1990’s an estimated 30 million people were affected by bulimia. Philosopher Ian Hacking calls this ‘semantic contagion’ — the idea that naming and describing a condition creates the means by which the condition spreads.

Those concerned with the rise of individuals identifying as transgender fear that young adults who may have confusion and/or genuine gender dysphoria questions — some of which might subside with time — will now find an online subculture ready to embrace them, and reinforce the idea that their experience is completely normal.

However, to some in the trans community, these questions about the legitimacy of challenging gender identity are in and of themselves a threat to the safety of the trans community. The online LGBTQ community can be intolerant to anyone asking questions about the potential harms of hormones and life altering surgeries.

The online community can be especially hostile towards the group known as detransitioners. That is, individuals who embraced the gender identiy discussion, hormones, and maybe even surgeries, only to regret their actions later. Many of these individuals are suffering life-long physical ailments as a result of their medical interventions.

The Detransitioners

There is a small but quickly growing number of vocal detransitioners who are being recognized for attempting to transition or fully transitioning genders, only to later come to regret the decision. Some of these detransitioners simply stop taking hormones after a short time, while others come to change their mind after going through so-called top and/or bottom surgeries which seek to remove breasts on females and alter the genitalia of a male or female.

One of the most well known detransitioners is a young woman named Chloe Cole. At the age of 12, Chloe began taking puberty blockers and testosterone in the hopes of transitioning to be a male. At age 15, Chloe had a double mastectomy to remove her breasts. Less than a year later she came to regret the decision. She has since become a vocal opponent of giving children access to puberty blockers, hormones, and so-called gender reassignment surgery.

The exact number of detransitioners is hard to obtain because most nations and medical institutions are not tracking long term outcomes after hormones and surgeries. Some estimates claim the number of detransitioners to be at 1%, while others believe the number is likely much higher but not detected because of the stigma and fear of public attacks.

In 2019, investigative journalists in Sweden released Trans Train, the first of several reports examining the nation’s policies around gender affirming care and the potential dangers in recommending such care. The journalists spoke with several detransitioners as part of their investigation.

As the young woman notes, there is often backlash for detransitioners who share their stories as they are accused of giving fuel to opponents of medical procedures for children and other transpeople.

For example, James Caspian, a psychotherapist who specialises in working with transgender people, has faced backlash for proposing research about “detransitioning” to the Bath Spa University in South West England. Caspian was enrolled in a Master of Arts program at the university and sought to document what he says are a rise in numbers of detransitioners. After initially accepting his proposal for research, the university changed their minds and rejected it. Caspian continues to defend his work, even taking his case with Bath Spa University to the European Court of Human Rights. He eventually published his paper independently.

While detransitioners have become an increasingly important point of the gender identity debate, an August 2023 study which surveyed 139 people 2 or more years after mastectomy said participants had “low rates of decisional regret and high levels of satisfaction with decision following gender-affirming mastectomy”. However, the researchers called for further research and “condition-specific instruments to assess decisional regret and satisfaction with decision following gender-affirming surgery”.

The Autism Overlap

Another major area of concern relates to studies highlighting an overlap between those on the autism spectrum and those identifying as transgender.

For example, a February 2022 independent review commissioned by NHS England and NHS Improvement highlighted a number of issues relating to gender identity and gender dysphoria treatments. The review, led by Dr. Hilary Cass, former President of the Royal College of Paediatrics and Child Health, found that,

“approximately one third of children and young people referred to the U.K.’s Gender Identity Development Service (GIDS)  have autism or other types of neurodiversity”.

Additionally, an August 2020 study found that individuals who do not identify with the sex they were assigned at birth are three to six times as likely to be autistic as those who identify with their biological sex. It also found that so-called “gender-diverse” individuals are also more likely to report autism traits and to suspect they have undiagnosed autism. The results come from an analysis of five unrelated databases that all include information about autism, mental health, and gender. The five datasets included 641,860 people; 30,892 with autism and 3,777 identifying as gender diverse.

The researchers explored the relationship between gender identity and six other mental health conditions which can occur simultaneously with autism, including schizophrenia, depression, and attention deficit hyperactivity disorder (ADHD). The study found that “gender-diverse” people have higher rates of all six conditions than cisgender individuals. The highest reported association was for autism and depression.

The authors concluded, “Our study demonstrates that transgender and gender-diverse individuals have elevated rates of autism diagnosis, related neurodevelopmental and psychiatric conditions, and autistic traits compared to cisgender (normal) individuals. This study has clinical implications by highlighting that we need to improve access to care and tailored support for this under-served population.”

So with all this information regarding the lack of long-term safety data for hormones and body alteration surgeries, and detransitioners speaking out to warn others, and signs of a potential social contagion, why does it seem like these aspects of the conversation are not being highlighted by the media, academia, or the medical establishment?

Instead, we see the media, academics, and various medical professions promoting transgender rights regardless of the potential for harmful outcomes.

Read Part 3