[The full post is ~5300 words and way way too long for the Motte's 20k character limit but I'm posting as much as I can fit.]
If you've ever been curious about the etymology of cis and trans as prefixes, just know they're Latin for "the same side of" and "the other side of", respectively. These prefixes are widely used in organic chemistry to distinguish between molecules that have the exact same atoms with a different spatial arrangement. Notice, for example, how in the cis isomer below on the left, chlorine atoms are oriented toward the "same side" as each other, but on the "other side" of each other in the trans isomer.
[chlorine on hydrogen action too hot for the motte]
The dashed line is just me simplifying the geometric comparison plane (the E-Z convention is much more precise in this respect), but regardless, this is meant only to illustrate how talk of cis or trans is necessarily one of *relative positioning. *A single solitary point floating in space cannot be described as the same or other "side" of anything when there is nothing else to contrast it against.
Now this is just organic chemistry, not real life, but the cis/trans convention is applied consistently elsewhere. In the context relevant to this post, "sex" and "gender" are the two anchor points --- the two chlorine atoms in the dichloroethene molecule of life --- and their relative resonance/dissonance relative to each other is the very definition of cis/trans gender identity. To avoid any ambiguity, I use sex to refer to one's biological role in reproduction (strictly binary), while gender is the fuzzy spectrum of sex-based societal expectations about how one is supposed to act. If your sex and gender identity "align", then you are considered cis; if they don't, then you are trans. Same side versus other side.
But what does it mean for sex and gender identity to "align"? There is an obvious answer to this question, but it is peculiarly difficult to encounter it transparently out in the wild. For reasons outlined below, I will argue that the elusiveness is completely intentional.
More than two years ago I wrote a post that got me put on a watch list, called Do Trans People Exist?. The question mark was barely a hedge and the theory I outlined remains straightforward:
I'm starting to think that trans people do not exist. What I mean by this is that I'm finding myself drawn towards an alternative theory that when someone identifies as trans, they've fallen prey to a gender conformity system that is too rigid.
Two years on and I maintain my assertion remains trivially true. One change I would make is avoiding the "fallen prey" language because I have no idea whether the rigidity is nascent to and incubated by the trans community (for whatever reasons), or if it's just an enduring consequence of society's extant gender conformity system (no matter how much liberal society tells itself otherwise). If you disagree with my assertion, it's actually super-duper easy to refute it; all anyone needs to do is offer up a coherent description of either cis or trans gender identity void of any reference to gender stereotypes. But I'd be asking for the impossible here, because the essence of these concepts is to describe the resonance or dissonance that exists between one's biological reality (sex) and the accordant societal expectations imposed (gender). Unless you internalize or assimilate society's gender expectations, unless you accede to them and capitulate that they're worth respecting and paying attention to as a guiding lodestar, concepts like "gender dysphoria" are fundamentally moot. A single point cannot resonate or clash with itself, as these dynamics necessitate interaction between distinct elements.
The position I'm arguing is nothing new. The Oxford philosopher Rebecca Reilly-Cooper had already established the incoherencies inherent within this framework conclusively and with impeccable clarity in this lecture she gave way back in 2016 (website form). It's wild how her arguments remain perfectly relevant today, and if anyone has attempted a refutation I have not encountered it. And yet this remains a controversial position to stake, but not because it's wrong. Rather, I believe, it's because of how insulting it is to be accused of reifying any system of stereotypes nowadays.
In case it needs to be said, stereotypes can occasionally offer useful shortcuts, but their inherent overgeneralization risks flattening reality into inaccuracy. The major risk relevant to this discussion is when stereotypes crystallize into concrete expectations, suffocating individual expression with either forced conformity due to perceived group membership, or feelings of alienation due to perceived incongruence. The indignation to my position is also understandable given how the foundational ethos of the queer liberation movement was a rejection of gender normativity's constraints.
You're not obligated to take my word for this, but I do tend to feel an immense discomfort whenever I hold a position that is purportedly controversial, and yet I'm unable to steelman any plausible refutations --- a sense of "I must be missing something, it can't be this obvious" type deal. I did try to bridge the chasm of inscrutability when I wrote What Boston Can Teach Us About What a Woman Is. My plea to everyone was to jettison the ambiguous semantic topography within this topic and replace it with concrete specifics:
To the extent that woman is a cluster of traits, I struggle to contemplate a scenario where communicating the cluster is a more efficient or more thoughtful method of communication than just communicating the specific pertinent trait. Just tell me what you want me to know directly. Use other words if need be.
Because right now it's a complete fucking riddle to me if someone discloses that they "identify as a woman" or whatever. What, exactly, am I supposed to do with this new information? Suggesting that stereotypes are the referent is met with umbrage and steadfast denials, but if not that, then what? Over the years I've tried earnestly to learn by asking questions and seeking out resources, and what I've repeatedly experienced is a marked reluctance to offer up anything more than the vaguest of details.
The ambiguity I'm referring to isn't absolute, however, and there are two notable exceptions worth briefly addressing: body modifications and preferred pronouns.
Sex does not only determine whether an individual produces large or small gametes --- an entire armory of secondary characteristics comes along for the ride, whether you like it or not. If a female happens to be distressed by their breasts and wants them removed, you could describe this scenario in two very different ways. One is that this person "identifies as a man" and their (very obviously female) breasts serve as a distressing monument that something is "off". The other way is that this person is simply distressed by their breasts, full stop, without any of the gender-related accoutrements. [These two options are not necessarily exhaustive, and I'm open to other potential interpretations.]
Is there any difference between these two approaches? The first framework adds a multitude of vexing, unanswerable questions (Does comfort with one's secondary sex characteristics require some sort of "affirmation gene" that trans people unfortunately lack? Is the problem some sort of mind/body misalignment? If so, why address one side of that equation only? Etc.) within an already overcomplicated framework. The other concern here is if the gender identity becomes prescriptive, where an individual pursues a body modification not for whatever inherent qualities it may have, but rather because of some felt obligation to "complete the set" for what their particular identity is supposed to look like.
The second framework (the one eschewing the gender identity component) would not dismiss the individual's concerns and would be part of a panoply of well-established phenomena of individuals inconsolably distressed with their body, such as body integrity dysphoria (BID), anorexia, or muscle dysphoria. The general remedies here tend to be a combination of counseling and medication to deal with the distress directly, and only in rare circumstances is permanent alteration even considered. I imagine there is some consternation that I've compared gender dysphoria with BID, but I see no reason to believe they are qualitatively different and welcome anyone to demonstrate otherwise. Regardless, I subscribe to maximum individual autonomy on these matters, and so it's not any of my business what people choose to do with their bodies. The point here is that preferences about one's body (either aesthetic or functional) exist without a reliance on paradigm shifts of one's "internal sense of self". If someone wants to, for example, bulk up and build muscle, they can just do it; it's nonsensical to say they first need to "identify" as their chosen aspiration before any changes can occur.
The other exception to the ambiguity around what gender identity* means* is pronoun preference. Chalk it up to [whatever]-privilege, but I concede I do not understand the fixation on pronouns. The closest parallel I can think of are nickname preferences, but unlike nicknames, pronouns almost never come up in two-party conversations, so it's difficult to see why they would be any more consequential. I personally accommodate pronoun preferences out of politeness (and I suspect almost everyone else does as well), the exact same way I would accommodate nicknames out of politeness. If I happen to refer to my friend using frog/frogs pronouns, it's not because I believe they're actually a frog; I'm just trying to be nice and avoid getting yelled at. Regardless of the intent behind them, pronoun preferences are a facile and woefully incomplete account for what we're warned are suicidal levels of distress around one's incongruent gender identity, so this can't be the whole story.
So on one extreme you have potentially invasive body modifications that are at least commensurate with the seriousness of the distress expressed, and on the other side you have the equivalent of a nickname preference that is relatively facile to accommodate. In between these two pillars, however, is a conspicuous vacuum of silence. My conclusion is that this missing middle is really just gendered stereotypes, but nobody wants to admit something so laughably antiquated out loud.
Well, almost nobody.
I've had this post sitting in my drafts for months largely because of an ever-present concern that I was unfairly shining a spotlight on the craziest examples from the trans-affirming community. My perennial goal with any subject is to avoid weakmanning, but with this issue I have no idea how to draw the contours and discern what arguments are representative and thus fair game to critique.
The lack of contours means I can't prove this next part conclusively, but I noticed a shift over time regarding which talking points were most common. The perennial challenge for this camp remains the logical impossibility of harmonizing the twin snakes of "trans people don't owe you passing" and "trans people will literally kill themselves if they don't pass". At least as late as 2018, there was more of an apparent comfort with leaning more toward openly reifying gendered roles and expectations. For example, in this Aeon magazine dialogue between trans philosopher Sophie Grace Chappell and gender-critical feminist Holly Lawford-Smith, Chappell uses the word script in her responses a whopping forty-one times.
But by far the most jaw-dropping example of this comfort comes from a lecture by Dr. Diane Ehrensaft, currently the head psychologist for the UCSF Benioff Children's Hospitals' gender clinic. When a parent asked how to know if a baby is trans, Dr. Ehrensaft literally said that a baby throwing out a barrette is a "gender signal" the baby might not really be a girl, the same way another baby opening their onesie is a signal they might be a girl. Seriously, watch this shit.
This is such a blatantly asinine thing to say that it depresses me to no end that the auditorium didn't erupt in raucous laughter at her answer. I don't even know how to respond to it. Maybe it bears repeating that babies are dumb. At any given moment, the entirety of a baby's cognitive load is already stressed over having to decide between shitting and vomiting. Dr. Ehrensaft conjures up this tale about how dumb babies are able to divinate the eternal message that "dresses are for women" out of thin air (or maybe directly from Allah), and that same dumb baby also has the ingenuity to cleverly repurpose their onesie into a jury-rigged "dress". I'm not claiming that it's impossible for young children to notice and even mirror societal expectations, including gender-related ones. Indeed, research indicates wisps of this awareness can start manifesting very early on, with children reaching "peak rigidity in their gender stereotypes at age 5 to 6" followed by a dramatic and continuing increase in flexibility. But it remains a jaw-dropping level of projection and tea leaf--reading on display here by Dr. Ehrensaft; the simple explanation that a baby might open their onesie because they're a dumb baby is apparently not worth consideration.
Dr. Ehrensaft is illustrative of the intellectual rigor that is apparently expected from the lead mental health professional in charge of the well-being of an entire clinic's worth of young patients. Matt Osborne wrote a devastating piece about her very long history of dangerous quackery. My mind was blown when I found out that Dr. Ehrensaft happened to be at the scene in 1992 desperately trying to whitewash the Daycare Satanic Panic and the unconscionable misery the "recovered memory" movement caused. In response to some highly suggestive interviews by therapists, preschool children alleged bizarre and horrific sexual abuse by staff involving drills, flying witches, underground tunnels, and hot-air balloons. The notorious McMartin case resulted in no convictions, with all charges finally dropped in 1990 after seven years of prosecutions. Two years later in an aftermath report of the similar Presidio case, Dr. Ehrensaft notes how the children's abuse narratives often contained fantasy elements, such as devilish pranks and hidden skeletons. This should normally be grounds for skepticism, but Dr. Ehrensaft stridently refuses to question the veracity of the accounts, and explains away the outlandish aspects as simply the result of trauma management --- the kids were using imaginative fears as a protective barrier for their (according to Dr. Ehrensaft) unquestionably real trauma. Given her general credulity, it's no surprise why her writing on the topic of gender identity is a murky soup of pseudo-religious nonsense about "gender ghosts" and "gender angels".
What exactly is the explanation for trans-affirming professionals like Chappell and Ehrensaft explicitly encouraging the necessity of adhering to gender scripts? Were they misled? Did they get the wrong bulletin? How? Why aren't their professional peers correcting them on such an elementary and foundational error? So many questions.
You can't keep drawing from the well of gender stereotypes so blatantly without anyone noticing. My general impression of the field is people realized how idiotic they sounded when their talking points were solidly anchored upon the veneration of (purportedly antiquated) gender roles and gender scripts. The response to this inescapable criticism has largely been to subtly pivot into the realm of empty rhetoric. But because of the necessity to cling onto strands of the initial assertions (for reasons I'll explain further), the result is a strenuous ballet of either constantly leaping between the two positions, or uncomfortably trying to straddle both.
Dr. Ehrensaft gives us an example of the vacuous. Her onesie/barrette poem of an answer above is from a video uploaded in 2018, but here's how her website explains gender nowadays, except with one particular word switched out:
This core aspect of one's identity comes from within each of us. Flibberdibber identity is an inherent aspect of a person's make-up. Individuals do not choose their flibberdibber, nor can they be made to change it. However, the words someone uses to communicate their flibberdibber identity may change over time; naming one's flibberdibber can be a complex and evolving matter. Because we are provided with limited language for flibberdibber, it may take a person quite some time to discover, or create, the language that best communicates their internal experience. Likewise, as language evolves, a person's name for their flibberdibber may also evolve. This does not mean their flibberdibber has changed, but rather that the words for it are shifting.
Can anyone reading this tell me what flibberdibber is beyond that it's something inexplicably very important?
It's probably too much to expect philosophy to throw us a lifeline here, but even with those low standards, the response from the trans-inclusionary philosophers has been a complete fucking mess and followed a similarly strenuous pivot. For example, in the 2018 paper Real Talk on the Metaphysics of Gender, Yale philosopher Robin Dembroff argues for a more "inclusive" understanding of gender. But in doing so, Dembroff explicitly acknowledges the glaring contradiction between decrying a category as oppressively exclusionary while simultaneously petitioning to be included within it. The apparent solution on page 44 to this conundrum is rather. . . something:
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Notes -
I’m a trans person and I’m honestly tired of how politicised this condition has become. I’m going all-in on the hypothesis that’s it’s a physical condition caused by an endocrine abnormality. I highly recommend reading this post or any of Dr Powers’ posts on his subreddit.
All of this philosophising on the nature of transgenderism is like trying to psychoanalyse the cause of stomach ulcers (which is something clinicians did until they were revealed to be caused by bacteria). There’s clearly something physically abnormal with transgender people and their brains, and one of the manifestations of that is gender dysphoria and behaviour atypical of the patient’s birth sex.
I don’t care one iota about my “gender identity”, following any gender scripts, or whether my interests are typical for men or women. I don’t “identify as a woman”, whatever that means. I would vastly prefer if pro-trans clinicians focused on actual clinical markers like improper methylation of testosterone, or the extremely high rates of PCOS in trans male patients, or MTHFR mutations. This is the kind of scientific research that would actually help our understanding of transgender people.
Instead we have this focus on babies turning their onesie into a dress. Anybody on both sides can write a lengthy essay full of navel gazing on the sociological basis of gendered behaviour that supports their pet theory, and turn being trans into a moral problem. You can debate endlessly about what is a woman, which is a philosophical problem. Or you can do DNA testing on trans patients and discover rates of certain mutations far in excess of the normal population, examine aromatase and sex hormone production, and look at correlations between gender dysphoria and other physical conditions.
Seems to be like the latter is far more useful. Plus, no one can have a political argument over DNA methylation patterns.
I would be all in favour of your proposal. Do you know who wouldn't? The loudest trans activists out there.
Twenty years ago, gender dysphoria was understood as a rare and unfortunate medical condition which caused intense distress among those suffering from it, who deserved respect and compassion. Nowadays, trans is seen as something wholly unrelated to any medical condition (never mind a psychological disorder) and to suggest that only people who have been formally diagnosed with gender dysphoria by a qualified mental health professional are "really" trans is a form of essentialist gatekeeping. Hence all the navel-gazing about what a woman "really" is: if it was put down to a simple binary choice "do you have gender dysphoria yes/no", then some of the most vocal trans people out there would be forced to concede that they aren't really trans at all. On some level they must know that they would not pass a diagnostic test for gender dysphoria with flying pink-and-blue colours: they don't have stereotypically feminine/masculine interests, they don't experience distress looking at their naked bodies in the mirror, they haven't undergone gender reassignment surgery (nor have they any desire to), in many cases they aren't taking hormones and have no plans to. All they really want is to be treated socially as a woman, and perhaps gain access to women-only spaces.
I think saying "instead of navel-gazing about what a woman really is, we ought to be investigating the underlying biochemistry behind gender dysphoria" is sort of missing the point. The current state of the discourse (and, more importantly, the current state of legislation) in the Anglosphere admits no intrinsic relationship between the transgender community and gender dysphoria. Gender dysphoria is now a condition incidentally suffered by some, but far from all, trans people, where before it was treated (more properly, in my view) as a rule-in criteria for membership of the group: being a trans person without gender dysphoria would be like being a vegetarian who eats meat. Before we can even begin to shift focus towards investigating the neural substrates of this medical condition, we need to roll back ten years of dualist nonsense about an "internally felt sense of gender identity" and acknowledge that self-ID, wherever implemented, is a fantastically ill-thought-out piece of legislation.
Unfortunately vocal anti-trans activists are just as bad as the vocal trans activists you described. A relatively moderate trans medicalist perspective as you described would be just as vilified by either side.
Also, I’m not necessarily in favour of strict gatekeeping of trans identity when it comes to medical treatment, especially for adults, for the same reasons I’m not in favour of strict gatekeeping for ADHD. You’re incentivising whoever is most motivated to get through the gatekeepers, and those aren’t necessarily the ones that would benefit the most from the treatment. See this excellent post by Scott Alexander.
Although in the case of the trans activists you mentioned, it wouldn’t be a problem as they’re not interested in medically transitioning at all, so removing gatekeeping when it comes to HRT and surgery would have no effect on them. If you’re not actually dysphoric and pursue transition, it will give you reverse gender dysphoria - so having the gatekeeping be the medical treatment itself is self-correcting to some extent.
I agree with Yassine that adults can do whatever they want with their own bodies. I suspect that I'm far more of a bodily autonomy absolutist than the average person, and if an adult male wants to have their penis fashioned into a crude neovagina, then that's their business, more power to them, and the fact that they haven't been diagnosed with gender dysphoria should be no object (although I don't think the state should pay for the procedure, any more than they should pay for boob jobs or whatever the Bogdanoffs did to their faces). In the context of adults who want to take hormones and undergo gender reassignment surgery, I don't think there's any real ethical dilemma: adults are allowed to make choices about their own bodies, even ones they may later come to regret. The burden of proof is much higher for children and teens, for obvious reasons.
Do you think there should be legal gatekeeping? That is, should anyone be entitled to change the sex on their birth cert or driver's license, or only people who can demonstrate that they suffer from gender dysphoria?
I am generally in agreement with you, but I have had scenarios thrown in my face that I don't know how to answer. I would like to hear your opinion.
You and I both say that it's an adult's personal business what they want to do with their bodies, but when does it become someone else's business? When they want you to call them a specific pronoun? What about if you're hooking up with them? What about if you're in a long term relationship with them? Do you think that it's a man's business if his wife is actually an mtf, or is that solely the wife's business? What about if an mtf goes out to a bar looking for a man to bang, would the fact that they're not really a woman be the one night stand partners business? I don't know the answer. I love to think of things as people's personal business, I really do, but then there are all these edge cases that everyone I know wants to have encroach all the time.
My comment was about medical transition specifically, and I agree that numerous other components of trans activism do not fall under "it's my body and I can do with it as I please". Nonetheless, I'll try to answer your question.
I completely agree with Jordan Peterson that no one should be legally compelled to address someone by their preferred pronoun. Knowingly failing to do so may be rude, but it isn't "hateful". I try to use people's preferred pronouns as a courtesy, but fortunately it doesn't come up very often.
If you go home with someone and discover that their genitalia are different from what you had presumed, you are perfectly entitled to leave. Doing so does not make you transphobic or bigoted one iota. When trans rights activists accuse people of not being "straight" but simply having a "genital preference" my response is yeschad.jpg - that's what a sexuality is. It's perhaps a little dishonest for the trans person in question not to disclose it upfront, although on the other hand I don't think people should be socially expected to disclose every potentially germane fact about their bodies to a prospective one-night stand e.g. that one episode of Friends where Chandler dates a girl with a wooden leg. I don't think people with prosthetics should be expected to disclose that upfront up everyone they're interested in going to bed with, even though many people are (understandably!) put off by prosthetics.
What if you can't tell visually? I've heard that surgeries of this sort these days produce a very realistic looking vagina, even if it doesn't feel realistic, such that you may only know by actually sticking your penis in. And even then, many people may not even know what a fake vagina feels like, they may assume something else is up.
I am very sceptical.
Even in the unlikely event that their neovagina didn't tip you off (visually or tactilely*), a hundred other things would. The width of their shoulders, the narrowness of their hips - there are loads of cues which are difficult enough to mask with clothing and makeup, and effectively impossible to mask in the nip. The likelihood of you going to bed with someone without realising they're a trans woman is so low as to be functionally nil. It's not a possibility that you should devote any time or energy into avoiding.
*Or even (and I feel kind of dirty even pointing this out) olfactorily.
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