Re: Sarah Haider's "Accept by default"

24-07-2022

This is a response to a post by Sarah Haider titled "Accept by default", which is about how she cannot bring herself to accept transgender people. I have (hopefully) written this in such a way that it can be followed without having read the piece it's replying to, but you are still encouraged to read it, if only to check that I'm not misrepresenting her words.

I've seen similar sentiments expressed elsewhere, so this is indirectly a response to multiple pieces. My intent here is, ideally, to convince the authors of such pieces and those who agree with them - for this reason I've tried to avoid polemical statements and to leave out discussions that are not directly relevant.

Haider says she feels pressured into accepting things that she is not ready to accept, into holding beliefs that she cannot make herself hold. I can imagine her frustration; I think trying to force or guilt someone into a position is the absolute worst way to try and convince someone and tends to achieve the exact opposite. So, I will try to use argumentation instead. I will explain my reasoning for why I don't see her hypotheticals as very realistic, and also clarify some things which I think are simply misconceptions.

Background

I think it will be useful to first define some terms clearly.

Let me first describe what I'll call the 'traditional view on gender'. According to this view, someone who was born with a penis is and will always be a man, and someone who was born with a vagina is and will always be a woman.

Transgender people are, in essence, those who wish to live in violation of the traditional view on gender. This includes for example someone born with a vagina who wants to live as a man; it can also include someone who wants to live as neither man nor woman. I'll sometimes abbreviate transgender as 'trans' as is commonly done.

I'll define sex (the attribute, not the act) as the combination of all biological aspects of man-/womanhood. Two straightforward ones are genitals and sex hormone levels, but there are quite a few more things to it, as anyone more knowledgeable than me about intersex people - those whose sex does not neatly line up with either male or female - can tell you.

Gender, then, I'll define as the combination of all non-biological aspects of man-/womanhood. This includes any psychological and sociological differences between men and woman, and social norms about what is appropriate in terms of appearance (e.g. clothing, hairstyle) and behaviour for men versus what is appropriate for women.

In terms of sex and gender, the traditional view on gender says that gender is completely determined by sex and that sex does not change. Transgender people are people who want to (or already do) live as a different gender from the one associated with their birth sex; in addition, most trans people want to change several aspects of their sex (or already have).

Major aspects of sex can be changed nowadays using medications which affect hormone levels, genital surgeries and other surgeries. The result of those surgeries is always an intersex body and different from what it would be if transformation magic were an available option, but the outward appearance can mostly be matched to what is desired. All these medical interventions fall under the term 'medical transition'. This as opposed to 'social transition', which involves at least a name change. [1]

Transgender people and those who advocate for them want to challenge the traditional view on gender and are currently doing so more visibly than ever. This has unleashed fiery debates about the traditional view, about the nature of transgenderism and about how society should treat transgender people - these debates are all strongly linked, to the point of being one debate. Given the heatedness of this debate, Haider's post has undoubtedly made quite a few people angry and so, no doubt, will mine.

What if

What I see as the main arguments in Haider's piece is a series of "What if...?"-style questions. She questions what makes people transgender.

The standard answer goes something like this. Transgender people have some kind of biopsychological difference from non-transgender people, due to which they experience the gender associated with their birth sex as wrong. They usually experience strong miserable feelings about their body or about gendered expectations or treatment. They want to live as the gender that they feel they are 'on the inside' and often to have their bodies altered. This is not without its drawbacks. Medical transition comes with steep costs, long waiting times and fierce interrogations by psychiatrists. Social transition comes with bullying from peers, contempt from large sections of society, discrimination, the risk of hate crime and the risk of unsupportive parents, which can imply losing one's relationship with them or even getting kicked out on the streets.

Before we move on to Haider's criticisms and alternatives, it is worth noting that this narrative is quite strong. Transgender people have a clear view of what is wrong and a clear view of what they need. The potential for negative consequences they are willing to accept suggests that it is really a need for them; there is also clear evidence that being supported in transitioning has a very large positive impact on their well-being. It all fits together quite logically.

Haider asks: what if this narrative is wrong? She suggests two alternatives. The first is that it might be due to a "cultural unmooring" - I'm not sure whether she means that the person has come loose from their culture or that the culture as a whole has come loose from... something else. Either way, she seems to be suggesting that transgenderism might be a sociocultural phenomenon instead of something innate.

A sociocultural explanation of transgender people's experiences has quite a few things to explain. It has to explain the experiences of the many trans people who report having had their first realisation of transgender-ness at a very young age and at a point when they did not know other people like them existed; for many, they were as young as eight, for some as young as four, according to the survey results of one paper [2]. It has to explain how transgender people appear in modern western society even as the traditional view on gender is quite deeply ingrained into that society and even when their parents strictly enforce gender norms - the explanation can certainly not be a direct one. It has to explain how transgender people also appear in quite different cultural settings, such as Mexico in the early 1900s [3]. There are many other examples from the past, though not all equally well documented.

I don't see a theory that attributes transgenderism to primarily social causes as a viable pursuit. Regardless, until an actual concrete theory is formulated and, more importantly, until it comes with a 'cultural remedy' for this 'cultural unmooring' that results in outcomes at least as good as gender-affirming care, this cannot be considered a serious alternative.

Haider's second suggestion is that maybe, transgender people in general are actually cognitively misattributing symptoms of an "unformed psychological malaise" to transgender-ness. She also points to detransitioners, who pose a bit of a challenge to the standard transgender narrative. Detransitioners, for the purpose of this piece,[4] are those who at some point in their transition come to the conclusion that they are not transgender after all and start a 'detransition' in the other direction. Their existence implies that it is, in fact, possible for people to mistake certain other experiences for being transgender.

However, what Haider is suggesting is that this might be the case for all or most trans people. This starts to seem far-fetched when we look the properties of this unspecified 'malaise'. The bad feelings that trans people are supposedly misinterpreting occur specifically in situations related to gender. Now, one might argue that it could start as a general feeling and after the misinterpretation has taken hold, these negative feelings become accentuated in gender-related situations. However, this begs the question of how people could interpret a general unhappiness as transgenderness, more so if they don't have the prior knowledge that transgender people exist.

I do not mean to imply that everyone who, as a child, experiences negative feelings due to gender-related situations is trans. It happens quite a lot that children experience feelings that seem similar to those of transgender kids (perhaps to a lesser extent, though?) or display 'gender-nonconforming' behaviour or maybe even express a wish to be the opposite gender, but then it all disappears at the onset of puberty. However, when it doesn't disappear around that time but instead grows stronger, one is dealing with quite a different beast altogether.

I think this hypothetical 'malaise' would have to be awfully specific and resemble what one might call 'gender dysphoria'. Even more strangely, there are many others besides those who turn out trans, who experience something similar in childhood and can even make a similar misattribution; it would have to be explained how the same event (the start of puberty) can either dissolve or intensify this 'malaise' for children who are supposedly all equally confused. I cannot see it as a serious theory. And again, until it is made into a concrete and logical theory and there is a working treatment option to go with it, it cannot be considered a real contender.

My conclusion is that transgenderism seems to be innate and due to some biopsychological difference. What difference that is exactly, I have no clue. Haider describes her friends giving some interesting theories. She notes that they don't have much evidence for these theories; I think this is logical, as whatever is going on involves the brain, an organ notoriously hard to prove anything about. See, for example, mental disorders: multiple theories with a few partially explaining brain pathways is par for the course in the field of psychopathology. And of course, we do not refuse help to depressed people just because there is a lot of debate about the precisely nature of their problem. So why would it be different for transgender people? It is not, as Haider suggests, a "moral crime" to accept transgender people while we don't understand what exactly causes them to be transgender. It would be a moral crime to deny these people care that they strongly desire and makes them demonstrably happier, only because we're still waiting for the biological underpinnings to be determined.

This brings me to a common reaction in trans circles when it comes to the trans healthcare debate: to question whether it should be a debate at all. They argue that just as it is surely someone's own choice what type of clothes to wear and what name to use, it should be someone's own choice whether they want to take hormones or have surgery done. They see non-transgender people who can't really know what it's like debating whether it is the right choice for them, or even whether they should have that choice at all. Essentially, the argument is one of bodily autonomy. I think I should address two responses to this, though I do not see Haider making them, just because I have seen them brought up often.

Of course there exist those who regret certain medical transition interventions. Looking at those who decide to pursue genital surgeries in particular, we see that there are people who later regret it, although they are rare (one survey of surgeons [5] found around 0.2% - to be safe, let's say less than 1%). There are people who reach this stage in spite of checks that occur before then. The negative outcome for them is reason to refine those checks to catch more of those people while being mindful of potential for false positives; it is reason to make extra sure people have all the information about possible outcomes and risks of the procedures. I think doctors are acting in good faith on that front (or they would presumably and hopefully lose their job), but there may very well be room for improvement. What it is not reason for is blindly restricting gender-affirming care to try and protect people from their own choices.

One other group frequently brought up is minors. Minors can access some gender-affirming medical interventions, though parental consent is required until they reach the age where they are legally able to give full medical consent (the age of majority or, in some countries, 1 or 2 years younger). Before that age, some interventions, genital surgeries in particular, are entirely off-limits even with consenting parents. Breast reduction surgery is, in some cases, allowed some time before that age. In general, there is a build-up from least invasive to most invasive interventions, starting with things that are classified as fully reversible, and starting only when the first stages of puberty have already been experienced. [6]

Is this all exactly right? I don't know. I think the medical experts making these rules are likely suited to the task and acting in good faith. The doctors making approval decisions for individual minors should, of course, duly consider both the potential consequences of delaying and those of approving, and try to act in the best interest of that specific minor in light of their situation. And of course, they should give as clear as possible information about possible outcomes to the minor and their parents, and follow the applicable standards for medical ethics. I see no reason to think they aren't largely doing exactly that. I see no reason to treat those decisions as all the same and make a one-way decision for those doctors and for all their patients. There are many cases where delaying, in light of the suffering likely to be caused by that, is simply the wrong choice.

Haider makes one other suggestion, this one not about the nature of transgenderism. She suggests - if I understand correctly what she is saying - that maybe, the orthodox view on gender is crucial to the functioning of society. She does not give any reason why this might be the case, and I cannot think of any. It seems very possible, to me at least, to imagine a society that has let go completely of the traditional view and is still working fine. Why would it lead to the collapse of society to let a 'weird' group of people who aren't hurting anybody live their life as they want to?

If anything, rigidly enforcing the traditional view on gender is what seems more likely to lead to societal disaster, as it would involve taking away existing freedoms from a hated minority - if taken far enough, it would even involve taking away existing freedoms from everyone. Furthermore, I think there is a large amount of hurt that can be prevented by letting go of the traditional view, and there is potential for enormous compounding positive effects.

Research

One of the reasons I started with some definitions was to preemptively try to disarm a misconception expressed by Haider. She speaks as if what trans advocates are undermining is biological sex itself. It simply isn't; as I hope is clear at this point, what is really being undermined here is the idea that gender must always correspond to sex.

Haider refers to trans advocates as 'gender ideologists' - the 'gender ideology' referenced boils down, as far as I can tell, to the concept of 'gender identity'. 'Gender identity' is described as a part of gender, namely a strong feeling of what gender one is 'on the inside', a sort of deep self-knowledge. First of all, calling people ideologists for this ignores that it is first and foremost an attempt at explaining what it feels like to be transgender. Trans people really do experience a strong feeling that what they are 'on the inside' does not match their body or society's expectations, and 'gender identity' is a way of putting this into words.

I'm also not sure it is such a far-fetched idea. Imagine you ask a random non-transgender woman to do the following thought experiment. You ask her to imagine that tomorrow morning, she wakes up in a male body and that suddenly all her friends and family are calling her 'John'. If you let her think about this for a bit and ask more questions, then in my estimation she is likely to tell you that she would still be a woman and that she would experience a lot of distress from having a penis and everybody treating her as if she were a man, that this is not be something she would get used to after a while.

Of course, this is an imaginary woman and I can let her say whatever I want, but I think this response is believable and more or less what one would expect. And this woman has just expressed her belief that she has something that I can only call a gender identity, which would stay the same even if her sex changed completely. What is so unreasonable about this concept?

Haider says she has spent countless hours looking into this issue, and I believe her. But it is surprising that in all that time, not a single trans rights advocate has been able to free her of the notion that trans people are "deconstructing biological sex". I suspect she could have spent quite a bit more of that time listening to what transgender people themselves have to say, and maybe a bit less in the places where she has the term 'gender ideologist' from.

Or maybe she has been listening to trans people, but it just doesn't land for some reason. Haider seems to see the negation of the traditional view on gender as inherently unreasonable; maybe it could help her better understand and accept the transgender phenomenon if she investigates why she thinks that.

Changing her mind could get ever harder for her, however, due to which people will associate themselves with her. After writing "Accept by default", anti-trans people will come to her by themselves; meanwhile, most pro-trans people will have lost any and all desire to spend energy on her after reading the first "What if". If she is not mindful of this, she could be walking herself into a powerful echo chamber.

Footnotes

[1] Some caution is advised when interpreting or using the term 'gender transition'; many interpret it as referring primarily to medical transition, whereas it can refer to just social transition. Also, not everybody who pursues medical transition wants all of the interventions I have described. In this piece, when I talk about just someone's 'transition', I mean the entire process for them, no matter how much medical intervention it involved.

[4] 'Detransitioner' can also refer to people who detransition for other reasons, for example medical reasons.

Further reading and watching

I have two recommendations for those looking for more information or more in-depth (and more competent) trans advocacy than I can provide:

• CN Lester, "Trans like me"
• Contrapoints (Youtube channel)