This piece undermines its own argument. Kumar acknowledges that “completed suicides among trans youth are vanishingly rare”. This fact directly undercuts the main urgency used to justify fast-tracking medical interventions.
If suicidality isn’t as widespread or extreme as commonly portrayed, then what’s the harm in slowing down and seriously exploring other explanations? Some of these youth might be gay, gender-nonconforming, autistic, or responding to social and peer dynamics.
Kumar also treats several unsettled scientific debates as if they’re closed. He omits the literature on desistance, ignores rapid-onset presentations, and assumes the Dutch protocol applies cleanly to today’s very different cohort. But even the Dutch model was cautious, narrow, and highly screened.
He calls for “evidence-based counseling” while selectively citing only evidence that supports transition. An honest evidence-based approach would admit we’re in uncharted territory, and that many interventions are being adopted before long-term outcomes are known.
Framing healthy adolescent bodies as “wrong” may actually create the distress we’re trying to solve. The strategic failure here is also medical, not just legal.
Detransition among minors who accessed pubertal suppression or hormonal therapy is currently estimated at 1-30% with higher figures in the US. No robust studies of regret among minors or young adults have ever been conducted. I lead the largest study on detransition in North America. @theonepercent
The study you linked is among the better ones from the US but it is reflective of a sample who socially transitioned at very young ages (early onset) which is not representative of people who realize a trans identity in adolescence or young adulthood (late onset). These are considered two distinct populations in gender affirming healthcare research.
The biggest limitation in estimating prevalence of detrans or regret is lack of prospective longitudinal research collecting data at 10+ years post tx. Detrans/regret occurs at means of 4-10 years (ranging months to 20+ years). In US, 2 & 5 year prospective studies are the longest term prospective studies available and they were not designed to examine detrans/regret as an outcome of interest. Many studies aiming to report prevalence of regret have between 20-40% patients lost to follow-up which is another limitation to having a clear sense (the article I co wrote with a couple colleagues in the BMJ discusses issues in studying detrans). To be very clear, trans rights and respect for gender diversity ought to be considered alone, irrespective of detransition or treatment regret, but the science of studying this particular outcome is very poor at the moment.
*Edited six months later for an update on the Olson sample referenced above (re: early socially transitioned trans children, JAMA paper). At a mean of ~8 years follow-up, roughly 16-20% of this sample had a second identity change (mostly shifting from binary trans to nonbinary, while others shifted to their birth-assigned gender - no results are reported on whether these are youth who'd accessed blockers or hormones, though). This is a really impressive, well-designed longitudinal study to watch over the years. The mean mean age of the sample is currently just under 15, so most have still not hit adulthood). Access, dissertation length monograph: https://srcd.onlinelibrary.wiley.com/doi/10.1111/mono.12479
Your contention of 'Puberty blockers are widely considered reversible and safe' isn't true and you omit the difference with precocious puberty blockers - nearly all people who go on puberty blockers for dysphoria then go on to cross-sex hormones. There are known risks with bone density and height implications and there are unknown effects on brain development, which we understand very little. We have genes on sex chromosomes that are activated during puberty, and surmising, it's reasonable to assume some of these may effect brain changes in combination with hormones that will impact our development into mature socialised adults.
The reversible is also fallacious, most people on puberty blockers go on to cross-sex hormones, so the pause and think doesn't work as claimed. This is not surprising as social transition is already a very powerful intervention and because gender affirming care is a cultural construction that already influenced the child. There is a dearth of open-ended therapeutic enquiry or consideration of factors like peer influence, contagion, internet, progressive parents, comorbidities etc.
You portray natural puberty as an optional thus betraying quite an extreme relativism where there is no normative in human development.
What many people fail to see is that trans is a culture bound syndrome, influenced by cultural narratives and the medical system itself. Why would a mental dis-ease need to be treated with power endocrine drugs, why is trans identification so prevalent with young people and clearly influenced by culture (it seems to be dropping in recent years after a big spike).
If you are a serious thinker you should examine what a 'trans person' even is. The narrative of born in the wrong body doesn't really make a lot of sense, there is no empirical evidence for an internal gender identity construct. Many young people don't even have these narratives initially, and are often influenced by social media to interpret natural doubts as evidence they are 'really trans'. Seriously go and spend time on a trans subreddit or discord and get a visceral sense of how media shapes us.
There is an opportunity for a new generation of leaders and thinkers to do better on this issue, particularly on the left which after all points to Foucault and social constructionism all the time. Perhaps thinkers need to take these ideas seriously for medical conditions?
This piece undermines its own argument. Kumar acknowledges that “completed suicides among trans youth are vanishingly rare”. This fact directly undercuts the main urgency used to justify fast-tracking medical interventions.
If suicidality isn’t as widespread or extreme as commonly portrayed, then what’s the harm in slowing down and seriously exploring other explanations? Some of these youth might be gay, gender-nonconforming, autistic, or responding to social and peer dynamics.
Kumar also treats several unsettled scientific debates as if they’re closed. He omits the literature on desistance, ignores rapid-onset presentations, and assumes the Dutch protocol applies cleanly to today’s very different cohort. But even the Dutch model was cautious, narrow, and highly screened.
He calls for “evidence-based counseling” while selectively citing only evidence that supports transition. An honest evidence-based approach would admit we’re in uncharted territory, and that many interventions are being adopted before long-term outcomes are known.
Framing healthy adolescent bodies as “wrong” may actually create the distress we’re trying to solve. The strategic failure here is also medical, not just legal.
Detransition among minors who accessed pubertal suppression or hormonal therapy is currently estimated at 1-30% with higher figures in the US. No robust studies of regret among minors or young adults have ever been conducted. I lead the largest study on detransition in North America. @theonepercent
This study has 220 participants and the rate is 2-4% regret — 5 years on average after beginning treatment.
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2825195
Can you provide any sources that would back up your 1-30% estimate and higher than 30% in the US?
The study you linked is among the better ones from the US but it is reflective of a sample who socially transitioned at very young ages (early onset) which is not representative of people who realize a trans identity in adolescence or young adulthood (late onset). These are considered two distinct populations in gender affirming healthcare research.
The biggest limitation in estimating prevalence of detrans or regret is lack of prospective longitudinal research collecting data at 10+ years post tx. Detrans/regret occurs at means of 4-10 years (ranging months to 20+ years). In US, 2 & 5 year prospective studies are the longest term prospective studies available and they were not designed to examine detrans/regret as an outcome of interest. Many studies aiming to report prevalence of regret have between 20-40% patients lost to follow-up which is another limitation to having a clear sense (the article I co wrote with a couple colleagues in the BMJ discusses issues in studying detrans). To be very clear, trans rights and respect for gender diversity ought to be considered alone, irrespective of detransition or treatment regret, but the science of studying this particular outcome is very poor at the moment.
https://pubmed.ncbi.nlm.nih.gov/35452119/
https://pubmed.ncbi.nlm.nih.gov/38944803/
https://www.bmj.com/content/381/bmj-2022-073584
https://pubmed.ncbi.nlm.nih.gov/40096683/
*Edited six months later for an update on the Olson sample referenced above (re: early socially transitioned trans children, JAMA paper). At a mean of ~8 years follow-up, roughly 16-20% of this sample had a second identity change (mostly shifting from binary trans to nonbinary, while others shifted to their birth-assigned gender - no results are reported on whether these are youth who'd accessed blockers or hormones, though). This is a really impressive, well-designed longitudinal study to watch over the years. The mean mean age of the sample is currently just under 15, so most have still not hit adulthood). Access, dissertation length monograph: https://srcd.onlinelibrary.wiley.com/doi/10.1111/mono.12479
Thank you for this
Your contention of 'Puberty blockers are widely considered reversible and safe' isn't true and you omit the difference with precocious puberty blockers - nearly all people who go on puberty blockers for dysphoria then go on to cross-sex hormones. There are known risks with bone density and height implications and there are unknown effects on brain development, which we understand very little. We have genes on sex chromosomes that are activated during puberty, and surmising, it's reasonable to assume some of these may effect brain changes in combination with hormones that will impact our development into mature socialised adults.
The reversible is also fallacious, most people on puberty blockers go on to cross-sex hormones, so the pause and think doesn't work as claimed. This is not surprising as social transition is already a very powerful intervention and because gender affirming care is a cultural construction that already influenced the child. There is a dearth of open-ended therapeutic enquiry or consideration of factors like peer influence, contagion, internet, progressive parents, comorbidities etc.
You portray natural puberty as an optional thus betraying quite an extreme relativism where there is no normative in human development.
What many people fail to see is that trans is a culture bound syndrome, influenced by cultural narratives and the medical system itself. Why would a mental dis-ease need to be treated with power endocrine drugs, why is trans identification so prevalent with young people and clearly influenced by culture (it seems to be dropping in recent years after a big spike).
If you are a serious thinker you should examine what a 'trans person' even is. The narrative of born in the wrong body doesn't really make a lot of sense, there is no empirical evidence for an internal gender identity construct. Many young people don't even have these narratives initially, and are often influenced by social media to interpret natural doubts as evidence they are 'really trans'. Seriously go and spend time on a trans subreddit or discord and get a visceral sense of how media shapes us.
There is an opportunity for a new generation of leaders and thinkers to do better on this issue, particularly on the left which after all points to Foucault and social constructionism all the time. Perhaps thinkers need to take these ideas seriously for medical conditions?