Facts versus feelings in the transgender debate

Ryan T. Anderson argues that evidence, not ideology, should be our guide.

The question raised in the 1989 movie When Harry Met Sally is whether a man and a woman can be “just friends.” The question that people are asking in the wake of the stir that Caitlyn Jenner has catalyzed is whether a man can become a woman. If you’re looking to understand the transgender movement that is sweeping the United States, Ryan T. Anderson’s When Harry Became Sally is a perfect place to start.

Read on for key takeaways from this important, timely book.


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The resurgence of medical support for transgenderism has been driven by ideology—not evidence.

The first known case of a sex reassignment was in 1930. Einar Wegner was a Danish painter who believed he had a female identity, which he called “Lili Elbe.” This approach to addressing gender dysphoria (i.e., the emotional and psychological condition of believing one’s gender is different than one’s biological sex) would remain at the fringes of medical practice and culture for decades after. Harvard Medical School graduate and psychiatrist-in-chief at Johns Hopkins Hospital, Paul McHugh, truncated all reassignment surgeries at the hospital in 1979. Numerous medical institutions followed suit. There’s been a resurgence of the medical practice in recent times, but the reversal has not come as a result of new medical evidence but ideological strong-arming.

This book argues that McHugh’s instincts were accurate. The cream of the scholarly crop in biology, psychology, and philosophy point to the basic facts that sex is an embodied reality—as opposed to a purely mental or emotional phenomenon—and that gender is the social-cultural expression of that sex.

The truth that has been suppressed by activists and journalists is that the transition procedures have not made a dent in the staggering transgender suicide attempt rates (41 percent compared to 4.6 percent among the general population). Furthermore, 90 percent of the cases of gender dysphoria resolve themselves as children grow older and learn to accept their embodied sex.

This is a discussion that matters for everyone, as there are serious consequences for misunderstanding human nature and for building culture and policy around those misunderstandings.


The ideology of transgender activists is full of contradictions and built on the shaky, subjective foundation of feelings.

It is important to differentiate between transgender activists and the transgendered. There are many people who suffer from gender dysphoria who want to be at home in their body, and who do believe that their feelings do not determine reality. Activists, by contrast to many trans individuals, do believe that feelings are the ultimate determinant of reality. This radical claim is the central tenet of the transgender activist’s faith. It is dangerous to have something so subjective and fluid as the foundation upon which a worldview rests, but that is precisely what many have done. What this leads to is a picture of the world that is full of holes.

For example, activists make metaphysical claims that the true self exists within the embodied self—a kind of dualism common in ancient Greek philosophy—while also maintaining a materialist view of the world that only the physical is real. Gender is just a cultural construct, but, apparently, it is also possible for gender to be trapped inside the body. The real self is whatever a person feels or believes to be real, but the real, deepest self can also be discovered. Activists believe strongly in an extreme individualism that allows the individual to do whatever they want and force reality to conform to their feelings; while also defying anyone who disagrees, and advocating for the state’s enforcement of transgender ideology.

The transgender activists have formidable tasks before them: They must develop coherent, sound definitions of gender and gender identity. They must also better articulate what it means to identify as another gender, and how someone can know if they are in fact experiencing the feelings of the opposite sex. Even if the activists are able to adequately account for these feelings, they still have to explain how the feelings drive reality—why just feeling like a boy or a girl makes you a boy or a girl. They also have to explain why sex is determined by an internal experience, but other clear physical markers like race and height are not determined by feelings. They must also settle their metaphysical stance about the nature of human being. Is gender identity a biologically fixed fact that someone realizes, or is it a matter of feelings and, thus, flexible? Yet another challenge for the transgender activists will be to develop a coherent, compelling vision of the common good, and how society should be structured.


The media tends to tout the transition “success stories” and ignore the horror stories.

Another reason that it is important to have a conversation about the transgender moment is that the people who “detransition” (i.e., stop their transition process) are often ignored or even attacked by the media—particularly in the case of women who halt the transition.

Cari Stella posted a video in 2016 in which she reflected on her journey from woman to man to woman. She was socially trans at 15, began receiving hormonal treatment at 17 until 22, at which point she decided to detransition. Her choice to truncate the transition process was not for lack of support. She lives in a city that has a reputation for being very supportive of transgenders and sex reassignment procedures. There were trans coworkers in leadership at the company that employed her.  Friends, family, and coworkers were sympathetic, and, by all appearances, the transition appeared successful. In her YouTube video, Cari confides that her internal state was a different story, however.

While the transition process initially filled her with a sense of wholeness, the existential goal posts continued to move just out of reach. In her video, she describes an epiphany that there were deeper issues of self-hatred and inability to accept herself as a woman, and that she needed to confront lies like the inferiority of womanhood. She calls out therapists who are over eager to rush people into the transition process, and who act as if transition is the best and only option.

Third Way Trans, or TWT is a site created by an anonymous detransitioned man. He writes that he was not athletically gifted, but he was extremely bright, taking math classes at a local high school while still in fourth grade. So he was branded a nerd, unable to relate to peers of the high schoolers.

He was bullied on a regular basis. At a young age, he was already wishing he were a girl. Looking back, he explains the longing as a desire to escape the bottom of the male pecking order. If he were a girl, he could be kind and could cry without feeling like he was an inferior boy. This sense of isolation grew, and he transitioned when he was 19. He created TWT after twenty years of transition, a process that he describes as painful. When he was 19, his therapist provided hormone treatment after just two sessions, without fully understanding the context surrounding his feelings. It wasn’t until years later when he met with a psychotherapist (instead of a gender therapist) who helped him deal with the root issues that perpetuated his disassociation from his body, that he wanted to offer help and hope for those struggling with gender dysphoria. While acknowledging that his experience may not help everyone, he wants to show people there are other ways of confronting their dysphoria.  

These are just two of the many stories detransitioners are telling. A common thread running through their stories is that therapists make a grave mistake by presenting transition as the only solution available to the gender dysphoric.


Activists and media do more harm than good for those struggling with gender issues.

Journalists and medical practitioners tend to exaggerate the blessings of reassignment. Part of the problem is that when they speak about successful transitions they refer to the surgery itself. But so what if 49 in 50 procedures are successful? To truly evaluate success, we need to expand the criteria to include emotional and psychological markers. What is more, these markers should not just gauge how trans individuals feel immediately after surgery, but months and years afterward. There are few studies tracking long-term emotional and psychological results, and even fewer that are thorough.

What is even more saddening is that those who detransition are either ignored or attacked by the very activists who championed their cause. Something the media often fails to mention is that many of the trans victims are victimized by the activists themselves. Despite the popular claims that activists make on behalf of the trans group, plenty of trans people have no desire to transition and are actually looking for help in accepting their embodied self.

As long as the activist community treats their ideology as orthodox, they will continue to shout down conscientious objectors and burn heretics and apostates at the cultural stake.


Trans activists advocate an overly aggressive regimen for young children who show signs of gender dysphoria.

In 2012, the Washington Post published a piece about a young girl named Kathryn who insisted since age two that she was a boy. Her parents were concerned, but figured it was a strange phase that would pass. But Kathryn’s identification with the male gender was consistent, persistent, and insistent. In keeping with the Human Rights Campaign’s recommendations for journalism, which have now become journalistic convention, the article’s writer refers to young Kathryn as a “he.” We’ll set aside the fact that debate is bypassed with the ontological claims that the child is correct about her gender, and focus on the facts of the case.

Kathryn (or “Tyler”) is not yet old enough for full reassignment, but her trajectory is in keeping with the common regimens:

Has she identified as a gender different than that of her sex assigned at birth? Check. Has she done so “consistently, persistently, and insistently?” Check. Kathryn then began what is called the social transition: new clothes, new toys, a new name, and new pronouns.

As a child approaches puberty—usually between eight and ten—puberty blocking drugs are prescribed to prevent the body from developing in a way that is at odds with the child’s felt gender. During this time, breasts disappear and testicles shrink.

At around age 16, doctors begin injecting cross-sex hormones. Those who identify as girls are given estrogen injections to augment breasts, and those who identify as boys are given testosterone.

At age eighteen, individuals may decide to complete the transition with a sex reassignment surgery, in which the last vestiges of sex at birth are removed and new genitalia and secondary sexual characteristics are constructed.

This is the standard procedure that transgender activists advocate. The age at which each of the phases commences is getting continually lower. This decreases the likelihood that children will be able to consider a different course. They will be hemmed into a particular course of action far before they are emotionally, psychologically, and socially developed enough to realize the ramifications of their feelings. The burden of a choice that has monumental implications should not be allowed to rest on the shoulders of young children.


Capitulating to children’s feelings and starting the transitions early locks them into transition and diminishes the chances for desistance.

Most people who are honest intellectually and otherwise acknowledge that there are clear differences between children and adults: Emotionally, socially, biologically, and psychologically, adults are (hopefully) more developed than children.

An ideology that places a premium on feelings makes the leap from legitimizing adult feelings about gender to legitimizing those of small children.  Transgender activists treat children the same as adults, which is dangerous.

Children’s brains are plastic and elastic, very responsive to input from people and environment. To encourage transition in children encourages a trajectory that makes the possibility of desistance, or halting the transition process, far less likely. As mentioned earlier, the data strongly suggests that any gender-discordant phase is resolved in somewhere between 80 to 95 percent of cases. Even the more honest liberal scholars agree that the findings on this are consistent and conclusive, and that the activist attempts to debunk these figures have been weak and obviously ideologically motivated.

Some researchers in favor of adult transition are against initiating the transition process for children. Cases like the Welsh physician who began administering cross-sex hormonal injections to a 12-year-old child are overly aggressive, and the United States is in need of some guiding regulations, as there are currently no minimum age requirements for transition treatment.

Not only are the regimens too aggressive, but the evaluations often lack rigor. “Consistent, persistent, and insistent” identification with a different gender is the common benchmark, but many gender-affirmative medical specialists rely on intuition to predict which children are genuinely in need of reassignment. When one clinician at Children’s Hospital Los Angeles was asked how she could tell, she simply repeated “It’s clear; it’s clear,” suggesting that her experience with hundreds of cases has sufficiently honed her intuitions. Other researchers and scholars take serious issue with the methods and claims that “it’s clear.” Even cases of “consistent, persistent, and insistent” identification with a particular gender are not so simple. There is very little research on the reasons some children desist and others don’t.

As with the stories of detransitioners, the facts about desistence in kids are brushed aside or mocked by activists and the media. Such cases fly in the face of the popular narrative that gender is an innate, deeply-rooted reality, and so they must be quashed. Vox, Vice, ThinkProgress, and other left-leaning publications consistently paint detransitioners and desisters as pawns in bigoted, right-wing schemes.

The middle ground is hard to come by in these discussions. There’s not wiggle room for kids who are just trying to figure things out. At this point, the parents of desisters have not formed a united coalition, preferring to keep low profiles.


Responding well to the transgender movement requires kindness, tolerance, and finesse—not acceptance of activist ideology.

The transgender movement was, in part, a reaction to the view that there is a rigid distinction between the sexes, not only in biology, but in terms of activities and demeanor. The remedy, which the transgender movement shares in common with feminism, is to eradicate any rigid delineation, not just in activities and demeanor, but also in biology. The connection between gender and sex is now considered negotiable.

In this transgender moment in which the United States finds itself, it is essential for people to rediscover a clear, robust conception of the sexes and gender. We must reject gender fluidity, but we also must avoid overly restrictive views of males and females. A boy who likes poetry and is sensitive is not more like a girl, and a girl who would rather play sports than paint her nails is not like a boy.

Striking a proper balance between allowance for expression of maleness and femaleness while also rejecting the notion of gender interchangeability is a significant cultural undertaking, but we must. Sexuality is already a challenging arena to navigate, especially for children. The introduction of gender ideology only adds strain to an already fragile sexual ecology. Exceptional cases like gender dysphoria should be treated as just that: exceptions. The exceptions cannot become the basis for entirely new rules.

Tolerance and love are essential components of any response to individuals struggling with gender dysphoria. But we must also be mindful of the harm that will come from restructuring society around a small minority of individuals (estimates range from 1 in 200 to 1 in 20,000). The children are particularly vulnerable. These attempts at radical inclusion are not simply asking that kindness and tolerance be extended toward the gender dysphoric and transitioned—they are demands for hook-line-and-sinker acceptance of the activists’ ideology.


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