Review: Irreversible Damage
One might have assumed that from the sensationalist title, Irreversible Damage: The Transgender Craze Seducing Our Daughters. But Iâll start with the âgoodâ, or at least what could have been good.
I do think there is something unusual going on with the dramatic rise in transgender identification, and particularly with the rise in nonbinary identification among AFAB people. Clearly to some degree, rise in transgender identification is just basic economics. As the cost decreases, in terms of social stigma, the coverage of treatments by insurance, and even the mere reduction in information costs, people at the margin are going to be more likely to choose it.
But thatâs not necessarily the whole story. That economic logic applies to homosexuality as well, and certainly many more people today are openly homosexual than in the past. But homosexuality is well-attested historically, and a lot more common than transgender identification. Effeminate behavior in AMAB people is common across cultures and closely associated with homosexuality, though complete cross-sex identification is rare (e.g. the Chevalier dâEon). I suppose you could consider eunuchs in many cultures as âmale-to-nonbinaryâ, though that was almost always very coercive. Female-to-male identification is in many (but not all) cases hard to tell apart from cisgender women simply trying to escape misogynistic social roles. And female-to-nonbinary identification is very uncommon historically.
Of course, there are many possible explanations for this rise (e.g. new medical technology). But it warrants investigation, and the âsocial contagionâ hypothesis shouldnât be dismissed out of hand. That is, we know there are a number of culture-bound disorders, like anorexia/bulimia recently or âhystericalâ paralysis in earlier years (itâs my understanding that people suddenly becoming blind or paralyzed is a lot less common today than in e.g. Freudâs time), that are particularly common in adolescent women and seem to be some kind of way of dealing with stress. Especially when a previously very rare condition starts spreading among friends (who know each other independently), itâs not inconceivable that it could be an example of this sort of thing. And the fact that someone might mistakenly latch onto gender dysphoria as the source of their problems doesnât mean it doesnât legitimately exist in other people, just as the existence of anorexia doesnât mean there arenât people who could legitimately stand to lose weight.
Moreover, the common total opposition to any kind of non-subjective diagnostic criteria for gender dysphoria and the treatments for it is concerning. Obviously, I understand why this reluctance exists: in the past, baseless criteria have been used to heavily restrict treatment, which encourages patients to lie, which then only further âconfirmsâ the validity of the criteria. But âif you think youâre transgender, then you areâ is not helpful to people actually questioning, and itâs clearly not true, as there are a number of people who desist or detransition.
And the climate of dogmatism and intolerance that surrounds discussion of these issues is certainly cause for concern. The transgender activists calling for this book in particular to be banned or pulled from shelves is totally counterproductive, in my view. If something is factually wrong, then you can explain why itâs wrong. If you donât and just resort to calling names, it makes your own case look weaker to those not already on board.
Unfortunately, the author of this book is totally unequipped to explore these issues in a rational and responsible way.
Thereâs not much point trying to refute the âscienceâ of the book, as it is almost entirely anecdotal. Sometimes thatâs okay, as the quantitative information may not be there yet. Certainly, there is not a whole lot of rigorous quantitative research on the best approaches to HRT or many other aspects of gender dysphoria treatment.
But the approach of the book in trying to make its qualitative case for concern is totally incoherent and unpersuasive.
For one, the author appears not even to notice the tension between her reiteration of the standard argument that kids these days are too coddled and infantilized and her truly relentless paternalism and complete lack of trust in the ability of individuals to make their own decisions. And not just toward middle school or high school kids, but toward college students (most of her actual examples of âgender ideology gone too farâ) and even college graduates! You get the impression that adulthood should be pushed back to 25 at a minimum, maybe 30 for good measure.
Itâs not just serious medical interventions in middle and high school students the author opposes, like puberty blockers. Even the occasional use of binders is too serious a danger to be countenanced. Or most absurdly, even social transition alone. Sure, you might think thatâs harmless. But have you considered that it might be very difficult and embarrassing to the child if they want to take it back? Checkmate, gender ideologues!
Itâs not that those social costs donât exist, of course. But the author displays no sense of proportion or of the countervailing costs of non-intervention in the case of a false negative. The slightest danger from wrongly transitioning is played up to the nth degree, while the harms of gender dysphoria are just normal teenage girl stuff that they should tough out.
But is Lupron actually a neutral, low-risk intervention? Imagine youâre a fifteen-year-old girl. But unlike all of your friends, you have no pubic hair; youâve never had a period; you have no breasts; youâve never experienced orgasm. In terms of size and function, you have the vagina of a pre-pubescent girl. Sound like a neutral intervention?
These arenât side effects! Theyâre the intended result! The child doesnât want breasts or a period or female sexual development. Obviously, these would be bad effects for a cis girl, but you canât just transfer that to a trans child. The proper equation is to take the harm times the probability of wrongly giving this to a cis child against the benefit times the probability of correctly giving it to a trans child. Youâre always going to get the result you want if you ignore the other half of the cost-benefit analysis.
The author professes that of course gender transition is appropriate in some cases and sheâs not talking about adults. But thatâs belied by her seeming opposition to every possible actual route.
And she is incredibly slanted toward the point-of-view of the parents:
Katherine began reading everything she could about Lupron. Originally used in cancer treatment and in kids with precocious puberty, it is now prescribed off-label to prepubescent kids to halt the onset of puberty before beginning cross-sex hormones (typically administered up to two years later). The goal is to block the secondary-sex characteristics that would make eventual âpassingâ as the opposite sex more difficult if one continues on the path to medical transition.
But the more Katherine read, the more disturbed she became. When the medical papers she read cited studies, she tracked down those and read them, too. âSo first of all, the studies show that when a kid is put on puberty blockers, almost 100 percent will go on to do cross-sex hormones.â
This is true, though the reasons are not entirely clear. One possibility is that a young person would only go on puberty blockers in the first place if she was reasonably certain of wanting to lead a transgender life. Another is that, after years of socially identifying as a person of the opposite sex, the social costs of taking it all back are quite steep. Itâs hard to change your mind about something youâve been insisting on for so longâeven if you might wish you could.
But it was the next thing she learned that sent Katherine spinning. âWhen youâve stopped puberty with puberty blockers and go straight to cross-sex hormones, you absolutely guarantee that you will be infertile.â When the gender clinicians pushed Katherine to start her preteen child on hormone blockers, they were proposing that she put Maddie on a path toward infertility. Her faith in the gender therapists fell apart.
Katherine could not understand how psychologists would encourage this, how doctors would allow it, or why medical professional standards would permit parents to consent to eliminating such a vital human capacity on behalf of their minor children. And yet, right in front of her, schools were encouraging it, parents were going along with it, the media was celebrating it, and everyone was acting as if this were perfectly kosher. It was enough to make her think she might be losing her mind.
Whatâs more, even if her daughter did not start puberty blockers and instead waited puberty out and then began cross-sex hormones (testosterone), this carried all sorts of risks of its own. Endometrial and ovarian cancer. Hysterectomy.
So puberty blockers are bad, not because of inherent risks (which the book doesnât discuss), but precisely because virtually 100% of adolescents on them continue on to take cross-sex hormones. And thatâs bad because the child wonât undergo female sexual development. Which is the whole point of taking them in the first place! Of course going from puberty blockers to cross-sex hormones is going to cause infertility! Was she expecting it would make the child grow balls and start making sperm?
What about social transitioning? Also too risky. What if they feel like they canât back out of it?
Okay, what about literally doing nothing and waiting until adulthood to make a decision? Also too dangerous!
The approaches the author seems implicitly to endorse? Refuse to use their preferred name and pronouns; after all, donât they have the right to use âthe name they gave herâ (gag)? Cut up any binders. Pack the child across the country to a âhorse farmâ or in the case of an immigrant, to a more traditionalist Indian community.
If we take the author at her word, transition is legitimate only if you get there by overcoming opposition at every turn. Itâs like the Jews refusing people three times before they will allow them to convert.
And it has a truly tone-deaf unawareness of the fact that some parents might genuinely be abusive. A typical passage:
But Jett is not the only one making promises. For Motherâs Day in May 2017, male-to-female cycling world champion (competing against biological women, that is) Rachel McKinnon was moved to encourage trans-identifying adolescents to cut off their own mothers. âKids whose parents maybe donât support them as much as we would hopeâunfortunately this is too common. I want to give you some hope, though. I want you to know that itâs okay to walk away from unsupportive or disrespectful or even abusive parents.âÂČÂč
Thatâs a heck of a Motherâs Day gift to mom. But McKinnon offers something elseâshe calls it âhopeâ: âI want to give you hope that you can find what we call your âglitter family,â your âqueer family.â We are out there, and the relationships that we make in our glitter families are just as real, just as meaningful as our blood families.â
Sick with the flu? Find yourself in a car crash? Dumped by the love of your life? Not to worry. McKinnon will be right over.
The book also canât make its mind up about its stance on gender.
At times, it adopts a TERF-type view that gender isnât real, just a bunch of stereotypes and a tool of oppression of people with uteruses. It puts forth the insane idea that kids are only exposed to gender stereotypes in the first place by âgender ideologuesâ teaching them critically in the classroom:
It isnât hard to imagine that this might be the first time a young girl even hears of these stereotypes. Her Gen X parents may never have found it necessary to tell her that sports were once allegedly the exclusive province of boys or that art, after being male-dominated for most of history, later came to be associated with girls. But gender ideologues make sure she learns that things like sports and math are for boys. Itâs essential that she learns gender stereotypes because, without them, âgender identityâ makes no sense at all. And when a boy realizes that he enjoys some of the âgirlâ activities, like painting or dancing, the revelation that he is not entirely a âboyâ readily tees up.
And the completely baseless notion that schools are somehow teaching that pathbreaking women werenât really women:
California, New Jersey, Colorado, and Illinois all have laws mandating LGBTQ history be taught in schools. As a practical matter, this has meant rewriting social studies textbooks and curricula to âoutâ the likes of Sally Ride, who kept her lesbianism a secretâperhaps because that wasnât how she wanted to be remembered. She seems to have considered being the first woman in space a little more important. Other giants of history are similarly vulnerable to a âbaptism of the deadââthe chance to reemerge as non-binary, genderqueer, or trans.
While all this sexual identity politics marches through the front door, a large-scale robbery is taking place: the theft of womenâs achievement. The more incredible a woman is, the more barriers she busts through, the more âgender nonconformingâ she is deemed to be. In this perverse schema, by definition, the more amazing a woman is, the less she counts as a woman.
Note that nowhere does it actually say that they are teaching Sally Ride was non-binary, genderqueer, or trans. Because it obviously isnât true.
Indeed, theyâre doing precisely what the author claims to want elsewhere! Teaching that just because a woman has some trait or behavior that is typically masculine, such as being attracted to women, sheâs no less of a woman.
Contrast this passage, from another part of the book:
In May 2019 I got a call from a friend who had just taken her thirteen-year-old daughter for a first bra fitting at Nordstrom. It went badly, my friend said, and my mind leapt to the typical reasonsâso much dressing room exposure, the icy hands of a lingerie specialist, this stranger who eyeballs cup size and fit before delivering her verdict loud enough to be enjoyed by the other occupants of the changing room.
But it turned out that the problem had come in a slightly different package: six feet tall, pancake makeup blurring a stubbled jaw, two breasts grafted onto a muscular torso like add-ons. Weeks later I headed to the Nordstrom to confirm my friendâs story. The employee was elegant, attentive and professional, fluttering around the floor in a tulle skirt, pink manicured nails trailing her every gesture like streamers. But there was no mistaking that this lingerie specialist was male.
âWhat would have happened if I hadnât been there?â my friend asked me, again and again. âWhat if I had sent her into the dressing room alone, and she was too embarrassed to say anything?â
A man may find it hard to imagine just how much mortification attends a typical teenage girlâs experience of her changing body. Even in a private dressing room with only women present, teenage girls cling to their clothing, terrified their perfectly normal bodies might actually be hideous and worthy of scorn. If urinals were made to accommodate female micturition, girls would still never use them.
This anxious modesty only increases at the prospect of being spied on by the opposite sex. It could not have been much of a surprise to women when British news reported in October 2019 that girls whose school bathrooms had turned coed were skipping school to avoid the shame of using those facilities during menses. The horror of handling a period, even in a closed stall, was too much when next to a boy. [âŠ]
But even after the shame of adolescence fades, many women refuse to see a male obstetrician. It is, in fact, quite typical for women to prefer that another woman handle their pap smears, annual physical, post-rape examâto want only a woman to execute any touching that might, in another context, feel sexual. My friendâs reaction to the Nordstrom lingerie experience was utterly standard for women of my generation. But it is also quickly becoming outdated.
Could this be an example of the kind of restrictive gender roles that the author claims to be opposed to? No, these are just biotruths, obviously.
Apart from the slanted and shaky nature of the arguments, the book is full of this kind of pointless sarcastic commentary â on injecting testosterone:
But you canât join a church without a baptismâcanât claim to be blood brothers unless you spill a little blood. This is the trans bar mitzvah, and it is joyously undertaken. Pain is proof of commitment to the cause. âObviously itâs a bearable pain and completely worth it,â Alex Bertie reassures his viewers, before exclaiming, âYeah, Iâm on testosterone!⊠Iâm not pre-T anymore!â You can almost hear him address his YouTube congregation: Today, I am a man.
Mocking peopleâs appearances:
They donât exactly âpass,â which makes it hard to imagine their fitting in in a mostly not-transgender world. Theyâre much smaller than the average man: they have more petite hands, and slenderer faces. They seem doomed to snag double takes from passersby when they want toâand just as often, when they donât. Since they almost never undergo the phalloplasty necessary to achieve one of the defining features of manhood, itâs hard not to see their male identities as fragile; a quick trip to a urinal, and the jig is up.
Or repeating what people say in a funny voice:
And Teen Vogue routinely educates girls that gender is a social construct. âThe truth is, not all women menstruate and not all people who menstruate are women,â one article blithely informs readers, as if that were factual.
And just general bad faith:
Kindergarten teachers read from I Am Jazz, and the little ones are taught that they might have a âgirl brain in a boy bodyâ or vice versa.
Schools that administer this instruction never acknowledge that, as a scientific matter, itâs gibberish. It is biologically nonsensical to suggest that a girlâs brainâevery cell of it stamped with XX chromosomesâmight inhabit a boyâs body.
âI think gender is identical to biological sex, which is identical to having XX or XY chromosomes. Therefore, when someone talks about having a âgirlâs brain in a boyâs bodyâ, they must mean that the brain is XX while the rest of the body is XY. I am very smart.â Itâs not that the author is actually addressing the question of whether itâs possible for someone assigned male at birth to have a more female-typical brain and arguing the negative. She is just playing a stupid word game.
The book is also just phenomenally hostile to the concept of nonbinary identification, without any substantive argumentation:
Some non-binary and agender influencers do go on testosteroneâbut the effect theyâre shooting for is the in-between state. As Ashâs agender friend Chandler explains, âThere are two different things that a lot of non-binary people on testosterone will do. Either they will take [T] for a short amount of time at a regular dosage, which is what I plan to do, or they will take it at a lower dosage for a more constant amount of time. And so I might change my mind and do that.â An adult might wonderâas I didâwhat doctor oversees this witchcraft? This trial-and-error administration of hormones with indeterminate and shifting goals? What would possibly be the Hippocratic justification for removing a natal femaleâs breasts to give her the appearance of a âneitherâ?
I told Buck that one of the aspects of the current trans phenomenon that unsettled me most was its anger: the in-groupâout-group hysteria, the insistence on naming and punishing enemies. And another thing bothers me, too: the apparent asexuality of the members of this group. Were any of these teenagers interested in having sex one day? In so many instances, the more dramatically these trans-identified teens transfigured their bodies, the more their dysphoria spikedâthe harder they pushed away even the possibility of sexual intimacy.
Far be it from me to advocate teenage sex. But in the course of writing this book, Iâve come to view this monster differently, now that itâs been so utterly defanged. For humanityâs most notoriously libidinous demographic, itâs hard not to see that age-old rounding of bases as a twitchy expression of joy, the carnal declaration of hope.
Thereâs something horribly sad about teenagers who arenât even interested. Adolescent girls who would rather sit at home, dreaming of obtaining and injecting hormones, railing against âTERFsâ online, than indulging fantasies of kissing or touching another teenager.
Trans identification may be celebrated as a moment of liberation, but for many teens suddenly identifying, it very often seems to be a sad cult of asexuality, like the hand-painted sign in an antique shop reading âPlease Do Not Touch.â Perhaps these girls are protecting themselves from the endless assault of violent porn, or the hyper-glamorized internet images to which they believe theyâll never measure up.
Breast binders and top surgery come to seem a contemporary chastity belt, ensuring that no one will venture too close. The relentless dysphoria of these teenage girls, during and even after transition, seems so utterly incompatible with ever achieving the self-comfort necessary to share your body with another.
âFar be it from me to advocate teenage sex (but let me proceed to do so).â
Give me a break. This is the same kind of shit as the pitying view of lesbians, those poor deluded spinsters who will never know the touch of a man.
I mentioned the bookâs relentless paternalism earlier, but I forgot to mention that the author displays no awareness of the obviously sexist nature of her one-sided paternalism for the weaker sex.
Itâs also bizarre that the majority of the AFAB transitioners used in her examples of the lurking dangers, to whom she returns in an epilogue, do not detransition and show no signs of regret. Mostly, they just get on better terms with their parents after said parents stop being assholes. The author canât even cherry-pick convincingly!
In conclusion, this is not a good book.
