Maintenance Phase

"Rapid-Onset Gender Dysphoria" Part 1: The Cooties Theory of Transgender Identity

May 09, 2024
"Rapid-Onset Gender Dysphoria" Part 1: The Cooties Theory of Transgender Identity
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[Maintenance Phase theme]

Michael: Wait, you have to tagline us.

Aubrey: I do. 

Michael: What have you? 

Aubrey: You can tell me to pull this one back, if it's too close to home.

Michael: You'll hear a loud buzzer sound. 

Aubrey: Hi, everybody. And welcome to Maintenance Phase, the podcast that's pretty much just on Twitter to start shit with transphobes.

Michael: Oh, this you're sub-tweeting me. [Aubrey laughs] We're 10 seconds in and you're like, “I saw Mike's online presence yesterday.” 

Aubrey: I did. 

Michael: That is accurate.

Aubrey: I did see your online presence yesterday. 

Michael: I apologize for who I am on the internet, [Aubrey laughs] and in person and on podcasts. 

Aubrey: Good.

Michael: For the record, I’m very sorry about that. 

Aubrey: This is a good way to approach growth and accountability, I apologize for who I am.

Michael: All of my behavior and thoughts. I'm Michael Hobbes.

Aubrey: I'm Aubrey Gordon. If you would like to support the show, you can do that at 

Michael: Wait, wait, wait, we have news on that though. 

Aubrey: We do have news on that. 

Michael: God, we have so much housekeeping. Okay, let's do this as quickly as possible. 

Aubrey: Mike and I have been talking about the show and how to keep it going with his other podcast, with my books, and movies and all of that. The way that we're going to do that, so that the show doesn't go away is we're just going to have a slower pace than we have in the past. 

Michael: Yes. 

Aubrey: Instead of an episode every two weeks, it'll probably be closer to an episode a month. 

Michael: The thing is, we're both stretched thin lately, because Aubrey is finishing her next book and has been doing this movie and I'm doing other podcasts and also, I have some other upcoming stuff happening. Basically, we were talking about what our options are, and it's like, one of them is to just lower our standards for the show and just churn out episodes and stick to every two weeks schedule. But we don't want to do that. 

The other option is to just stop doing the show and we also don't want to do that. And so, what we are going to do is we are going to keep our shows to the level of quality that we're comfortable with, and we're just going to release them when they're done. 

Aubrey: Yup. 

Michael: We're going to continue doing Patreon bonus episodes every month. Those are like a little bit more hangouts. Those aren't that difficult to keep the pace going. We think we've always said that there is no such thing as a bad reason to stop supporting us on Patreon. If you're not comfortable, because the pace of the episodes is going to slow down and you're like, “Eh, there's probably other shows that I could support,” completely fine with us. We absolutely do not want you to feel bad about that. 

Aubrey: And you have been very outspoken about this, and I could not agree more. We're also big fans of like, hey, do you want to go join the Patreon and then download everything and then quit the Patreon? 

Michael: Yes. 

Aubrey: That's totally fine. 

Michael: So, also, if you want to do that and just once a year, signing up, download all the bonus episodes and then cancel, that's also super chill. Anyway, this is just to say that the episodes will continue until morale improves. [Aubrey laughs] We love you. We don't want to go away. We don't want to make bad shows. 

Aubrey: Yeah. We want to be able to meet our own standards. Being productive, helpful media. 

Michael: Speaking of helpful media, Aubrey has further house-keeping. 

Aubrey: Oh, it's very fun, Mike. 

Michael: It's happening. It's finally happening. 

Aubrey: I am the subject of a documentary called Your Fat Friend, and you can currently stream it. 

Michael: Anyone?

Aubrey: It's directed by Jeanie Finlay, who is an absolutely brilliant director. This is her 9th feature.

Michael: Jeanie.

Aubrey: It was shot over a six-year period, starting when I was writing anonymously on medium.

Michael: And your makeup was hell a different.

Aubrey: It was so different. I was really into an extremely dark lip.

Michael: Yeah. [laughs] 

Aubrey: It's available almost everywhere. All you have to do is go to, rent it for yourself. You can send it as a gift to friends and family. I'm just really excited for people to actually, all the way, be able to see it.

Michael: Go watch it. 

Aubrey: Yay.

Michael: Okay. We're finally getting to the show. Housekeeping done. 

Aubrey: Housekeeping complete. 

Michael: Today, Aubrey, we are talking about Rapid Onset Gender Dysphoria.

Aubrey: Yes.

Michael: Which, according to what you told me eight minutes ago before we were recording, you don't know anything about. You haven't heard of this concept. 

Aubrey: We've touched on this a little bit in the show. I spent a number of years of my life organizing around trans healthcare as my main thing. I continue to know and love many, many, many trans people and stay tapped into parts of the conversation. But the parts that I have tapped out of are the parts that are full moral panic shit, which is a lot of it right now.

Michael: Okay. So, I was going to actually ask you for a favor in this episode. 

Aubrey: Oh.

Michael: I know there's a lot of people who just don't know that much about youth gender affirming care, which is what we're going be getting into. One of the things you find in a lot of moral panics is there's always this argument that like, we should be allowed to ask questions. You can't even ask questions. I want to stress, you are allowed to ask questions. People are allowed to be curious about this issue. And even a little bit concerned about this issue. All of us have dealt with the American medical system. 

I know friends that were prescribed antidepressants very young, and look back and were like, “Ah, I don't think I was ready for that. And I don't think that was appropriate for me at that time.” And so, what I'm trying to do in this episode is to speak to those legitimate concerns and lay out the information of what we know. And so, I was going to ask you to be our proxy for-

Aubrey: Sure.

Michael: -people who might be a little bit concerned about this. 

Aubrey: Yeah. 

Michael: And so, channel your inner reply guy. [Aubrey laughs] Feel free to ask me. Ask the tough questions. 

Aubrey: I have an inner reply guy. You have an outer reply guy. 


Michael: You're just channeling me now. You're doing a Mike impression. [Aubrey laughs] But so, I think really, the starting point for this entire conversation and the good faith people that we're trying to speak to, is that there have always been trans people. Trans people are real. 

Aubrey: Yup. 

Michael: If you don't agree with that as a premise, then I have nothing to say to you-- [crosstalk] . 

Aubrey: Trans people are real and not new. 

Michael: Yes, exactly. 

Aubrey: Pretty much every person, including trans people, have been around for as long as there have been people. 

Michael: So, for this, I talked to Jules Gill-Peterson, who is a historian. She wrote an entire book about the history of trans medical care and trans medical care for kids. The field of trans healthcare-- Again, this goes back much further, but modern transgender affirming care starts with the synthesis of estrogen and testosterone in the 1930s. In the 1960s is when we first start developing the field of gender affirming care. We start using hormones and plastic surgery for transpeople. By 1979, we have the first medical standards of exactly the steps and what this should start looking like. 

Aubrey: Those are the Harry Benjamin standards, yeah? 

Michael: He pioneered the care and then we got the formalization of standards. I think it was 10 or 12 years after his book came out. 

Aubrey: Yes. I will say the Harry Benjamin standards are not beloved by trans people. [chuckles] 

Michael: This is also something that Jules Gill-Peterson talked about is that the history of trans gender affirming care is like-- First of all, we didn't call it gender affirming care. It was mostly trying to talk trans people out of being trans. 

Aubrey: Yup. 

Michael: A lot of the stuff that you hear now uses this much more recent history as the starting point. They're like, “Oh, they just out of the blue, started doing gender affirming stuff on trans people.” But they were doing stuff to and with trans people for much longer than that. But it was mostly trying to talk them out of it and trying to get them to live as cisgender people. And so, in the 1990s is when we start getting the first studies on does this care work? How do people feel about it afterwards? 

The first studies come out of Sweden. There's one that tracks every single person who got gender affirming surgery between 1972 and 1992, and only 4% of people regret getting the surgeries and have gone back. In 2014, we get a comprehensive review of every single surgery that's been done over 50 years in Sweden. 2.2% regret rate. 

Aubrey: It's fascinating to me that regret rates have become such a big part of this conversation, because most of the rest of the time, cis people do not care how trans people feel or do not act as if we care how trans people feel, right?

Michael: Yeah. 

Aubrey: So, much of the history of trans healthcare is the history of cis people's discomfort with giving trans people what they have been very clearly, very consistently needing for a long time.

Michael: That's a weird thing for a reply guy to say.

Aubrey: Oh, sorry. Okay.

Michael: A little bit weird. 

Aubrey: I am switching into reply guy-- [crosstalk] 

Michael: I think that's a little bit weird for someone who has one job-- for someone who has one job for this show. Interesting.

Aubrey: Oh, I'm going to be bad at it, but I'm going to try.

Michael: Put on a goatees and some Oakley's. 

Aubrey: The thing that I thought I would say as the introduction to my reply guy think, this is how bad I'm going to be at this was I know you are, but what am I. 

Michael: Oh, yeah, that's pretty good, actually. [Aubrey laughs] Just go, “Nah-uh,” after everything I say. 

Aubrey: [laughs] Yeah, fourth grade reply guy. 

Michael: One of the things to really say, and this isn't something that is really disputed, if you really get down to it, is that gender affirming care in adults is extremely successful. We're talking about regret rates that are one half to one-third what regret rates are for nose jobs and knee replacements. People really [chuckles] feel better after they get this kind of care of theirs. It's still preliminary, but there's early results from a survey of 90,000 trans people. Among people who have been taking hormones, the regret I strongly regret getting this is under 1%. Just transition in general, it's only 3% of people say that they're either less satisfied with their life or very unsatisfied with their life. 

There's also a systematic review that looks at 55 studies of gender affirming care in adults. 

51 out of 55 find that gender transition improves wellbeing. The other four find mixed results or just no finding at all. So, basically, you can't find studies that find harms, like, I'm worse off. Again, this is a show about the foibles of having overconfidence in medical research and overconfidence in existing medical systems. And so, I'm not going to say that every single person who's ever gotten gender affirming care loves it and it's perfect in every way. This is a field that continues to be refined, but there are very few fields in medicine and medical procedures for which you find this kind of satisfaction. 

Aubrey: The idea that there are simply two genders is something that we have built up so many systems around. It's a major organizing principle. I think part of what happens for this stuff is that people feel this sense of worldview upheaval happening, and they take it out on trans people who are the people who they see as being responsible for that worldview upheaval, right? 

Michael: Right. So, basically, as we start getting more and more data on gender affirming care and how it makes people more satisfied with their lives, it makes sense to people in the field that we have this kind of care that works for adults. We know that a lot of trans people, not all, but many trans people, start to show signs of being trans at four years old. We should probably start to explore this for kids. 

Another thing that Jules Gill-Peterson mentioned was that, again, this is not the first care for trans adolescents. But the care for trans adolescents had always just been conversion therapy. They're like, “I'm a girl.” No, you're not. That was basically how it worked. And so, basically, everything else they've tried manifestly isn't working. And so, they're like, “Okay. As a last resort, [chuckles] let's try affirming these kid’s gender.” 

And so, in 1987, the first clinic in the Netherlands starts providing the first gender affirming care to kids. In 1997, we get the first study that is published of these very early patients. Actually, this is in yellow, but I'm going to send it to you. Usually, it's in green. 

Aubrey: Oh, it's not in anything. It's just in- [crosstalk] 

Michael: Well, for you, when I paste it's in nothing. But for me--

Aubrey: It's a good thing. We had that lead up then. 


Michael: Fascinating. Fascinating look behind the scenes.

Aubrey: Scintillating [Michael laughs] peak behind the curtain. 

Michael: If you sign up on Patreon, this is the stuff you get. 


Michael: Woo.

Aubrey: It's pure gold, but I can't see the gold. 


Aubrey: Adolescence is a phase in which many identities, e.g., political or religious, are developed. Professionals fear that experimenting with certain aspects of gender, such as gender role behavior, will lead adolescents to conclude that they have a gender identity problem and that they will, as a result, wrongly seek a medical means of resolving their confusion. The chance of making the wrong diagnosis and the consequent risk of postoperative regret is therefore felt to be higher in adolescents than in adults. 

Michael: I think that this is the heart of all of the anxieties around this issue, especially from people that haven't had gender dysphoria as kids, is that you think about your time as an adolescent, and you're like, “Yeah, I was playing around with my identity.” You're a goth this week, and you're a prep the next week and you are in different social groups. We want to make sure that we're establishing that kids are really trans and really settled in this identity before they get any kind of irreversible medical procedures. 

Aubrey: Yes.

Michael: That's something that strikes most people as fairly reasonable. But the reason why I wanted to include this is it shows that from literally the first study on this, the doctors know this too. 

The idea that this extremely obvious thing is not also obvious to the doctors [chuckles] who are practicing this kind of medicine is fairly implausible. It shows up in the studies. They're like, “Hey, look, we know this is a time when kids are experimenting,” and that might include some gender expression experimentation. And so, we want to make sure in this field that we're talking to the kids, we're getting some holistic assessment. This is something that the field has been aware of since literally day one. 

Aubrey: I'm in the bag for big child. [Michael laughs] I'm in the pocket of big child. I was raised by a lady who's an early childhood brain development expert. That was her field. 

Michael: Ooh, Piaget-hive. Piaget-hive, rise up. 

Aubrey: [laughs] Her assessment has very consistently been that like, “Our issues around children are that we don't believe them when they tell us what's going on.” 

Michael: Yes.

Aubrey: But we get ourselves into really sticky situations when we decide that children, as a whole, are unreliable narrators, like, necessarily. That's not a carte blanche. I believe you when you say there's a monster under your bed. 

Michael: Right. 

Aubrey: But that is a. you're telling me there's a monster under your bed and I believe that you're really afraid of something. And that fear deserves tending too. 

Michael: And so, this first study sets a precedent a lot of the further studies. The study, they basically look at the first 22 kids who got gender affirming care, and they asked them three years later, “Are you happy about it?” And zero regret. [laughs] All of the kids are very happy with this. 

Aubrey: Wow.

Michael: We get another study in 2011 of the first 70 patients at this Dutch Clinic. Two-year follow up, all of them continue the treatment. They're now doing puberty blockers and hormones. We also start getting surveys from other countries. So, in 2014, we get a survey of 84 kids, which is, every single patient that this clinic in Vancouver saw over 13 years, they find a reduction in suicide attempts. We also get the first studies out of the UK gender clinic. One of them follows 201 kids and finds improved psychological functioning. 

In 2014, we get a study that follows 55 patients for an average of seven years, and they find that they have the same mental health markers as cisgender kids, which is actually huge, because trans kids tend to have higher rates of depression, anxiety, suicidality, lower quality of life, and of course, higher gender dysphoria than cis kids. And so, the fact that if we're intervening early enough, it's like, “Holy shit, these kids are roughly the same as their cisgender peers.” That's actually like a really big deal. 

Aubrey: That phenomenon is something that I feel like I observe more weaponized by deeply anti-trans folks than understood with compassion as like, “Oh my God, we could tackle a bunch of mental health stuff before it even really develops,” right?

Michael: Yeah.

Aubrey: But it very often ends up being like, “Well, look at these unstable trans people,” right?

Michael: Exactly. Yeah.

Aubrey: More often how that gets billed. 

Michael: So, I just want to pause here in like 2014, 2015 to say that like, all of what we're seeing in youth gender affirming care medicine at this point is fairly standard. We do this with lots of other medical treatments. We have this thing that seems to work in adults. Over time, we slowly expand it to kids. If we have a migraine treatment, that's like, “Hey, it works in adults. Let's see if it works in kids.” 

As you get more data, you make bigger studies and you start giving it to more kids and you just develop a body of research over time. This is a podcast that has criticized other studies for being really small. A lot of these early studies are on, yeah, 100, 200 kids. They're really small. 

So, we're not going to say that we've established that this care is definitively great for every single person who gets it under every single circumstance. But yeah, this is promising enough to continue doing it and to continue doing it on larger numbers of kids. 

Aubrey: Yeah.

Michael: This is essentially what has happened. In the first two decades of this field, you have a lot of small studies coming out mostly because you're simply not giving this care to that many kids. The clinic in the Netherlands says they have nine patients per year for the first couple years. This isn't really a debate about, like, is this the perfect care for every single person all the time or not? It's like, is this promising enough to keep giving it to people? [laughs] At this point, it would be bananas to stop giving care to kids on the basis of the fact that there aren't larger studies, when large studies are literally impossible.

Aubrey: It becomes this sort of chicken or the egg thing, which is like, we need larger studies in order to provide more care to more trans people. And we can't provide more care to more trans people until we have larger studies. 

Michael: Exactly. So, what we have, basically, is the field exploring gender affirming care for kids throughout the 2000s, 2010s. But that's all under the radar. I don't know about you. I was not aware of this at all until it started showing up in popular media in the mid-2010s. 

Again, it's like a very small field. And so, we finally get the first appearance of this as an issue in the mid-2000s, where I can't find exactly patient zero for this. But in 2006, we get a Barbara Walters special about this kid named Jazz Jennings, who transitioned and was living as a little girl. And then there's an Atlantic article called A Boy's Life. 

Aubrey: God, the amount of misgendering in this era. Whoo.

Michael: They're misgendering and deadnaming this kid throughout the article. 

Aubrey: Jesus fucking Christ. 

Michael: So, there's this entire decade where trans people in general are getting more visibility. We start getting these little inklings of the trans kid’s thing. There's an Oprah special in 2011. There's a 2013 article in the New York Times. We then, in 2014, get the Time Cover like the transgender moment because Orange Is The New Black is on, and Laverne Cox is in it. Caitlyn Jenner comes out in 2015, cover Vanity Fair. Huge deal. There's all these bathroom bills in 2016. 

Aubrey: Yeah. Prior to all that, we get Chaz Bono. 

Michael: Yeah, Chaz Bono. Yeah, exactly. It's just like, this is becoming a much more prominent issue. And also, this is really the end of the gay marriage fight. Obergefell is 2015, I believe. At the time, the Christian right, they just lost, like, gay marriage in public polling in the law is recognized everywhere. 

Aubrey: Yeah. All of a sudden, there was a lot of anti-porn advocacy, which was a funny one turned-- [crosstalk]

Michael: Yeah. It's like, you guys just have free time. 

Aubrey: It was just a real mission drift moment of like, “Oh, fuck, we lost our thing.” And unfortunately, they have found their new thing. 

Michael: What you start seeing is these inklings of this issue of what they call gender confusion. 

Aubrey: Right. That's the whole fucking trans-trender fucking bullshit. 

Michael: Yeah. [gibberish] talking about. 

Aubrey: [gibberish]

Michael: This is the way that they conceive of trans people, just as a group is basically people that as kids, they're confused. As adults, they're like sex perverts. 

Aubrey: That's the thing that I find really remarkable about so much of the both the studies and the discourse around this, is that it feels like there's so little accounting for the immense force of transphobia.

Michael: Aubrey, I just want to point out that we've been recording for 40 minutes, and you haven't done any reply guy shit.

Aubrey: Not one reply guy. 

Michael: The duality of the show is that you can't pretend to be a reply guy and I can't pretend not to be a reply guy [Aubrey laughs] for even five minutes, neither one of us can manage. 

Aubrey: Listen, our identities on this are consistent and persistent. 


Michael: That's actually the perfect metaphor for this. We can stop now. [Aubrey laughs] I say, it doesn't work. So, for this, I interviewed Julia Serano, who is a biologist. 

Aubrey: Oh, wonderful. Yeah. 

Michael: I'm drawing heavily on her work. She has a very detailed timeline. The way that she described it was, there's just these swirling anxieties. Because a lot of parents are reading these articles. And so, in 2015, we have the establishment of three websites. The first is called 4th Wave Now, which is supposed to be a reference to fourth-wave feminism, I guess. 

Aubrey: Wow. Uh-oh, I hate it. 

Michael: So, this is an excerpt from the about page. You should probably do a British accent for all these, because whenever I think of transphobia, it's in a British accent in my head. [Aubrey laughs] [in British accent] “They’re mutilating the kids, innit?” 

Aubrey: No. Absolutely not.

Michael: What they did that was impeccable.

Aubrey: Governor. 


Aubrey: “4th Wave Now was started by the mother of a teenage girl who suddenly announced she was a “trans man” after a few weeks of total immersion in YouTube transition vlogs. The daughter has since desisted from identifying as transgender. After much research and fruitless searching for an alternative online viewpoint, this mom began writing about her deepening skepticism of the ever accelerating medical and media fascination with the phenomenon of “transgender children.” Boy, oh, boy, the level of scare quotes in this. 

Michael: There's a weird reluctance to identify these as transphobic websites. But I feel like if you're putting the term trans man and transgender children in quotes. 

Aubrey: Yeah. 

Michael: Remember, in the 1990s how they used to put gay marriage in quotes? 

Aubrey: Yeah.

Michael: In extreme right publications, [chuckles] it was like, they're trying to call wives and wives. I think we can be comfortable looking back on that and being like, this was homophobic. 

Aubrey: Yes.

Michael:  If you look through the archives of this website, every single post is about how discrimination against trans people is overblown, and the suicide rates aren't really all that high. Some of the post titles are neuroplasticity, the gaping logic hole in the transgender house of cards. Another one's called, how is this not a cult? Another one is baby boomer's head explodes. How did identity politics gain all this traction? 

Aubrey: Oh, good. It's part of identity politics discourse. Great.

Michael: Exactly. I was going to read you a whole paragraph, but it's so boring. They also have some Soros stuff. So, there's a post called The Open Society Foundations and The Transgender Movement. 

Aubrey: Oh, fuck. 

Michael: Maybe you don't want to say it's transphobic. I don't know if I really want to litigate that, but this is anti-trans blog. This is a blog of anti-trans messages. I think that's pretty well established. 

Aubrey: I think we can probably all agree at this point that ex-gay conversion therapy is also a pretty fucking homophobic venture, right?

Michael: Yeah.

Aubrey: And the contours of the debate around the existence of trans people are really similar to that. You aren't who you say you are. You can't be trusted to narrate your own identity. I would say, actually, arguably the unreliable narrators of their own identity are people who display this kind of gatekeeping to other people's identities. If you're doing this kind of thing, I don't know that you get to decide if your actions are bigoted or not. 

Michael: So, that's one of them. That's 4th Wave Now. There's another one called Transgender Trend, which I'm going to send you-- 

Aubrey: Oh, fuck off. 

Michael: I know. 

Aubrey: “We are an organization of parents, professionals and academics based in the UK who are concerned about the current trend to diagnose children as transgender, including the unprecedented number of teenage girls suddenly self-identifying as “trans.” 

Michael: Suddenly.

Aubrey: “We are also concerned about legislation which places transgender rights above the right to safety for girls and young women in public toilets and changing rooms along with fairness for girls in sport.”

Michael: It's about fairness in girl sports. 

Aubrey: “This idea that this gives aid and comfort to people who want to sexually assault girls and women.” That's the one where I'm like, “I don't know how you see this as anything other than bigotry.” [laughs]

Michael: Well, this is what's so fascinating to me is like, slippery slope arguments are a mainstay of conservative rhetoric. There's like, a man's going to marry his horse or whatever. But what's wild about the bathroom stuff, the trans bathroom stuff, is that the slippery slope they're warning of is already in place. People already use whatever fucking bathroom they want. 

Aubrey: What I would say to a paragraph like this is it sounds like you're really concerned with sexual assault, what is your work here on actual sexual assault, right?

Michael: Right.

Aubrey: It's very strange to be like, “I'm very concerned about sexual assault. Therefore, man, do I hate trans people.” Or, like, “I don't trust them.” Where you're like, “That's not a one to one. Those are two disconnected statements that you are making.” 

Michael: So, those are the first two websites. There's also one called, which we're not going to go as far into its now defunct, but it's basically the same thing. We're medical professionals, we're doctors and we're concerned about the medicalization of trans kids, blah, blah, blah, blah. So, these websites pop up in 2015. On February 20th, 2016, we have the first ever claim that social contagion is the reason why kids are trans.

Aubrey: Uh-oh.

Michael: This appears as a comment on the about page for 4th Wave Now.

Aubrey: Boy, oh, fucking boy.

Michael: We're going to dive into this, because it has a lot of components that we still see now. So, I'm going to say this. This is from a commenter called The Skeptical Therapist. 

Aubrey: There is this episode of Star Trek: The Next Generation, where the crew is introduced to a mysterious alien video game. It slowly infiltrates the crew and Wesley Crusher and another young ensign watch as the adults around them slip into addiction. Wesley begins to sense that something is amiss and goes to find Captain Picard. He is so relieved to find the captain and to be able to confide in him. 

As Wesley leaves, we see the captain reach into his desk with signature sang-froid and take out a gaming device. He too has been infected. As we suspected, the game is really an insidious mind controlling apparatus that will allow an alien race to gain control of the ship. This is what this trans madness feels like to me.

Michael: Long wind up. I have some comments about the length and tone of this. So, this is another relatively long excerpt where she talks about her own experience. 

Aubrey: “The alien mind control device made its way into my home about two years ago when my then 11-year-old daughter begged me for a Tumblr account, since her friends all had one. Foolishly, I consented without looking into it further. I wish I hadn't. This trend toward all things pan/bi/nonbinary/gender fluid/trans etc., has had a huge amount of energy among kids my daughter's age. I have watched it with some degree of suspicion and concern. But last month, the degree of my alarm grew. 

She started dropping provocative hints, such as asking if she could get a buzz cut. I found some writing she had left around the house where she wondered to herself whether she was “really a girl.” She was very excited a few weeks later when a new friend came out as trans.” 

For the record, this is a kid who has never had any gender nonconforming behavior at all. She has always been interested in art and dance at school. She is a little socially anxious, and that is the only thing that makes her susceptible to this, I think. 

Michael: This is really the er example of this social contagion phenomenon, where we have a kid, no signs of transness. And then all of a sudden, they get on Tumblr, a couple of their friends are trans and then boom, “Mom, I'm trans.” We then have another important component. Aubrey, read this paragraph. 

Aubrey: “It isn't that I am a hating ogre. I think if I really believed that my kid were profoundly unhappy in her body that this narrative was coming from her and not from social media and the kids around her, I would be reacting very differently. I would also be having a different reaction if I could convince myself that gender identity experimentation were essentially harmless. Girls want to pretend to be boys? Sure, why not. But it is absolutely chilling to think that these kids who are just doing what teens do get support from the adults around them that let them get stuck in the experiment, so that many of them wind up permanently changing their bodies.” 

Michael: This is another very important component and comes up so often in these accounts. It's like, I'm not a transphobe. 

Aubrey: Yeah.

Michael: If all I thought was this was a little identity thing, I wouldn't be so mad. But this is different. Something is going on that is going push her into medicalization and in all of these irreversible procedures. It feels like it's operating on this emotional register, where it's like, I need permission to be uncomfortable with this. 

Aubrey: Also, it feels really telling this. I think that if I really believed that my kid were profoundly unhappy in her body, that kind of language is requiring an amount of performed suffering in order to believe this identity. I think that rhetoric feels like it's popping up more and more. 

You can't be trans, because you're not unhappy enough. I'm not seeing you suffer in the body or gender presentation that you currently have. Ergo, your identity is not real, which is also something that is, boy oh, boy, pretty much guaranteed to create some suffering. So, I guess you did it. 

Michael: So, okay, final thing. This is the final component of this. I'm really belaboring this, because all four of these components will show up in every single account of social contagion from now until forever. So, here's this. 

Aubrey: “Her current school is wonderfully progressive and nurturing. But the school administrators all seem keen to jump on the “trans is terrific train.” They proudly proclaim to prospective parents that there are several kids transitioning in the upper school.” Oh, this is a private school, baby. Upper school. 

Michael: Yeah, upper school.

Aubrey: I recognize my people. 

Michael: Oh, okay. I thought it was like the top floor, but okay. 

Aubrey: “It seems like this fact is exciting to everyone and establishes without question they're all accepting super liberal cred. I have decided that the cult indoctrinators have had free access to her beautiful 13-year-old brain for two years now, and it is time that I intervene and fight for my daughter.” 

Michael: This also relies on this myth that it's like you're a lone voice of reason in an unreasonable world. 

Aubrey: It's so fascinating to me that being like, “Hey, we've had trans students here who are allowed to be who they are,” has been translated in this person, in their brain, to the trans is terrific train.

Michael: Right. 

Aubrey: It feels like such similar energy to the glorifying obesity energy where you're like, “You just saw a fat person who didn't look sad.”

Michael:  Right. And you're seeing it as you're trying to indoctrinate me. 

Aubrey: It just is wild to me the ways in which people tell on themselves in public. 

Michael: Right. 

Aubrey: I was talking to my brother about this last night. He was like, “Man--" A thing that he has said to me many times is that the things that are most opaque to us about ourselves and the things we think we're keeping as secrets, we're actually just blaring out to everyone around us. [laughs] 

Michael: Yeah. This is like when my therapist said that I'm a nervous wreck. Thanks. [Aubrey laughs] Throughout this entire panic, we're going to see a lot of claims about existing institutions being worryingly pro-trans in ways that seem a little dubious to me, partly from what I've read. I've interviewed numerous trans teens around the country. I've interviewed parents of trans teens. I've interviewed clinicians. This is not an experience that I've seen even in affirming contexts. We don't see this like, “I hope you're trans. I want you to be trans.” It's still a really, really difficult process of coming out. 

Aubrey: I just think about being this kid, and if your mom was saying these things about you on the internet?

Michael: Although, I actually part of me thinks that this might be fake. There's something a little perfect about the fact that it all started with a fight over having a Tumblr account, something Julia Serano mentioned to me, because we were talking about this decade before this increased visibility of trans rights and the emergence of this myth. 

A lot of this is a proxy for anxieties around kids and the internet. Whenever we have a new technology, whether it's graphic novels or jukeboxes or automobiles, there's a huge panic about how kids are using this technology. And of course, there's huge anxiety about the internet and teenagers and social media and everything else. 

And so, the fact that there's this trans thing, people transgressing gender norms, which makes people uncomfortable in general. And then we can also blame it on the internet. We can say, well, that she's going on Tumblr and now she's trans. It's just like this perfect combination of two existing sites of huge anxieties for parents. There's later studies of the people who are using these websites. And it's mostly middle class, upper middle class white women. 

Aubrey: Nothing bad has ever come from the anxieties of white, upper middle-class parents.

Michael: This is like the same suburban fear that gave us the stranger danger panic. 

Aubrey: Sure. 

Michael: This is just a group that is prone to anxiety, especially anxiety around teens, anxiety around technology. 

Aubrey: And it is a group of people who are very accustomed to their anxieties becoming a centerpiece of public policy. 

Michael: Exactly. 

Aubrey: It's also, "can I speak to the manager energy. [Michael laughs] I demand to speak to who can fire you. 

Michael: Yeah.

Aubrey: I say this as a person who is of that group of people.

Michael: As a member of the Karen community, [Aubrey laughs] I just want to call out my own people. 

Aubrey: It's the idea that every feeling that I have deserves tending to through policy and public discourse. 

Michael: Exactly. So, this is just a random comment on the about page of this blog in 2016. So, a week later, the blog turns it into a post. It has the headline, Tumblr snags another girl, but her therapist-mom knows a thing or two about social contagion. 

Aubrey: Boy.

Michael: I was planning on going down a deep rabbit hole on the concept of social contagion. This is something that has come up tangentially in other episodes. “I decided not to mostly because it seems like it's a pretty contested concept.” I read this really interesting meta-analysis that had something about gun violence. There's this theory that gun violence is socially contagious. There's these peer influences that normalize using guns to solve disputes. 

There was one study that found that one of the best predictors of somebody who's arrested for gun violence is like, “How many previous incidents of gun violence have there been in their neighborhood?” Okay. That might be social contagion, but that also might just be a poor neighborhood. 

Aubrey: Yeah, totally. 

Michael: And then the other one they mentioned was that apparently, there's a spike in gun violence when there's more depictions of gun violence on TV. But that actually feels like a different phenomenon to me, because it's not peer-to-peer influence. I started to notice this since I came across this literature that people just invoke social contagion as like, “Oh, it's social contagion, but isn't that just we do things that our friends do?” which is just totally normal behavior. 

My friend says, “This book is good.” And then I read the book. But then also, if a friend of mine is clinically depressed, I don't know if that would transfer to me in the same way. There are studies of depression. There's a study that compares college roommates, when one has depression and the other doesn't. You would expect, if social contagion was true, the second roommate to develop depression over time. And that doesn't happen. It clearly depends on what is being contagious and the relationship of the two people. 

It just is like, we should just talk about transgender identity as transgender identity rather than trying to put it in this frame of this concept that works sometimes and doesn't and just isn't really all that useful of a way to look at this. 

Aubrey: The energy of this feels so similar to the post-Columbine is Marilyn Manson to blame- 

Michael: Yeah. 

Aubrey: -discourse where I'm just like, “Guys, we got to rule out 129 things before we get to Marilyn Manson.” 

Michael: Exactly. So, it's not totally clear how this happens, but relatively shortly after this blog post on 4th Wave Now, the concept of social contagion starts going viral among conservative writers. So, in August, the American conservative publishes a piece called the Cult of Transgender-

Aubrey: Oh. Dude-- 

Michael: -which quotes a parent who emailed the author and says, “As a parent living the nightmare of having a teen who suddenly announces she's transgender, I can tell you there are no doctors who will do anything but agree there is no science behind this, there is no way to medically diagnose her. Her therapist knows that she is not transgender, but fears there is no way we can stop her.”

Aubrey: Oh.

Michael: There’s also shortly thereafter, a David French, current New York Times opinion columnist column in the National Review called The Tragic Transgender Contagion, where he basically repeats this myth of gender confusion. He's like, “Yeah, there's some people that say they're trans, but actually they're confused about their gender.” He also says, “Gatekeeping has been replaced by cheerleading. In the UK, where records are easier to obtain, clinics are facing an explosion in demand for “gender identity” treatment. At one major clinic, referrals quadrupled. At another, they increased 20-fold in 10 years.” 

So, these are all relative statistics. They're increasing tenfold. Remember the first year that the gender clinic opened, it had two patients? 

Aubrey: Right. You could say that about a lot of small businesses from year one to year two. 

Michael: It's always wild to me how the actual articles on this always contain the information debunking themselves, he mentions later in the piece, he's like, “Oh, the staggering rise,” etc. And then he says, “This UK gender clinic, they've had an unprecedented increase from 697 referrals to 1398 referrals in 2016.” So, that's 1,400 referrals to this gender clinic in the UK. There are eight million kids [chuckles] between 10 and 19 in the UK. So, that's 0.0175% have gotten referrals to the gender clinic, or 1 in around 6,000 kids. 

Aubrey: Right. 

Michael: These are also just referrals. There's already, at this time, years long waiting lists. And then once you get referred, you still have appointments and you then go through the process and you may or may not get a referral to endocrinology. So, these are very small numbers. But of course, all of this reinforces this idea of social contagion. 

Aubrey: They're just reaching for like, somebody has to be responsible for this. 

Michael: Right.

Aubrey: It can't just be that some people are trans, and now there is more of a way for more of those people to come out than 50 or 100 years ago.

Michael: We have been recording for an hour and 44 minutes, and we're getting to the thing that's in the title of the episode. 

Aubrey: Fucking great Mike [laughs].

Michael: [laughs] We are getting into the actual-- 

Aubrey: Oh, no.

Michael: This is a leftwing podcast. It is 90% context. 

Aubrey: Is this a two-parter or a no parter? [Michael laughs] We just never get to the topic. 

Michael: So, all of that is bouncing around in 2016. In February of 2017, we get the first appearance, finally, of the term, rapid onset gender dysphoria. This appears in a study by a woman named Lisa Littman, who is a professor at Brown. Before she was studying women's and reproductive health, she has no background in trans anything. But she publishes in February 2017, this very short poster abstract. It's like a column and a half in the Journal of Adolescent Health. The title is Rapid Onset of Gender Dysphoria in Adolescents and Young Adults: a Descriptive Study. So, this is the text of the study. So, this is under purpose. This is what it says. 

Aubrey: “Parents online are observed reporting their children experiencing a rapid onset of gender dysphoria appearing for the first time during or after puberty. They describe this development occurring in the context of being part of a peer group where one, multiple, or even all friends have developed gender dysphoria and come out as transgender during the same timeframe and/or an increase in social media/internet use. The purpose of this study is to document this observation and describe the resulting presentation of gender dysphoria inconsistent with existing research.” 

Michael: The existing research indicates that most trans people realize relatively young, and it's not something that just suddenly occurs in adolescence. So, on its face, it's like, “Okay, this might be a new phenomenon.” However, the first two words of this are parents online. [Aubrey laughs] So, this is not a survey of trans people who say, “Hey, I suddenly got this identity.” It's not that they developed gender dysphoria suddenly. It's that it felt sudden to their parents. As a project, it's so weird to try to propose and describe a phenomenon of self-discovery from other people.

Aubrey: And by asking other people who have alarmingly high rates of rejecting their own children for this specific thing, right?

Michael: Exactly. This is not just a survey of parents. This is a survey of parents who were recruited on 4th Wave Now, Transgender Trend and Youth Transcritical Professionals. 

Aubrey: Oh, fuck. 

Michael: Those three websites we talked about earlier are where the researcher posted the advertisement recruiting participants.

Aubrey: Boy, oh, boy, oh, boy. 

Michael: It's like saying, “Oh, we wanted to find out how many teenagers are worshipping Satan.” 

Aubrey: Ooh.

Michael: So, we went to parents who think their teens are [Aubrey laughs] and we surveyed a bunch of parents. And wouldn't you know it? 99% of teens are worshipping Satan. 

Aubrey: Yeah. It feels like a reverse engineering of like, “The science is here, because I'm uncomfortable.” 

Michael: Exactly. 

Aubrey: It just feels like such a classic overreach. 

Michael: So, the study, it just says, “Okay, we got 164 parents to fill out this survey.” It says 93% are female, 94% are white. I think this is important. 88% of parents answered that they believe transgender people deserve the same rights and protections as other individuals. 

Aubrey: But not my kids. 

Michael: This is again, this thing, this constant invocation of like, “We're not transphobes. We just want to say.” 

Aubrey: You know what it is. It's the parental version of NIMBYism. [Michael laughs] It's fine in theory, but not in here.

Michael: Not in my back child? 

Aubrey: Okay. 

Aubrey and Michael: NIMB-- 

Michael: Yes. 

Aubrey: [laughs] 

Michael: So, it is despite this thing of 88% of respondents say that like, I'm chill with trans people. 76.5% of people say that they believe their child is incorrect in their belief of being transgender. And then we get into the super red-flag stuff. 

Aubrey: Oh, that wasn't the red flag stuff? [chuckles]

Michael: Well, it's getting to the more comedic red flags, honestly. Some of the things that are in this are genuinely hilarious. So, here's the next couple paragraphs. It's not all hilarious, but we'll get there. 

Aubrey: “Although the expected prevalence rate for transgender young adults is 0.7%, 39% of the friend groups described had more than half of the preexisting friend group becoming transgender. On average, 3.5 friends per group became gender dysphoric.”

Michael: So, this is, again, asking parents for objective information that they would have no idea about? My parents did not know the makeups of my friend groups. 

Aubrey: “Where friend group activities were known, 64% of friend groups mocked people who were not transgender or LGBTQ.”

Michael: [laughs] This is my favorite shit. 

Aubrey: Honestly, it seems low. 

Michael: They hate you because you're straight. 

Aubrey: It's reverse discrimination. 

Michael: This is such a fucking tell to me of just how janky the survey is. 

Aubrey: It's also like you're talking about teens and children. 

Michael: Yeah. This has no relevance. 

Aubrey: They're making fun of you, because you wear skinny jeans. [Michael laughs] They're not making fun of you because you're straight. 

Michael: Also, it's like you're asking parents what their teens are making fun of them for. 

Aubrey: The answer is everything. 

Michael: Everything. 

Aubrey: You embarrass them in every way. 

Michael: Wait, keep reading, keep reading, keep reading. 

Aubrey: “Where popularity status was known, 64% of adolescents had an increase in popularity within the friend group after announcing they were transgender.” 

Michael: Again. It's like, how would parents know this? How would parents know this? 

Aubrey: Also, ask the trans kids. 

Michael: Yeah, it's not--

Aubrey:  Do people like you more for being trans? 

Michael: That's really weird. 

Aubrey: “Adolescents and young adults received online advice, that if they didn't transition immediately, they'd never be happy, and that parents who didn't agree to take them for hormones are abusive and transphobic.” 

Michael: You said that it's like this is coming from a place of anxiety. You can tell it's coming from some place of resentment too. 

Aubrey: Yes. 

Michael: It's like they're sitting around and they're mocking us. Like, why would you even ask this? 

Aubrey: “Adolescents and young adults expressed distrust of people who are not transgender, stopped spending time with non-transgender friends, withdrew from their families and expressed that they only trust information about gender dysphoria that comes from transgender sources.” Cis people are super on one about trans people. So, I'm like, “That's reasonable.” 

Michael: The thing is, it's funny that it's purporting to be a description of this phenomenon where people realize they're trans really quickly. What it really is is a portrait of what transphobic parents think is going on with their kids in online. But none of this actually sounds like, what you find on the Internet or the advice around trans people. This whole thing of like, they're going to call you transphobic, they don't even spend time with their non transgender friends anymore. It's like, dude, 1% of the population is transgender. Every trans person is spending time with people who are not transgender. 

Aubrey: Also, this is a core part of identity development, right? 

Michael: Yes. 

Aubrey: When I was in college, I was like, “I don't talk to straight people.” And then you fucking come out of it. 

Michael: Yeah, whatever. Yeah.

Aubrey: The place that that comes from is not a deep-seated bigotry against straight people or cis people or whatever. It comes from hard and fast signals from other people that you are not wanted here. 

Michael: Right. 

Aubrey: That is born of very clear behavior from other people. It's born of transphobia. 

Michael: Another thing that I think is really important to stress here after this study gets published is the entire concept of rapid onset gender dysphoria is actually distinct from social contagion in meaningful ways, because just because somebody discovers that they're trans quickly or suddenly, it doesn't mean it's not true. [laughs] 

Aubrey: Yeah. Totally.

Michael: There's something very weird at the center of this that it's like your discovery of your status somehow invalidates the status. So, the thing that I always think of is, I have an uncle who lives in Berlin. His husband, whose name is not Fritz, but I will call Fritz, grew up in East Germany, of course, was not exposed to any information about homosexuality the entire time that he was growing up. 

What Fritz says is that he knew he was different, but he couldn't put his finger on it. And when he was, I believe 19, he was watching a documentary on East German TV that was not a sympathetic documentary, but it was a documentary about homosexuals. And he says the minute he heard the word, he was like, “That's what I am.” 

Aubrey: Yeah. 

Michael: On some level, that is rapid onset homosexuality. [laughs] He finally had a term for it. But first of all, he is gay. He is now married to a man. That's not invalid for people to have this epiphany or sudden realization and like, “Yeah, you know what? Sometimes that does come from a friend.” Sometimes that does come from something you see on TV or fucking Tumblr. Who knows? But that doesn't mean that it's not true. 

There's just this really weird desperation to find some excuse to say that this whole thing is invalid, but it's not even clear at this point that rapid onset gender dysphoria even is a fucking thing, because nobody's interviewed actual trans kids about their experiences. So, this entire concept is from a fucking blog comment, right? 

Aubrey: Yeah. 

Michael: But then also, nothing about this phenomenon, even if it is true, means that it's all a fucking trend or it's fake or they're going to desist eventually. It just is another way that people discover things about themselves. 

Aubrey: I think one of the biggest tells in a bunch of the stuff that we've talked about today is the lack of curiosity. It's fascinating to me how rarely when people go, “Oh, there are all these kids, and they might all be trans,” and blah, blah, blah, that no one just goes, “Okay, then what?” 

Michael: Yeah. Then there's trans adults and then unclear. 


Michael: So, basically, after this extremely brief, not very indicative of anything study of, “rapid onset gender dysphoria” comes out, we then get this concept slowly moving from the right, from conservative publications, into polite mainstream news. So, in 2017, there's a BBC documentary called Transgender Kids: Who Knows Best? in The Globe and Mail, which a center right publication in Canada. There's an article called Don't Treat All Cases Of Gender Dysphoria The Same Way. This is a little excerpt, but--

Aubrey: “Rapid-onset gender dysphoria, seen primarily in teenage girls and university-aged young women, is characterized by a sudden desire to transition without any signs of gender dysphoria in childhood. It typically emerges after an individual has spent much time researching gender dysphoria online. 

A 2017 study found an association between this phenomenon and having a friend (or multiple friends) identify as transgender, suggesting similarities to a social contagion. These girls frequently also have other mental-health conditions, like autism or borderline personality disorder, that should be the focus of concern instead.” 

Michael: This is the final component of this myth that starts appearing at this time, that what we're really talking about here is kids with mental health problems. They might say they're trans, but they're really just acting out the fact that they have autism, or they have borderline, or they're depressed or something else. This is a very important component of this myth going forward. 

Aubrey: Well, also, this is where I'm going to channel Matt Bernstein. 

Michael: Oh, Matt [unintelligible [00:53:32] 

Aubrey: This is indistinguishable from the rhetoric in the 2000s and early 2010s, specifically around marriage, was just like, “If we do this, then it will be cool to be gay.” 

Michael: Yeah. 

Aubrey: It's very funny to me that there are so many straight cis people out there who are like, “Wait a minute, what if there are more somewhere?” And I'm like, “Surprised. There totally are.” 

Michael: [sighs] This is what is so frustrating to me is so much of this is driven by very explicit homophobia and transphobia. There are people who have legitimate questions and I'm fine to speak to those people. But there are also a lot of people who cosplay as someone with reasonable questions who are just fucking transphobes and homophobes. 

Aubrey: Absolute sea lions.

Michael: Yeah, exactly. There's lots of that shit going on too. To me, it's just such a fucking-- Yeah, it's just such a perfect little distillation of where this is, because it's the same messages, but it's sounding more polite now. 

Aubrey: Yeah.

Michael: It's like, well, there's a study that says, this rapid onset dysphoria. It has these characteristics. It's like, I can see reasonable people reading this and being like, “Oh, interesting.” 

Aubrey: Yeah. 

Michael: But not in totally good faith and being like, “Oh, wow, okay.” Because most people don't know a trans person, and they don't really have a lot of context for this issue. 

Aubrey: At one point, we did a focus group specifically on trans healthcare with cis people, I had heard for years and years and years, just knowing one queer trans person can make a whole world of difference for people. I was always sort of like, ‘Eh.” 

Michael: Yeah.

Aubrey: We did a focus group and asked people to list off the words that they associated with the word transgender as the opening exercise. Pariah was a word that came up over and over again. Someone wrote murder.

Michael: Okay. 

Aubrey: And then we got to this last guy, and he was like, “Wine lover.” 

Michael: [laughs] What? 

Aubrey: Hardworking Hall and Oates fan was one of it. And I was like, “What is going on?” So, the moderator of the discussion group was like, “It sounds like your words are different than everybody else's words. What's going on there?” And he was like, “Oh, I work with a gal down at the post office. She's great.”

Michael: Oh, that's so funny. 

Aubrey: He was the one person in the room who was close to a trans woman, and his words were just like, night and fucking day. 

Michael: It's also so funny that he also seemed to misunderstand the brief where they're like, “What do you think about transgender people as a group?” And he's like, “Janine loves Steely Dan.


Michael: And the Orioles, it's like, “I don't know that you understood the question, but you know what? I'll take it. Your heart is in the right place.” But then, I don't know if you remember this internet blow up, but in this wave of laundering, we have an article in The Stranger, Seattle's Alt Weekly Newspaper-

Aubrey: Sure.

Michael: -called the Detransitioners. They were transgender until they weren't.

Aubrey:  What the fuck, the stranger? 

Michael: Let's read a couple paragraphs. 

Aubrey: Oh, fucking shit. 

Michael: This one's long. 

Aubrey: “Jane, a 53-year-old woman in Southern California lived as a trans man for nearly 20 years before discovering radical feminist forums online and, soon after, opting to transition back. "I really thought I was trans," Jane said. "I really believed it. One hundred percent. I was even fired from my job for coming out."

The idea that the perceived boom in the trans population is due to peer pressure or social contagion can be uncomfortable for trans people and their supporters. It's also a theory frequently pushed by the right. In reality, no one knows exactly why so many people seem to have recently come out as trans or some other form of genderqueer. 

Michael: It's a mystery. 

Aubrey: The writer and trans woman Julia Serano argues in an essay on Medium that this is due to the shift from the old gatekeeper system of trans healthcare to the newer model that "takes trans people's experiences and concerns seriously." 

Increased visibility and societal acceptance are also logical explanations for the perceived growth in the trans population. More people are aware it's an option now. But, as a study published this year in the Journal of Adolescent Health notes, parents have begun reporting "a rapid onset of gender dysphoria" in adolescents and teens who are "part of a peer group where one, multiple, or even all friends have developed gender dysphoria and come out as transgender during the same time frame." 

Michael: So, what do you think overall? 

Aubrey: It just feels like it is holding all this shit at arm's length and is like, “Ah, it could be increased visibility, it could be social acceptance, it could be all these other things,” but it's not.

Michael: Right. We still have the fundamental problem that there's no actual evidence of this phenomenon of rapid onset gender dysphoria, [laughs] right? 

Aubrey: Yes. Correct. 

Michael: We don't have anything other than this study that is proposing it. And also, as we see in almost all of these articles, the story doesn't even have examples of it. So, Jane, the lead character, we meet her when she's 53, it appears she transitioned in her 30s. There's one other source in this article who started taking testosterone at 20. Maybe it's peer pressure, maybe it's not. But as a country, we're comfortable with adults making their own decisions as far as the medical care that they need. 

Also note, none of these people appear to have been rushed through medical transition. Another source in this article, who the author calls Jackie, is 17 when she starts reading about trans issues online. And then it says in the article, it took another three years in the passage of the Affordable Care Act for her to start hormone therapy. 

At this point, we're talking about adults. Adults can do whatever they want with their bodies. There isn't really any question of people being rushed into surgeries and rushed into care.

Aubrey: These are the conclusions of someone who has never sought healthcare in the United States. 

Michael: Yeah. 

Aubrey: Doctors will just be like, “Right this way.” 

Michael: I'm now going to take us down a 45 minutes tangent about my carpal tunnel-


Michael: -and how long it's been since anyone has given a shit about it. 

Aubrey: Hang on, I got to pop some popcorn. We're going to do some wax skeleton talk. 

Michael: The article is basically just saying like, “There's some people who identify as trans, and then at a later point in their life, they no longer identify as trans,” which I've never seen anybody deny. There's this weird thing, this narrative that goes around online that like, “Trans people refuse to acknowledge the existence of detransitioners.” I've never heard a trans person say that even privately. [laughs] 

Some people, “Your identity changes over the course of your life. And so, some people transition and later detransition.” This is a phenomenon that exists based on all the data we have now, it's quite rare. But I mostly see trans people being really charitable and really chill with these people. And also, I see most detransitioners saying just like, “Yeah, it's part of the journey that I'm on.” 

According to the research that's come out about this, there's also a huge amount of people who detransition, because it's really fucking hard to live as a trans person.

Aubrey: If you had asked me about my regret rate on Paxlovid when I was tasting pennis, I would have been [Michael laughs] like, “Really high.” But also, it fucking got rid of COVID for me. So, I'm good. 

Michael: I do regret the cherry bark extract for my, [Aubrey laughs] whatever the fuck that was. Where's my article? So, we're seeing this narrative start to show up almost everywhere, right? We have centrist publications, far right, center right and even relatively far left publications who are all pushing this thing of like, “It's a little mysterious. I think so many kids are trans,” and like, “Oh, there might be this thing where it's like rapid onset.” I think this really crescendos, an important chapter in the mainstreaming of this is a 2018 cover story in The Atlantic. The story was originally called Your Child Says She's Trans. She Wants Hormones and Surgery. She's 13. 

But they've since changed the pronouns, because the model on the cover was using he-him, or they-them pronouns at the time, and it appears that this outed them to their parents. It's not totally clear what happened. 

Aubrey: Oh, fuck. 

Michael: But it's now called When Children Say They're Transgender. To be fair to this article, it doesn't use the term rapid onset gender dysphoria. It's not explicitly proposing this as an explanation. But again, we see the same pattern where it's entertaining this social contagion theory as if it's on the same level as greater trans acceptance means that more people are coming out as trans. It's proposing these two things almost as if it's like a 50-50 thing. It's really constructing this, the mystery of why so many people say that they're trans all of a sudden. So, we're going to read a relatively long excerpt, because I think you really have to get the full context of this article to see what it's doing. 

Aubrey: “When parents discuss the reasons, they question their children's desire to transition, whether in online forums or in response to a journalist's questions, many mention “social contagion.” These parents are worried that their kids are influenced by the gender identity exploration they're seeing online and perhaps at school or in other social settings rather than experiencing gender dysphoria. 

Many trans advocates find the idea of social contagions silly or even offensive, given the bullying, violence and other abuse this population faces. They also point out that some parents simply might not want a trans kid. Again, parental skepticism or rejection is a painfully common experience for trans young people. Michelle Forcier, a pediatrician who specializes in youth gender issues in Rhode Island, said the trans adolescents she works with frequently tell her things like, “No one's taking me seriously. My parents think this is a phase or a fad.” 

But some anecdotal evidence suggests that social forces can play a role in a young person's gender questioning. “I've been seeing this more frequently, gender clinician,” Laura Edwards-Leeper wrote in an email. Her young clients talk openly about peer influence, saying things like, “Oh, Steve is really trans, but Rachel is just doing it for attention. Scott Padberg, one of Edwards-Leeper’s patients, did exactly this when we met for lunch. He said there are kids in his school who claim to be trans, but who he believes are not.” “They flaunt it around like, I'm trans, I'm trans. I’m trans” he said. They posted on social media. 

I heard a similar story from a quirky 16-year-old theater kid who was going by the nickname Delta when we spoke. She lives outside Portland, Oregon, with her mother and father. A wave of gender identity experimentation hit her social circle in 2013. Suddenly, it seemed no one was cisgender anymore. 

Michael: It says some anecdotal evidence suggests social forces can play a role in a young person's gender questioning. We've got this kid, Delta, who's like, “Well, suddenly, everybody's trans around me.” You don't really notice it doing it, but it is proposing this as a legitimate option based essentially on just anecdotes teens saying this. 

Aubrey: Really appreciating that Portland looms large in these anecdotes. [laughs]

Michael: Yeah, I know.

Aubrey: I think this is our third.

Michael: Plain Portland, when in doubt. 

Aubrey: [laughs] Sure. Listen, I think the language of this section is a lot like the perceived boom language in the last one, which is journalistically, your editor isn't going to let you say [chuckles] like, this is caused by social contagion. And a smart journalist who's been around the block knows that they have some level of responsibility to accurately describe what's going on here, regardless of how they feel about it. So, this, to me, reads another example of like, we want to promote this idea, we want to elevate this idea and we have to do that in a careful way, so that it sticks. 

Michael: We're going to dive in then on the story of Delta in a second. But this article does something that the same pattern that we see in so many of these identical at this point, feature stories that are about the tricky debate over trans medicine for youth. It doesn't really investigate whether or not this social contagion theory makes any sense like, “We looked at the evidence. Here's what we found.” 

It basically just proposes it as a theory while not actually offering any evidence for it. So, in the article, the article profiles a bunch of different people who transitioned and later ended up de-transitioning, but none of them were rushed through medical procedures. So, the opening anecdote of the article is somebody named Claire who identified as trans for a while and then eventually doesn't identify as trans anymore. And her parents say like, “We're worried that if we had taken her to a gender clinic, they would have pushed her through physical transition and she would have regretted it. But nothing happened.” [laughs] That's just a hypothetical. 

Aubrey: This is where this, as a project, really reveals itself to be about cis people's anxieties, about the existence of trans people. This is not and has never really been about healthcare. Healthcare is just a foothold. It's a system where we feel like we can have some influence. You focus on kids, because again, that's another place where you can be like, “I'm just concerned for their safety. Are you not concerned about kids?” 

Michael: Yeah. 

Aubrey: It's a very Mrs. Lovejoy, won't somebody please think of the children, kind of thing.

Michael: There's also someone whose timeline is a little murky, but it appears she socially transitions at 15, gets hormones at 16 and a mastectomy at 17. There's also somebody who socially transitions at 15, starts hormones at 17, gets a double mastectomy at 20 and de-transitions at 22. So, that's a five-year process. There's another person who transitions in her late 20s. So, just irrelevant to this issue completely. 

This Scott Padberg kid who was mentioned in the previous paragraph starts getting assessed by therapists at age 13. He is 16 when he's featured in this article, still has not had top surgery. So, he's in the middle of a three-year process that includes-- It appears very intense assessment by a medical professional. There's yet another kid who identifies as trans in 2014 and gets a mastectomy in 2017. 

So, it's not really clear what the intermediate steps are, but again, three-year process. This kid talks about an eight-hour assessment by two clinicians and weekly visits with a psychologist before they transition. I don't know what the scandal is about any of these. They're just straightforward. They are not being rushed. 

Aubrey: This is the other thing about this idea of rushed care. If you know anything about the fucking standards of care for trans people, you know that it's almost impossible to “rush care.”

Michael: Yeah, it's really funny to read the popular press that's just constantly raising the specter of kids being pushed into these surgeries versus the academic press, that is all about the barriers. There is cost barriers, there's logistical barriers. Not everybody lives near a clinic. It's actually, in reality, really hard to get this care, and yet we're constantly being told by these magazine articles that it's too easy, or that we should be worried that it's too easy, or there's a debate over whether it's too easy. And it's like, it's a fairly easily answerable question even in the text of these articles, right? 

Aubrey: Yeah. 

Michael: They can't come up with any examples of it happening. It actually reminds me a lot of the razor blades in apples on Halloween myth. 

Aubrey: Uh-huh.

Michael: There's no example of this ever happening. [laughs] Can I prove that it hasn't happened? No. But surely at some point, if we're supposed to be afraid of something, we should have a decent number of clearcut examples of it taking place. This is 2018 when this article is published, but we're now in 2024. There's a couple things that maybe get close, although a lot of those haven't really been confirmed. But we're still getting in these articles, these stories of people transitioning at 25 and people with years long transition peers like the person who sued the UK gender clinic had a five-year process and admits that she saw psychologists more than 10 times in that process. If that's rushed, then all medical care [laughs] in the US and the UK is rushed. 

Aubrey: It's not happening at a breakneck pace.

Michael and Aubrey: Yeah. 

Michael: So, we're going to zoom back into Delta, who is this kid who identifies as trans at 13. And so, we are going to read the description from The Atlantic article. 

Aubrey: “Delta's parents took her to see Edwards Leeper. The psychologist didn't question her about being trans or close the door on her eventually starting hormones. Rather she asked Delta a host of detailed questions about her life, and mental health and family. Edwards Leeper advised her to wait until she was a bit older to take steps toward a physical transition. As Delta recalled, she said something like, “I acknowledge that you feel a certain way, but I think we should work on other stuff first. And then if you still feel this way later on in life, then I will help you with that.” 

Other stuff mostly meant her problems with anxiety and depression. Edwards Leeper told Delta and her mother that while Delta met the clinical threshold for gender dysphoria, a deliberate approach made the most sense in light of her mental health issues. 

“At the time, I was not happy that she told me that I should go on and deal with mental health stuff first,” Delta said. But I'm glad she said that, because too many people are just gung-ho like, “You're trans. Go ahead,” even if they aren't, and then they end up making mistakes that they can't redo.” 

Michael: Again, we include a quote from a teenager saying that this is common when we've seen no evidence that it's common, but anyway. 

Aubrey: Footage not found. 

Michael: Yeah. 

Aubrey: Also, if people can't get healthcare until they deal with their anxiety and depression, Uh-oh I'm never getting healthcare. 

Michael: Yeah, no one will get healthcare. We're all anxious and depressed. 

Aubrey: Fuck. “Delta’s gender dysphoria subsequently dissipated though it’s unclear why. She started taking antidepressants in December, which seemed to be working. I asked Delta whether she thought her mental health problems and identity questioning were linked. “They definitely were,” she said, because once I actually started working on things, I got better and I didn’t want anything to do with gender labels. I was fine with just being me and not being a specific thing.” 

Michael: I know that's a long excerpt, but essentially the story we have here is she says that she's trans, but then it turns out she's experiencing some kind of depression anxiety stuff. Once we start working on the depression anxiety stuff, it turns out, “Ah, she's not trans.” The transness was an output of the fact that she was depressed and anxious. Once you deal with those underlying issues, the transness goes away. It's essentially a symptom. This is extremely important to this narrative. The fact that these kids are, again, basically confused.

Aubrey: They're not trans. They're just mentally ill. 

Michael: It's very similar to the narratives that we got around gay people in the 1980s and 1990s, when gay people also had much higher rates of depression and anxiety, were more likely to use drugs, were more likely to kill themselves. That was seen as an output of the gayness. Why should we affirm gay identities? These people are killing themselves at high rates. They're all sad to be gay. We should be fixing the gayness, because it's obviously causing them a lot of distress. But when we have marginalized groups that have higher rates of mental health problems, we should at least entertain the possibility that the depression and anxiety are outputs of being trans in a transphobic family, and a transphobic school and a transphobic country. 

Aubrey: I came out when I was 15, and got medicated for depression and anxiety that same year. That medication didn't make me straight. 

Michael: Right. [laughs]

Aubrey: Zoloft is not a conversion therapy. 

Michael: Once we get deeper into Delta's story, things get even worse. So, after this article comes out, both Transgender Trend and 4th Wave Now, these anti trans blogs, both positively promote the article. They're like, “We think this is great.” 

Aubrey: Oh, fuck. Yeah.

Michael: At one point in reply to one of these tweets, someone says, “Hey, it's weird that The Atlantic article didn't link to 4th Wave Now, because 4th Wave Now has a lot of resources that parents could use, if their kids are trans.” 

Aubrey: Yeah. 

Michael: And someone from 4th Wave Now replies, “Families profiled our fourth families.” That was the censor's line in the sand, removal of any mention of fourth. So, 4th Wave Now, according to this person, helped this article come about and provided sources. And then it appears late in the editing process, any mention of that was removed. 

Aubrey: Yikes. 

Michael: This is where it gets really bad, Aubrey. So, this kid, Delta, her mother is a blogger at 4th Wave Now. And at some time before The Atlantic article, she writes a post laying out her timeline of what happened with Delta. She starts off with scene setting. She says that she got her daughter started to identify as trans. She then got really radicalized on this when she saw a special about a National Geographic cover about the changing nature of womanhood and the way that femininity is changing in different cultures around the world. 

She talks about this a little bit and then she says, “From that point, it was like a cascade of ideas came into focus for me. I had small epiphanies about how all this impacted civil rights. 

The transgender politics and policies have the potential to undo civil rights for all people. 

Aubrey: Oh, fuck.

Michael: If civil rights are not based on material reality, then anyone, anywhere can undo them and change them. This seemed extremely dangerous to me. When that idea hit me, it was like a sucker punch. It was the pulling of the thread that began to unravel the tapestry of transgender ideology.” 

Aubrey: This is the UK shit of just somehow acknowledging and making space for trans people is like an assault on cis women. 

Michael: You said pregnant people, and now nobody can get medical care at the hospital anymore. 

Aubrey: Right. [Michael laughs] That's the reason we don't have abortion. 

Michael: People use different words. Okay, but then here is this mother describing her account of what actually happened with Delta.

Aubrey: “Just before this time, my kid was insistent on seeing a gender therapist and getting into a gender clinic to start transitioning. I dragged my feet. When we went to doctor appointments for totally unrelated things, they would refer my child to the gender clinic even though we'd already been, and tell my child they shouldn't have to suffer and that they could easily take testosterone to alleviate these horrible symptoms, like periods and breast development. It happened every time. The doctors wouldn't stop dangling the bait. Because of the turmoil this caused, I had to stop taking my child to the doctor unless it was an emergency. Jesus. Hell. 

Michael: Yeah. Huh. 

Aubrey: When we started on the new transgender journey together, my child and I decided that no matter what, this was not going to be the life focus. We opted not to join any queer youth support groups. What I've seen in those groups is that life becomes very narrow. One doesn't play music. They play queer music. One doesn't do art. They make queer art. My kid even began to notice this and didn't want to make life all about being transgender.” What? 

Michael: So, she then describes what is essentially like a campaign years long of telling her daughter that she's not really trans. 

Aubrey: Right.

Michael: She says that they watch this BBC documentary together, what appears to be at her behest. And then as they're watching it, she reiterates to her daughter that like, “You'll never really be a man.” Like, “You can transition. You can get surgery, hormones, whatever, but you're never really going to be a man. It's never going to work.” And the daughter apparently breaks down crying, and accepts this and eventually drops this whole thing. 

Aubrey: God.

Michael: This narrative of like, “Oh, she started working on her depression, and then the trans thing went away.” Maybe that's true. I don't love the way that we litigate these fucking anecdotes in national media. But also, another fairly plausible explanation of this is that she has a pretty transphobic mom who just kept saying, “No, you're not. No, you're not. No, you're not.” And eventually, she capitulated. 

Aubrey: Right. And this person lives with their parents, their parents determine what their life is going to look like, what they have access to, whether or not they go to the fucking doctor. 

Michael: Exactly. It's telling that none of this I think fairly explicit anti-trans rhetoric shows up in the article. We get a little bit of explanation of like, “The mother was skeptical, but nothing on the level of this.” It seems like the mother really self-radicalized during this process. And then we have this idea of that like, “Oh, well, you know, it was really the mental health stuff all along.” Maybe it wasn't. [chuckles] Maybe she would have desisted. Anyway, we don't know. But it's like, it's very telling to me that, again, we're constantly told to worry about parents and doctors pushing kids into transitioning too quickly. 

But the much larger problem is people talking their kids out of it, and people refusing to get their kids care. And parents who are so skeptical, the kids do have to go through a really upsetting puberty before they can get any appointments with doctors, much less the money and the insurance and all the other barriers. 

Aubrey: We're talking about this issue as if it is a level playing field and not kids with marginalized identities versus very politicized adults with all kinds of social, cultural and political power that those kids do not have. 

Michael: Right.

Aubrey: There is this tone and tenor of a bunch of this stuff that's like, “I'm speaking truth to power.” And I'm like, “Do you mean children?”

Michael: I also think it's worth noting that it's like, it's now 2018 when this article comes out. What we're basically talking about here is a two-year process where this concept of social contagion and rapid onset gender dysphoria appear on a pretty fringe anti-trans blog. And within two years, they are on the cover of The Atlantic. 

Aubrey: Man.

Michael: Next episode, we are going to talk about the extremely unfortunate story of how this ends up getting further laundered into government policy. But for now, first of all, I have no idea how this Atlantic article came about. I have no idea behind the scenes what the recruitment was. I also don't really care if you're telling the biography of a moral panic. What you're looking at is the messages that were available to the public, what were people reading and hearing at the time. 

What Americans were hearing was that trans rights are becoming more visible. You have these fairly fringe websites. You have this social contagion theory that starts bouncing around on the right. You then have academic journals who begin to explore this phenomenon of rapid onset gender dysphoria. And then you have cover stories in prestigious national magazines further exploring this phenomenon and talking about the debate within medicine. But then if you zoom in on any of these components, it's all just the same fringe websites. 

Aubrey: Yes.

Michael: This website invents the concept of social contagion. The concept of Rapid Onset Gender Dysphoria is based on interviews with people from these websites, and then The Atlantic writes an article that includes people who are bloggers on this website. 

Aubrey: Uh-huh.

Michael: Again, it appears like this groundswell, but we're just talking about one blog [laughs] that's doing this and a relatively small number of people. And again, we have no real evidence that there's any reason to consider this possibility at this point. And I also, in the same way that we talked about rapid onset gender dysphoria, that just because your onset was rapid, doesn't mean that it's not true. 

I also think the entire concept of social contagion is also worth thinking about a little bit. Because to me, it's like, the conversation about whether or not kids identify as something they're not because that's trendy just feels totally irrelevant to me. I'm gay. Some kid who identifies as gay when he's 13 because he sees something on TV, and then eventually a year later, he's like, “Yeah, probably not” Okay I [laughs]. 

That actually like a world where that kid is able to explore in an affirming environment is great. I would much rather have “too many people” identifying as LGBT and have the space to figure it out for themselves relatively young than a world where people are constantly telling them, “No, you're not. No, you're not. No, you're not.” I just don't care that much. 

The actual debate here, the extent to which this is a social dilemma or something that needs to be litigated in the cover of fucking national magazines is a medical systems question. It's like, “Are people getting irreversible treatments when we don't know what their actual status is?” To me, again, I think that is a reasonable question to ask. There's a good faith way to have this conversation. 

And again, years of this panic, now speaking from 2024, we still don't have any evidence that that's happening. The fact that a kid identifies as trans because they see it on TV, I think that's much more rare than people think it is. But is that possible? Sure. But the solution to that, if we're really so concerned with kids finding out whether they're really trans before they get any kind of medical procedures, then we should make social transition as easy as possible, then we should make schools as accepting as possible. The best way to know if you're really a girl is to try living as a girl for a while in a supportive environment. 

Aubrey: There is this idea that just questioning itself is like a sinister activity that has to be born of something manipulative or something, again, sinister. I just don't think that that's true. Actually, in a lot of ways, that's what your teenage and 20s years are for. You try on a bunch of shit and you go, “Oh, actually, I don't really like death metal.” [laughs]

Michael: Yeah. 

Aubrey: That's absolutely okay. I think if we slotted this into that territory of just like, “Oh, you're trying shit on. Maybe it's a thing you love forever and maybe it's not.” That feels like actually a really healthy place to be.

Michael: Yeah. 

Aubrey: That kind of framework make space for trans identities to be as legitimate as cis identities, right?

Michael: Right.

Aubrey: When we consider it a choice worth making. 

Michael: A lifestyle. A lifestyle choice. 

Aubrey: Yeah, that's right. That's what I meant to say. 

Michael: I know your real views.

Aubrey:  But when we make space for people to actually explore and actually interrogate, instead of just fucking defending themselves against attacks all the time, then more people can come to clearer understandings of who they really are. 

Michael: I also think, like, to pull rank here as a gay person. 

Aubrey: [laughs] Pull rank over who? 

Michael: Over the straights. Over the straights. 

Aubrey: [laughs] I thought you were saying over me. 

Michael: Oh, no, no. That would be so fucking funny, [Aubrey laughs] if I'm gatekeeping this podcast now. 

Aubrey: As gay man. [laughs] 

Michael: I think as queer people. First of all, this entire idea feels identical honestly to this whole panic of like, they're recruiting your kids. 

Aubrey: Yes. 

Michael: I think nobody wants to say recruitment, because that is like Anita Bryant flavor to it at this point and the panic about gay teachers in the 80s. But this is what they are talking about. This indoctrination, they're going to use your child's confusion and their mental illness and their vulnerability to tell them they're trans. That's basically what they're saying. As queer people, I think we know very intimately that you can't be recruited into a sexuality and a gender identity that you don't have, because we all tried recruiting ourselves into fucking streetness.

Aubrey: And there's no amount of stigma that will make queer or trans people cease to exist. It will just make their lives fucking impossible.

Michael: [chuckles] When I was a teenager, I tried making out with girls and stuff and dating girls. It did nothing for me. It was like, “Oh, my tongue is on someone else's tongue.” It was so fucking gross. The whole thing of sexual attraction is it's more than the sum of its parts. You don't think about like, “Oh, I'm putting my mouth hole on someone else's orifice.” 

Aubrey: How did we get here, Michael? 

Michael:  Well, give me space. Let me get there. [Aubrey laughs] I'm getting there. 

Aubrey: Are your grinder notifications going off again? 

Michael: [laughs] Fuck off. 


Michael: I pull rank and you even let me keep it. 

Aubrey: [laughs] 

Michael: Fuck off. But I think there's a fear among straight cis people that, like, experimentation is going to somehow ruin their kids. I think most people are not gay. I think if your straight kid, dates a boy for a while, he'll be fucking bored the way I was bored when I dated girls. And then you figure out like, “Oh, shit, this doesn't work for me.” You're not going to be tempted by something you don't want. 

This is why when we talk about these as if, telling young kids about the existence of trans people is going to make them trans. I've been really lucky to get to know a lot of trans people. The way they talk about their gender identity when they were kids, like, somebody I talked to for me and Peter's episode on this said that it's like she felt static in her brain. And then when she put on girl’s clothes for the first time, the static went away and she felt at peace. 

I have put on girl’s clothes for costume parties and stuff, and I don't feel anything because I'm not trans. I'm not afraid of experimentation in that way. Because if you're not trans, it's not going to tempt you. It's like, this is what I think is really missing from this is that people are afraid of somebody exploring their identity as if they're going to be bewitched into thinking that they're gay or trans. But that isn't how it works. 

Aubrey: But, Michael, the doctors wouldn't stop dangling the bait [Michael laughs]. That was my attempt at being a reply guy. 

Michael: You finally got there. [laughs]

Aubrey: I finally got there.

Michael: You couldn't do it with your voice though. That was the least convincing. 

Aubrey: I had to have a voice. I can. I can. [Michael laughs]


[Transcript provided by SpeechDocs Podcast Transcription]