Cari is a 22-year-old woman who previously identified as a trans man. She pursued medical transition at 16, with the support of TransActive Gender Center in Portland, OR. She was on testosterone by the age of 17, and had “top surgery”(double mastectomy) a few years later. Cari says she has been moving towards detransition for over a year now, and started taking concrete steps towards it a couple of months ago, including stopping testosterone.

In this interview, Cari shares her thoughts on transition, parents of trans-identified kids, and her experience with TransActive Gender Center, with a particular emphasis on that organization’s exclusionary focus on medical transition. For gender-dysphoric young people, Cari advocates for greater mental health support, as well as the chance to explore alternatives to hormones and surgery as treatments for gender/sex dysphoria. You can read more of her thoughts on her Tumblr blog.

Cari brings up a number of interesting and controversial points; your comments and questions are encouraged, and Cari is available to respond to them in the comments section of this post.

How old were you when you first began working with TransActive? What brought you there?

I was 16, and I had come out as transgender about a year prior. I found them through a friend who had received therapy there. They were the only gender therapists I could find who offered a sliding scale, which was huge for me since I was paying for my own therapy.

What services did TransActive provide or recommend?

I was given therapy there primarily for the purpose of transition care—getting a referral to an endocrinologist for hormone therapy, and a letter to change the gender marker on my driver’s license. I had been hospitalized about a year prior to starting counseling there due to suicidal ideation and non-suicidal self-harming behavior, but this was not a focus of treatment, other than discussing ways that transition would help with my depression. I was not receiving any other form of counseling for my mental health at the time.

They also recommended their therapy groups and “FreeZone,” which is a social group for trans children, their parents, and TransActive staff, but I didn’t attend those. FreeZone struck me as kind of a weird thing, since it would entail seeing my therapist and probably her other clients in a social setting.

Did any counselors there attempt to explore whether there might be other underlying issues which could contribute to you claiming a transgender identity? Was there ever a concern that other mental health problems could interfere with a “successful” transition?

My counselor did not explore this with me, other than what seems to be the standard, cursory question of “Would you be able to be happy being a butch lesbian?” or something along those lines. It seems like everyone asks this question, thinking it’s somehow going to help dissuade people who are transitioning for the wrong reasons, but with all the other positive things that are said about transition, it doesn’t really work. I didn’t know that I was a lesbian until after I had started to detransition (primarily due to dating trans men), so this question didn’t strike me as relevant at the time, and there wasn’t any discussion of alternative ways to deal with sex dysphoria. This may simply be because there isn’t much information about alternative treatments in general.

However, I also had an experience there which I believe to be directly negligent on the part of the therapist. During the course of my therapy, before I received a referral for hormones, I began to have trauma flashbacks, which I hadn’t previously remembered. I brought these up to my therapist, and her only response was to devote one or two sessions to it, and then continue with the transition therapy process. This process seemed to be primarily about validating pretty much whatever I said about my gender/planning and mapping out a timeline for my transition, and it was not brought up at any point that prior trauma might have anything to do with dysphoria. The implication that was always present, in therapy or in the other trans-related discussions I was part of, inside and outside of TransActive, was that if I was trans (and my therapist never gave me the impression that I might not be), my options were “transition now, transition later, or live your life unhappy/commit suicide.” To a teenager who is struggling with mental health issues, this is a very attractive proposal: “This is The Cure for all of the emotional pain you’re feeling”.

How did your parent(s) feel about your trans identity? Were they supportive? How do they feel about your decision to detransition?

My parents were supportive of (if a little confused by) my “social transition” (using my male name/pronouns, binding, etc) but thought that I should wait to transition physically until I was over 18.  The staff at TransActive told me I didn’t need their permission for hormones, however, and that they would refer me, so I think eventually my parents may have just gone along with it because they know how stubborn I am.

My parents are supportive of detransition, but told me they wanted me to make sure I was certain about it before “coming out” again. It’s kind of hard to explain that no, your son who used to be your daughter is now your daughter again.

This might be a good place to mention that I pretty recently came to the decision to detransition, so my experiences and opinions are influenced by the rather fluid and unsettled stage of life I’m in right now, and probably not representative of someone who has had more experience living as a detransitioned woman. I can speak as someone who feels that TransActive did not adequately prepare me for transition or present me with alternatives, but I don’t want to try to present my experience as an example of detransitioned women in general, only representative of me, one detransitioning woman.

It seems that many gender specialists, and certainly many activists, are highly critical of attempts to “pathologize” people who identify as transgender. In fact, there is a movement afoot that says attempts to “gatekeep” trans-identified people with other mental illnesses is a form of “ableism.” and that even a person with Down Syndrome or on the autism spectrum should be allowed to medically transition, even as a minor. What are your thoughts on this?

I don’t think that people with comorbid mental illness should necessarily be barred from transition. What I do think is that there should be significant attempts to treat those conditions first, to rule out their involvement in dysphoria. I’m ultimately of the opinion that adults are allowed bodily autonomy, no exceptions, but that if we’re going to medicalize being transgender (which is the basis for having insurance cover it, having it be a protected identity, receiving any kind of special consideration under the law for anything, really), then there needs to be a standard of care that includes ruling out less invasive forms of treatment. It’s not considered best medical practice to jump to major surgery for any other condition, if there’s a reasonable possibility that medication or lifestyle changes could provide the same benefit.

I think that in my case, it’s entirely possible that I would not have been responsive to the idea that transition was not the only means of helping me. I know myself, and how stubborn I am, which I can’t blame TransActive or WPATH or ICATH or the APA or anyone else but myself for. But I do think that they need to be at least exploring these options. If I had been exposed to the idea that transition was not the be-all end-all of treating dysphoria, and that there were other viable options like treating my underlying mental health issues, I would be much more comfortable with their practices. But I wasn’t.

Trans activists vociferously deny that social media/trends could be a factor for some teens wanting to transition, yet it seems obvious to outside observers that the huge increase in girls identifying as trans is at least partly a result of immersion in Tumblr, YouTube, and other online forums. Did “social contagion” play a role in your own identification as trans?

I believe that it’s an oversimplification to blame social media for the increase in early transitioners. I think it has definitely played a role in younger people finding out that transition is a thing they can do, which to my mind isn’t an entirely negative thing—this is the same platform that allows LGBQ youth to connect with others who have similar experiences and find community. I think the increase is probably similar to the increase in teenagers going through a “bisexual phase”—it doesn’t invalidate the experiences of people who really are bisexual and discovered this in their teens, but it does mean that with the increased visibility of LGBQ people, that there is a higher incidence of teenagers questioning their sexuality. Now, with information about transition being readily available online, and a growing community of trans people to connect with, more young people are questioning their gender. The only difference being, questioning your orientation doesn’t make you want to pursue permanent medical interventions to your body, and it isn’t posited as a necessity for an LGBQ person.

To answer the question that you actually asked, though, online forums did play a significant part in my decision to come out as trans. I wasn’t so much into YouTube, though, and this was before Tumblr was a popular site. However, once I actually did come out, many, if not most of my formative interactions with the trans community (i.e., ones that influenced my decision to transition) were in-person ones, either through support groups or social events or LGBTQ youth spaces.

You no longer identify as transgender. What was your process of deciding this wasn’t right for you?

Actually, this is kind of funny, since your last question was about social media influencing people to transition. My decision to detransition was largely informed by social media, Tumblr in particular. Not that the detransition community, such as it is, convinced me to do so; my interactions with other detransitioned women have been limited since it wasn’t until recently that I stopped just reading and actually started interacting. But in the short time I have been communicating with other detransitioned women, I haven’t really ever felt any kind of pressure from them to do something particular about my transition, or to subscribe to any particular ideology. Rather, my experiences of reading the writings of detransitioned women were influential to me because they gave me what organizations like TransActive never did: images of women who had experienced the same things I had, who had struggled with dysphoria, and had found methods of making peace with their bodies in a way that I was starting to realize transition never would for me. Transition was very helpful for me in a lot of ways, and I wouldn’t say that I regret my decisions, but at some point it just ceased to be helpful to me. I think it helped me to be comfortable with my body and at some point I realized I was comfortable enough that I could stop, that I was ready to recognize myself as female again.

Do you believe some kids or teens are “truly trans”? Do you think gender identity is innate or “baked in” at birth? And if so, what differentiates true trans from people who thought they were trans, but eventually decide to detransition?

I think the scariest thing for me in my decision to detransition is that I haven’t really seen a whole lot to differentiate people who transition and are content, and people who transition and realize they made a mistake. I’ve seen people who checked all the “true trans” boxes, who were “transmedicalists” or believed themselves to be “just men with a medical condition,” who later detransitioned, or reidentified with their sex, or at the very least expressed serious doubts about their own motivations for transition, whether they pursued those doubts or not. I’ve also seen people who really didn’t seem to check those boxes, who had been transitioned for years and were still very happy with their decisions. I’d like to say that I know exactly how to tell the difference between the people who will end up happy with their transitions, and those who realize it isn’t the right choice for them, but the truth is I don’t. I think that all we can really do is to ensure that there are attempts being made to present all options, and to rule out other issues that might need to be treated first.

I also think that there are people for whom transition is the best choice, or at least the best choice they could have made under the circumstances. I’m coming to terms with the idea that I really just don’t have conclusive answers, that it doesn’t seem like anyone does, and that perhaps the best we can do in these situations is to try to make peace with our bodies as best we can. That perhaps there just aren’t any easy, unambiguous, black-and-white answers about why people are dysphoric or whether transition is the right choice for them. That’s what I wish organizations like TransActive would embrace–not “this is your only choice,” not “this is not a viable choice at all,” but instead, “we don’t have all the answers, but here’s what we know about your options.”

Partly due to lobbying by TransActive and its director, Jenn Burleton, the state of Oregon now permits trans-identified teens as young as 15 to obtain surgeries (including mastectomies and hysterectomies) without parental consent. TransActive is networking with activists and lawyers in other states to push for lowering the age of medical consent nationwide. Given your own experiences, do you think there should be a minimum age for medical intervention for trans-identified people? What age is appropriate to begin cross-sex hormones? To receive “top surgery?” To undergo bottom surgery and/or hysterectomy?

I think the idea of someone being able to get transitional surgery underage is concerning—in the state of Oregon, you can’t get a tattoo underage even with parental consent, but you can be permanently sterilized at 15 without any parental input. This is built off the law that minors 15 and older can consent to their own medical and dental diagnosis and treatment, up to and including surgery, but it seems to me that these kinds of surgeries are things that can wait until someone is at least 18. You can’t diagnose many mental disorders, such as personality disorders (which I have personally seen as a contributing factor in people incorrectly thinking they are trans) until the age of 18, and it seems reasonable to me that permanent surgical interventions for what is arguably a psychiatric issue be held off on until that age. I don’t know what I think about underage hormone treatment, but I lean towards the idea that it should be available, but that again, proper alternative treatment and safeguards need to be in place, that it needs to not be the sole focus of treatment or option presented.

What advice would you have for parents who are concerned about the seeming trend in kids identifying as trans? There is very little support for parents who don’t simply go along with their child’s announcement.

I think it can be a very delicate thing, as I’m sure you know. Children and teens who are questioning their gender are usually in a very vulnerable state. I think they often feel that the people around them can’t understand what they’re going through, and that leads to feeing very alone and isolated. I know I felt that way, and when I encountered resistance to my transition, it really made me feel that interacting with those people was unsafe or that they felt contempt or condescension for me and for what I was feeling. I did cut off or restrict contact with a lot of people due to them not supporting my transition.

So I think it is of the utmost importance that parents go about it with a lot of respect for their kids and validation that what they are going through is an incredibly difficult and painful state, without that necessarily meaning you’ll go along with their desires unquestioningly. I think it’s possible to have a child-centered process without it being all about transition. Brainstorm with them about what they might be able to do to help them cope with their dysphoria, support them in going to therapy, but suggest that they examine other modes of treatment in therapy before seeking transition, things like that. Try to make yourself a safe and supportive person for them to trust with their feelings—this not only allows you to make suggestions to them and discover their underlying feelings and motivations for transition, but also means that they might not be as scared to say, “hey, I think I might have made a mistake/I have these questions and the community isn’t answering them.” Knowing that my parents supported me making my own choices and weren’t about to say “I told you so” was a huge factor for me in feeling comfortable when I told them about my decision to detransition

That said, I think it’s entirely reasonable to set the boundary that you aren’t comfortable allowing them to medically transition while underage. As my parents explained it, once you’re 18, you can make whatever decisions you want, but this is something that you should take responsibility for as an adult person, rather than us signing off on it for you. Of course, this didn’t end up working for me, since I lived in Oregon, a state that allowed underage consent to transition. But regardless of that, I think it was a good thought for them to have and express.

Do you think parents should buy binders for their daughters who identify as trans men? Some parents feel it amounts to a “slippery slope” that may lead to their child seeking top surgery.

I don’t know that I think a parent “should” give their kid anything other than, you know, the things any parent should give that have nothing to do with gender identity–food, clothes, medicine, age-appropriate activities, an allowance if you can afford it, etc. I always bought my own binders, and paid for my testosterone prescriptions even when my parents were paying all my other medical expenses. I do think it’s invasive that a lot of parents will cut up their children’s binders or confiscate them. I think if a kid buys something for themselves that’s helping them cope and not making permanent unhealthy changes to their body, then it should be tolerated.  Doing something like taking a binder away is really only going to deepen the distrust the kid might have. Obviously if they’re binding with Ace bandages or tape or something, that should be discouraged, but I don’t see an issue with a teenager having a safe means to bind. As to whether it’s a “slippery slope,” I suppose it’s possible. I think I would say the same thing about letting your child bind as I would about anything transition-related: I don’t think it’s right to bar your kid from expressing themselves or exploring their identity, but that the more important factor is making sure they have proper information and resources, including the ways they could cope with their body without these interventions, and ideally, role models who have found a variety of ways of to cope with their gender nonconformity and/or dysphoria.

Suicide risk is often given as the main reason children and teens should be “affirmed” in their trans identity. What do you think about that?

I think it’s something to approach with caution. Suicide risk is a good reason to treat a lot of mental disorders and medical conditions, and I think the fact that gender dysphoria is one of those disorders is not necessarily cause for alarm. Someone being a suicide risk without psychiatric medications is a good reason to give them psychiatric medications, someone being a suicide risk because of neuropathic pain, which isn’t likely to physically kill you, is a good reason to give them pain medicine. Someone being a suicide risk due to feeling disconnected from their physical sex can, I believe, be a good reason to give them cross-sex hormones and surgeries, provided other courses of action have been examined in an objective way, and having really looked at those other options, medical transition still seems to be the best choice.

What I think is more concerning is the trans community’s tendency to present suicide as basically the only alternative to transition, and to martyr trans individuals who do commit suicide, as I think we saw pretty strikingly in the case of Leelah Alcorn.

Trans activists decry “gatekeeping,” with the current trend moving towards “informed consent,” trust in self identification, and earlier and earlier medical intervention, even for children. Do you agree with this trend? Why or why not?

I think this has been pretty well addressed with my answers to other questions, but to make it explicit, my opinion is that gatekeeping is absolutely necessary. Denying someone any kind of care for their issues is medical neglect. Forcibly trying to change someone’s mind about being trans is medical abuse. Showing someone all available options, following a standard of care that takes all of them into account, and ruling out a differential diagnosis that could be treated without permanent bodily alterations, is neither of those; it’s just part of providing good healthcare.

There has been some tension between gender critics—especially gender-critical feminists—and women who have detransitioned. I have read that some detransitioned women feel they are used by feminists to make a point that all transition is harmful. Quite a few detransitioned women write that self hatred and/or internalized misogyny or homophobia were factors leading them to transition in the first place, but when these same factors are pointed out by gender critical feminists, detransitioned women sometimes object. I wonder how much of the tension is down to a generation gap? Some Second Wave feminists who experienced gender dysphoria as children believe that if medical transition had been available at the time, they’d have jumped at the chance and likely been diagnosed as trans. On a political level, if detransitioned women and gender critics could unite, they could have the potential to make important changes in how children/teens are currently treated. How can this rift between gender critics and detransitioned people be healed?

I believe you included this question to address my stated uncertainty about doing this interview, due to my experiences being co-opted by radical feminists in the past. However, my experience of this happening was while I was still in transition, so I don’t have personal experience of what you’re describing.

From what I’ve seen, I think a lot of the backlash from detransitioned women has to do with the, honestly, very unkind and insensitive way that some radical feminists talk about transition—saying that trans people are “delusional,” that transitioned/detransitioned people are “mutilated,” etc. Whether or not transition is a good idea (for anyone), this kind of attitude really trivializes the emotional pain, the social struggle, and the complicated and messy ways in which people come to the decision to make these changes to their bodies. In my own case, I believe I made the best choice I could, given the options I was presented with. I don’t appreciate being called “mutilated” for doing what I felt I had to in order to survive.

I think it’s really great that radical feminism focuses on the social roots of these issues and doesn’t just go with whatever choices people feel like making without examining them critically. But I also think that sometimes can lead to a lack of compassion for the people who make those choices, and a lack of allowance for nuance and grey area around how people interact with and cope with their social realities regarding gender. I don’t have a concrete answer for you about how radical feminists can ally themselves with detransitioning women, but I think it has to start with a good hard look at the way these issues are talked about, to make sure that we’re having these discussions in a way that shows empathy for the people who are affected by this, whether they’re questioning or transitioning or transitioned or detransitioned

How are you doing now? Have you received any support from doctors or therapists/counselors for your detransition? Does TransActive provide any services for people who change their minds?

By the time I decided to detransition, I was not receiving gender identity-related therapy. However, my current therapist knows of my detransition, and is fully supportive of it. In fact, he told me he would not have signed off on my transition if he had been my therapist when I was transitioning, given what I’ve told him of my circumstances.

TransActive does not, to my knowledge, provide any services for transgender adults, so I wouldn’t expect them to provide anything for detransitioning adults. (I’ve recently contacted TransActive asking if they have any services/could refer a detransitioning person to services, and will update this response once they reply).