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My review of Kathleen Stock’s Do Not Go Gentle (available as of last week in the US):

It’s a too-hot day at the end of June 2025. I’m in Strasbourg, sitting in the back of a packed room at the European Society for Child and Adolescent Psychiatry’s conference and watching a panel of Dutch psychiatrists squirm as they defend the expansion of medically assisted death services to “mature minors” suffering from mental illness. The program had framed the proceedings as a debate, but it unfolds like a freshman philosophy seminar: a forum not so much for serious questions as abstract musings, quelled by a figure whose fragile presence inhibits any real discussion.

You can tell how conflicted the clinicians are about what they are doing. They duck their heads and wring their hands. They cannot hold the audience’s gaze. They stress over and over again how euthanasia is not a right, that a doctor is free to refuse any patient her request to be euthanized or to refuse to participate in medically assisted deaths altogether. They note sharp spikes in applications for euthanasia in the wake of media coverage—and how often adolescents and young adults later retract their requests. They acknowledge how rapidly and unpredictably a young person’s circumstances can change (“so how can one tell whether there is no possibility of change in a young person’s condition? Is unbearable suffering truly hopeless?”), how young people’s brains are still forming, and how the “wish not to live cannot be equated to the desire to be dead.”

The clinicians warn that “the existence of euthanasia may undermine psychotherapeutic attempts, as well as the patient’s own capacities for resilience and hope” and put patients who are already struggling with their mental health in a position where they “must justify the decision to continue living,” rather than simply living by default. One clinician wonders: “Aren’t we asking the impossible of our young patients and ourselves with medical assistance in dying on the table?” It’s a question nobody involved can afford to answer.

Then an “expert by experience”—which is to say, an applicant for euthanasia—rounds out the panel: a young woman with a soft voice and scars up and down her arms. She tells us about the darkness inside her that surges and retreats, from which she has so far found only the most temporary relief. She describes her relationship with the euthanasia team as the first time she has ever felt like anyone was “walking with her” in her illness: not trying to “cure her,” not sitting in judgment of her desire to die. She assures us that the clinical team will “help” her for “as long as they can,” but it’s clear that, someday, she intends to walk through that door. She begs the audience not to lock it.

This strikes me as the right metaphor: the door that is now open. It is right that such a metaphor be double-edged. I can picture the open door as a quiet retreat, like a fire escape. But I can also feel the icy winds it admits. In other words, everyone must live with the choice of whether to walk through that open door or merely live with the drafts that blow through it.

You can read the full review at Fairer Disputations.

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One of the most troubling themes in online trans spaces is the social pressure to scuttle relationships with loved ones—parents, partners, friends—who express reservations about one’s decision to transition.

Transition inevitably creates interpersonal tensions: how do children feel when daddy starts presenting himself as ‘mommy’? How does a husband feel about his wife’s changing body? How do friends respond when asked to overwrite the past with a new story? These conflicts are frequent topics of conversation in online trans spaces—and the advice leans heavily in the direction of devaluing and discarding relationships, rather than sensitively navigating discomfort and change.

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Apologies for the delay on this. I’ve been completely swamped lately. Up next for book club, we’re going to read across the aisle again:

How Sex Changed is a fascinating social, cultural, and medical history of transsexuality in the United States. Joanne Meyerowitz tells a powerful human story about people who had a deep and unshakable desire to transform their bodily sex. In the last century when many challenged the social categories and hierarchies of race, class, and gender, transsexuals questioned biological sex itself, the category that seemed most fundamental and fixed of all.

From early twentieth-century sex experiments in Europe, to the saga of Christine Jorgensen, whose sex-change surgery made headlines in 1952, to today's growing transgender movement, Meyerowitz gives us the first serious history of transsexuality. She focuses on the stories of transsexual men and women themselves, as well as a large supporting cast of doctors, scientists, journalists, lawyers, judges, feminists, and gay liberationists, as they debated the big questions of medical ethics, nature versus nurture, self and society, and the scope of human rights.

In this story of transsexuality, Meyerowitz shows how new definitions of sex circulated in popular culture, science, medicine, and the law, and she elucidates the tidal shifts in our social, moral, and medical beliefs over the twentieth century, away from sex as an evident biological certainty and toward an understanding of sex as something malleable and complex. How Sex Changed is an intimate history that illuminates the very changes that shape our understanding of sex, gender, and sexuality today.

Looking ahead, we should read Kathleen Stock’s Do Not Go Gentle (out in the US July 7) and Noelle Mering’s (forthcoming) No Contact this summer and fall. Please drop other suggestions here!

There’s still time to register for the upcoming Rethinking Youth Gender Medicine conference in London, Sunday, July 5, and Monday, July 6! This should be a wonderful event, covering everything from the origins of gender medicine to the (unblocked!) puberty blocker trial to parent perspectives to the ethical thickets we find ourselves in. I’ll be speaking on beliefs about the body and transition that young people participating in online trans spaces hold. If you do come, please make sure to say hi!

You can view the program and register here!

At the outset of my graduate research, I wanted to understand how knowledge and beliefs about gender dysphoria, transgender identification, and transition/detransition are negotiated within online trans spaces and how members engage with questions, doubts, and alternative explanations. What concepts do members deploy to represent ambivalence or uncertainty? How do these concepts frame the subjects to which they are applied? How do these concepts structure, support, or complicate the search for personal identity and a sense of belonging within online trans spaces? Over time, I narrowed my focus to two key concepts, internalized transphobia (this week) and imposter syndrome (coming soon to a theater near you).

The questions members ask and the doubts they express—and the ways these questions and doubts are framed and managed collectively—offer a rich territory for researchers to explore. When a member asks questions—often about how to feel confident in their new trans identity or whether they should transition—or expresses doubts, this is an opportunity for the ‘community’ to socialize new or wavering members in line with community norms, values, and expectations. In my research online, doubts about the etiology and experience of gender dysphoria, trans identification, and the advisability of transition emerged as daily topics of conversation in online trans spaces. I believe online self-reports—which are not directed toward a particular outcome like convincing a loved one of the advisability of transition or securing a prescription—are a valuable source of insight into this population and the stories they tell about themselves online. These texts often read like autobiographical case histories, written self-consciously in what James Hillman calls the “therapeutic genre”: “that is, the story is self-reflective and focused upon the ‘problems’ of the main character.” These accounts also fill gaps in clinical knowledge, making space for experiences that patients may not air in the exam room.

The concepts of internalized transphobia and imposter syndrome surfaced repeatedly in these online spaces. These concepts were also made frequent appearances in research, clinical, and popular literature on trans identities (often with little connection to online usage, which we’ll discuss).

In online spaces, the definition of internalized transphobia—and how to differentiate internalized transphobia from other self-states, such as experiences of gender dysphoria—is a subject of much debate:

• “Internalized transphobia involves beliefs that trans people or attributes are ‘less than’ cis people or attributes. Dysphoria isn’t about being as good as a cis person but feeling discomfort with your body/presentation/etc. because it doesn’t match your internal experience of gender. I find it a bit insulting at times when people equate transphobia and dysphoria because it places a value judgement on the difficult experience of dysphoria and implies that if you just didn’t internalize transphobia you wouldn’t be suffering in that way.”

• “My internalized transphobia sounds like ‘I’m a freak’ ‘why can’t I be normal?’ ‘I wish I wasn’t trans’ ‘everyone thinks I’m delusional’ ‘I feel embarrassed that I’m not cis’ ‘I’m making this up for attention’ ‘nobody will ever want me beyond as an experiment/story to tell at a party’ My dysphoria is more of a body image issue. ‘No guys have my giant hips’ ‘I look like a girl’ ‘I’ll never pass’ When I look in the mirror despite passing 90% of the time I just see an ugly weird girl sometimes. Everything that is feminine about my body feels exaggerated and unbearable. Internalized Transphobia is ‘me vs. the world’ Dysphoria is ‘me vs. me’”

• “The way I managed to tell them apart was that internalised transphobia was hating being trans because I thought it was something bad/a personal failing and dysphoria was discomfort with being AFAB and everything that came with it.”

• “Internalized transphobia is Shane [shame] about being trans. Like if someone misgendered you, you might feel like you don’t deserve to correct them or be gendered correctly because trans people are less than cis and deserve less respect. This is caused by implicit or explicit negative trans messages in culture and is sometimes hard to shake. Dysphoria would be if the same thing happened but you felt invalidated and bad because you were seen as the wrong gender. You’re not ashamed of being trans, you’re frustrated that you are perceived in a way that doesn’t align with your internal gender identity.”

Another r/ftm poster asked for clarification about what internalized transphobia means, noting that “it kinda seems like people just throw it around at any instance of someone not liking an aspect of being trans” and observes that the term may be used to police “anything that isn’t 100% positive about transness.” A single commenter responded to this post, offering parameters for use but agreeing that “the phrase is used a bit too broadly as well”:

“i think some trans people tend to take anything not positive about transition personally because they may see us complaining about aspects of transition we don’t like as ‘ammo’ for transphobes. by labeling it as ‘internal transphobia’ you can point it away from ‘trans people sometimes have aspects of transition they don’t like’ and make the narrative ‘you don’t like these aspects specifically because of external factors you’ve taken to heart’.”

Another poster commented on seeing the term internalized transphobia applied to a diverse range of subjects, from “not wanting to appear to trans” and “being disconnected from trans communities” to “[s]aying hey guys instead of hey folx.” Someone else critiqued the concept of internalized transphobia in order to make a broader critique of the culture of “venting” and reassurance-seeking in online trans communities as potentially seeding new sources of anxiety and insecurity among other—particularly younger—community members, warning that “putting your insecurities out on the internet for others to see may have an effect on younger trans people who came to this subreddit for help and community. For example, a feminine trans guy sees a post asking ‘is it okay for trans guys to be feminine’ and sees the comments debating it, and now feels as if there’s something wrong with him. Putting your insecurities online can give those same insecurities to others.”

Members who expressed reservations about gender dysphoria, their trans identity, or the advisability of transition were frequently counseled to work on their internalized transphobia. Experiencing internalized transphobia was generally regarded as a symptom of gender dysphoria and a sign of being transgender.

Research to date tends to regard internalized transphobia as an application or extension of the minority-stress model (see Austin & Goodman, 2016, for example) or a form of internalized stigma (Rood et al, 2017). Rood et al surveyed the literature at that time, finding 11 studies linking internalized transphobia to psychological distress, decreased resilience, increased uncertainty, and “inconsistency with one’s self-concept.” The researchers then conducted 30 in-depth interviews with transgender-identified and gender-nonconforming adults in order to better understand “the experience of accepting and internalizing negative social messages and experiences about one’s identity.” Research subjects reported frequently encountering negative messages about transgender identities, “most notably… messages that labeled TGNC [transgender and gender-nonconforming] individuals as aberrations and unnatural” or “inherently deceptive.” Participants reported feeling sadness, anger, fear, anxiety, negative self-perception, and difficulty affirming one’s own transgender identification in response to negative social messages about transgender identity. One informant described how such messages “ma[d]e me question myself, and I always felt a lot of guilt, and I just felt like, ‘Why can’t I just be normal?’ Sometimes I had a lot of self-doubt. I thought, ‘Did something happen to me to make me like this?’ and ‘What if I’m really not what I think I am?’ And it was just very scary thinking like that, because it just made me feel very insecure and lost.”

Scandurra et al (2018) examined “the role of internalized transphobia as a mediator between anti-transgender discrimination and mental health.” The authors define internalized transphobia as “self-stigmatization via the internalization of negative attitudes about being transgender,” which may manifest in shame and self-hatred. Austin & Goodman’s (2016) study of “The Impact of Social Connectedness and Internalized Transphobic Stigma on Self-Esteem Among Transgender and Gender Non-Conforming Adults” found that “although social connectedness is a significant predictor of self-esteem, it does not moderate the negative impact of internalized transphobia.” Recent research posits that internalized transphobia resulted from exposure to “microaggressions” (e.g., Austin & Goodman 2016). But my findings suggest that the interaction between distressing social interactions and internalized transphobia may be bi-directional: awareness and adoption of the concept of internalized transphobia may sensitize trans-identified people to an ever-wider array of (previously neutral or even positive) experiences that then cause anxiety, discomfort, or pain.

Bockting et al (2020), the creators of The Transgender Identity Survey: A Measure of Internalized Transphobia, defined internalized transphobia as “discomfort with one’s transgender identity as a result of internalizing society’s normative gender expectations.” The researchers noted three primary ways internalized transphobia came up in their clinical work with this patient population: in the form of “intense shame and guilt about being transgender” and/or “negative attitudes” toward other transgender individuals (the researchers refer to these orientations as “vertical” internalized transphobia—directed against the trans-identified or gender-questioning self—and “horizontal” internalized transphobia, which is directed at other transgender-identifying people); in attempts to “conceal their feelings about gender and identity from others,” either by suppressing their transgender identification or attempting to “pass” as a member of the opposite sex so that no one knows their transgender status; and in the reluctance of some transgender-identified individuals to associate with other transgender people “because of having internalized society’s negative attitudes or to deny or avoid exposure of their own gender variance.” The researchers identified potential protective factors, such as “affirm[ing] [one’s] gender variance, embrac[ing] a gender identity that transcends the gender binary, and surround[ing] themselves with other TGNC people to take advantage of the available peer support and empowerment.” Respondents who scored highly on internalized transphobia expressed agreement with prompts like “I sometimes resent my transgender identity”; “Being transgender makes me feel like a freak”; “When I think of being TG, I feel depressed”; “When I think about being TG, I feel unhappy”; “Often, I feel weird like an outcast or a pervert”; “I often ask myself: Why can’t I just be normal?”; “I sometimes feel that being TG is embarrassing”; and “I envy people who are not transgender.”

But I suspect that the relationship between social connectedness, belonging, minority stress, and internalized transphobia may be more complicated than research to date has captured. The concept of internalized transphobia appears to be deployed primarily to frame, neutralize, and counteract questions and doubts about gender dysphoria, trans identity, and the advisability of transition and/or detransition. Individuals may apply the internalized transphobia frame as a way to disown or distance themselves from negative thoughts and feelings about transition. What might otherwise be understood as a dissenting or questioning inner voice can be rejected as one’s internalized transphobia: something one has a responsibility to overcome because internalized transphobia is seen as a form of self-harm or self-victimization as well as a source of potential harm to other trans people. Labeling negative thoughts and feelings about trans identity and transition as internalized transphobia provides a potent way of pathologizing doubt.

In online spaces, internalized transphobia is viewed as a kind of chronic mental affliction. Sufferers are encouraged to monitor themselves for symptoms that may indicate a resurgence of the underlying illness. In this way, internalized transphobia resembles other internal targets of thought reform, ranging from the sinfulness that troubles the faithful to the ‘bourgeois mentality’ that plagues aspiring communists. In her study of totalist groups, Terror, Love, and Brainwashing, Alexandra Stein describes how such acts of “label[ing] and provid[ing] an interpretation of the follower’s discomfort [...] thus neatly did away with it by deflecting it back on the follower.”

In some cases, internalized transphobia operates as a caveat that enables members to express dissonant, unpopular or subversive thoughts, feelings, and experiences. In online trans communities, such thoughts, feelings, and experiences center largely on themes of self-doubt about the origins of gender dysphoria, the validity of trans identity, and the advisability of transition-related interventions. By deploying internalized transphobia, posters can vent views that threaten community beliefs, then place the blame for these transgressions elsewhere, thus preserving both precious beliefs and bonds.

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Falsely transitioned due to OCD, I forced myself to have gender dysphoria

I often see a common sentiment in the mtf trans community that you should transition very quickly, as to avoid further masculinisation. The whole idea being that if you don’t transition now you will never pass or be able to transition in the future. Whilst for them that may be true, for me it really played off my OCD. I felt that if I didn’t transition now I may regret it in the future.

The other issue I faced was seeing me as a man as an inherent evil. It was as if me aging as a man somehow made me a predator or a criminal. I think this was exacerbated due to some online discourse from some radical feminist groups. The idea that all men are bad etc.

The combination of these two issues seemed to make me con myself into feeling gender dysphoria. That isnt to say it doesn’t exist for some people, but for me I almost forced it and identified with it to the extent that I began to feel like I felt it.

Upon reflection, I never really had dysphoria growing up and liked many aspects of being a man. I am not blaming the trans community or anything, more so my OCD.

The whole rhetoric that dysphoria can’t be overcome made me believe I had to transition and that I had to take hormones (DIY). It made me fear future regret from masculinisation rather than fear actually masculinising.

I believe now that my brain is so elastic that I could probably just make myself like my male features by framing them in a positive way.

Has anyone else had this and recovered? I’d like to just be a man now but it’s a struggle as I still don’t entirely know the truth.

This young man highlights several popular beliefs that circulate in online trans spaces (and one belief circulating more widely) and shows very clearly how these beliefs can push young people who’ve never really even experienced anything like gender dysphoria to begin with to transition any way, including in maximally risking ways, like going the DIY (do-it-yourself) route.

• “Dysphoria can’t be overcome” = I have to transition

• “If you don’t transition now you will never pass or be able to transition in the future” = I have to transition right now

Young people feel as though there are no other ways to deal with the way they feel and that they will never feel differently in the future. Instead, the ‘party line’ in trans spaces is that negative feelings about one’s body will never go away. At most, one can suppress one’s desire to transition (and one’s identity as trans) for a time, existing in a state of denial.

Fear of possible future regret displaces any consideration of whether transition makes sense right now. Young people are told that transition regret is rare—specifically, that less than 1% of people who transition later regret it, and that those who do regret transition do so for extrinsic reasons, due to discrimination or lack of social support—at the same time that they hear that what they’ll really regret is not transitioning.

While some boys dread growing facial or body hair or developing other masculine features, the young man here described being more afraid of “future regret from masculinisation rather than fear actually masculinising.” That makes it sound like he didn’t hate the ways his body was changing in the moment (remember, he said he “never really had dysphoria growing up” and “liked many aspects of being a man”), only the way he might feel about those changes down the road.

Mixed-age trans spaces are full of older transitioners—especially MTFs—who tell themselves and the youngsters in their midst that they wish they’d transitioned years or decades ago. They fantasize about how different their appearances and the entire course of lives would be if only they had taken puberty blockers or started estrogen at 14. Trans-identified boys come to believe that their bodies are being poisoned by testosterone—that every minute testosterone courses through their veins unchecked, more damage is done.

Any boy spending time in MTF spaces sees evidence of that ‘damage’ everywhere he looks, both in terms of psychological damage (older men bemoaning their hopeless fates and detailing their messy personal lives) and in terms of physical ‘damage’ (men in push-up bras and wigs and bad makeup who look like men in push-up bras and wigs and bad makeup—men no one will ever mistake for a woman). Boys who believe they still have a chance at ‘passing’ constantly confront images of the future in which they waited too long to act.

Boys who don’t—or didn’t—hate their bodies and don’t—or didn’t—hate the idea of growing up to be men end up in desperate flight.

Which brings us back to this:

The other issue I faced was seeing me as a man as an inherent evil. It was as if me aging as a man somehow made me a predator or a criminal. I think this was exacerbated due to some online discourse from some radical feminist groups. The idea that all men are bad etc.

Some boys and young men respond to the vilification of masculinity by doubling down. Call this the Andrew Tate template. Whatever the culture finds crass, they’ll make crasser. Whatever they’re accused of, they’ve done worse.

Sensitive boys and young men may see no way to be a good man. They see healthy expressions of masculinity ridiculed, dismissed, or problematized. They may see no way to approach a girl they like that won’t lead to rejection (or worse) and no acceptable way to act on their sexual desires in the future. And, at the same time that they reject masculinity, they may fear they won’t be able to live up to the expectations put on men. They don’t want to be tested and found wanting.

Becoming a ‘girl’ absolves the ‘original sin’ of being born a man. It offers intimacy (sexual and nonsexual) with the opposite sex. It promises (though rarely delivers) a gentler reception and an easier set of expectations, since trans spaces portray life as a girl as life played on ‘easy mode.’ They’re encouraged to approach transition as a video-game checklist of sorts: estrogen, breast augmentation, facial-feminization surgery—never mind that there’s no end to the quest.

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I Sometimes Wonder If I Would Have Been Happier in a World Without AGP or Trans Medicine

Sometimes I wonder if I would have been happier if I had been born in a time before AGP, gender dysphoria as a concept, and transgender medicine existed.

I’m not someone who grew up believing I was literally a girl trapped in a boy’s body. I was able to function as a male and fit into society well enough. Looking back, I think that if those concepts and medical options had never existed, I probably would have lived my entire life as a man.

That’s not to say I wouldn’t have had any issues. I’ve had female embodiment fantasies since childhood, and I suspect relationships and sex with women would have been difficult for me. But if remaining single were socially acceptable, my life path would have been much simpler. I could have lived as a man while carrying a vague sense that something was slightly off.

For people who experience severe gender dysphoria from early childhood, I think the opposite may be true. A world without transgender concepts or medical treatment would probably be much harsher for them than the modern world. I’m only speaking about my own case.

I also don’t think social media is merely about comparison. Cis people compare themselves to others online all the time. The bigger effect, for me, is that social media made me aware that another path existed at all.

I learned about AGP. I learned that medical transition was possible. I saw people who had pursued that path and, to some degree, achieved the life I had only imagined.

Once you know that such a path exists, it becomes difficult to ignore it. It’s not that I believe transition is guaranteed to succeed or make someone happy. But knowing that the possibility exists makes doing absolutely nothing feel much harder.

Before learning about AGP, I had very little body dysphoria in the sense that people usually describe it. But after learning about these ideas and seeing examples of people who acted on them, that alternative became much harder to dismiss.

So sometimes I wonder whether my life would actually have been simpler if I had never known any of this in the first place. Not perfect, not free of longing, but simpler.

Elsewhere, he provides a more detailed breakdown:

For most of my life, I never related to the typical “I always knew I was a girl” narrative from trans communities.

I wasn’t feminine socially.
I didn’t think I had a female soul.
I didn’t naturally identify with women in everyday life.

What I did have, since childhood, was:

* persistent self-feminization fantasies
* strong envy toward female bodies
* discomfort about becoming an older male
* an almost obsessive fixation on becoming female despite being mostly asexual toward other people
* and sexuality that became heavily tied to imagining myself as female

For a long time, I assumed this would eventually disappear.

I thought maybe:

* I would someday become a normal heterosexual man,
* adulthood would “fix” me,
* relationships or masculinity would make these feelings fade,
* or this was just a phase caused by isolation or escapism.

So I spent years treating it as:

* a weird fetish,
* a private shame,
* or something I simply needed to suppress better.

Then a few years ago, mostly through Japanese GC / TERF reposts and commentary about Western trans discourse on X/Twitter, I started reading discussions about AGP and late-transitioning trans women.

Ironically, this was the first time I encountered a framework that felt disturbingly accurate to my own psychology.

Especially stories involving:

* repression through conventional male adulthood,
* attempts to live normally,
* marriage/work/fatherhood,
* and dysphoria becoming unbearable later in life.

Before that, mainstream trans narratives often felt emotionally distant to me.

But this was the first framework where I thought:

“Wait, this is uncomfortably close to my actual psychology.”

And one thing that affected me very strongly was realizing that these feelings might not actually disappear with age.

Until then, I had unconsciously assumed that eventually I would “grow out of it,” become psychologically normal, or stop caring about feminization.

But after seeing repeated stories of people suppressing these feelings for decades and still experiencing severe dysphoria later in life, something changed psychologically for me.

The moment I started believing this could be permanent, my previously vague discomfort around being male suddenly became much more intense and harder to ignore.

At the same time, starting HRT has genuinely made me feel better psychologically.

The obsessive/self-sexualized aspect has become weaker, and the idea of no longer continuing to masculinize feels deeply relieving to me.

I also never strongly wanted fatherhood or biological children, so the long-term tradeoffs feel psychologically acceptable to me.

And honestly, even if social influence played some role in how I interpret myself psychologically, I still feel that I want to continue HRT for the rest of my life.

And recently I remembered that TERFs often talk about transgender identity as a form of social contagion or ROGD.

So now I can’t stop wondering:

Did I socially “catch” this from TERF discourse on X/Twitter itself?

Ivan Illich’s “only pain perceived as curable is intolerable” in a nutshell. Interesting to note that the ‘trigger’ was learning about autogynephilia specifically, rather than connecting to the general idea of being trans. But this actually fits many of the interviews I’ve done, where young people describe the idea of being trans bouncing off of them at first. Only later did some more specific prototype attach itself to their experience and redefine that experience in its own terms. Awareness-raising can be a mixed bag.

The poster describes vague discontents (“something was slightly off”) and “female embodiment” fantasies that—at least in his remembering—predated contact with the idea of being trans and transitioning. He imagines an alternative future where he just lived as a man, “not free from longing,” but free from the distress and agitation that new ideas about autogynephilia and transition heaped on top of his discontents.

When the life he had only imagined—a fantasy he might have been able to manage or contain—was presented to him as an option, when he was confronted with men like him traipsing down that path, the nature and intensity of his discontent was transformed. He notes that before he learned about autogynephilia, he had “very little body dysphoria in the sense people usually describe it.” He was “able to function as a man” and “fit into society well enough.” These positives have all shifted into the past tense. So now there is distress in his body that he didn’t experience before. Now he’s on estrogen and believes that transition is the only way to move forward:

The only thing that has ever sexually aroused me is the idea of myself becoming feminized. Because of that, I am effectively asexual toward other people and cannot seek fulfillment of those desires externally. For that reason, I believe that transition is necessary for me in order to address those desires, and that is how I came to the decision to transition.

Having gained this knowledge and understanding, I will not stop, and I cannot be stopped.

He even visited a brothel—having had no prior sexual experience—to double-check his theory that his “sexuality is self-directed, not partner-directed, and that this matters for how I think about HRT and my future.”

But he also feels trapped and unreal:

If I continue as a man, I feel like I want to die.

If I try to transition, it also feels like a different kind of dead end.

Either way, it feels like a dead end.

Sometimes I think I would have been happier if I had never learned about AGP.

If I had just lived as “an asexual man with a strange fetish,” maybe I could have avoided this level of distress.

Of course, it’s possible that the dysphoria would have surfaced later in life anyway.

But at least right now, it feels like knowing made things worse.

Right now, I don’t see a good outcome in either direction.

… and “not fully real” when he remembers he’s on estrogen:

I’ve been on HRT for about 2 months, and I’ve been noticing a specific pattern that I’m trying to understand.

About 8 months ago, I saw myself as a cis asexual male with a somewhat unusual fetish. I assumed my AGP-related thoughts would eventually fade, so I didn’t treat them as something serious or permanent.

After learning about AGP and Blanchard’s typology, that assumption changed. It gave me a framework that made my experiences feel consistent rather than temporary, and that played a role in my decision to start HRT. My gender identity is still male—I don’t think of myself as “a woman inside”—but I chose to move forward with this anyway.

Since starting HRT, I haven’t had major physical changes yet. However, I’ve noticed that at certain moments—specifically when I become consciously aware of the fact that I am on HRT—I sometimes experience something like dissociation or depersonalization.

It’s not constant. Most of the time I feel normal. But when it happens, it’s like there’s a sudden shift:

- “I am taking hormones” stops feeling like a continuous, grounded reality and instead feels distant or abstract

- My actions don’t fully register as my own, almost like I’m observing myself from the outside

- There’s a slight sense that what I’m doing isn’t entirely “real”

These episodes are relatively brief and seem tied to that moment of recognition rather than physical sensations.

Another thing I’ve noticed is that during these moments, my sense of gender-related discomfort seems to weaken. It’s not that anything is resolved—it just feels less immediate or less “owned.”

At the same time, I do like some of the effects of HRT so far, especially the reduction in libido and the idea of preventing further masculinization, and I currently intend to continue HRT for life.

He displays the same mix of stubborn certitude and persistent doubt that you find everywhere online. He will not stop and cannot be stopped… but what if he’d never started? How do you live with knowledge you can never unlearn? (Spend some time in online trans spaces and you’ll find, again and again, people actively transitioning who say they wish they’d never heard about trans people…)

Would it have been better had he gone on as he was, rejecting the trans prototypes he encountered, dismissing the idea of transition, hoping his confusing feelings would someday subside, and investing his efforts in suppressing what he saw as a “weird fetish” or “private shame”?

He gets some interesting responses, which are worth a read. “Sounds kind of like infohazard theory, the idea that just learning certain information can be harmful to the learner,” one responded. “It's something I wonder about sometimes.”

A detransitioned woman who describes herself as autoandrophilic (a female attracted to the idea of herself as male) recounts how fixation fuels distress:

I’m not sure how to compose my comment into something coherent, I’ve always been one to ramble and miss the point. But I wanted to comment on your post anyway.

Like you, I have ASD, and similar to you I have, or used to have fantasies of being the opposite sex. Just have it in reverse, autoandrophilia, because I was born a female.

Seeing how you wrote about the western approach to trans resonated with you, took me back to how I first happened upon the idea that my feelings of not fitting into the stereotype of my gender and having autoandrophilic thoughts along with strong gender envy..were a sign that I should transition. What followed was that I researched the hell out of transitioning and filled my days with content related to the topic, which is very common to us ASD folks. Naturally, the more I spent my time on this, the worse my anxiousness became, and I started believing that I will die if I don’t transition. While previously having a steady, low dislike for my female body, suddenly it felt like I couldn’t live in it anymore. Transition became an obsession. An escape to problems I had and of which several I didn’t even recognize or didn’t want to aknowledge. After all, it is much harder to accept yourself as you are and put in years of psychological work and work through traumas. Who wants to do that? And who can do that all alone with no support?

I feel like I’m rambling now, like I said. Sorry. But I hope that even though you’ve felt HRT being helpful so far, you can think about the future you and your health. Because we are not built for flooding our bodies with excess hormones. I felt great the first few months on testosterone, but 2 years of it has left lasting effects on my body, even 6 years into detransition. And guess what, my autoandrophilia has lessened by about 90% as I’ve aged. Or maybe it was partly due to the traumatic trans experience, who knows. As I made the decision to detransition, I vividly remember thinking that I don’t want to pretend anymore, and instead just to be me. With all of my quirks and all. Poisoning and mutilating my body was never going to fix anything, cuz it is not the magical solution many would love for us to think it is.

Sometimes, transition is the only path forward that not only promises healing and transformation but provides actual material and emotional support (“Who wants to do that? And who can do that all alone with no support?”).

And a fellow autogynephilic male supplies one of the best descriptions I’ve read of the way online trans content can warp perception and desire:

You are asking a very important question here and let me tell you before those people who object everything come. This question was very important in my journey to navigate as a person who doesn’t have that much dysphoria. We are products of our time and we are getting affected by outside world more than we think.

I wouldn’t be in this position if there was no internet and I didn’t knew all this was possible. It just creates a tunnel vision and makes you blind to see what is real and what is not. Sometimes we don’t even realize this is not what we truly want but keep staring at them with enchanted eyes. I became prisoner of my childhood dreams and I let that dream go crazy with porn and materials but in the end I’m not that child anymore and this is not something I actually want with all the flaws.

There was some people who can’t help it for all the history while there was no hrt [hormone replacement therapy] but what it has evolved today is beyond those people. Probably you would think much different about your life, what you want and your relations if you never knew about this such a thing is possible( possible to what extend [sic]?). It is a very toxic and consuming issue because you find the satisfaction that you should seek outside inside and it’s making things just worse.

Even when you think about it as a problem it is a way to entertain the idea. Its very hard to look objectively to this but it’s possible. When you decide what you are and what will be right way to walk you can disproof people claiming they have found their true self. Even the ones with natal feminine behavior cannot past beyond being a replica of true women. When I think about all women in my life what I understand from femininity and what makes me aroused to replicate is very limited material and it’s replica whatever happens.

I’m just a victim of my childhood imagination and my search of femininity as a male. I’m victim of uncontrolled internet use and lack of spiritual guidance. As a man I’m tough and hard by nature and Im designed to seek softness and femininity. The only way to navigate is disproving the things I see and I’m very good at it.

What a metaphor. Under the dominion of a new idea, one becomes a “prisoner” of impossible dreams who sees the world through “enchanted eyes” and loses track of what he knows and truly wants for himself.

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Romantic and sexual encounters

Dating, romance, and sexual intimacy were frequent topics of conversation. The sample included 65 posts relating to dating, 11 posts relating to marital relationships, 70 posts about sexual relationships, and 21 posts that explicitly mention avoiding sexual and romantic encounters. These concerns about dating, romance, and sexual intimacy crop up concerning existing and prospective romantic and sexual encounters and relationships, spanning from pre-existing relationships with heterosexual male or homosexual female partners—relationships that posters worried would be altered or terminated by a change in gender self-identification—to the possibility of future sexual and romantic involvement in configurations that include males attracted to other males, males attracted to females, females attracted to other females, and females attracted to males. Some trans-identifying females identify as “straight men” (females attracted to other females), while others identify as “gay men” (females attracted to males) or bisexual/pansexual (attracted to people of either sex). Some specifically seek out “T4T” (trans-for-trans) relationships, which may involve either female or male partners.

The question of how one’s sexual and romantic partners describe their sexual orientation was a recurring source of insecurity. Some described current relationships as “doomed” by their transgender identification, believing that a lesbian partner would not remain with a “man” (of the female variety) or that a heterosexual male partner would not want to be involved in a “gay” relationship (again, with a female partner). Some expressed discomfort with the way others perceive their sexual orientation and romantic relationships, like the woman who described feeling like “a fucking mess” after a friend referred to her as being in a “lesbian” relationship (“I haven’t felt this dysphoric in years. I’m running through all the things I’ve said, done, and felt in front of them and wondering what it is about me that they see as a woman. I know that doesn’t make sense, but that’s what my dysphoric ass brain is doing”).

Concerns about sexual and romantic opportunities during and after transition were typically characterized as a “mindset” in need of changing, rather than as factors to consider as part of the decision of whether to transition:

“have any of you ever felt like people who are only interested in men won’t be into you? like, i get really sad when i like a girl and i find out she’s straight bc i always assume she won’t see me as a real man and won’t want be with me, and it happens doesn’t matter how the person treats me. the girl can be super supportive and respectful and maybe be even hitting on me but i’ll always assume she’s not into me and she’s just being nice or something. i believe it falls under internalized transphobia and i wanted to know if any of you ever dealt with something like this and how can i change this mindset?”

A 16-year-old described feeling “so scared that no man-attracted person could ever be attracted to me once I tell them I’m trans,” before clarifying that “I know that this is false… but I have no idea how to go about breaking down these misconceptions I have built up which affect me so badly… my own feelings and insecurities have lead me to believe that cis people would be disgusted by the idea of dating me because I’m trans.” She then expressed fear of disclosure and potential rejection, as well as concerns about being considered disgusting and sexually “inadequate.” Finally, she reframed (discounted) her fears about potentially not being able to find a compatible romantic and sexual partner to align with community norms: “I know this is my own internalised transphobia and dysphoria talking.”

Members of these online spaces frequently reported no sexual or romantic experience whatsoever. “I’ve never had a sexual fantasy involving myself. Ever,” as one young woman wrote. “I can’t really conceive of myself as [a] person to desire and be desired, to love and to be loved.” Thus, for many, their ideas about attraction and sexual encounters appeared to be largely or entirely theoretical and often assumed the shape of trans maxims like “hearts not parts” that encourage members to be “inclusive” in their sexual attractions, rather than exercising “genital preferences,” a coded and disapproving way of referring to sexual orientation.

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• Listener question: “From time to time, you have both mentioned some criticisms of some aspects of the “gender resistance.” Are there additional concerns or criticisms you have (about strategies, goals, framing, etc)? Do you think there is anything the “movement” needs to be cautious of or avoid?”

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More annotated sections from my thesis. Are these interesting? It lets me say more than I could say there… You can find the first installment here.

Doubts about the limits or “futility” of transition

Doubts also appear to flare when community members are confronted with the limits of hormonal and surgical interventions for transition, specifically the impossibility of fully transitioning from female to male and the inability to rewrite one’s past experiences and socialization. For example, one young woman, who had not yet initiated testosterone, voiced frustration about the limits of what medical transition offers and that, even if she were to successfully ‘pass’ as male, “I’ll always be the odd one out”:

“even with t, when I do pass I’ll just be a weirdo with a vagina. Oh god and what scares me most is that once I pass on t pre top surgery I’ll be even weirder. Like some person posing as a guy, who really has boobs and a vagina. Even once I’m ‘accepted’ by other men, I’ll always be the odd one out with NO FUCKING PENIS. The one who had to take shots to be barely a fraction of a man. My body grew fucking breasts and now I HAVE TO PAY TO GET THEM REMOVED.”

Another expressed concerns about the unpredictable effects of testosterone in the form of “nightmares… about my body not changing much yet me developing a deep voice or a full mustache. I would still have this female feminine body but with some hyper masculine features that contrast. People in my dream still perceive me as a woman. I feel like I am not able to escape from the femaleness of my body.” This strikes me as a dream about getting stuck partway: changed, but not changed enough. Masculine but still female.

[See my recent post on the 1973 article, Dreams of Transsexuals Awaiting Surgery” for more on this…]

The sense that changes wrought through hormones and surgeries are not “real” appears to trouble some community members, as in these two posts:

• “Lately when I look in the mirror, I get so critical of the way I look. I tell myself all the reasons that my face or body looks girly, which not only makes me dysphoric but also starts making me view myself as a fraud- as in, I start thinking of myself as a woman just cosplaying as a man, or that I don’t ~actually~ look the way I do because anything that’s been caused by testosterone isn’t “real”.”

• “Even when I do feel certain that I’m trans, I still feel like I’ll never be [a] man. There are times when I try to imagine myself living as a guy in the future, but sometimes it feels weird; it’s like I’m looking at an entirely different person, and I wonder if this is a sign that I shouldn’t transition at all because I’m clearly not sure if this is something I really want. It’s like I’m playing pretend at being a guy, fooling myself into thinking I’ll ever be anything other than my AGAB [assigned gender at birth] and that I’ll always be stuck with the current body that I have.”

A user who reflected on the experience of being trans while high on marijuana wrote about the difficulty of accepting the prevailing community belief that gender is self-determined:

“I just know that I desperately want to be biologically male, and I can’t get that. And to be honest, I don’t know if I ‘feel like a man’. I definitely have always had feelings of ‘I should have been male, male feels like it would fit me better’, but I still have a hard time thinking to myself, ‘I am a man’, it just doesn’t feel true, and I thought if I took testosterone for a long time and became accepted by other guys, that it would finally start to kick in for me that I’m really a guy, but I just don’t feel it.”

Here we are have the hope that testosterone will stabilize a shaky sense of self. This is, needless to say, not among the well-studied effects of taking testosterone. It’s not working and now she is trying to disentangle the feeling that she should have been male from the advisability of transitioning to appear more masculine: is this a fantasy that can or should ever be imported to the real world, or not?

She reported that this inability to consistently self-identify as male carried over to not seeing other trans people “as the gender they are”:

“I don’t know how to leave that outdated belief behind. And it’s probably why I’m having this gender crisis. I don’t know if that makes any sense but as I’ve said before, I don’t wish to hurt anyone with what I’ve said, even though I know it still will. But I don’t want to think this way anymore. I feel like I still need ‘convincing’. Sometimes I read detrans stories and it scares me because now I wonder if I really did just transition to escape misogyny, because I grew up thinking boys are cooler. […] I just wish I could learn to be cis and not have dysphoria but... I just don’t want to. I don’t know what to do. I feel like I’m at a crossroad but no matter what path I take it will never lead me to happiness because I can never be a cis male and it hurts but I don’t know how to reconcile with it.”

What we see here is someone grappling with what she is and isn’t allowed to say and think about transition. She “do[es]n’t wish to hurt anyone” with what she says, but she knows she will. She doesn’t want to “think this way anymore” but she can’t stop. Right after she says she “still need[s] ‘convincing,’” she describes shopping for alternative stories, including detransition narratives that unsettle her when they draw too close to her own experiences and when they remind her that what she desires is not possible.

Social interactions

Members of online spaces frequently described experiences of heightened social anxiety, anxiety over ‘passing’ (being perceived as a member of the opposite sex), avoiding potentially distressing interactions, and experiencing social isolation. Social anxiety and isolation were often mentioned before, during, and after trans identification and transition.

Members often anticipated negative encounters with dread, such as a 30-year-old who wrote that, “Since transitioning, though, my fear of people and of places has returned. I went to a regional meeting for my job recently and was terrified the whole time. I’m happy to report that everybody was extremely nice to me, but I couldn’t help project my fears that I was hyper-visible, that I seem like a joke to people.”

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I’m trying to get caught up on a few urgent work projects so a quick post today—excerpting (and updating/annotating, in and out of brackets) the parts of my thesis that discuss the doubts girls and young women express as they consider taking whatever the next step is in their transition and emerging doubts about whether transition is helping.

Community members often reported doubts in connection with transition milestones, such as choosing a new name, coming out to family and friends, starting testosterone, scheduling surgery, or altering legal documents.

One young woman—facing delays in accessing testosterone—expressed feeling unsettled by the insurance company deeming this medication “not medically necessary”:

“[Delays are] really frustrating, and it’s giving me intense feelings of trans imposter syndrome. Especially because the insurance company language is that they deny medication deemed ‘not medically necessary.’ If it’s ‘not medically necessary,’ then maybe me being trans is made up, and maybe I’m putting myself through all this emotional trauma for nothing.”

She then quickly clarified that “I don’t actually believe this” and blamed “the thoughts that are running through my head” and “the feelings they’re causing”—in effect disowning her negative thoughts and feelings about transition [this will be a theme]. Sure, these thoughts are running through her head but they’re not hers. She finds what little recourse from doubt she can in the false (but widely promoted) belief that these treatments are “medically necessary.” As soon as that false belief is shaken, she worries she’s putting herself “through all this emotional trauma for nothing,” which is quite an extreme statement.

A university student, on the verge of coming out to classmates, described experiencing persistent self-doubt, despite receiving social support for her trans identity, which appears to be not very protective at all:

“It is weird, because there is no reason at all why I should feel like this. I grew up in a very supportive environment… I’m constantly asking myself if this is the right thing to do. If I’m sure it’s not just a phase. All the transphobic things I’ve seen somewhere on the internet come back to me and try to make me believe I’m wrong… I can accept anyone else [as trans], but I can’t believe in myself and my own feelings.”

See again: disowning doubts about transition, which she blames on “all the transphobic things I’ve seen somewhere on the internet.”

Another young women expressed mixed feelings about changing her legal documents. This gap between how she expected to feel about a legal name change and how she actually felt caused her to wonder whether she had tried hard enough to be happy before deciding to transition:

“I got the news my change of name has been approved and I’m grateful but it brought up a few feelings I’m not sure how to deal with it. My imposter syndrome is off the charts today because if this is a good thing, why am I sad about losing ‘girl’ me? And did I really try to be happy living as her? Maybe I’m faking? Shouldn’t I be *happier* about this if I’m really a guy and if I’m not, how can I expect getting hormones next to feel?”

Another, anticipating an upcoming consultation to start testosterone, asked for reassurance that “I’m not making some massive mistake”:

“I’ve been looking forward to this for so long, but now that it’s almost here I’m terrified. I feel like I did when I first started questioning, like maybe I’m just super effed up and it’s trauma masking as dysphoria.”

A young woman reported a spike in self doubt in the lead-up to “top surgery,” and described attempts to alleviate these doubts by “doing my best to see this as a medical treatment for dysphoria but there’s always a lingering fear in the back of my head.” [Again: recourse to belief in medical necessity…] Another asked, “Is feeling anxious/scared right at the precipice of physical transition normal?? It just feels like they’re going to use it against me to say I’m not trans.” [Red flag here for concealing doubts from medical providers for fear of being denied access to interventions.]

A young woman who previously identified as nonbinary and underwent a double mastectomy (“which was emotionally hard as hell”) but had recently come “to the realization that I’m actually a man (or at least man adjacent) and I want to go on T[estosterone],” described “shitting myself I’m so scared of transition”:

“In therapy we discovered that I have massive internalized transphobia. Other people can be trans and I am totally supportive, but /I/ can’t be trans cuz that means I’m a freak. I hate myself for this mindset, both because I feel gross for feeling that way and because I hate that I have to have this internal battle to become my happiest, free-ist self. Has anybody else had this experience? How did you overcome and heal? What was your experience transitioning through it anyways?”

We saw this before and here we see it again: I can accept other people’s trans identities, but not my own. Social pressure to accept other people’s identity claims, however sketchy, keeps trans-identified young people trapped, even as they grapple with crippling doubts about their own trans identities, which they struggle to take literally.

Doubts about whether transition is helping

Redditors frequently reported the onset or exacerbation of gender dysphoria after adopting a transgender identity and/or taking steps to socially or medically transition (42 posts). According to self-reports, experiences, sensations, thoughts, and interactions that did not previously cause distress—or caused only mild or fleeting discomfort—subsequently became severe or even debilitating. In some cases, the self-reported chronology of distress began with the revelation of a trans identity, as opposed to distress preceding trans identification. A typical post in this vein began “I started to accept that I’m trans 3/4 months ago, and with this realization came dysphoria, loneliness [...] I started transitioning shortly after said realisation and from that point my dysphoria started to progress [worsen] (because I finally understood that being identified as a female by society was extremely uncomfortable for me).”

Another young woman asked: “How do I deal with my sudden realization of my gender dysphoria?” She describes a recent revelation around trans identity (“a few months ago”), in a context of limited “physical dysphoria” and “no signs of it in my childhood.” Since coming out as transgender, she reported that her experiences of dysphoria have become “crippling” and “incapacitating,” and compared “getting deadnamed or misgendered” to getting hit by “a school bus.” She described fixating on particular body parts (“tiny hands,” “lack of hairiness,” and her voice). Despite her fears of “moving too fast” with transition, she expressed feeling reassured by the “real”-ness of the distress and gender dysphoria. In other words, coming to identify as trans has intensified her negative feelings, which (somewhat perversely) reassures her her trans identity is real.

Others describe an initial “high” after coming out as trans that quickly burns off: “I’m not happy like I was over the summer when I came out,” one young woman observed. “What if I’m just unhappy forever no matter what I do? Is transitioning just something I’m doing to feel like my life has a purpose, like I won’t be lost and unsure and depressed forever? What if it’s not actually ‘the answer?’ What if there is no ‘answer’ and I’m just like this?” She’s touching here on alternative explanations for trans identification and transition: trans identification answers the question: Who are you? Transition answers the question: What do you do next?

Another Redditor who had come out as trans one month ago reported feeling “super confident” initially, followed by an emotional crash as the poster contrasted this new self-identification with what the poster “see[s] day after day” (a “womanly” body that made the poster feel “I am fake”). The poster then explored the doubts that this sense of discrepancy dredged up, including being “scared that I was wrong about being trans”—while at the same time wondering if the doubts are a “coping mechanism” for being unable to transition right away. She concluded with a series of declarations—“I want to be one of the boys (not the problematic ones lol),” “to kiss boys as a boy,” and to be a “male model”—followed by an expression of frustration at being unable to “confidently say that I’m a way [she probably means ‘boy’] without questioning myself/doubts.”

Another young woman described seven years of gender fixation, which worsened after the poster adopted a trans identity. The poster explained this increase in distress as the result of becoming “aware that I have repressed my dysphoria my whole life”:

“so basically i’ve repressed my gender dysphoria and also euphoria my whole life and even up until now for whatever reason i literally deprive myself of things i know that will make me euphoric and i’m starting to think if it’s because i’m scared of being who i really am, of my truth (ftm). it’s only been a year since i accepted that i’m trans and ever since then my dysphoria will come in waves. however, now the waves are more frequent and worse each time ever since about a week ago i became aware that i have repressed my dysphoria my whole life.”

[Strong echoes of the recovered-memory movement here…]

A 15-year-old reported not having experienced gender dysphoria or “disgust from being called a girl” until after learning about the possibility of being transgender, at which point these experiences and self-perceptions began to inspire intense feelings of “disgust”:

“now that i finally realized that my thoughts arent [sic] normal cis thoughts and realized i would be so much happier if i were born a boy, its [sic] so much worse. Its [sic] always at the back of my head now. i wake up hoping my chest is gone and im disappointed when its not, i look in the mirror and i look as feminine as ever (i dont [sic]), i wake up and i am referred to as someones [sic] daughter, a sister, and i feel disgust. hearing my names makes me disgusted. i wish i was just okay with who i am.”

Posters frequently commented on their experiences of deteriorating mental health and potential causation, like one who self-reported that, “since I realised I might be trans I feel worse about my body, but I’m afraid I’m deluding myself into thinking it’s dysphoria when I was completely fine with it [my body] before”:

“Is it possible my brain is doing that? Is it possible I’m making this up? I really wish I were male, but I feel like I’ll never be able to be one. I feel so weird. I’m so afraid of being seen as ‘weird’ because I’m trans, of being seen as ‘a girl pretending to be a boy’. Concerning dysphoria appearing out of the blue : for instance, I liked my breast (i found it pretty? although I liked it being small and people saying it’s flat made me happy...?) before but now I started disliking it, possibly because I told myself ‘you’re not supposed to like it’. I’m really afraid I’m faking it, what should I do? Is the distress I feel towards my body dysphoria or fear of making the wrong choice about my life? Could I be consciously analysing my body to find points I should be dysphoric about? Or is it just that realising [I’m trans] made me realise my discomfort was dysphoria?”

The poster referenced a set of expectations about what being transgender is like (“now I started disliking it, possibly because I told myself ‘you’re not supposed to like it’”) and the possibility that “consciously analysing my body to find points I should be dysphoric about” may explain the poster’s increased distress.

Some community members report that attempts to mitigate distress—such as taping or binding one’s breasts—may exacerbate distress instead, for example, in the following self-report, where taping appears to draw attention to other (gender-incongruent) features of the body while also creating a distracting “sensation” on the poster’s chest: “I got trans tape it finally arrived I put it on and now I just keep paying attention to my other traits that make me dysphoric instead of my chest since now its mostly fine but also the sensation of having the tape on my chest makes me dysphoric too (and thats why I stopped using a binder plus it caused damage to my ribs).”

Multiple posters in the sample reported adopting self-harming behaviors only after identifying as trans, which is something I hope (/doubt) clinicians are screening for. A 14-year-old who reported coming out as transgender one year ago described persistent self-doubt about trans identity alongside deteriorating mental health: “ I feel like my mind is just making a mess about this, I have tons of venting posts or me just doubting everything about myself. And in plus [sic] of that I’ve been quite suicidal for the past months, and I started to develop a self harm problem (I don’t think it’s an addiction though).” A 19-year-old reported that “I recently started self harming as a way to distract myself from all of these thoughts. Now I just feel like such a stereotype… I have my 6-month T check-in with my doctor in less than a month and I’m not sure what to say when they ask about my mental health like they always do. If I answer honestly, I’m afraid they’ll want to stop my hormone therapy. If I lie, though, I’ll feel awful, and I’ll continue to not get the help I need.”