Sarah: I think most people in this space will know who you are already but could you introduce yourself in a sentence or two, just in case?
Joe: Clinical psychologist and psychoanalyst. These days, I work almost exclusively with trans-identified males, men who have detransitioned, and men who struggle with autogynephilia. I also teach and supervise other therapists.
Sarah: One of the things I think you understand and speak to very well—based on other conversations we’ve had—is the impossible bind boys growing up today are in. So I think if I could ask you to talk about that, that would be a good place for us to start.
Joe: I think it’s hard for boys and young men to come of age today. Richard Reeves [author of Of Boys and Men] talks about loss of manufacturing jobs and the hollowing out of the middle class. I’ve been thinking more about other contributing factors like the blank slate view of gender, that gender is all socially programmed. This idea has infiltrated schools and this is what children are being brought up to believe: that boys and girls are basically the same, it’s all down to enculturation, therefore we can shape boys to be anything we want them to be.
The APA put out guidelines for working with men and boys in 2018, with the point of view that all masculinity is effectively toxic masculinity. This is a pervasive view among therapists, with the implication that we need to teach boys how to become more like girls: more empathic, not so competitive, more emotional, not aggressive. So when you’re growing up as a boy and you hit puberty and testosterone starts changing your body and your mind and your emotions, you’re living in a world where those things you’re experiencing are viewed as bad. And there aren’t any cultural aids around anymore to help boys channel all of that. Boy Scouts became Scouts/Scouting America, which is co-ed, boys and girls together. There are very few times and places where boys are allowed to get together in groups and encouraged to be competitive or even aggressive in healthy ways.
The question is: how do you channel that energy into something that has societal benefits, which is what other cultures have done historically? I’ve been reading ethnographic studies of other cultures and they all have rituals for boys who are coming of age to help them become warriors but also to become protectors. We used to have ideas of chivalry: that men are more powerful and that this power places an obligation on men to protect women and children.
Sarah: Sometimes it seems like—in the absence of healthy and positive models of masculinity—we’re offering boys two dysfunctional templates. You can reject the judgment and be Andrew Tate or you can reject yourself and reject the idea of becoming a man altogether.
Joe: We as a culture are failing boys by not teaching them how to become men anymore.
When boys enter puberty, their minds and bodies are dramatically changed by a surge in testosterone. It’s not only their sex drive but often a rise in competitive aggression, risky behavior, and a readiness to respond with anger. Today, we’ve lost sight of what a powerful transformation this can be. Popular resources for boys hitting puberty—like Growing Up for Boys by Alex Frith and Felicity Brooks—minimize the differences between pubertal changes for boys and girls and neglect the powerful male sex drive. Either that, or we view it as a bad thing to be condemned and drummed out of boys.
So, when a pubescent boy suddenly has way more aggressive energy to manage and channel, and an urgent drive toward having sex, what is he supposed to do with that? He’s grown up in a culture that tells him those things are wrong and that he needs to be more like a woman. And he doesn’t want to be a bad guy, doesn’t want to be an upholder of the patriarchy. Sometimes he’s deeply disturbed by his sexual impulses. I’ve had clients who wanted estrogen so they wouldn’t have spontaneous erections anymore because it was so upsetting.
So, if you feel bad about yourself, if you’re confused or feel uncomfortable with the way your body and mind are changing, the appeal to become a woman can be a big draw, especially if you’re a quirky boy who doesn’t fit in with the alpha males anyway. They’ve been drummed out of that hierarchy. They’re not very successful with girls. They don’t know what to do with their sexual energy and aggression. Then gender comes along and offers a way out.
And then there are boys who are sick of being shamed for being boys and being told everything they do is wrong. They’re tired of being shamed.
Sarah: It looks to me like there’s a real mix of motivations and several distinct pathways for boys and men who get sucked into trans identification. A lot of boys in these online spaces seem to struggle with the idea that male sexuality is innately aggressive, deviant, problematic, or predatory (or all of the above). Boys often talk about feeling like “creeps” for liking girls (as boys) and wanting to spend time with girls. They talk about being disgusted by their bodies, and in particular bodily functions like erections. Some boys seem to fear not being able to measure up to impossible standards of masculinity. Others seem to spend so much time online, playing video games, for example, or consuming pornography, that they seem to have lost track of their physical bodies altogether.
Based on your observations, what factors drive boys to dissociate from their bodies? What do you see as key push and pull factors for boys and young men to identify as trans? What does the prospect of transitioning to live as a girl or woman appear to offer these boys?
Joe: There’s an ROGD [rapid-onset gender dysphoria] contingent that comes out in their mid-to-late teens. The ROGD boys often have cheerleaders offline, often a girl, whether that’s a classmate or an older sister who is really supportive of their trans identity. So transition can be an opportunity for a quirky boy to get attention from girls, touch them, be touched by girls who put makeup on them and do their hair. The boys are just trying to develop some sense of who they are. They’re kind of lost, trying to develop an identity, and they found a way to explain their quirkiness or unease or differences by saying oh, I’m trans, that accounts for it. They get group membership and a sense of identity that way. With most of these boys it’s not very sexual. I’m not saying that doesn’t play any part. But it’s not the driver.
The older clients I see, those are the AGPs [autogynephiles]. The youngest AGP I’ve seen was in his early 20s and he was being groomed online. But most of the AGPs I see were not groomed. Instead, they’ve got this closet fetish they’ve been trying to manage for years. And then they encounter this new way of thinking about their urges—that they’re trans—and learn that they should indulge it.
With AGP guys, there’s this whole other identity they’re attracted to and it’s very sexual. It’s like a mosquito itch they just cannot not scratch.
Sarah: I’ve noticed trans-identified men tend to be much more explicit than trans-identified women when it comes to talking about their trans identity as an alter ego. So they say things like “I let Michelle out today” or “I’m finally starting to see Ginger in the mirror.” A lot of this sounds like old-fashioned crossdressing lingo to me.
I wanted to ask you about something else I’ve noticed, which is the way trans-identified boys and men often mention feeling ‘relaxed’ when they shift into their ‘female’ personas. What do you think they’re referring to?
You’ve got to read this [2002] article by Amy Bloom in The Atlantic, “Conservative men in conservative dresses.”* She quotes this one crossdresser who says, you women really have it down, you know how to kick off your shoes and relax! I find this in every AGP man I see. It’s a de-stressing thing. There’s this idea that being a man is very stressful, whereas becoming a woman, well, you start menstruating and that marks your entrance into womanhood. It’s a natural evolution, as opposed to masculinity, where you have to be made into a man, conform to expectations, and that requires a lot of grit and aggression and living up to societal expectations. It’s a demanding and stressful thing.
I still think there are a lot of pressures that boys feel growing up about what it means to be a man, even if they’re also being told men should be more like women. Look at superhero movies: men are rescuers, men save the day, then there are men of business, who are real powerhouses. Many of the guys who become AGP are really stressed out by demands of being a man. They erroneously think of womanhood as being way easier. I remember something I saw online where this AGP guy posted a photo of himself as a woman and it said it was just too hard being a man so I became a woman. They think womanhood is easier and that, if you could be a woman, you could escape from all the stress of being a man. One of my AGP clients, when he’s totally freaked out, puts on this French maid’s outfit and a duster and lives out his fantasy of being this ditzy French maid who has to do exactly what she’s told. And it’s relaxing!
Another client will come home and put on a girl’s jumper, just a tight-fitting piece of female clothing. Another guy whose wife is pregnant, they had a great sex life beforehand but she lost all interest in sex, and there are all these life changes around responsibility and now his AGP fantasies are in overdrive. And he didn’t understand why those fantasies would be thrown into overdrive until I was helping him see that he was facing all these new responsibilities with no source of comfort, so he turned to his fantasies to seek comfort. Again, this starts with the false idealization of womanhood as being easy, the idea that women have “got it all,” which can give rise to envy and hatred. And that envy can encompass bodily processes like being pregnant and menstruating and I think a lot of these men, when their wives become pregnant, they experience that as a deprivation, something that diverts their wife’s attention, and they may feel envious of what women can do.
It’s also worth noting that this relationship can shift over time. Anne Lawrence wrote about how, as they age, AGP men begin to feel toward their feminine self the way old married people feel about their spouse. It’s a great quote. It’s like they develop this entire relationship with this other version of themselves.
Sarah: What you said about needing to be made into a man made me wonder… if you have to be made into a man, does that spark the idea that you can be made by effort into a woman? Women who transition just don’t talk about putting in the effort the way men do.
Which brings me to one of the stranger corners of trans Reddit—and that’s really saying something!—which is r/transmaxxing, which describes itself as a “community for people improving their lives by transitioning from male to female.” But it’s hard to tell if this is one of those things that only exist on the Internet or if it’s a real strategy being adopted by boys and young men who feel like they cannot compete in the sexual marketplace or measure up to standards of masculinity. What do you make of this?
Joe: I think they feel like failures as men, they really do. They think they’ll never get a girlfriend. That sense of failure is huge and drives them on some level to think: OK, I might as well be a girl instead.
Sarah: What is the role of obsessive thoughts and addiction-like behaviors that many of these boys and young men appear to manifest? Might treatment approaches for obsessive-compulsive disorder or addictions work for trans-identified boys and young men?
Joe: I hate the word addiction and the way everything gets boiled down to a medical concept. I don’t think about it that way. I think about addiction as a form of psychic retreat, which is how I think about AGP. The ‘French maid’ I mentioned had lived on the street as a heroin addict for a couple of years. He told me once that the only thing better than AGP fantasy for making the world disappear is heroin. Heroin is great because your whole life is about “how do I get my heroin today?” Everything else goes away. It’s a complete withdrawal from reality. Which is what I think AGP is. When the world becomes too stressful, you can withdraw into this delusion that you are this sexy object of your own desire and everything else goes away. These fantasies are all-consuming and everything else disappears. This “making the world go away” is exactly what happens in extreme forms of addiction because you’re dealing with more than you feel like you can manage.
Sarah: What do you wish the rest of the world understood about boys and men who identify as trans?
Joe: It’s hard to get people to look at the ROGD boys as a new and different cohort. What we’re seeing now is something else. Jon Haidt has done great work talking about how social media and the Internet have ruined mental health for a generation. And then if you layer on the things we talked about earlier about boyhood and manhood and how hard it is to come of age—I think a lot of things came together to create this whole new type of trans-identified boy who is not all that different from the girls.
Sarah: How can you reach these boys and young men in therapy?
Joe: What I focus on is trying to get at issues through the back door. I’m always trying to get boys to think about their future. When gender comes into the picture, everything else goes away and gets replaced by transition. So I try to help boys think about what they’re good at, what actions they can take to make use of their skills. I focus a lot on developing masculine self-esteem. Men in particular feel good when they’re good at something and when they can put that something to use. Gender discussions seem like dead ends to me. But if my clients come to feel better about themselves as boys and men, maybe the drive to transition won’t seem so strong.
Sarah: How do these boys and men think about their bodies?
Joe: With the ROGD boys, even though they talk about bodies, and bodily changes like softer skin and growing breasts, they’re pretty detached from their bodies. They don’t have much of a relationship with their actual bodies. They treat their bodies like an avatar you can think about any way you want.
With guys who are AGP, I try to help them move out of this obsession with bodies and body parts to thinking about states of distress and how they can soothe themselves. They’ve come to rely on their AGP fantasy as a kind of psychic retreat from all the stress they can’t manage. I think these things get hardwired from habit so it’s more or less ingrained. One thing Michael Bailey and I agree about is that you can’t cure AGP. It’s never going to go away. But I want my clients to become sensitive enough to their inner lives to understand why their fantasies are coming on so strong right now, to see it as a warning sign that maybe there’s something deeply painful or stressful going on in their lives that they need to attend to. If I can help them find different ways to care for themselves, then they won’t need to resort to the big guns, the AGP fantasy. There are better ways of soothing yourself.
Sarah: In your experience, what factors contribute to desistance and detransition for boys and men?
Joe: Sometimes they realize the kind of sex they were fantasizing about was between two men and that they were just gay, not women. In other cases—and this is why [detransition] can take seven to 10 years, I think it’s finally coming to terms with the fact that transition failed. You can only sustain this delusion for so long, I think, unless you descend into deeper states of mental illness. A big part of transition is the idea that you’ll become this new and improved person and I think it’s not possible to sustain that belief indefinitely.
Sarah: What are some of the best articles, essays, and conversations you’ve encountered that provide insight into the mental and emotional lives of these boys and young men?
Joe: Anything by Richard Reeves. Christina Hoff Sommers wrote a great book a while back called The War Against Boys. Plus there are a number of people I follow on X who’ve been beating the drum about the crisis among boys and young men for years now: Lisa Britton (@LisaBritton) is great. So are Scott Galloway (@profgalloway) and Chris Williamson (@ChrisWillx).
You can find Joe on Twitter at @drjosephburgo and Substack at @bpdgoesviral.
*Thanks to Lisa and Rags for supplying links.
Wanting to transition as a way of retreating from the world might also apply to young women who feel like failures at femininity and so take on a trans identity.
Brings to mind the conundrum: why do some people feel so fearful of the world when they live in the safest place and time in human history?
This is a wonderfully nuanced conversation, Sarah. It threads the needle on so many tangential issues.
I appreciate women like you who look at us without judgment, but with compassion. Thank you.