Addressing the right-wing’s false narrative around “medicalized homophobia”

There’s a curious talking point that won’t seem to die right now that just got a major boost from everyone’s least favorite author. In shorthand, you’ll most likely see the narrative referred to as “medicalized homophobia”, which posits a conspiracy theory that asserts that gender transition of any kind is an elaborate attempt to convert lesbians and gay men to heterosexuality through hormones and surgical intervention. Despite being baseless on its face, it’s an incredibly popular talking point and certain to come up in any discussion where an anti-trans campaigner wishes to dodge the accusation of being anti-LGBTQ.

In fact, we now know for certain thanks to leaked documents that some of the most virulently homophobic organizations in the United States paid an awful lot of money to make these talking points common. The Alliance Defending Freedom (ADF), who was responsible for the Dobbs v. Jackson decision that overturned Roe v. Wade, paid anti-LGBTQ hate group the American College of Pediatricians to promote this idea. The truth is actually much more interesting, and it tells a very different story.

Abolishing Compulsory Heterosexuality

While medicalized homophobia did very much exist in an earlier world of gender medicine, the advent of the affirmative model has helped to end this altogether.

Gender medicine didn’t begin as homophobia at all. It’s foray into such territory was actually at the helm of the now discredited sexologists who were once its largest proponents. These also happen to be the same people who today levy the accusation most readily, such as the now infamous J. Michael Bailey. Contrary to the fantasy world in which Blanchard and Bailey seem to live, studies consistently show that the majority of trans people identify as non-heterosexual, with non-monosexual identity such as bisexuality in the lead. (go team!)

During the early days of psychiatry’s stranglehold on gender care, endocrinologists and psychiatrists were stringent in their criteria around who would be allowed to medically transition. In fact, the single most common criterion had nothing to do with gender at all: it was indeed about who trans people were attracted to. While not true of queer-led organizations like the Institut für Sexualwissenschaft which was burned to the ground in 1933, most titans of early to mid twentieth century gender medicine were adamant that only those who could transition into heterosexuality would be allowed to do so; trans lesbians and trans gay men were almost universally turned away. This tradition was upheld by the current narrative’s most ardent proponents, people like Ken Zucker and Ray Blanchard.

Bailey. (2003). The man who would be queen : the science of gender-bending and transsexualism. Joseph Henry Press.

J. Michael Bailey famously even stated in his transmisogynistic opus “The Man Who Would Be Queen” that trans women who were attracted to men, who fit into Blanchard’s inane typology as “homosexual transsexuals” were objectively and without fail more attractive. So much so that he considered attractiveness to be an identifier of “true transsexuality”. Bailey believed somehow that trans women who dated men were smaller in stature more physically demure, naturally feminine and therefore more deserving of transition. Bailey actually went so far as to label women he considered HSTS as on the whole less intelligent— something that tellingly he considered to be a naturally feminine trait. If you’re suddenly thinking “wait but that just sounds like garden variety misogyny”, that’s because that’s exactly what it is. Just as the assertion that lesbians are inherently less attractive is garden variety lesbophobia.

While there are certainly people who have at times in history transitioned because somehow this was imagined to be a less challenging life than living as someone openly attracted to the same sex or gender, this is far and away not the primary reason for which most people seek transition, and it definitely isn’t the reason now. Jules Gill-Peterson describes several of these in Histories of the Transgender Child., but these also happened at a time during which non-heterosexual sex was illegal and punishable severely. Acceptance of cisgender lesbian, gay and bisexual people continues to rise and the majority of people in the United States support same-sex relationships, including marriage and adoption.

From DSM-IV to DSM-5-TR and beyond

But the Zuckers, Blanchards and Baileys of this world no longer hold the keys. Starting with DSM-5, Gender Identity Disorder was formally scrapped by the APA in recognition of not only its problematic and unnecessarily pathologizing history, but its total worthlessness as a scientific taxonomy. When Gender Dysphoria took its place in 2013, many of us who might have been turned away from pediatric gender clinics had we had the option, would no longer be turned away now on the basis of sexual orientation. This change had no negative effect on non-LGB trans people, but to LGB trans people, it meant the different between access to lifesaving care and not.

But perhaps more importantly, those who would have met criteria for GID would not meet criteria for GD. Since the formal move away from GID, “effeminate boys” as Stoller, Green, and Zucker loved to call patients assigned-male at birth at their clinics have been disambiguated from transgender girls.

We know this in part because of the shocking difference in desistance rates. As the right-wing loves to tout, 80-90% of pediatric gender dysphoria was reported to have ameliorated by adulthood. Whether this was organic, or induced by a queerphobic society is impossible to tell. But there’s a simple explanation: feeling some degree of dissatisfaction with one’s gender is not the same as being transgender. In samples used by sexologists like Zucker to establish these “rates” all perceived gender-nonconformity was used as selection criteria. Most studies of “desistance” prior to the modern era were of referrals, and most of them referrals of children who would not meet the current definition of gender dysphoria— not patients who either self-identified or were formally diagnosed with GID.

Speaking epidemiologically, imagine a paper that purports to calculate the rate of influenza infection in a given area by extrapolating from data on cough and cold remedy customers at CVS. Sure, you can absolutely track trends, and you may even be able to establish an index of the rise and fall of infection surges. But what you cannot do is calculate the actual rate of influenza in the general community, and you cannot say for certain that the reason people bought those medications is influenza. But most importantly, you wouldn’t be able to use whatever metrics you derived from such data as a proxy variable for something entirely different without introducing a whole host of new complications. With each of these, you run into added confounders, biases and ecological fallacies. Even if we allow that there is likely some significant collinearity between children who would be diagnosed with GID and children who would be diagnosed with GD, they aren’t the same. And the degree of difference is a tremendous one.

Curiously, under the new criteria used at pediatric gender clinics, our desistance rates have plummeted. Psychologist and literal superhero Kristina Olson found that of the 317 patients included in her retrospective chart review, an astonishing 95% of binary-identified trans youth persisted in what Zucker would have called “cross-gender identification”. An additional 2.5% moved from a binary trans identity to a nonbinary identity. In other words, 97.5% of patients followed by Olson persisted in some form of trans identity after 5 years. While perhaps one of the most compelling studies of late, Olson’s is not alone.

”Five years after an initial binary social transition, 7% of youth had retransitioned at least once. Most youth (94%) were living as binary transgender youth at the time of data analysis, including 1.3% who retransitioned initially to cisgender or nonbinary and then retransitioned back to binary trans identities. A small number of youth were living as cisgender youth (2.5%) or nonbinary youth (3.5%).”
Kristina R. Olson, Lily Durwood, Rachel Horton, Natalie M. Gallagher, Aaron Devor; Gender Identity 5 Years After Social Transition. Pediatrics August 2022; 150 (2): e2021056082. 10.1542/peds.2021-056082

Trans people are actually super gay, and we love every minute of it

But what’s extremely important is that modern samples also show a stark truth: in every single clinical sample, the overwhelming majority of transgender patients identify as lesbian, gay, bisexual, pansexual or queer. The most frequent sexual orientation among most contemporary samples are non-monosexual identities like bisexual or pansexual. Studies consistently find that heterosexuals trans people are in the minority, and the majority of people who transition do so in such a way that would either change nothing about how the outside world would categorize our sexuality (eg, I was bisexual before transition, and am, surprise, still bisexual), or would reclassify them from straight to gay or lesbian. There is a reason “transbian” has entered into the common queer parlance.

In fact, studies with modern samples so consistently find this that I chose the two articles whose demographics tables appear above completely at random from BU’s library database. I actually hesitated to use these as these are on the lower end of non-heterosexual identification, whereas both clinical experience and large scale studies have found rates closer to 70%. This isn’t new, either. Kuper et al found in 2011 that only 14% of transgender participants currently identified as heterosexual, whereas 54% of participants did prior to transition. If hordes of us are indeed transitioning for the end goal of being heterosexually-identified, we’re doing a terrible job of it.

The reality is that the relationship of sexual orientation to gender is complex and dynamic. Somehow, our culture has lost the plot on the reality that sexual orientation, like gender, changes for many over time. It’s not uncommon for people later in life, often after decades of marriage to a partner of the “opposite” gender, to come out as lesbian or gay. And why should it be? Realistically, it takes many of us years to undo the damage of living in a hyper-homophobic society. And more to the point, the very things that impede us from coming out about our sexual orientations are quite tethered to the things that prevent us from coming out as trans. I came out as bisexual only a few years before coming out as a woman.

But there’s one more really important point, that we cover in our 2022 paper for Critical and Radical Social Work: the idea that there are scores of parents who would rather have “heterosexual-appearing” trans children than cisgender children who were openly gay is patently absurd. For this to be even remotely feasible, we would have to imagine we live in a world that simply does not look like the one in which we now live. Remember J. Michael Bailey?

Bailey recently published a now-retracted paper with Suzanna Diaz, who runs the website “parents of ROGD kids”. Despite the fact that Diaz is actually quite fond of this talking point, her own survey showed much higher levels of acceptance of queer identity than trans identity. While we can’t draw an awful lot of conclusions from her survey given the enormous methodological and ethical flaws surrounding the paper, it’s worth pointing out that something which was designed to support Diaz’s worldview failed in this one capacity.

And this one reported statistic does indeed reflect the experiences of many, many trans people whose loved ones begged them to “just be gay” when they came out as trans. Curiously, this doesn’t appear to be dependent on who trans people are actually attracted to. This question has been asked of nearly every sapphic trans person I know, who then had to explain that they indeed were actually “just being gay”, and it was more obvious to the outside world after transition. The logical disjuncture here likely stems from our cultural inability to separate sexual orientation from gender in our minds, even though reality has already done so without waiting for us.

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