The consequences can be severe for those who believe themselves to be trans, take hormones or get surgery, and then later wish they could revert back.

The transgender movement has a problem with false positives. Set aside, for the moment, concerns about women’s athletics becoming dominated by biological males, or fears that male sexual predators may assume trans identities to gain access to female-only spaces, from locker rooms to hospitals to prisons.

For the sake of argument, accept the premise of the transgender movement: a woman can be born with a male body, or a man with a female body, resulting in gender dysphoria that is best treated by social and medical transition to affirm gender identity rather than biological sex.

This Doesn’t Solve the False Positives Problem

Even if this is granted, the problem of false positives remains: what about those who mistakenly claim a transgender identity? The growing ranks of those who regret transitioning prove that mistaken diagnoses and treatments are happening. Those whom have de-transitioned are providing testimony, with their words and the scars they bear on their bodies, of the harm that transitioning does to those who mistakenly undergo it.

Transgender advocates and allies should be concerned about these errors, especially as claims of transgender identities and requests for medical transition are rising rapidly. Even those who accept transgender ideology and support transition as a treatment for gender dysphoria should not want people to mistakenly transition. They should favor rigorous screening to reduce the likelihood of such mistakes.

But trans advocates are often dismissive—even hostile—toward those who no longer identify as transgender, or who have resolved their gender dysphoria without transitioning. For example, Jesse Singal, a liberal writer who is supportive of trans identities, was heavily criticized for addressing the problem of false positives in The Atlantic, and the magazine took the unusual step of running a series of responses.

Another case in point is the reaction to the identification of rapid-onset gender dysphoria. Before finally being vindicated, the study that described this phenomenon was attacked and even suppressed—all because it raised the possibility that some instances of transgender identity are induced by social contagion, rather than an innate, immutable gender identity at odds with biological sex. In both of these instances, the transgender movement resembled a moral panic, and moral panics are too afraid to worry about false positives.

The Scourge of the Moral Panic

The threat of suicide is the main driver of this panic. Parents are told that their children will kill themselves if not fully supported in a transgender identity, with trans advocates deploying lines such as “Would you rather have a dead son or a live daughter?” that panic parents into approving transition. Those who identify as transgender do have horrifyingly high rates of suicide and attempted suicide, but these rates include those who go through full transition.

Furthermore, the problem of false positives would remain even if transition were generally the best treatment for gender dysphoria in terms of patient happiness and mental stability. Misdiagnosis makes the right treatment wrong. A rational trans movement would want to avoid mistaken transitions, even while advocating for transition in general. Instead, those who raise the issue of false positives are bullied or ignored.

Rather than addressing this issue and working to improve pre-transition screening and therapy, trans advocates deny and minimize the problem. Perhaps they believe that admitting to any difficulties will harm the movement. Perhaps they are afraid of the doubts raised by the testimonies of those who resolve gender dysphoria without transition, or those who have de-transitioned.

Parents who champion transition may want to avoid the uncertainty raised by false positives: what if, instead of saving their child from suicide, they are complicit in harm? Transition is risky and much of it is irreversible. If begun early, it includes using off-label drugs on preteen children to retard puberty. Transition itself includes administering cross-sex hormones that carry significant health risks and begin to alter the body in permanent ways. Full surgical transition sterilizes the patient.

Thus, because those who mistakenly transition suffer significant harm, false positives also raise the question of medical malpractice. In many cases, gender dysphoria is essentially self-diagnosed by children or parents (perhaps with the help of internet strangers), and the medical profession rubber-stamps the requested transition. Is the pressure to approve and expedite transitions causing therapists and doctors to be negligent in diagnosing and treating gender dysphoric patients, especially minors? If so, the booming transition business would have legal incentives to marginalize those who have de-transitioned.

We’re Seeing a Strong Denial of Reality

The dismissal and denigration of false positives is motivated by fear: activists fear complicating the narrative; parents are afraid of doubts that suggest they are harming, rather than saving, their child; the medical industry that profits off transition is afraid of legal liability for its mistakes.

This denial of the reality of misdiagnosis has significant policy effects. Pretending that false positives do not exist with regard to transgender identities encourages trans advocates to propagandize young children—if it is impossible to be mistaken about gender identity, then teaching children about transgenderism cannot confuse them. Likewise, denying the existence of false positives is necessary to support taking children away from parents who oppose transition—the child’s desire to transition must always be acceded to if there are no false positives.

The same reasoning is behind bans on therapy (even if it is voluntary adult talk therapy) that might help someone resolve gender dysphoria without transition, or help a person de-transition. If there are no false positives, then gender dysphoria always requires transition, and trans identities are forever.

To borrow a phrase, the trans movement and its allies are denying the existences of those who de-transition and desist from gender dysphoria. This may serve short-term interests, and alleviate immediate fears. But everyone, including those who accept the broad transgender narrative, should be concerned about the risk of false positives.

False positives are not just statistics; each one is a person who should be respected and protected from harm.