Note: All screenshots in this post were taken from the publicly accessible WPATH Facebook page on 9/3/2016. Please visit the thread in question for full context and to see any edits and/or additions that have been made since this post was published.

UPDATE 9/4/16: Several allegations have been leveled at the writers of 4thWaveNow and Cari in the most recent comments on the WPATH Facebook page. We invite you to read our post, Cari’s survey results, and the WPATH thread, then decide for yourself whether there are any distortions of fact in our reporting.

4thWaveNow would like to address the fact that the parents who create and manage this blog use pseudonyms; we also protect the anonymity of our commenters. All of us are keenly aware that we have no right to expose our children–some of whom have a social media presence–to the harsh light of public scrutiny. Our primary concern is protecting their privacy. And in this age of the Internet, compromising our privacy will compromise theirs. One has only to look at the history of what trans activists have done in their attempts to silence critics in the past, which have included vicious attacks on not only the adults who have spoken out, but at times upon their minor children. We are simply not willing to expose our children to this risk.

If it were possible to have an “honest dialogue” with the activists and public figures who are having such a huge (and in many cases, deleterious) impact on the lives of our children, we would welcome that. If we saw, even once, professionals acknowledging that there is indeed a social contagion going on amongst teenagers; if we heard any of the points we make being honestly engaged, it would be different. Instead, what we get are unceasing ad hominem attacks, professionals and journalists who should know better yelling “TERF!”, and constant accusations that unless we get behind the medical transition of our own children, we are driving them to suicide. This is not an atmosphere for reasoned dialogue. And that is why this blog came to be in the first place.

We will continue to provide a platform for people like Cari and others who have been frozen out of the public discussion on the issue of pediatric transition. Until mainstream journalists are willing to present a more balanced picture of this very serious and increasing trend in Western society, that work will be left to bloggers like us.

Two weeks ago, Cari, a 22-year-old former teen client of TransActive Gender Center in Portland, OR, announced an online survey designed to better understand the experiences of detransitioned women. She has completed work on this phase of her project, and today posted the survey results, with a detailed interpretation, on her blog.

I won’t be going into exhaustive detail about everything the survey revealed; Cari’s blog post provides an excellent write-up and analysis. What I will be doing, instead, is reporting on the reaction (posted on the public WPATH page) of Dan Karasic, MD, top gender specialist and UCSF psychiatrist—which amounts mostly to minimizing the significance of Cari’s work and attempting to discredit several of her most important findings.

Cari’s survey ran for only two weeks, from August 16 – 31. Most surveys recruit participants for months or even years. That over 200 women responded in such a short timeframe should put to rest any notion that “desistance is a myth.” And the fact that the survey was shared on social media means that it likely reached a demographic that most trans activists deny exists: young women who became interested in medical transition due, in part, to social contagion (a phenomenon currently being studied by a researcher at Mt. Sinai). As Cari notes,

“Leaving aside all the other data this provides, the sheer number of responses is pretty amazing. Given that the survey was open for 2 weeks and was shared through a couple of Facebook groups, most of which were private, and Tumblr, I think we can safely say that detransitioners are not quite as rare as some would like to have us think.”

In his Facebook post, Karasic attempts to dismiss the 62% of respondents who said that “political/ideological concerns” were a factor in their decision to detransition– by implying that these concerns are on par with people who reject their own homosexuality due to religious beliefs!

To be fair, Karasic does say that “some exploration” of negative reactions to hormones is appropriate (albeit in the no-gatekeeping, informed consent model). But comparing these women’s thought processes to evangelical Christianity? This is an astounding leap. “Political/ideological” concerns could mean any number of things, including that these women began to think more critically; that they began to question some of the rhetoric of transgender ideology and came to realize that they were, in fact, women–no matter how fervently they once believed otherwise. In fact, this is rather the opposite of someone going back in the closet because their religion told them they were evil sinners.

But that’s not even the worst thing about Karasic’s opening volley: He fails to mention that respondents could choose more than one reason for deciding to detransition. It’s either a willful or clueless misinterpretation of the data to imply that the only–or even the main— reason these women detransitioned was because of ideological concerns.

Of at least equal significance is the fact that 59.4% of respondents found alternative ways to cope with their dysphoria. For any other situation involving drastic medical interventions, the possibility of an alternate solution or “cure” would be of great interest. But no one on that WPATH Facebook thread is celebrating; in fact, they don’t even mention this key finding.

Karasic also dismisses the survey as “skewed” because it was posted in forums where people critical of transition could easily find it. This is rich. The few studies we are beginning to see of trans children and teens are being conducted by researchers using their own patients—children who have been socially and medically transitioned by parents and clinicians heavily invested (ideologically and financially) in the business of pediatric transition. And Cari’s survey looked at detransitioned people who, by definition, are rather more likely to be critical of transition in general; such an obvious point seems to be lost on Karasic and the other commenters who pile on to say the sample is “unrepresentative.” Unrepresentative of what?

In a followup comment, Karasic plays the well-worn “they weren’t really trans” card with another misread of the survey’s data.

What? A whopping 48% of the women in Cari’s survey formerly identified as trans man/FTM—nearly half.

It’s odd to see how easily Karasic discounts this group of women, given that “informed consent” based on self-reported identity is the standard of care he and others at WPATH increasingly support.

But here’s where Karasic’s reaction gets really interesting. Cari’s survey found that 42% formerly identified as nonbinary or genderqueer. So that’s 90% who did not identify as female. Just from reading Karasic’s comment, we might think he would not support transition for those 42%. Yet only a few months ago, he argued that medical transition should be freely available, via informed consent, to people who identify outside the binary.

Which is it, then? These detransitioned women weren’t really trans, so they goofed—but how can they have goofed, when Karasic actively promotes medical transition for anyone who wants it? Because who could possibly be excluded from self-identifying as “nonbinary”?

One of the most important findings in Cari’s survey (utterly ignored by Karasic and the other commenters) is that the majority of respondents not only had very limited therapy (aka “gatekeeping” in current trans activist lingo), but also believed, after the fact, that the counseling they received prior to transition was inadequate—as Cari herself has said about her experiences at TransActive Gender Center. Cari writes:

“117 of the individuals surveyed had medically transitioned. Of these, only 41 received therapy beforehand. The average length of counseling for those who did attend was 9 months, with a median and mode of 3, minimum of 1, and a maximum of 60. I’d like to have something cool to say here, but I’m honestly just stunned at the fact that 65% of these women had no therapy at all before transition.”

Why is it that Karasic and the others on the thread have nothing to say about this key finding? Given that this is a survey of people who chose to detransition—many of whom were quite unhappy about their transitions and the services they received from gender specialists—wouldn’t it be worth exploring the idea that some were perhaps too easily granted the opportunity?

What’s more, these women have, by and large, a very negative view of their transitions.

But Dan Karasic, like most activist-clinicians, is not really a believer in gatekeeping. As he said in another post just a few days ago, easy access to medical transition and cross-sex hormones is something to be desired—hopefully at the first follow up visit.

Presumably, the young clients at Dimensions seek medical transition to relieve their dysphoria. Interestingly, Cari’s survey found that the majority of detransitioned women saw improvement in their dysphoric symptoms after beginning to detransition:



“…cumulatively, 88% of the individuals surveyed experienced physical sex dysphoria. Individuals who experienced only social dysphoria were more likely to report that their dysphoria was improved by detransition (91%, versus 73% for individuals with sex dysphoria), and none of these individuals indicated a worsening of dysphoria, however even among those with sex dysphoria, only 9% reported that their dysphoria had increased since detransitioning.”

The implications of this are profound. If 59% of the sample found “other ways to deal with their dysphoria” which led them to detransition—and then, having detransitioned, found their symptoms improving still more—one would think this data would keenly interest Dan Karasic and his followers. What if there are cheaper and less drastic ways to deal with gender dysphoria?

To Karasic’s credit, he does concede—while stopping short of admitting that “real” trans people might actually regret their transitions– that some formerly trans-identified women do end up feeling their medical transition “wasn’t right for them.” But he manages to minimize even that.

It’s apparent that that Dr. Karasic, along with other WPATH members (in the comment below, “liked” by Dr. Karasic), don’t really see what the big deal is if some women change their minds about the hormones and surgeries that have forever altered their bodies.

They can just change back or quit hormones—what’s the worry? It’s all just an experiment anyway, kind of like tattoos and piercings.

These people seem not to be familiar with the growing number of detransitioned women who have their own blogs and websites, wherein they speak of their sadness at the irreversible changes wrought upon their voices; the body hair; the loss of their breasts; some have gynecological difficulties.

Activist-clinicians are invested in the idea that regret rates are low—even though this generation of young people is the first to experience medical transition. There is no data on long-term regret rates for these young people, and Karasic knows it, as do most other gender doctors. They don’t know. No one does. Cari deserves enormous credit for sticking her neck out to do this survey, because the gender doctors sure as heck aren’t going to do it for her and the other women who are in the same boat.

One wonders: How many of these women will it take for doctors like Dan Karasic to take them seriously? 500? 1000? Will there need to be 5, 10, 20, replicated studies, conducted over decades, thousands of women, before these gender specialists take their needs seriously, once they have detransitioned? (I will note that most of the studies utilized by trans activists and gender specialists to support what they’re doing consist of very small cohorts, with “low quality evidence,” as recently pointed out by the Centers for Medicare and Medicaid Services, but it’s convenient to dismiss data that doesn’t fit one’s narrative.)

So, what would constitute regretters “per se”? How many? What percentage? What criterion will satisfy Karasic and the other activists and clinicians piling on the Facebook thread to essentially say that Cari’s data (and Cari’s own experiences, presumably) are bunk?

Update 9/5/16: One very telling answer to the “How many?” question comes from a WPATH commenter who pontificates:

Cari (who has joined the conversation on the Facebook page) replies,

And who is writing NIH grants to study thousands of detransitioned trans men? Who has in the past? It’s easy to sit on a high horse and shoot down the efforts of a 22-year-old who suffered medical harms and is interested in delving more deeply into the experiences of women like her. Easier still to tell her those harms won’t be worth taking seriously for 20 years, until there are thousands of regretters “per se.” In the meantime? Business as usual.

It’s predictable that trans activists are loathe to admit that detransitioners may be more common than they they think. But medical doctors? Wouldn’t one think that MDs, psychiatrists, and other gender specialists would demonstrate appropriate concern about people who went through medical transition but expressed profound regrets later on? Even more importantly: Why don’t people like Dan Karasic see it as a good thing that the women in Cari’s survey found other ways to deal with their dysphoria besides drastically altering themselves with hormones and surgeries?

How about showing some respect for this one detransitioner, Cari, who cares so much about this issue that she has created and written a fine analysis of a survey about detransitioned women? Rather than glibly dismissing her work as just another worthless TERF thing that can be safely ignored, wouldn’t it behoove Karasic and his followers to take her seriously? Why would a 22-year-old woman who had undergone years of testosterone injections, a double mastectomy, and who is now speaking out publicly via YouTube go to this much trouble if there weren’t a real issue here?

Why doesn’t WPATH as a whole start earnestly figuring out how to provide services for people who regret their transitions, or who need help and support for re-identifying with their natal sex? After all, the gender specialists got these people into it; do they feel no responsibility whatsoever to help them get out of it? Is the “care” provided by gender doctors a one-way-street? Apparently, if you ever decide to get off the trans bus, you’ll have to find your own way home.

The activists and clinicians piling on the Discredit the Detransitioner Survey thread seem a lot more interested in denigrating and dismissing the reality of detransition than attending to the medical and psychiatric needs of people harmed by medical transition. Activists pushing an agenda? Yeah—don’t want to talk about this. But doctors? Where is their commitment to learning the truth, however inconvenient that truth might be?

But then, the line between activists and clinicians seems to be rather blurred. I’m not sure there is much of a difference anymore.

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