159. Irreversible Damage? | Abigail Shrier

[0] Welcome to the Jordan B. Peterson podcast.

[1] I'm Michaela Peterson.

[2] This is episode 11, season four, with Abigail Schreier.

[3] Abigail and Dad discuss identity, gender dysphoria, the increased rate of gender transitioning procedures among young female adolescents, details of these procedures, de -transitioning, her personal experiences while writing her book, Irreversible Damage, and more.

[4] Abigail Schreier is a frequent contributor to the Wall Street Journal and author of Irreversible Damage, The Transgender Crays Seducing Our Daughters.

[5] This episode is brought you by NordVPN.

[6] I don't know how this is allowed, but with NordVPN, you can unlock Netflix and your favorite entertainment websites.

[7] They have a 30 -day money -back guarantee and unlimited bandwidth.

[8] If you ever start traveling again, a VPN like NordVPN is highly recommended.

[9] A VPN connection establishes a secure connection.

[10] between you and the internet.

[11] Via the VPN, all your data traffic is routed through an encrypted virtual tunnel.

[12] NordVPN has an extension for Chrome browser, and if you're not using Chrome, what are you doing?

[13] Which is lightweight and user -friendly with the first click.

[14] It secures your browsing in seconds.

[15] For NordVPN's birthday, every purchase of a two -year plan will get you one additional month free and a surprise gift.

[16] go to www.

[17] norgVPN .com slash Peterson and use code Peterson.

[18] Enjoy this episode.

[19] Today I'm speaking with Ms. Abigail Schreier, who is a writer for the Wall Street Journal, and the author of a recent book, which was named by The Economist as one of the notable books of 2020, Irreversible Damage.

[20] The Transgender Cray's seducing our daughters.

[21] Thanks for agreeing to talk to me today.

[22] Thank you so much for having me on.

[23] So why did you write the book?

[24] I wrote the book because a woman wrote to me. And I had written a piece for the Wall Street Journal on transgender pronoun laws that we have in New York and California now that assign criminal and civil penalties for failing to use someone's preferred pronoun and I pointed out that these laws are straightforwardly unconstitutional in the United States and a reader wrote to me she read this and she said maybe you'll take up my issue but I'm a mom my daughter had no symptoms of gender dysphoria throughout you know her growing up but gender dysphoria being the severe discomfort and one's biological sex but she went off to college he had a lot of mental health problems and she went off to college and with a group of they all decided they were transgender and she started a course of testosterone and I'm you know I've had this problem with they're now an epidemic of these young girls who are in a lot of very real pain deciding that gender must be their problem and very quickly obtaining hormones and surgeries and she told me that no journalists would take it up she had she had written to many journalists and I tried to find her an investigative journalist who would write about this or at least investigate it and when I was unable to find one.

[25] Finally, three months later, I got back in touch with her.

[26] I said, all right, I'll look into it.

[27] Okay.

[28] So, well, I can tell you that I have had some trepidation about even conducting this interview.

[29] Yeah, well, it's because this is such a, it's exactly the sort of issue that you can get pilloried for.

[30] And I've had a fair bit of that over the last number of years.

[31] I mean, I was very unhappy with the Canadian government's language, provision Bill C -16 and my comments about that caused a whole sequence of chain reactions I suppose that changed my life completely I was concerned at that time that the movement let's say the political movement of the political ideology that I saw as driving the language legislation Bill C -16 would manifest itself in psychological trouble for people.

[32] And so I'd read this book called The Discovery of the Unconscious by Henri Elmberghé and he talked about psychological contagions and documented them going back hundreds of years as a matter of fact and I was aware that such things occurred and it struck me as highly likely that confusion about gender identity on the ideological and categorical front would translate itself into confusion about gender among adolescents in particular, who were just starting to catalyze their gender identity.

[33] And so you claim in the book that this is a epidemic.

[34] And one of the things I'm wondering about is, what relevant stats do you have at your disposal?

[35] And why language like that?

[36] Well, I actually asked a bunch of, you know, I interviewed, I conducted nearly 200 interviews, for the book.

[37] And I actually asked a lot of scientists once I had some numbers, what do you call this?

[38] What is it when you have, we have a hundred year diagnostic history of gender dysphoria and it always afflicted boys and men.

[39] Okay.

[40] And now for the very first time in the last decade, there has been a giant surge in a different population claiming to be gender dysphoric.

[41] It is shifted from from onset in young boys and to teenage girls with no childhood history.

[42] and it's shifted from men to women.

[43] So I asked them, when you have a demographic jump, and all of a sudden they are, as these teenage girls now, the leading demographic.

[44] So these are girls who, as a population, experienced virtually no gender dysphoria throughout history, suddenly being the leading demographic.

[45] I would ask them, what do you call that?

[46] Is there a scientific term for this?

[47] And they would always say, yes, epidemic.

[48] I see, I see.

[49] Okay.

[50] So in your Wikipedia, page, which, well, I read it this morning, and it struck me as a place where a battleground was likely taking place, occurring.

[51] In the book, it says, in the book, Schreier accuses social media of playing a driving role in girls' decisions to identify as transgender, excuse me, based on the unproven and contentious hypothesis of rapid onset gender dysphoria.

[52] She advocates for withholding gender -affirming medical care for transgender youth, a fringe position not currently supported by most reputable medical organizations.

[53] And one of the things you do document in the book is the rapid move by organizations like the American Psychological Association and the American Psychiatric Association to change the wording that they've used surrounding the discussion on gender identity.

[54] Correct?

[55] Yes, that's right.

[56] I mean, they have changed the wording, but the bigger change, of course, is that they've gone to an affirmative care standard, which means that they no longer apply any medical judgment.

[57] They simply surrender all judgment and agree with or affirm the patient's self -diagnosis.

[58] Right.

[59] And along with that goes the, and this is part of what made me nervous about talking to you, and I still probably am, is that as a medical practitioner, as a psychotherapist, psychotherapists are now bound as far as I've been able to determine by examining the law to adopt precisely this gender -affirming position and I believe that that's the case in Ontario so I don't do adolescent therapy but if I had a young adult say 18 or older come to me who was expressing confusion about their gender identity let's say or was gingerly testing the waters to determine if perhaps they were transgender I believe that I'm required by law to to adopt a position that would affirm that fundamentally.

[60] That's right.

[61] Yes, sort of Damocles hangs over professionals' heads now.

[62] And what it says is, you must agree with the patient's self -diagnosis.

[63] Put another way, it suggests that you should begin with the conclusion.

[64] Your conclusion must be that this person has gender dysphoria.

[65] And then you can, you know, go along from there and start prescribing treatments.

[66] That's not how medicine or any other area of therapy is practiced.

[67] You don't begin with the conclusion.

[68] You investigate it.

[69] Now, you brought up my Wikipedia entry.

[70] I'm sorry.

[71] No, go ahead.

[72] I mean, obviously, the number of lies that have been put into that, I didn't start the Wikipedia entry.

[73] Others did, and there's been back and forth fights with activists and so forth to rewrite it.

[74] But, of course, I don't, you know, advocate any.

[75] I mean, it's not true.

[76] I mean, so much of what has been said is not true.

[77] First of all, the affirmative care standard, That's the problem.

[78] And I don't advocate a particular method of treating transgender people.

[79] I don't even advocate a method of treating transgender teenagers.

[80] All I'm pointing out in the book is that there seems to be a sudden rise in these teenage girls who are subject to peer influence and social media influence deciding their transgender.

[81] And there are no medical safeguards for these girls.

[82] There's no means right now and no one determining whether they actually have the correct diagnosis before proceeding to treatment.

[83] That's it.

[84] Right.

[85] So I guess the catch -22 here is that if the statement, most reputable medical organizations affirm or put forward an affirmative care requirement, then any position that questions that or objects to it is, in some sense, by definition, fringe.

[86] Well, it's a good question.

[87] I'm not saving at all that you're.

[88] position is a fringe position.

[89] It's a matter.

[90] I don't see how that can be avoided under the current circumstances because the laws and guidelines are written as if this is a fait accompli, right?

[91] That we understand transgenderism completely and gender dysphoria and that, you know, all the answers are already in.

[92] And I don't think that's true for any psychiatric diagnosis.

[93] Yes, I would just say that it is friends in so far or it appears fringe because all the doctors who disagree and there many and they're speaking up all the time are silenced.

[94] They are told that they could lose their license if they don't immediately affirm the adolescent, no matter what her other mental health problems are, and immediately go along with facilitating her transition.

[95] Right.

[96] You talk about the former, about the occurrences at the Mental Health Institute at CAMH in Toronto.

[97] Yes, that's right.

[98] I mean, you had, you know, Ken Zucker, you know, the, truly a giant and, and the, in the field of gender dysphoria who actually oversaw the authoring of the definition of gender dysphoria.

[99] He was fired.

[100] Right.

[101] So let's talk about Ken Zucker for a moment or two.

[102] So as you said, he occupied a very prestigious position in the world of transgender treatment and I think was universally regarded as the most outstanding and most objective scientists working in this.

[103] this field.

[104] I've spoken to him about it on some occasions, not publicly ever.

[105] And he struck me as a dedicated clinician and researcher.

[106] And he advocates, advocated for, and still advocates for as far as I know, wait and see treatment method based on the presupposition that most children with gender dysphoria who are, who events and interest in transforming their body to that of the other sex, should be encouraged to wait because if a waiting technique, it's not a technique even, I suppose, if waiting is, with sufficient patience, most of the children who manifest these concerns desist.

[107] I think it's 70 to 80 percent of them.

[108] A certain percentage, fairly high, come to the conclusion that they're gay.

[109] And it's perhaps the case that that's driving some of their early gender disforated.

[110] a confusion about their identity.

[111] And Zucker was fired from CAMH and also pilloried in a variety of newspapers and other publications as a consequence of what was essentially his mainstream stance.

[112] Now, I believe, and I haven't followed this up recently, but I believe that he was engaged in the number of court battles with the publications that had gone after him, and I believe that he won his legal cases.

[113] He did.

[114] They had to apologize.

[115] And they settled with him.

[116] I mean, they really wronged him.

[117] Yes, definitely.

[118] I mean, that's what happens when professionals speak out on this issue.

[119] And, of course, when I say speak out, all they're expressing is concern that there is an over -diagnosis here.

[120] You're seeing young teenage girls who do not seem to have typical gender dysphoria, nonetheless be immediately fast -track towards transition.

[121] So I'd asked you a little bit earlier about numbers.

[122] Do you have any sense of how prevalent this is?

[123] And also, I'm interested in, and I'm sure the listeners, watchers would be as well, rate of increase.

[124] Sure.

[125] So in America, it's a little harder to come up with these numbers, although I'll tell you the numbers that I do know, okay?

[126] It's harder because we don't have centralized medical care like they do in Britain.

[127] In Britain, where they have centralized medical care, they can tell you that the number of young women being referred for gender treatment has exploded over 4 ,000 percent in the last decade.

[128] In America, we don't have centralized medical care and you don't even need a diagnosis of gender dysphoria to start treatment.

[129] You can start a course of testosterone without ever having received a diagnosis of gender dysphoria.

[130] So they're a little harder to come by, but here's what I can tell you.

[131] In 2018, 2 % of high school students said they were transgender.

[132] So that's 2 and 100 kids.

[133] That's an enormous increase over the what was historically the rate of gender dysphoria in the population, which was 0 .01%.

[134] So 1 in 10 ,000 people went from Woffley 1 in 10 ,000 people to 2 and 100 high school students.

[135] We also know that between 2016 and 2017, the number of females requesting gendered surgery in the United States quadrupled.

[136] So we know these are the exploding race.

[137] And then of course, I've interviewed.

[138] many therapists and Lisa Littman at Brown University did her survey and when you talk to therapists when you talk to parents you get the same thing over and over and that is that the leading demographic asking for gender transition is teenage girls teenage girls with no childhood history of gender dysphoria now here's here's a contentious issue so generally speaking for the the story of long -term gender dysphoria to be coherent a girl would have to claim that she'd always known that she was in the wrong body, that she was a boy and that that had been the case ever since early childhood.

[139] So maybe she'd be speaking as a teenager.

[140] Now, you make the claim in your book that girls who go online who are searching for information about transgender identity often encounter coaches who tell them to falsify their personal narrative and to claim that they've always been gender dysphoric.

[141] despite the fact that that's not the case.

[142] Is that a reasonable summary of what you found?

[143] Yes.

[144] Yes.

[145] So you can see that it's a complete diagnostic mess from a therapist's perspective, and even from a conceptual perspective, because the people who are on the other side of the argument than you, let's say, are going to claim that the reason that these rates have skyrocketed to the point where they're at now, is because there were always that many people who had gender dysphoria or who were transgender, but the weight of public opinion was held so strongly against them that they had to stay in the closet, essentially, and were unable to adopt their true identity.

[146] And the claim is going to be made as well that you're radically exaggerating the proportion of people who are putting themselves forward for transgender transition procedures, let's say, who have been coached.

[147] Right.

[148] Okay, so let me respond to a few of those things.

[149] First of all, I don't think that's right.

[150] I mean, I agree with you that that's what they would say, but here's, I've thought about that claim, because, and here's what I would say in response.

[151] If this were just, as they say, a natural reversion, now that there's greater societal acceptance of transgender people, that they would say, oh, you would expect to see a natural reversion to what we're seeing now, which they might claim is a normal base rate of transgender identification in the population.

[152] The problem with that is, number one, we're only seeing this sudden spike among teenage girls.

[153] Where are the women in their 30s, 40s, 50s, and 60s who were denied the opportunity to come out as transgender?

[154] They should be coming out, too, but they're not.

[155] Can you also point out, I guess the other thing that you might conclude is that if the people, if the bulk of the proportion of people who were claiming a transgender identity in the past were male, then release of the social strictures on identification should have produced an explosion in males.

[156] It's not easy to figure out why there is an explosion in females.

[157] Okay, so that leads us to another extremely troublesome topic, which is.

[158] why the explosion in teenage females.

[159] Now, you do attempt to explain that in your book.

[160] And so maybe you could outline for the listeners exactly what your conclusions were.

[161] Sure.

[162] Teenage girls are famous for this, for falling for every hysteria, right?

[163] We know that the way young women and they're psychologists who've done wonderful work in this area, Amanda Rose is one of the University of Missouri, who I interviewed, teenage girls tend to spread these psychic epidemics because they are very their modes of friendship involve co -rumination taking on their friend's pain they like to rehash their own pain and they like to take on their friend's pain and they are even willing to suspend reality in order to sort of get on the team of their friend okay so would it be i'm being a real son of a bitch in this interview to some degree because I've been trying to think up all the objections I possibly could to your perspective because it's so contentious.

[164] And so I'm going to put forward things that I'm thinking about that are critiques.

[165] And it's not that I'm believing them, but they need to be brought forward.

[166] So a skeptic might say that you are relying on stereotypes of feminine behavior in adolescence to justify your claim that it's girls that are susceptible to a kind of hysteria and that that's an outdated that's an outdated and sexist i suppose hypothesis no i'm not relying on stereotypes at all i'm relying on evidence if you look at the anorexia it afflicts one population if you look at bulimia it afflicts one population and it grows and it spreads among friend groups just as this does.

[167] It's young women encouraging them each other in self -harm.

[168] And if you look at cutting, same thing.

[169] And we know, we clinicians have known for years that you cannot house anorexics together in a hospital ward without being very careful because they will encourage each other to lose more and more weight.

[170] We know that women do that.

[171] Right.

[172] And you see that online with regards to anorexia, right, with the pro -anocytes and the pro -bolemia sites.

[173] Right.

[174] It wasn't men who came up with thinspiration.

[175] Now, I, I, inspiration, right, inspiration to lose more and more weight.

[176] It was young women.

[177] Now, of course, men get involved in all kinds of, you know, bad behavior and encourage each other in all kinds of bad behavior.

[178] But this kind of, you know, socially spread self -harm has proven over and over to be endemic to young women.

[179] Well, you can't group antisocial males together when they're teenagers because they get worse.

[180] So that's well known.

[181] And in fact, if you take antisocial boys and you put them with pro -social boys, the pro -social boys become more antisocial.

[182] The antisocial boys don't get better.

[183] And that was discovered back in the 1930s.

[184] In the Somerville study, the detrimental consequences of grouping antisocial boys together, it was the very large -scale study that was designed to, in principle, to reduce the risk of children, boys at risk for developing criminal behavior and alcoholism and so forth, was one of the first longitudinal studies.

[185] It was a complete failure in that the treatment group, who were subject to all sorts of benevolent, at least in principle, benevolent interventions, did much worse than the control group.

[186] And after much painstaking analysis and heart -rending doubt, the studies' authors concluded that housing the children together in the summer camps they had put out for them to get them out of the inner city was actually the cause of their increased pathology in adulthood.

[187] So it does happen among males.

[188] Now, Tumblr is also something that you discuss as a new mode of, perhaps a new medium of social contagion.

[189] And as far as I know, that's also a social media forum that's essentially female dominated.

[190] Is that correct?

[191] I believe it is still, but though I have not up to date on the latest, you know, of who looks at Tumblr.

[192] But it always has been, yes, predominantly female.

[193] Right.

[194] So, all right.

[195] Here's another question.

[196] What made you convinced that you were qualified to do this?

[197] Because if I was a critic, again, I guess that's the next place that I would attack, right?

[198] Because you're not a mental health professional.

[199] And so it might be asked, well, what right do you have to investigate this even?

[200] That might be one question, but then also to draw conclusions.

[201] Well, as I'm sure you saw, when you read my book, I didn't draw any medical conclusions.

[202] That is, I relied entirely on experts, and I do believe it is a journalist's job to look into medical phenomena, including epidemics and so forth, and investigate them and rely on the medical judgment of experts, and that is precisely what I have done.

[203] This isn't my, you know, all I did was investigate a phenomenon with neither a particular hypothesis in mind, but just being willing to listen to a lot of experts.

[204] And it was their testimony and their explanation that I put into the book.

[205] Do you think that it's, do you think that you were even handed in your selection of experts?

[206] I mean, because one of the ways that you can bias an outcome, obviously, if you have a political agenda you can bias an outcome by selecting experts that testify in one direction and of course that the transgender activists and and perhaps the medical and psychological and medical and psychological associations themselves might regard people like ken zucker as experts who you know would appeal to someone of more conservative sensibilities perhaps well sorry i'm not i think what you're saying is did i I bias it by only looking at certain kind of experts.

[207] And in case will I say, no, I didn't.

[208] If you read the book, I interviewed experts of all persuasions.

[209] But more importantly, there are literally thousands, I believe, certainly hundreds of books celebrating immediate medical transition for teenagers.

[210] There is precisely one book that did an investigation of the risks and benefits and concerns that might be had around the medicalization of teenage girls.

[211] That's it.

[212] One one book.

[213] And the question is, so do all these experts have a voice?

[214] Of course.

[215] I don't claim to have done and conducted my own scientific study.

[216] All I did was show a willingness to speak to the experts who are very, very concerned about what's going on here.

[217] Okay.

[218] So let's dig even the layer deeper, I suppose, is why the claim that you just made for example that there is a very large literature supporting the idea of medical transition and a very small literature criticizing it is striking i don't understand it what's going on like what's driving this why is it that the medical associations and the psychological associations have rushed so precipitously into gender identity affirmation when the cost of it, when it's taken to its logical conclusion, is extraordinarily invasive surgical modification, which carries substantive risk, and which I think it's, of which I think it's fair to say, has disputable benefits.

[219] Why is this happening?

[220] Well, there are a number of reasons it's happening, but if you're asking why more medical, you know, more doctors and therapists aren't speaking out, I think the answer is because if even Jordan Peterson is concerned about having this interview with me and with all of your courage and all the stances you've taken, imagine what far less courageous doctors are willing to say.

[221] It still strikes me, it still strikes me as, as.

[222] remarkable that this change has occurred over such a short period of time.

[223] I mean, one of the things you do in the book, and maybe you can talk about this, is document the nature of the treatment, the medical treatment for gender dysphoria, when the treatment is gender transition.

[224] So you talk about the use of testosterone and its subsidy on university campuses, and then you talk about.

[225] about the more invasive surgical transformations double mastectomies phalloplasty and and which is the creation of a new penis if you use that word loosely um these are very these are not minor procedures including the use of testosterone and it's remarkable to me given that how fast these guidelines for treatment have changed.

[226] Well, I think you're right.

[227] The medical, the activists have been very aggressive and very effective here in the medical accrediting institutions.

[228] But I think that all of, at root of all of these changes is a series of polite lies that we were, that we swallowed, unfortunately, in the public sphere.

[229] So in the last week, for instance, the California Insurance Commissioner has said that for the purposes of insurance in California, that breast surgery, top surgery, double mastectomy on healthy breasts for even teenage girls needs to be regarded no longer as cosmetic, but something that corrects abnormal structures.

[230] Because if you've accepted the lie that a young woman who says she's a boy truly is a boy, then healthy breasts become abnormal structures.

[231] This is the corruption of language.

[232] So you must remove them regardless of her age.

[233] yeah well language tends to be associated with action and it was the corruption of language that i objected to you know four years ago because it has consequences now you know you made the strongest statement so far i would say that you made in our interview which is the lie that an adolescent girl who thinks she is a boy truly is a boy and i suppose it's language like that that gets you in trouble to the degree that you get into trouble because that's a pretty strong statement um the gender theorists who are driving this movement, I would say, put forth the proposition that, first of all, that an individual always knows what gender they are, even if that that changes from day to day.

[234] There isn't an authority outside the individual themselves that can opine on gender identity.

[235] That's part of the philosophy that drives the gender affirmation movement, I would say.

[236] Correct?

[237] Right.

[238] That's part of the philosophy, but unfortunately there's no biological or empirical or means of verifying that.

[239] We have no means of establishing that a girl who believes she is a boy is truly a boy.

[240] Well, it's more of a definition than anything else, right?

[241] It's a place to start.

[242] It's an axiom.

[243] The axiom is that the only person who can offer an informed opinion about their gender is the person themselves, no medical professionals, no parents, no loved ones, no one else, only the individual.

[244] And that's even the case if it changes from day to day or hour to hour.

[245] Right, exactly.

[246] They begin with a conclusion.

[247] Okay, and then the other claim, and this is the one that I have difficulty with logically, is that a girl who thinks she is a boy is in fact a boy trapped in a girl's body which seems to me and that that's been the case ever since birth and it seems to me that this is a form of the biological essentialism that the gender theorists typically decry proposing as they typically do that gender is a social construct now it isn't obvious to me how gender can be a social construct and be something immutable from birth that's only known to an individual themselves, which sounds a lot more like a biological explanation to me. So...

[248] Right.

[249] Right.

[250] I mean, I interviewed affirmative therapists, and I would say to them, and they would say, well, some kids are gender fluid.

[251] And I would say to them, well, then how can you recommend, you know, top surgery on a young woman who's who may be turn out to be gender fluid meaning she decides at some point she isn't she was wrong she isn't a boy she's a girl and and um you know this response was essentially well only she can know her truth i mean we are we are we're this is not medicine any longer it's closer to witchcraft so let me let me let me let me let me start at the beginning um and outline the hypotheses of the book So over the last five years, there's been a tremendous transformation in the language and the conceptualization that's been applied by medical associations in relationship to gender.

[252] And gender has been defined as something that's a personal choice, essentially, and that personal choice has been extended to the domain of physiological transformation.

[253] and medical professionals have been required, are now required, to exceed to any requests for physiological transformation on the part of their clients or patients as a consequence of the mandates of their professional organizations.

[254] And the consequence of that has been a shift in the transgender phenomenon from a tiny percentage of primarily males to a one in 50 percentage of primarily adolescent females, many of whom are undergoing the full physiological or many of whom are undergoing at least part of the physiological transformation process.

[255] That sums it up, essentially, I believe.

[256] I'm not sure I totally followed that, but I think so.

[257] Okay.

[258] Well, I probably should have asked you this at the beginning of the interview, but the basic, I was trying to outline the basic argument that you were making.

[259] Right.

[260] The basic argument that I'm making is that girls are, is that a large population of teenage girls who probably do not have gender dysphoria, they certainly have an atypical form of gender dysphoria, are able to quickly obtain hormones and surgeries.

[261] They are very much, you know, they're acting under, you know, social media influence and peer influence.

[262] We have numbers on that.

[263] certainly not my studies, but others have done studies on this.

[264] And they're acting under the influence of peer influence and social media influence.

[265] They are quickly obtaining hormones and surgeries, and there is virtually no medical oversight of this process.

[266] That's the thesis of the book.

[267] Right.

[268] And so the alternating hypotheses are either that there's been an explosion in transgender identifying individuals because the social structures have been taken off the diagnosis.

[269] or that this is a form of psychological contagion.

[270] Right, I don't think it's the former.

[271] I started to explain why.

[272] One of the reasons I said is you would expect, you know, a large, you know, rise in transgender identification across populations.

[273] It wouldn't just be teenage girls.

[274] You would see women in their 40s, 50s, and 60s.

[275] You would see more men, you know, coming out as transgender in comparable rates.

[276] But not only that, you're seeing among this population, we know that rates of states.

[277] suicide and depression are rising as social acceptance of gender dysphoria is going or transgender identification is going up.

[278] But we would have predicted that those things going down with social acceptance.

[279] Instead, it seems to be, you know, coincident and comorbid with teenage girls' mental health crisis in which we're seeing very, very high rates of anxiety and depression.

[280] I have to think about, I have to think for a minute here.

[281] And I want to go back to why this is happening.

[282] So there's been a political, arguably, no, I won't, I won't state that.

[283] There's been a transformation in the way that transgender identity is conceptualized and treated in the last five years.

[284] What's motivating the people who are, who have been behind this transformation?

[285] what's in it for them well i think that there are you know people who are there are a number of things there is a strong ideological and and um financial commitments and incentives for certain people to insist that that that transition on demand regardless of age context or other mental health problems be always immediately facilitated right well it seems like that's that becomes necessary to prove something, it seems to me. And that's what I'm trying to get at, is that it's necessary to set up the medical systems so that gender dysphoric, transgender identifying teenagers have access to the full arsenal of medical transformation.

[286] And that helps demonstrate that some other axiom is true.

[287] What is that?

[288] Is that is the axiom that gender is in fact socially constructed?

[289] Do you see what I mean?

[290] You said there's an ideological reason.

[291] What I'm trying to do is to specify that reason.

[292] I'd like to understand that reason.

[293] I don't know that there is a larger sociological or ideological goal.

[294] I think they are ideologically motivated.

[295] So, in other words, they have these commitments, but I don't think that they're trying to prove something, you know, except in the way that I suppose that they are saviors of some kind.

[296] You know, look.

[297] Well, that would be, that would certainly be something to, that would be motivating to prove.

[298] I mean, if you notice the doctors who are pushing this very often, what we're certainly seeing in the United States is a young generation of doctors and therapists who are activists first, and doctors or therapists second.

[299] We're seeing this across society in all kinds of professions.

[300] Their ideological commitments precede their professional investigation.

[301] They begin with their conclusions.

[302] Yeah, well, the ideological commitment is that this is what I can't wrap my head around it because the ideological commitment, if it's that gender is socially malleable or a social construct, which seems to be, that seems to be a fundamental axiom that drives this kind of ideology.

[303] I can't see how that can live side by side the proposition that the girl who's trapped in a boy's body has an immutably male identity.

[304] Well, I think a lot of them, yeah, a lot of them just insist on the immutability.

[305] The problem is we know that's not true.

[306] Well, except that they also insist on gender fluidity.

[307] Right.

[308] But they also insist on gender to fluidity.

[309] I mean, I could answer your question this way.

[310] What is non -binary?

[311] Because right now in the United States and throughout the West, certainly true in Canada, you can get your breasts removed, not if you say you're transgender.

[312] You don't even have to say you're transgender.

[313] But if a young woman, 16 or up, says she is non -binary, that's enough to allow her without a therapist's note to get her breasts removed.

[314] Now, how do we know that a non -binary person has no breasts?

[315] I know that a man has no woman's breasts.

[316] How do we know that a non -binary person has no breasts?

[317] Well, that's, see, that's a, that's a very good illustration, I would say, of the mystery that I'm trying to nail down, is that your claim is that breasts or no breasts, it's all the same to the non -binary identity.

[318] But that isn't the way it plays out.

[319] The way it plays out is that there's, the breast removal proceeds forthwith.

[320] and so that's not i don't i don't understand that um well there are no diagnostic markers at all or evidence of a non -binary identity except to say so of the patient part of part of it's a matter of definition now one of the things that you do in your book i thought this was quite interesting is make the claim that when gender theory is taught in schools the classic binary genders are presented in a very stereotyped manner, very stereotyped, very unidimensional stereotyped manner.

[321] And then any personal deviation from that stereotype is regarded as evidence for a non -binary identity.

[322] And so that's a matter of definition in some sense, right?

[323] Because you could say that the only genuine genders, and this would be the redefinition of the word gender in some sense.

[324] The only binary genders are the stereotypes, and if you are deviant from those stereotypes on any of the multiple dimensions along which they're defined, then you are, in fact, another gender.

[325] You can, you can, you can, you can, you can, you can, you can set up a definitional structure in that way and have it be coherent.

[326] The question is, what are the consequences of that?

[327] So the consequences is a lot of confusion for young people trying to sort these things at who they are out at a time when that's typically done in adolescence.

[328] I mean, the problem with saying these, yeah.

[329] Can you distinguish that from freedom?

[330] You know, because if I was going to take the perspective that was opposite to that, I would say, no, no, what you're doing by deconstructing the concept of gender itself is allowing adolescents much more freedom and exploration of their identities during a critical period than would otherwise be the case.

[331] Now, I would temperamentally tend to side with the confusion hypothesis.

[332] I think it's a catastrophe to confuse adolescents with regards to their gender identity just when they're attempting to catalyze that identity, right?

[333] At the same time that hormonal transformations are at their peak and they're undergoing a profound transformation in self to offer them a plethora, an infinite plethora of ways to.

[334] be, none of which have been tested in some sense in the world seems to me a recipe for disaster.

[335] But does it look like freedom?

[336] No, it doesn't look like freedom.

[337] And I'll tell you why, because these girls are miserable.

[338] Just look at the number of young women on YouTube who regret their transitions already.

[339] They adopt behaviors after deciding online on some social media site that their true identity is is is is non -binary oh no wait it's two spirit now i'm a two spirit oh no wait i'm a gender once they go through these they they lead lives i mean if you you know if you talk to them talk to their parents they are when i i wouldn't if these young women were flourishing i wouldn't have written the book that's that's not a sad story they're flourishing but instead they're cutting off their parents they're dropping out of school they have no meaningful employment they all their friends are only transgender they hate all all cis people.

[340] You see patterns that are desperately unhealthy.

[341] Well, it seems to me, you know, and maybe this is a consequence of not taking the idea of a social role with sufficient seriousness, is that there's a lot more to identity than your personal feeling.

[342] Identity is something that's negotiated in the social community.

[343] And an identity is actually a tool that you use to adapt so that if you have an identity that functions, we could say, you manage to find a long -term stable mate.

[344] You manage to have children at some point in your life.

[345] You manage to have gainful employment so that you can support yourself and maybe in a meaningful and productive manner.

[346] You are able to use your own time outside of work and social obligations in a manner that's meaningful to you.

[347] You regulate your use of drugs and alcohol so that you don't fall by the wayside in that manner.

[348] So what it means is that an identity is partly who you think you are, but it's also partly the manner in which you interact with other people.

[349] And if that identity is going to be useful, let's say, if that identity is going to be valid, it has to provide you with a mode of being in the world.

[350] And part of the problem with this multiplication of gender identities is that it's not obvious how you can manifest them in the world without transforming the entire world, which isn't going to happen in your lifetime.

[351] And so that's, see, and maybe that touches on, to some degree, touches on what it is that's driving this, is that it's some deep desire for a radical social transformation so that anything goes and some what would you call it's it's pushing look everybody feels to some degree the restrictive nature of social roles you know i just said that you have to adopt an identity so that you can get by in the world but that doesn't mean that there isn't a fair bit of your individuality that's squashed and crushed as you adopt that identity and and become in some way like everybody else and maybe this is a rebellion at least in part against that notion of having to become like everyone else the unfortunate reality is though that if you don't there's no place for you i think that's right i mean the young women who do you know these are overwhelmingly and you look at Lisa litman's study and uh you know the the number of women were and i've seen you know my own interviews the these women are overwhelmingly white middle and upper middle upper middle class and they they have no um victim status they have no easy victim status and they need one.

[352] They need one to get by socially.

[353] They aren't a minority in any sense.

[354] But this is the one status they can choose.

[355] See, they can't always choose to be gay, you know, but they can choose to be trans.

[356] No one knows better than they do who their gender is, is the saying goes.

[357] So no one can question them the moment they say they're too spirit or trans.

[358] Well, then another theme, I would say, that emerges from your book is the increasing social inacceptability among adolescents of what would have been more normative gender identities like these these girls that the generation that you're describing it was also is also characterized according to the research that you did in your book and research that's been put forward elsewhere by a dearth of intimate relationships.

[359] And so it also seems to be, right?

[360] One of the things you pointed out was I think it was, I don't remember if you talked about 16 -year -old girls or 18 -year -old girls, but in the year and a half preceding being asked the question, half of them hadn't had anything that resembled any aspect of an intimate couple's relationship.

[361] That seems to be a radical transformation.

[362] So is it also partly that the more, traditional gender roles aren't working?

[363] No, I don't know that they aren't working.

[364] I don't know that they've ever explored them.

[365] Look, these are young, very sheltered young girls.

[366] These are the generation that grew up with helicopter parents.

[367] And they have barely ever had a kiss.

[368] They've never held hands.

[369] They spend all their time on their phone.

[370] They don't know their own bodies and their own desires.

[371] And they don't know, and they haven't experienced romantic relationships with each other.

[372] So they don't know who they are and they don't know what they want.

[373] And instead they turn to the internet to answer all their questions.

[374] What do you suppose this happened?

[375] I mean, I thought that the statistic that you put forward about the lack of intimate relationship, because those were population -based statistics, if I remember correctly, right?

[376] You weren't looking at a small minority of teenage girls who were on the road to transition.

[377] This was that generation.

[378] Right.

[379] Why aren't these teenagers dating and and interacting with members of the opposite sex like they were only 15 years ago or 20 years ago?

[380] What's failed?

[381] Do you see this as a consequence of technological transformation?

[382] There are many, many, many things at play.

[383] One, they're with mom all the time.

[384] These kids report being with mom, they don't get a driver's license until much later.

[385] They don't spend time with each other.

[386] They're with mom all the time.

[387] Even they talk to her all day.

[388] They text her all, you know, in a constant basis.

[389] So they don't have freedom to be alone with each other.

[390] And then when they are alone with each other, rather than being intimate and sharing things and exploring each other and, you know, even just in a verbal way or in any way, they're on their phones.

[391] So that's at play.

[392] There's also pornography.

[393] I mean, we've seen, you know, there've been studies that show or there's statistics that show that young men are experiencing erectile dysfunction.

[394] young men, men under 30, at rates we've never seen before, because of online porn.

[395] So basically the one thing that biology evolved, that men were evolved to be able to do, social media or online porn content, has made it hard for them to do, you know, difficult for them to achieve.

[396] And we've never seen, you know, these kinds of rewiring of human sexuality that's going on because people aren't spending time with each other in person.

[397] And these young people are spending time online alone.

[398] Yeah, okay, so part of, you do see at least part of this transformation as being driven by the phone, by the constant, by the constant, constant electronic tethering, let's say.

[399] And part of that tethering is to the parent.

[400] And part of that tethering is to friends, but it's mediated by electronic communication.

[401] It's not direct one -on -one interaction.

[402] And maybe that's the case with the boys.

[403] Yes, but the images the girls see online are just as frightening because they're seeing violent porn at very, very young ages.

[404] Women being choked within an inch of their life, this is what young girls think sex looks like with the opposite, you know, with a man. And they're terrified of it.

[405] It doesn't look anything to look forward to.

[406] Instead, it looks like something to run away.

[407] Well, it's never presented with regards to pornography, sexuality is never represented as part of, an intimate relationship right it's its own thing sex it's not an integrated part of a loving relationship which is what it should be under optimal circumstances you don't you don't see that that doesn't attract widespread impulsive viewing right but it's also violent and that's the that in some you're you're right there's always been this porn that exists in playboy and whatever divorced from intimate relationships, fine.

[408] But what young girls at age 11 younger are seeing are violent, violent porn.

[409] That's what they know of sex.

[410] And they're seeing it at a very young age and it's terrifying.

[411] Okay.

[412] So let me ask you about that.

[413] I mean, how confident are you in that proposition?

[414] I mean, we're trying to determine why it is that there's a general generation of young women who are much less likely to engage in dating intimate relationships of the classic teenage style and it's not like anybody knows the answer to this because it's such a new phenomenon and so are these tentative hypotheses that you're putting forward or do you have some how how solid are you in your belief that these are the fact that you've correctly identified the factors that are driving this Well, the core thing I look at in the book is, you know, what's going on with, why is there this epidemic, the sudden explosion, and what are the risks and benefits, and why, you know, are these girls thriving?

[415] Are they doing well?

[416] And should we be concerned and why?

[417] Okay.

[418] Now, the part of this observation was to look at the culture and what was going on in the culture and observe the fact that young women are having sex and intimate relationships at much lower rates.

[419] That is not my research.

[420] That was done, you know, by, there are a number of people who have been doing this.

[421] Kate Julian had a wonderful article in the Atlantic in which he interviewed many psychologists about this.

[422] But it's, it's been, you know, something that many psychologists have observed and studied.

[423] And very unexpected, very unexpected development.

[424] Right.

[425] It's not exactly.

[426] It's not what you'd predict at all.

[427] When all the social constraints or many of the social constraints have been removed from every possible form of sexual behavior.

[428] the consequence of that has been a precipitous decline in sexual behavior among adolescents.

[429] And I guess we didn't talk at all about what the role of the boys might be in this.

[430] Like are girls not dating, let's say, and engaging in intimate relationships when they're teenagers because of something that's changed with them?

[431] Or have the boys stopped asking?

[432] You know, that's a good question about whether.

[433] So I didn't, what I was trying to say is I didn't look into specifically or investigate why there's this, you know, sudden drop in sexual activity or even intimate relationship activity among teenagers.

[434] So there are things I can surmise from looking at the culture and writing about the culture as I do.

[435] But do I have studies on this?

[436] No, I don't know.

[437] I don't have, you know, a real answer that I have come across yet.

[438] Well, the pornography question is an open one, right?

[439] because that that's a form of easily accessible gratification with endless novelty that's never been you know it's possible for a young man to see more beautiful nude women in one afternoon than any human being that ever lived before 1950 would have seen in his entire life right and right and of such variety i mean that right well no novelty is a huge driver of sexual arousal and and and pleasure.

[440] And so the, and I mean, I also think that's part of the reason why I don't just think it.

[441] There's evidence for this, but it's one of the drivers for the proliferation of multiple forms of pornography is that novelty is a driver of sexual arousal.

[442] And so there's an arms race online that consists of a combination of sexual imagery and novelty.

[443] And that would drive the production of violent videos, for example.

[444] or anything that's different, right, is going to add an edge, a novelty edge, especially to a hardened pornography user.

[445] Hardened is probably the wrong word there, by the way.

[446] Right.

[447] And the problem with this, of course, is not that there's so much pornography, I mean, online, but of course that we're also seeing men be less inclined to engage in intimate relationships, less able to even perform.

[448] I mean, these, you know, because of it.

[449] I mean, it's the rewiring of young people so that they're so incompatible for each other.

[450] That's the real sort of disturbing part.

[451] If these young people, and this applies to this young, you know, group of women who suddenly decide their transgender, if they were forming families and living good lives, that's a success story.

[452] But that's not the story.

[453] That's not the story that I found in my book.

[454] Right.

[455] Unless you define success as being allowed to pursue whatever fragmentary identity occupies their consciousness at any given time.

[456] And you can define it that way, right?

[457] I mean, you're using, and I would use as well, I would say, more conservative criteria for what constitutes a good life.

[458] You know, as a clinician, I listed as a clinician, it struck me that you can assess someone's mental health with some degree of accuracy by looking at the success of their embeddedness within their social community.

[459] And that's why I outline markers.

[460] of a good life like gainful and meaningful employment and education to the to the to the extent of your intelligence and the ability to form an intimate long -term relationship and children and all these things that seem to make up the bedrock of life but again to some degree that's a matter of definition right you could object to all of that and say well no that's a very 1950s or 1970s way of looking at the world and that's long gone and and now what we're trying to do is facilitate people's the broadest possible range of choices among people so that we have a world that's much more diverse in its expression of identity.

[461] It's a very difficult argument to contend with.

[462] I think it's deeply wrong.

[463] I think it's too confusing for people, but...

[464] I mean, except that a lot of these young women, their mental health after the trans identification deteriorated.

[465] So they're not able to function.

[466] Look, I have no, I have interviewed many transgender adults who are flourishing.

[467] They're leading good lives.

[468] They're gainfully employed.

[469] They are happy.

[470] They're socially connected.

[471] That is not a problem story.

[472] The reason that this young girls are the subject of my book is because they're not flourishing.

[473] They're not doing well.

[474] They're not connected to friends and family.

[475] They're not staying in school.

[476] Do you think, and I don't know the literature on this, And I guess it's partly because it's so soon after the phenomenon emerged itself.

[477] Do you know the literature on the relationship between mental health and movement through the transitioning process?

[478] It's tricky, eh, because you point out in your book that if you're an anxious teenage girl or maybe even an anxious teenage guy and you're given testosterone, at least in the short term, that.

[479] can do wonders for your anxiety.

[480] And so whether or not mental health improves might depend very much on when you measure it.

[481] So if you're anxious and your identity is chaotic and you take testosterone, the immediate consequence of that is that you're going to be much less anxious, at least.

[482] And why wouldn't you think immediately that that's evidence that there was something astray with your identity that this magic hormone fixed?

[483] You know, time frame is a killer problem when you're trying to assess mental health.

[484] So what studies are, or what data are you looking at when you generate the proposition that going down the medical transition road isn't producing the positive outcome that it's hypothetically designed to produce?

[485] Well, first of all, I only say that it's not producing that outcome for these teenage girls who I believe are misdiagnosing.

[486] So I don't make a claim about transgender adults who went through therapy, arrived this decision as mature adults and are living, you know, a life as a transgender person, I never make a claim that that wasn't a good or the right move for them.

[487] Right.

[488] Well, I don't, and I don't know, I don't think that there is a reliable literature on the long -term outcome of gender transition surgery, even in those cases.

[489] Because it's, so, so, and the phenomenon we're discussing is much newer than that.

[490] So the data aren't, it's very difficult.

[491] called for the data to be in yet.

[492] So I'm wondering, again, why you concluded that it's not working?

[493] Well, there are a number of reasons.

[494] First of all, you know, obviously I used Lisa Lippman's study, which was the jumping off point for my book, Brown University public health researcher who looked into this.

[495] You're also seeing clinicians report the same across the Western world that they're seeing a sudden spike of gender dysphoria that seems to be peer -motivated or gender dysphoria that seems to be peer motivated and social media motivated.

[496] It's not an organic problem and it doesn't look like traditional gender dysphoria.

[497] You're also seeing numbers of detransitioners explode on YouTube.

[498] So if you go to YouTube week to week, the number of detransitioners, and you're right about the timeline, by the way, of course that's always going to be relevant.

[499] So testosterone does deliver a high, as you said, and it does suppress anxiety.

[500] So, some women who self -medicated with it feel great after they've started a course of testosterone.

[501] But very often, if you listen to these transition or accounts, I've listened to many, many of them, they will report that then after that spike, their anxiety and depression came right back.

[502] And there's a woman I recently listened to called Waffling Willow, she goes by on YouTube, who did a 12 -part series on my book.

[503] I never met her.

[504] I didn't know about her until she did this, but she's a detransition.

[505] or did a 12 -part session on my book in which she said, yes, this was totally her experience.

[506] As a teenager, she transitioned very quickly.

[507] And at first she felt great on the testosterone.

[508] And then she realized that, and then she had basically a crash in which all of the other mental health issues that she had returned.

[509] Yeah, well, that's a good example of the difficulty in doing longitudinal mental health outcome studies, especially in an uncontrolled environment.

[510] Clinical studies are notoriously difficult to conduct.

[511] And the time frame problem devils them.

[512] And this is a particularly nasty situation given that testosterone produces that initial high.

[513] So you can cherry pick your data to some degree.

[514] If you look early in the transition process, you might well see an improvement.

[515] And then you can argue about what's contributing to that, you know, whether it's just the pharmacological effect of the testosterone or if it is actually proof that the gender identity confusion in question was real.

[516] There's also, of course, the Tavistock report out of the gender clinic, the largest gender clinic in the United Kingdom, which showed that there was no mental health improvement, no improvement in suicidal ideation for young women who have been started on, you know, puberty blockers and then cross -sex hormones.

[517] So, you know, we aren't seeing the improvement that was supposedly, you know, claimed as the rationale for starting young people on these treatments.

[518] Yeah, I wonder, I'm going to go back to something that we talked about earlier when we were trying to pin down what the motivation for this ideology might be.

[519] Like the notion that your identity is yours alone to determine.

[520] strikes me as it's a profound it's profoundly narcissistic it seems to me to be predicated on the idea that you have the right to be master of your own master of your own domain master of your own your outcome regardless of people around you you're the only person that has to be taken into account so that would go along with the express claim that you're the only person that can determine what your identity is.

[521] It seems to me to be a very infantile and narcissistic wish that that might be the case, you know, that you could decide who you were and that the world would be forced to bend around your will.

[522] And I can understand that again, as I said, because everybody fights a battle against society molding them and destroying their individuality while they're socialized it's a it's a there's something there that's valid to rebel against but generally speaking as you mature you start to understand that you have to negotiate your way through the world with other people and that the benefits of being acceptable to other people outweigh the costs to your own narcissistic self -determination and it's it's the desire to not have to to contend with that compromise that drives, I believe, that drives the insistence that you are the only person that can determine your identity.

[523] That's right.

[524] I think that the activists in this movement have a lot more in common with, say, the Black Lives Matter movement and others such, you know, so -called woke movements than they do with adult transgender people.

[525] When I talk to interview, you know, gender adults, they don't have a gendered.

[526] insist that they were always girls or always boys.

[527] They don't ask you to suspend reality.

[528] They say, look, I had gender dysphoria from the time I was a child.

[529] You know, I struggled with it for many years.

[530] As an adult, I went through therapy and I realized this was the way to, you know, calm my gender dysphoria.

[531] And this is how I'm most comfortable presenting.

[532] That's not imposing anything on the world, really.

[533] But the group of insistent activists, many of whom are not transgender themselves, but insist that we suspend reality that medical professionals agree with them.

[534] Yes, you were always a girl or you were always a boy, this kind of stuff.

[535] This is an aggressive ideological movement that really has nothing to do with gender dysphoria per se.

[536] Yeah, well, I've been trying to put my finger on while I was reading your book as well, what it is that's the driving factor.

[537] And, you know, if you look at, there's broad philosophical streams like those that emerge from the writings of Rousseau that claim that human beings as individuals are essentially good and pristine in their fundamental nature and that culture it's culture that corrupts them you know and it's a very one -sided view you can take the Hobbesian perspective which is exactly the opposite and say that well people are self -interested narcissistic and malevolent and it's only society that makes them good and I would say a balanced viewpoint emerges if you integrate both of those views even though they're paradoxical to some degree.

[538] You pay for your socialization and you benefit and you sacrifice something of value, but you also gain.

[539] And that's what you decide if you're mature.

[540] If you stay locked in the notion that social pressure in and of itself is the perverting force that destroys your soul and your psyche, then you're going to be motivated to push as hard as you can to justify your claims that your identity is something that you yourself determine and that no one has any right to interfere with that whatsoever.

[541] And maybe if you have to sacrifice people in order to justify that claim, that's okay because the claim is important enough to you so that those sacrifices are warranted.

[542] No, I got a sense of horror in some sense from reading your book, especially when you started to describe the surgery.

[543] And so maybe we could walk through that a little bit.

[544] Let's say that you do decide to walk down the gender transition road as an adolescent female, you can look forward to a high that's generated by testosterone, and maybe that's something short -term and positive.

[545] But what else can you look forward to?

[546] Well, I suppose the next, what can you look forward to?

[547] I mean, you get the high, facetious, gotcha.

[548] Yes.

[549] Well, the, the, so the testosterone delivers that, but it also comes with risks.

[550] I don't know if you want me to talk about that.

[551] those yes and and also the experience you talk about voice deepening and hair development and all of right walk through it what walk through what happens to a person if they if they go down this road for the in the first few months on testosterone at 10 to 40 times what a young woman's body would normally experience her voice will change and masculinize that does not seem to go away um you know her she will make she will her facial features will change they will round her shoulder shoulders will broaden and it will redistribute fat.

[552] So if she's concerned about her fat, all of a sudden, in the places women develop fat, belly and thighs, all of a sudden, wow, she's lost weight and she can develop more muscle.

[553] The problem is that a lot of these changes are permanent, the masculinization of the facial features and whatnot.

[554] And also that comes with very big risk of cardiac arrest and cardiac risk seems to be much, much higher than a woman would normal experience, even more than a man would normally experience, it seems.

[555] And you also discuss the effects on fertility and sexual pleasure.

[556] Right.

[557] So vaginal atrophy and uterine atrophy occur.

[558] It can be quite painful.

[559] And so in some cases, making intercourse impossible if there's enough atrophy, it's quite painful.

[560] And because of the increased risk of endometrial cancer, a doctor typically recommend at five years on testosterone at prophylactic hysterectomy.

[561] So even assuming that the testosterone doesn't impact her fertility, which it may, the hysterectomy certainly will make that impossible.

[562] So, you know, those are some of the risks of testosterone, but the biggest risk of all, of course, is that we have no idea all the long -term effects of what testosterone at 10 to 40 times what her body would normally happen will do to her.

[563] Right, and that's a long -term course of treatment.

[564] Right, because she can't go off it.

[565] Because if she goes off it at any point, she will go back.

[566] Some of her changes will revert.

[567] She'll go back to an in -between male and female look.

[568] So once you start, you become a permanent medical patient, and we just don't know, you know, we don't have enough evidence of what will happen, you know, to these patient population, all the problems they will incur in the long term.

[569] then of course there's double mastectomy which is the only cosmetic surgery or considered cosmetic surgery I'm aware of that you show up without a mental health professionals note even as a minor you can have your breasts removed it destroys biological function obviously it destroys all capacity for breastfeeding as well as erotic function very often and and and yet you know And you outline some of the potential side effects of that as well.

[570] The, I believe, monthly engorgement of breast tissue and leaks and that sort of thing as a consequence of only partial removal of the breast tissue.

[571] I got that right?

[572] Right.

[573] And whether the testosterone is enough.

[574] I mean, you know, if you go off testosterone, your breast may refill with milk, even after they've been removed, you may have some drainage problems.

[575] I mean, drainage is another side effect that often happens.

[576] very often women are unhappy with the look they want a second surgery to repair the look of it.

[577] And why are they unhappy with the look?

[578] Because they're chasing an asymptote.

[579] They're running after a horizon.

[580] The final look of being a man which they never, which is always a little bit out of reach.

[581] I mean some of the people I interviewed for the book are forensic anthropologists because I wanted to know about skeletons.

[582] What are there skeletal differences between men and women?

[583] And it turns out there are even the sloping of the forehead won't be quite right they'll be smaller they'll have smaller hands they'll have differently shaped pelvises no matter what other you know surgeries they get they're they're they're actually their femurs will attach differently for a woman than they do for a man right and that accounts for the difference in gait and there's a difference in in angle of the forearm connection to the to the upper arm as well because of the difference in hip hip to waist ratio, all these subtle differences between men and women.

[584] It's hard enough for a man to be an ideal man, much less a woman, to be transformed into an ideal man. And if you're an individual who has some questions about the acceptability of your physical appearance, then you can imagine that it's quite likely that that's going to be maintained as you make the transition to another gender.

[585] Right.

[586] And there's something else I asked one of the doctors about, because I started looking at many pictures of the young women who had received a double mastectomy.

[587] And I noticed something.

[588] I said, wait a second, look at their hips.

[589] They have women's hips, which become even more obvious once they've had their breasts removed.

[590] So, you know, the doctor said to me, that's right.

[591] There's a surgery.

[592] There's another surgery they can get if they're concerned that their hips are protruding too much.

[593] So you see that this is not an easy fix.

[594] And yet it's being doled out, you know, quite, quite casually.

[595] Right.

[596] And by casual.

[597] And by, You mean that there's no screening in place, essentially, to stop women from beginning this transformation process.

[598] And that also you point out that so many medical health insurance schemes, like those provided by universities, now cover the testosterone, certainly, but also the medical procedures themselves to reduce their cost to a point where they're much more accessible than they would be otherwise.

[599] That's right.

[600] I talked to a woman a week or two ago whose daughter suddenly decided she was trans at university.

[601] She was at a very top American university.

[602] And at university, she not only started a course of testosterone, but she was able to get her breast removed.

[603] Yes, well, that would be rather shocking news for any parent to contend with.

[604] So let me shift gears for a minute if you wouldn't mind.

[605] What has been the personal consequence for you of writing this book?

[606] I mean, I can't imagine hitting a more active hornet's nest.

[607] So is it okay that you wrote it?

[608] Do you regret writing it?

[609] And what's happened personally to you because you've written it?

[610] You know, it's been something of a journey.

[611] You know, when I started this project, it was so, you know, once I started, I was just in a sort of a constant state of shock and revelation.

[612] And I couldn't really believe this was happening.

[613] And it would struck me, the more I investigated it, it struck me as such obvious madness that there would be no, you know, oversight and no, you know, guardians or gatekeepers in place that I just kept thinking at the end of this, everyone's going to be shocked and, you know, this will become a safer procedure or, you know, everyone will have to agree.

[614] I didn't write the book for religious people.

[615] I didn't write the book for conservatives.

[616] I just wrote it for common sense people who were.

[617] interested in the number of teenage girls suddenly coming out as transgender.

[618] And I was, I couldn't, I mean, the number, I can't even tell you how many parents have called me since the book came out while the book was coming out, telling me that 20, 30, 40 % of their, you know, whatever, very high, 15, 20, 30 % of their daughter's seventh grade class suddenly decided they were transgender.

[619] Sometimes at girls' schools, their boys weren't even relevant.

[620] It was at a girl school or at least they weren't around um so on the one hand i and then the and then of course in the in england the high court came out and it came out with a decision that effectively um verified everything i had to say in the book um they they said right that was the case of the detransitioning girl i mean i thought i thought five years ago i thought or more i thought this will all come to an end when these adolescents hit adulthood and start to bring the lawyers into play for everything that was done for them, let's say, when they were teenagers.

[621] And that high court case, do you want to just outline that briefly for people?

[622] Sure.

[623] A young woman named Kira Bell brought a case against the, she brought a claim against the Tavistock Gender Clinic in England in which she said, I was started on these treatments, hormone treatments, I was sure I was transgender.

[624] I had, I started, you know, I had never had a childhood history of gender dysphoria, but as a teenager, I was very uncomfortable in my body, and I decided I was transgender, and at 16, I was started on the course of puberty blockers and then cross -sex hormones.

[625] She eventually went on to have her breasts removed, and she realized as a young woman in her 20s that she was, she had gone down the wrong path, that none of this had made her any happier and that she wasn't supposed to be transgender.

[626] She was a lesbian.

[627] And that was all.

[628] And she had no, and she was very upset that nobody had stopped her.

[629] Nobody had exercised any judgment.

[630] It had been a celebration only zone from the moment, even from medical professionals and therapists from the moment she decided she was transgender.

[631] And the court looked at this population of teenage girls and was horrified.

[632] And if you read the decision, you know, as I have and written about it.

[633] It's, it's, it just came out in, in December.

[634] Right, right.

[635] No. This is new.

[636] They, they said that it's in, it basically, you know, young people under 16 should not be allowed to be giving informed consent.

[637] They can't give meaningful consent to doing away with their future fertility.

[638] They're children.

[639] And there's in no sense, is this informed consent for a possibility of a sexual life?

[640] Because in many cases, they may, this may lead to sexual dysfunction.

[641] They can't for, close sexual life, a healthy adult sexual life, and fertility as minor.

[642] Well, even, you know, how many 19 -year -old women who claim to not want children have children in the upcoming decade?

[643] I don't know the statistics, but I do know that a very large number of 19 -year -old women that I knew when I was 19 had decided that they weren't going either eventually had children or were very unhappy that they didn't, you know, by the time they had hit their mid -30s.

[644] And so that's right.

[645] I mean, we don't know that much about our future selves.

[646] And the question is, under what circumstances we should be allowed to sacrifice them.

[647] You know, so.

[648] That's right.

[649] And that's the problem.

[650] It's not that these girls are having these feelings, but that our adults are immediately supplying the irreversible treatments without any medical judgment or differential diagnosis.

[651] Well, you also, this is part of what's horrifying about your book.

[652] We didn't talk about some of the other surgical complications, for example, with regards to phalloplasti, which we might want to dive into just briefly, because I wasn't aware of the mechanics of that particular operation, let's say, and it's enough to give you pause, I would say.

[653] In any case, well, let's do that now.

[654] Why don't you talk about phalloplasty and describe that?

[655] Sure.

[656] It begins with the desleeving of the forearm.

[657] They have to remove the fat and muscle from around the forearm.

[658] That's what's used as the shaft of the neophyllus.

[659] How much is removed?

[660] Oh, gosh, many inches.

[661] If you see young women videos, you can go online and see views of women who've had their forearms desleeved.

[662] It's a long stretch of the forearm in order to get enough skin to form the neophalus.

[663] then they have to transfer a peripheral artery and nerves to that area.

[664] They have to graft it, obviously.

[665] It's extremely difficult work.

[666] Future surgeries are needed if you need it to be able to, first of all, just making it able to have a urine stream without infection is extraordinarily difficult.

[667] Often that complications include urine that spray.

[668] rather than streams, it's extremely difficult to achieve.

[669] And then, of course, having it harden at all as difficult.

[670] It requires a further surgery.

[671] And what does the surgery entail for that?

[672] Is that inflatables?

[673] Yes, that's right.

[674] There's some sort of inflatable thing put into what would be like the sort of the testicle, I mean, the scrotum, the manufactured scrotum.

[675] So to make it inflatable, but it's very hard to get it.

[676] hard it's very difficult to get it hard enough to penetrate for sex and if you do get penetration what's the pleasure that oh are they able to get the same amount of sexual or the you know achieve orgasm actually that it depends on um i don't know how often they're able to achieve any kind of sexual orgasm but i do know that um you know if they start out if their their puberty is blocked by, you know, early on, and then they go to cross -sex hormones and then they have these operations, sexual dysfunction and inability to ever achieve orgasm becomes much more likely because they never finished their, you know, all the tanner stages involved in, you know, making a young person be able to eventually achieve orgasm.

[677] So there are a lot of problems.

[678] But the biggest problem with this surgery, I'm told, you know, I've interviewed a lot of surgeons, And I'm told that that surgeons who do this very well and are very skilled at this and very highly trained in this can do a pretty impressive falloplasty.

[679] But the problem, of course, is these are big moneymakers for hospitals.

[680] There's a lot of pressure to do this surgery.

[681] And I keep hearing from surgeons that the people who are doing these surgeries are very often not qualified.

[682] They're not qualified in transfer peripheral nerves.

[683] Each of these microsurgeries involves a different separate fellowship.

[684] and they haven't done those because the hospitals are so desperate to make this extra money that they're not applying the traditional safeguards that they normally would.

[685] Well, it doesn't take much imagination for someone who's undergone surgery or have witnessed someone who underwent surgery to imagine just exactly how complicated and difficult this is, especially to bring about anything approximating success.

[686] So we didn't finish our discussion.

[687] of the impact on you personally.

[688] So you said that you were continually shocked.

[689] So it was, I imagine, somewhat demanding psychologically to do the research that was necessary to write the book.

[690] But then there's also the consequence of publishing it and the notoriety or unpopularity that that might have produced.

[691] Right.

[692] So I suppose, you know, I suppose I would fall into disagreeable as my personality category that I learned from you.

[693] In the sense that I'm not someone who you know, lies really bother me. They just bother me on a moral, intuitional level.

[694] So I really sort of wrote this, not looking to make friends, but just because, gosh, the truth seemed obvious and it was fairly horrifying.

[695] And it didn't affect me personally or my family personally.

[696] So if it had, I think I would have had trouble writing it.

[697] I don't think I would have been able to.

[698] Women who's and fathers, mothers and fathers who have watched their daughters go through this are absolutely devastated.

[699] And it's not something I would have been able to do if this had been a personal issue.

[700] But I wrote the book.

[701] I thought it was a very fair treatment.

[702] Makes you wonder too when you're doing analysis of the outcomes of surgery, if you take into account the effects of that on the immediate family members.

[703] if that's a valid scientific question.

[704] You know what I mean?

[705] Like you could say, the only person who's ever affected by a surgery is the person upon whom the surgery is performed.

[706] And perhaps that's the case and perhaps that's a reasonable perspective.

[707] But we are embedded in familial structures.

[708] And if a surgical procedure makes person A temporarily happy or even maybe happy over the long run but devastates five other people, it seems to me that it's at least worth asking the question of whether that should be taken into account, especially when you're talking about teenagers.

[709] Right.

[710] I don't think it's that it devastates the parents because they can't stand the thought of having a transgender son or daughter.

[711] In fact, they were overwhelmingly politically progressive and supported, and they were big, they considered themselves allies long before gay rights was possible, you know, sorry, gay marriage was possible in America.

[712] So, we're legal in America.

[713] So it wasn't that.

[714] It's they were so miserable and so devastated because they thought their daughters were so miserable and regretting this already or likely to regret it because they saw the lives their daughters were leading.

[715] So I think while I was writing the book, I just thought this is so obviously true.

[716] You know, everything, there's everything in the book is true.

[717] Nobody has pointed to a single factual error.

[718] And the book has been under a tremendous amount of fire now for six months.

[719] And how have you withstood that?

[720] So I think that the hardest thing about the fire in a certain sense is all the, to be honest, you know, is all the polite people out there who won't even, you know, who are willing to say, oh, you know, you're effectively, well, you wrote that provocative book as if, as if they don't, They almost don't seem not to know that it's a journalist's job to go out and investigate phenomena, especially cultural ones, that seem to be real.

[721] I didn't go looking for trouble.

[722] Trouble is all around us in America today.

[723] I mean, you know, I mentioned the, you know, states are lowering the age of medical consent across the country so that kids can get all kinds of surgeries.

[724] I mean, in Oregon, the age of medical consent is 15.

[725] So a 15 -year -old in Oregon can get her breast.

[726] removed without her parents' permission.

[727] Now, you don't need to be a religious person to find that disturbing or alarming.

[728] You don't need to be conservative for sure, but just a thinking person who says, gosh, that seems really young.

[729] I know I had a lot of crazy ideas at 15.

[730] You know, I'm glad no one would have given me that option.

[731] Who do you want to read your book?

[732] Oh, you know, and I mean, the book is for anyone to read, but I suppose parents, parents have been very helpful.

[733] by it.

[734] Or they felt, you know, they felt it was very useful.

[735] Clinicians have told me it's very useful in just helping them sort of develop a, you know, sense that they're not completely insane when they think this is a whole lot of kids suddenly deciding their transgender out of the blue.

[736] This can't be right.

[737] There's no oversight, you know, feeling that they're not alone.

[738] But, you know, I'm happy for people who are affirmative therapists to read the book.

[739] I mean, I'm happy for anyone to read the book.

[740] You know, unlike those who have called for my book to be banned and burned, I'm not in favor of those things.

[741] You know, I would be happy for anyone to read it.

[742] And of course, I would never want another book banned or burned.

[743] And so you remain pleased with your decision to write it.

[744] The truth is I'm not sure I could have done anything else.

[745] I mean, once I was aware of what was going on.

[746] I wrote an article about it for the Wall Street Journal.

[747] And it's got a huge amount of traction.

[748] I mean, people were writing to me across the country, even across the West to say, yes, this is going on in their daughter's school.

[749] Yes, let me tell you my story.

[750] I mean, I'm sure there are people who could have walked away from that, but I'm not one of them.

[751] I thought, gosh, there's something worth investigating here.

[752] And how could I just walk away from that and not look into it?

[753] Well, you know, I think that's probably a reasonable place for us to end what do you think do you have anything else that you'd like to say oh um no i i i just uh thank you very much for having me on and uh and um you know a big admirer of yours and i really appreciate the opportunity to talk about well um i'm i'm pleased that you were willing to discuss your book and uh it's i'm hoping that many people will read it and think about what it and think about it.

[754] There's lots to think about the transgender surgery being part of that, but by no means necessarily the largest part.

[755] So, thank you very much.

[756] Can I just say one more thing?

[757] Yes.

[758] Just say one last thing.

[759] Look, the lies have to stop somewhere.

[760] I could have walked away from this.

[761] I'm not saying it's been fun, and I'm not saying it's been easy, since the book came out.

[762] There have been plenty of times when I thought, I really don't know if I chose the right path here.

[763] But I have to tell you something, the lies have to stop somewhere, don't they?

[764] I mean, they're just, we're right now, we're living through a blizzard of them.

[765] And at some point, someone has to say, you know, a few of us who are just, you know, willing to need to say enough.

[766] We have to subject this to the same medical scrutiny and the same skepticism that we would subject anything else to any other medical phenomenon yes well terrible as objecting to the lies might be I suspect that it's not as terrible as the consequences of letting them flourish unchallenged I mean that's right I mean a lot of young women are getting badly hurt and at some point somebody has to be willing to say something yeah well I I hope I hope that your book helps That would be what anyone who is thinking clearly would hope.

[767] Thank you.