 During this forced vacation from my YouTube channel, what else can I contemplate but gender dysphoria, transgenders? And today we are going to discuss two topics, much shunned, much censored, much feared, much suppressed. The first one, is the phenomenon of transgenderism? Is it a form of social contagion? Also we are going to touch upon narcissism and how it may be connected to transgender phenomena. But first and foremost, is it communicable? Is it, as some conservative thinkers say and some scholars, is society a social pressure, peer pressure? Is this a vector of transmission, so to speak, of transgender inclinations? That's the first question. And the second question is, detransitioning. How widespread is it? And what does it teach us about the transgender phenomenon? First of all, before we proceed, I've been saying repeatedly in numerous videos. There is a huge difference between sex and gender. Sex is a sign that birth is usually based on visible genitalia. It's a sign by the delivery in doctor. Gender is learned. It's acculturated. It's socialized. It's performative. That's why we call it gender role. People with specific sex organs, secondary or primary, can choose a gender which is non-conforming, a gender which does not conform to their genitalia or other sexual, other sex parts. So gender and sex are two totally different issues. And here starts the major confusion. Gender dysphoria is actually very often about sex, not about gender or not only about gender. It should have been called appropriately sex dysphoria or sexual dysphoria or something containing the word sex. But it's called gender dysphoria. It's been called gender dysphoria for like forever, for decades. And this created God awful confusion. Both sexuality and gender are fluid. Even sex itself, which is supposedly a biological determinant, even that is fluid. It can be changed. But gender definitely is fluid. Gender roles. Sexual orientation is fluid and very often changes over the lifespan. So there's a lot of fluidity and plasticity built into sexuality, gender and even sex. And the confusion is so massive that we all stumble in the dark talking at cross purposes, not being able to communicate meaningfully. And whenever communication fails us, whenever language breaks down, emotions erupt, especially negative affectivity, emotions such as anger, fear of the unknown. So today I'm going to do my little best to contribute to throwing sunlight on some of the more convoluted and dark alleys of this debate, if you can call it debate. It's more like a skirmish or a squirrel. My name is Sam Vaknin. I'm the author of Malignance of Love, Narcissism, Revisited and Former and Current Professor of Psychology and Finance. Having dispensed with this, let's delve right in. Moira Shilaji, I hope I'm pronouncing her name correctly. Moira Shilaji is the President of the American Academy of Pediatrics, AAP. And she released no fewer than two statements, one on August 22nd last year, 2022. This statement was published in The Wall Street Journal of All Places. The other statement followed three days later on the 25th of August, 2022, and it was in the form of an AAP daily briefing. Presumably she was just trying to clarify The Wall Street Journal widely misunderstood statement that she had released. She was trying to clear the air. The debate has become vicious and pernicious and poisonous and aggressive to the point of violence and very often spilled into violence. And a lot of the debate revolves around the question or the issue of, is gender dysphoria a clinical entity? Is it a real thing? Is it a true condition similar, let's say, to cancer or tuberculosis or schizophrenia? Is it a disorder? Or is it just a choice? Is it a lifestyle? Or is it dictated by biology? And what's the contribution of biology? What about society and culture? How do gender roles interact with underlying biological sex? And how do the two put together create sexuality? None of these questions, believe it or not, have clear answers. So she referred to two papers and the two papers dealt with a very, very difficult, ornery question. Can gender dysphoria be learned? Is it mimicked? Is it the outcome of exposure to other gender dysphoric individuals? It's as if gender dysphoria was kind of some kind of epidemic, contagion, with an infectious agent, a pathogen. So the two papers were published, the first one was published in 2018. At the time there was a health expert working in Brown University and they hypothesized, they proposed the existence of a condition called rapid onset gender dysphoria, ROGD. The lead author, a woman, described rapid onset gender dysphoria as a social contagion, or at least one of the reasons for ROGD was supposed to have been social contagion. When the paper was published, it ignited a firestorm. There was criticism from every segment of the population, not least of which from the transgender community. And of course immediately the paper was withdrawn and suppressed and censored and eliminated and burned at the stake and shredded, which is what many of you would like to do to me. Okay Shoshanim, was this paper published in 2018, was it supported by any research? The truth is not really and the even bigger truth is there's no research about transgender issues. The topic is so sensitive, is so politically incorrect or politically correct, depending on which side of the walk movements you are, that academics stay away, they shy away from it. We don't have any data as to transgender phenomena including surgical interventions, gender affirming care, nothing, we know nothing about any of this. We haven't followed up on people, we don't have outcomes, we don't have analysis, absolutely nothing. And that's because some of the findings may unsettle the transgender community or may unsettle the conservative wing of the intellectual life in the United States, which is increasingly more vociferous and may I say unduly aggressive. Four years later, 2022, there was a second paper published in the August issue of Pediatrics, the authors of the paper attempted to test the hypothesis of rapid onset gender dysphoria. And more specifically, they try to ascertain or to measure the possible social contagion. Now just to remind you social contagion simply means if you're exposed to gender dysphoric people, you're more likely to become gender dysphoric yourself. This is the vector of social contagion. Now we have many, many phenomena which involve social contagion. Mob psychology is an example, the behavior of crowds, cults. In many, many cases, we communicate behaviors to individuals via collectives or via social structures and social institutions, including peers, for example. So 2022, the study was published. And it was more substantial than the 2018 paper. They checked the birth ratios between 2017 and 2019, the birth ratios of transgender diverse individuals to female sex at birth individuals. And the idea was to see if there is a decrease or an increase in adolescents who self-identify as transgender diverse. In short, they established a benchmark, how many people were assigned female sex at birth. And then they followed up on these people trying to see how many of them outed and declared themselves to be transgender diverse, how many adolescents identified as such. So the first thing they found, which is not surprising at all, is that people who identify as transgender or transgender diverse, they're subject to bullying, victimization, and the suicidality among these people, among these youth, is much higher when compared with cisgender peers. That came as no surprise to anyone. The authors concluded that actually their findings were, and I'm quoting, incongruent, incongruent, not supportive of the ROGD hypothesis. In other words, their findings did not show any social contagion. And the reasoning behind this was it is so difficult to be transgender. You pay such a high price, socially, you're victimized, you're bullied, you're ridiculed, you're shunned. The price is so high that it's very unlikely that you will try to emulate or imitate someone who is gender dysphoric. On the very contrary, you will try to keep away. So this was the 2022 conclusion. So what can we make of these two studies, which seem to contradict each other? There is a general perception that there is an increase in prevalence of gender dysphoria. And this may be not entirely true. Perhaps the prevalence and incidents haven't changed, but what has changed is that people are more compassionate, more educated and more accepting. So it is less challenging to out yourself, to come out and acknowledge and admit and confess that your gender dysphoric, especially in youth among the young people. So are we, is the debate over? Can we now say safely that there is no social contagion? The transgender community and population, they feel very threatened by this idea of social contagion. Because if there is social contagion, and if it is considerable, then the whole transgender issue is nothing but a fad, it's a fashion, it's not real, it's not a clinical entity. It doesn't reflect any biological or psychological, true, veritable, verifiable processes. If on the other hand, social contagion is very minimal, if at all, then we are talking about a real phenomenon. And unfortunately, there are no answers. We don't know. The samples are too small, the methodology is questioned and academics are afraid, they're terrified. They don't dare to touch this issue. We must study this. Because if gender dysphoria is social contagion, especially among peer-sensitive adolescents, in adolescents we know that peers are the main socialization agents. Peers teach you everything you know about sex. Peers exert pressure on sexual identity and sexual orientation and to a large extent form it. Peers have a huge role in gender formation, gender role formation, and sexual identity. If there is social contagion, we can put a stop to it, and we should even put a stop to it. If however, social contagion is minimal, one, two percent of the cases, then we should revert to the opposite pole. We should afford and we should provide gender-affirming care. We should help youth to transition, because then transgender is a real phenomenon. And here's the breaking news. We don't know yet scientifically if gender dysphoria is a real thing. We have no studies, no rigorous studies at least, which support either side of the debate conclusively. And that is a shame and a disgrace in 2022. In the meantime, because there's such a paucity of studies, such a dearth of data, everyone and his dog has a stake in the debate. Psychologists, psychiatrists, psychoanalysts, medical doctors, transgender, their families, their friends, conservatives and liberals, everyone is throwing his or her head into the ring and it's a melee. It's a mess. It's a wrestling match rather than an informed medical debate because it boils down to a medical issue. It involves not only the mind, it involves the body. So we find, for example, a month ago, February 15, we find a series of announcements by Italian psychoanalysts and they oppose the use of puberty blockers for gender dysphoria. The debate started in January when the Italian Psychoanalytic Society issued a call to the Ministry of Health signed by the president, the president, Thanopoulos. Thanopoulos is a great name. I don't know what he's doing in Italy. Okay. So the document expressed, I quote, great concern about the use of drugs that block pubertal development of minors diagnosed with gender dysphoria. And then there was a list of warnings based on the idea that, and I'm quoting again, the ongoing trial circumvent careful scientific evaluation and the document calls for rigorous discussion. I can't agree more. I fully agree. I agree with all these things. There's no serious scientific study of the issue and we need to become serious about it and we need to go rigorous. So what do we base today? What do we base our diagnosis on? If there's no real science, there are no major studies, there are no big samples, there's no follow up on what is happening to individuals having transition, what do we base all this on? Well, believe it or not, we base it on claims. People come and say that their gender dysphoria and that's where it begins and that's where it ends. There's no way to carefully and critically evaluate social identity in progress. The document says, only a minority of children who state that they do not identify with their gender confirm this statement after puberty. Suspending or preventing psychosexual development while waiting for the maturation and definition of the child's stable identity is in contradiction with the fact that this development is a central factor in the process of identity definition. That's a very convoluted and long way of saying children have no clue as to what their gender or sex is end of story and quite true. We acquire these determinants of identity only in mid-adolescence, not earlier. So children can't make these decisions and can't report truthfully about their inner states because these inner states are in flux. They are not stable, they're not firm and they're definitely not life long. The statement by the Italian Psychoanalytic Society continued, even when the declared gender dysphoria in pre-puberty age is confirmed during adolescence, the developmental arrest won't result in a body that is different from a sexual point of view from the original one. The sexual development of the body, even when it contradicts the internal orientation, allows an erotic fulfillment that a blocked or manipulated body does not offer. So here it's more debatable, many transgender people report that they're pretty happy with the new bodies they have. And this biological determinism, you're born with genitalia and the genitalia determine your gender and how you function in society and basically your fate. That belongs in the 1930s and 1940s. There is no place in post-modern society on the one hand. So it's not true to say that once gender orientation becomes clear to the individual in adolescence, transitioning to a different kind of body would be unsatisfactory. That's not true, that's not supported by anything and the overwhelming vast majority of transgender people report exactly the opposite. And so a large number of professional social societies in Italy countermanded the letter of the Psychoanalytic Society and they published an open letter. So the Italian Society of Endocrinology, the Italian Society of Pediatrics of Pediatric Endocrinology, Diabetology, Andrology, Sexology, Pediatric Psychiatry, National Observatory of Gender Identity, I mean a host of societies and associations spring to the rescue kind of. And they confronted the Psychoanalytic Society and that included the Society of Psychiatry, National Order of Psychologies, etc. And so they said the text describes the treatment with hypothalamic blockers in adolescence with gender dysphoria as an experimental treatment, but it is not. In fact, the therapy is approved in many countries in the world, Italy included, and there are very favorable opinions by bioethics committees all over the world. And so these Italian societies and associations of professionals, they wrote, such medical treatment is reserved for carefully selected cases following multidisciplinary and personalized evaluation. We agree that the scientific data available to date confirm the gender identity reaches stability only at pubertal age during adolescence and not in pre pubertal age or in childhood. Therefore, as widely documented in international recommendations, hypothalamic blockers can be prescribed only when puberty is already underway, which is the way it should be all over the world, including in the United States. Transgender adolescents are very vulnerable. They have much higher rates of depression, anxiety, suicide risk, distress. It's a conflict between one's feeling of oneself, one's experience of oneself, and one's body in a way the body is perceived as a strange, alien, or even as a traitor, there's a sense of betrayal sometimes. And these associations continued in their open letter to say, follow-up studies show that treatment with puberty blockers can significantly reduce behavioral and emotional problems and reduce suicidal risk as well as improve overall psychological functioning in adolescence. And so there's a debate not only in the United States, even in a way more traditional society like Italy. The psychoanalytic society of Italy is right in saying the following. I'm quoting, There are no rigorous carefully collected and independently controlled data, nor studies on the difference in terms of suicide between allegedly transgender kids who take the drug and those who do not. dysphoria often coexist with mental disorders such as depression, eating disorders, or autism spectrum disorders. We need a differential diagnosis, but few people deal with it. That is the core of the problem. The problem is there is a surge of adolescence, including sometimes children who claim that they don't feel gender-wise. There is a discrepancy between their gender roles as assigned by society, mainly, and their sex is determined by their genitalia at birth. And they would like to transition to create conformity, to create a strong association or correlation between equipment and its use, or change the equipment, change the genitalia and other sex organs and so on and so forth in order to reach such a conformity. But so the problem is not this. There's clearly a phenomenon. The problem is we don't know enough. We have no information. We have no data about anything, literally about anything. Is it socially communicable? What's the influence of peers? We never conducted a study with a control group. How about, are there any biological determinants that can be identified? I don't know, hormones, something. Is there a correlation? Is there intergenerational transmission, for example? What's the effect of puberty blockers? There's no follow-up. Can you believe this? There's no follow-up that I'm aware of as to what happens to transgender people having undergone interventions and treatments. And so this debate is not going to end until we bravely tackle the issues that I've mentioned without fear and without censorship. And one of the main issues we need to study is something called detransitioning. Detransitioning is when transgender people regret the decisions they've made. Now, if you dare to mention the word detransition or the word regret, in on any of the forums of transgender people, you will be castigated, chastised, drawn and quartered, burned, and your ashes spread on all five oceans of the globe. These words are taboo, forbidden, verboten, nichts, don't say them. It's as if there's no such thing. Transgender people essentially deny that there is such a thing. And the academic cohort that is, dare I say, financially invested in the transgender industry because it became a cottage industry, this academic cohort equally denies detransitioning, the very existence of detransitioning. But the truth is detransitioning exists. And there is a huge debate because there are no studies. Whether detransitioning constitutes 2% of the transgender population or is it closer to 35%. I refer you to studies by Dr. Kenan McKinnon. So transgender people, let's be clear. The majority of transgender people are happy, content and egocintonic with their decisions. But there are transgender people who have undergone interventions and treatments including surgical treatments and regret it and are unhappy about it. This phenomenon is real. It exists. People who have detransitioned or regret their decision to transition, they don't dare to speak out. They feel ashamed. They don't want to endanger the transgender community by providing weapons and arguments to the opposite side, to the conservative camp. So they keep mum, they keep quiet. They feel stupid. They feel that they've made the wrong decision and no one likes to own up to making wrong decisions. And so it's as if you're not allowed to speak about these experiences. People who detransition deserve the same supportive care as young people who wish to transition. Detransitioning can even happen because gender identity is fluid. I keep telling you, it's all in flux. And so we need to be compassionate about these people and we need to study them because studying detransition can shed light on the mechanics and the dynamics and the etiology of transitioning. In short, if we study why people regret transitioning, we're going to learn a lot about transitioning. The decision making that goes into transitioning, the emotions, the cognitions, the causation, what causes transitioning, the connectivity to gender and or sex, et cetera, et cetera. I think detransitioning is a rare opportunity to learn the truth about gender dysphoria, transgender phenomena and so on and so forth. I don't think they should be shunned. Detransitioning is rare. They're not absolute figures, but many authorities say that it's something like 2%. And so these cases are perceived to be isolated and dangerous to the transgender community. So ideology and politics trump, excuse me for the word, trump science. Like you're not supposed to study because there's a campaign going on. There's an agenda here. There's a battle, a war, and you don't ask questions. You don't cast doubts when a war is going on. You're patriotic and you do your duty and you shut up. And that is of course very wrong. It's very wrong. Gender affirming care is a necessity in my view only in late adolescence. Detransitioning is also a necessity. We need to be tolerant of a two-way street. Never mind how slack the traffic is either way. We need to allow people to make choices even after they have made choices. Transitioning shouldn't be a dead end, an irreversible course of action. Transitioning should never be irrevocable. So we need to study this. And the shocking truth is, I know you're not going to believe me, but the shocking truth is there are no large-scale studies tracking people who receive gender care as adolescents. None. There are no studies that ask adolescents who transition. Are you satisfied with your treatment now that you're much older? You receive gender affirming care when you were 13 and then you went through interventions when you were in your 20s and now that you're in your 40s, are you happy with it? Are you satisfied? Have you done the right thing? No one. There have been a series of studies and they had severe limitations. Some focused on people who receive treatment as adults, not adolescents. Some followed patients for a short period of time. Others lost track of like 80% of the patients and so on and so forth. McKinnon says there's a real need for more long-term studies that track patients for five years or longer. Many detransitioners talk about feeling good during the first few years of the transition and after that they may experience regret. Dutch researchers reported the results of a study which supposedly is the biggest study ever. It was a study of transgender youths and they reviewed prescription drug records and so on. They found the Dutch found that 704 out of 720 adolescents who started on puberty blockers before taking hormones continued with the treatment after four years. 16 discontinued. So this sits well with the 2% rule. Only 2% regret the decision. This also would indicate that we are not dealing with social contagion. If 98% of youth who transitioned and were treated received gender-affirming care were treated with puberty blockers and so on. If 98% of them are happy with their decisions, satisfied, continued treatment after four years, that couldn't be merely pure pressure or social contagion which would take some real need, some real urge and desire to transition. And so regret is rare. No one says it's not rare. But even rare phenomena teaches a lot about the rule. Even small minorities edify us about the dynamics of majorities. So we need to study this. Dr. Malian van der Loes, which was the lead author of this study, she says it's important to have evidence-based medicine instead of expert opinion or just opinion at all. And she's right. Science is not about opinions. Science is reliable evidence. Frequencies. Tests. Control groups. What the heck is going on? How can such a much disputed, most hotly disputed area, ethical debate in modern life, ethical dilemma, remain so virgin in terms of scientific studies? And they say we cannot. There's a clinical psychologist. Edward Leeper and he says we cannot carry on in this field that involves permanently changing young people's bodies if we don't fully understand what we are doing and learn from those we fail. We need to take responsibility as a medical and mental health community to see all the outcomes. Part of the problem is that transitioning is ill-defined like many other things in sexuality, in the study of sexuality. De-transitioning for those who transition socially may be another changing name, preferred pronouns, dress, other forms of identity expression. So that's de-transitioning. For those who receive medical treatment, de-transitioning typically includes halting hormone therapy. So not all people who stop treatment, for example, report that they regret transitioning. So this is a complex phenomenon de-transitioning. We have to separate the emotional side from the executive side, decisions to stop receiving treatment from the social side. Some people just stop receiving hormone therapy when they've achieved certain physical changes with which they're comfortable. They go midway. Some are unhappy with the side effects of hormones. Some are unable to cope with long-standing social stigma and discrimination and so on and so forth. We need to go deep, and first and foremost, we need to create terminology, a dictionary common to everyone. We don't have an argument in physics about what is energy or what is a black hole. It should be the same here. There shouldn't be arguments about what is gender, what is dysphoria, what is de-transitioning. For example, patients who had their ovaries or testis removed no longer produce hormones that match the gender-assigned at birth. And so what's happening with these people? We know that they have a medical price and so on and so forth. How do they perceive this medical price, side effects and so on? Are they angry? Are they happy? Was it worth it and so on? Early Van den Buesche, an author of a study in Germany, says many respondents describe experiences of outright rejection, outright rejection from the LGBT plus spaces due to their decision to transition or to de-transition. So this intolerance should stop. On the one hand, the transgender community must open itself up and allow diversity and allow different voices to interact. On the other hand, science should take gender dysphoria a lot more seriously and study the phenomenon time and again, rigorously, until we finally can tell the world and the adolescents who seek our help. What the heck is going on? What is this entity that we are dealing with? Clinical, biological, social, peer pressure, what? And what would happen to them statistically? Should they choose different courses of treatment? I know no other field in medicine so neglected, so infantile and so primitive after 40 years. It's a shame. Time to move on.