Florence Ashley is a Canadian bioethicist, speaker and activist based in Toronto. They are a guest speaker at the 2021 health summit hosted by the Community-Based Research Centre (CBRC), a community-led research and advocacy group in Canada promoting the health of gay, bi, trans, Two-Spirit and queer men. Called Disrupt and Reconstruct, the summit takes place online from Oct. 27 to 29. The following essay is adapted from Ashley’s keynote address.
At the end of 2020, Quebec passed a law that banned conversion practices across the province—the first in Canada to protect both youth and adults. These practices aim at changing, repressing or discouraging people’s sexual orientation, gender identity or gender expression (often known by the acronym SOGIECE). Driven by the belief that being queer, trans or gender nonconforming is a sin or otherwise undesirable, these practices try to turn us all into cisgender, heterosexual, gender-normative subjects.
Although the Quebec law passed, the process was not without worry. I remember waking up to worried text messages from a legislator a month earlier. Members of the National Assembly had received letters from groups claiming that including gender identity under the law’s protection would do untold harm to the many youths who “falsely” believe themselves to be trans due to social contagion, mental illness and unaddressed trauma. Hoping to take the wind out of their sails, I rushed to write a carefully sourced letter emphasizing the unsubstantiated nature of those concerns.
In the end, the legislators were not swayed by the anti-trans arguments. Respite was short, though: a few weeks later, the same dance was repeated as the federal Standing Committee on Justice and Human Rights received a deluge of submissions asking for the exclusion of trans people from the government’s proposed national ban on conversion therapy.
Organized opposition to protecting trans people from conversion practices is not an isolated phenomenon. It’s part of a broader movement against trans existence that surged in Canada, the United Kingdom, the United States and many other countries in the last decade. The U.K. recently saw Bell v. Tavistock, a court case that successfully curtailed minors’ access to puberty blockers and hormonal transition until it was overturned on appeal. And in the U.S., many states have passed or are trying to pass laws that would criminalize providing gender-affirming medical care to minors.
When I began my research on trans conversion practices years ago, trans conversion seemed to be on a slow decline. These practices were far from disappearing, with anywhere from 12 to 20 percent of trans people experiencing them; but the consensus around gender-affirming care was solidifying, and the old guard that engaged in conversion practices was retiring or dying. Looking at the upsurge of opposition to trans youth care in the last few years, however, I fear a resurgence of trans conversion practices. Young therapists who were previously uninterested in trans youth are beginning to publish papers opposing gender-affirming care and calling for more “exploration.” Access to care is regressing in Europe, with countries that previously offered gender-affirming care, such as Sweden, now disallowing it before the age of majority. Parents who may previously have tolerated or even accepted their child’s gender identity and expression are now told by conservative politicians and alleged “feminists” that they should reject their children’s identities and take them to therapists who will help them “accept their natal bodies.” And because trans youth care has become so partisan and polarized, empathy and scientific expertise is far less likely to win over undecided parents.
Let me be plain: the organized opposition to gender-affirming care is serving trans youth to conversion practitioners on a silver platter. In the coming years, we will likely see more and more conversion practices targeting gender identity and expression. And, worrisomely, it will likely take more than a decade before we can fully assess the resulting consequences and the devastating harms on members of trans communities. As research teaches us, trans people who have experienced conversion practices are 2.27 times as likely to attempt suicide in their lifetime, and 4.15 times more likely if they experience conversion practices before the age of 10. If these numbers weren’t worrisome enough, the overall suicide attempt rate in trans communities is about 40 percent. We are not dealing with small numbers.
Those who want to fight the resurgence of trans conversion practices should be aware of the rhetoric used to promote it, and how to respond. At the heart of movements opposing gender-affirming care are the related theories of “desistance” and “rapid-onset gender dysphoria.” The theory of “desistance” argues that about 80 percent of trans children naturally grow up not to be trans, whereas the theory of “rapid-onset gender dysphoria” claims that we are in the midst of an epidemic of youths falsely believing that they are trans due to social contagion, mental illness and unresolved trauma, including internalized homophobia and misogyny. While both theories purport to be scientific, they fall apart under closer scrutiny and have been widely criticized by the scientific community for their methodological flaws and questionable interpretations of evidence.
The theory of desistance is based on all children referred to gender identity clinics—even though as many as 90 percent of them didn’t identify with a gender other than the one they were assigned at birth. The theory of rapid-onset gender dysphoria, meanwhile, is based on a single study that recruited parents from transphobic websites and asked them if they thought their child came out “out of the blue” and due to social pressure. The study also claimed that the children’s worsening mental health was due to not really being trans—not the much more obvious answer of having transphobic parents. (If you are interested in knowing more you can read the two peer-reviewed articles I wrote debunking these theories.)
The take-home message is that even though the claims may sound scientific, science does not support them. As I explain in my work, these theories are “a deliberate attempt to weaponize scientific-sounding language to dismiss mounting empirical evidence of the benefits of transition for youth.” Unsurprisingly, the theory of rapid-onset gender dysphoria has been openly rejected by the American Psychological Association and the World Professional Association of Transgender Health. Trans youth know who they are. Gender–affirmative care remains the tried–and–true consensus approach in trans youth care. By contrast, trans conversion practices are opposed by virtually every respectable professional organization. Identifying conversion practices and rhetoric, combatting misinformation and promoting gender-affirming care are critical to curbing the coming resurgence of trans conversion practices.
Solely engaging anti-trans movements on scientific grounds, however, would be missing the mark. While they purport to be scientific, movements against trans youth care, like the theories that they appeal to, are not based in science and reason. More often than not, they are based on a deep, visceral reaction of the possibility and desirability of transness—whether in general, or for a particular individual. This is a juncture not won over with reason but with heart.
To fight trans conversion practices, we must engineer a world in which youth coming out as trans is a moment to rejoice in—a world in which devaluing transness is unthinkable. And for that to happen, we must make trans lives not merely livable but allow them to flourish. So show up for trans people everywhere. Support trans people in your lives—especially those who are the most marginalized. Amplify their voices. Advocate for them. Demand institutional and structural changes. Tolerance was never enough.