Seven years ago, in my first Public Discourse article, “I Was a Transgender Woman,” I shared that the reprieve provided by surgery and life as a woman was only temporary, and that traumatic childhood events explained my desire to identify as female. In my experience, and those shown in many other personal testimonies and academic studies, the neglect of traumatic childhood events and other mental health issues leads to an excessive focus on gender and a potentially dangerous rush to medical and surgical interventions.

Medical professionals have coined the term Adverse Childhood Events (ACEs) to refer to a range of negative situations a child may face or witness while growing up, such as physical neglect, parental separation or divorce, living in a household in which domestic violence occurs, or living in a household with an alcoholic. These experiences negatively alter the brain at a deep level where most basic needs originate and a person’s identity is formed.

According to Dr. André Van Mol—the co-chair of the American College of Pediatricians’ Committee on Adolescent Sexuality and a contributor to Public Discourse on transgender issues—in the overwhelming majority of cases, the desire to switch one’s gender identity is closely connected to adverse experiences in childhood. More broadly, studies have reported a high frequency of childhood emotional and physical neglect and abuse among transgender-identifying individuals.

In my case, my longing to identify as female was due to early childhood trauma that fractured my male identity. My grandmother made a purple chiffon evening dress for me and affirmed me as a girl from ages four through six, and my uncle sexually abused me before I was ten. In my desperation to cope with the abuse, my child’s mind invented the belief I should have been a girl.

Thousands of former transgender-identifying individuals have contacted me over the last twelve years, and their stories always include ACEs that were never treated. Hurtful events of childhood—a loss or trauma such as divorce, an alcoholic parent, or sexual abuse—started the desire to become someone else.

More recently, I’m hearing from parents whose teenagers suddenly announce they are transgender. With a few e-mails back and forth, the parents identify what might have happened to precipitate the child’s crisis. Some say their teens have anxiety over the bodily changes of puberty, or don’t have friendships and adopt a transgender identity to garner positive attention at school. Some parents review the teen’s internet history and discover that strangers on the internet befriended their vulnerable teens and urged them to transition.

I hear from young adults who transitioned and want their lives back. They share with me that they had mental illness, or they were addicted to pornography or anime games, or they were bullied, or perhaps they didn’t feel valued in the family.

The Role of Mental Illness in Transgender Belief and Surgery

Trauma in childhood is known to have broad impact on child development and on the occurrence of mental health problems later in life, while some academic research shows that mental illness precedes the onset of transgender ideation in young people. This suggests that gender distress is not the problem—mental illness is.

For example, a major 2018 study of mental health in transgender-identifying youth found overwhelming evidence that mental illness is present before the onset of transgender belief. This study compared over 1,300 trans-believing youth with age-matched peers using clinical data gathered from three large pediatric practices in California and Georgia. The findings were startling and alarming. Psychological disorders such as anxiety, depression, and attention deficit disorders were several times higher than the peer group, suicidal ideation was up to 54 times higher, and self-harm was up to 144 times higher.

Similarly, Professor John Whitehall, Professor of Pediatrics at Western Sydney University, reports that “numerous reviews reveal the majority of children confused about their gender also suffer from diagnosed mental disorders, such as depression and anxiety. Moreover, there is an extraordinary representation of children with Autism Spectrum Disorder whose appreciation of reality is already known to be challenged.

It is folly to suggest that the first and only step in treating deep hurt and trauma done to a person’s identity in childhood is to alter the body with cross-sex hormones and surgery.

Given the role of ACEs and mental illness in the development of beliefs about transgender identity, it is folly to suggest that the first and only step in treating deep hurt and trauma done to a person’s identity in childhood is to alter the body with cross-sex hormones and surgery.

But that’s exactly what is happening today. I hear from people who wake up from the transgender surgery nightmare, distraught and sometimes suicidal for allowing something so destructive and ineffective.

So-called “gender specialists” often ignore evidence of coexisting mental issues or dismiss it as irrelevant, diagnose patients with “gender dysphoria,” and immediately prescribe cross-sex hormones and surgery on healthy body parts.

For example, in a November 2021 article, clinical psychologist David Schwartz explains ways in which existing mental conditions are often ignored. He reports that in a significant number of cases with young people for whom gender was the ostensible issue, it turned out that more serious psychiatric conditions were present but not mentioned by the child, the parents, or educational or health professionals.

Schwartz argues that “the use of pharmacological and surgical interventions in the treatment of gender dysphoric youth, especially in light of what is known about the transience of cross-gender identification in children, is mistaken both clinically and ethically.” He recommends psychotherapy as the best treatment option for these patients.

The neglect of mental conditions and the rush to surgery happened to me in 1983, even though I shared my cascade of early-life adverse experiences with my own gender specialist. As research indicates, this playbook continues today, even in the case of young people. For example, two recent studies report that detransitioners felt they had been rushed to medical interventions with irreversible effects, often without suitable (or any) mental health treatment.

As Texas Attorney General Ken Paxton concluded in a legal opinion last month, inflicting irreversible interventions on innocent children who can’t perceive the long-term consequences constitutes child abuse.

The Destructive Detour of “Gender Dysphoria”

Why would medical practitioners overlook mental illness and rush to treatment or surgery? One factor is the diagnosis of “gender dysphoria.”

In 2013, the American Psychiatric Association changed the diagnosis of “Gender Identity Disorder” to “Gender Dysphoria” and stated that the goal was to reduce stigma of mental illness for the patients (no longer “disordered”), yet still provide a diagnosis code to satisfy the insurance companies. It was not about providing better care based on scientific evidence, but to allow the patients’ feelings and perception to dictate the diagnosis and make others pay for “treatment.”

The APA fact sheet emphatically advises: “People whose gender at birth is contrary to the one they identify with will be diagnosed with gender dysphoria.” Nothing is said about psychotherapy or treating existing mental conditions first.

The disastrous effect is that once clinicians make the diagnosis of gender dysphoria, they stop looking for contributing factors such as mental illness and adverse childhood experiences. They skip psychological evaluation and proceed directly to prescribing cross-sex hormones and removing healthy body parts. The exclusive focus is on “gender” to the exclusion of all else.

Diagnosing someone with “gender dysphoria” is a destructive detour in patients with mental disorders and identity confusion, as demonstrated by the case of Richard, a young man who cried out to me for help.

The issue is not gender “misassigned” at birth. The true concern is a broken core identity.

Richard received ongoing psychiatric care from the age of thirteen, and was diagnosed with schizophrenia and bipolar disorder arising from physical and sexual abuse. His precarious mental state didn’t stop the clinicians from diagnosing him in 2021 at age twenty-six with gender dysphoria, stuffing him with cross-sex hormones, and surgically refashioning his healthy, fertile male genitals into a crude, barren pseudo-vagina, destroying his dream of someday having children of his own.

Five months after surgery, in August 2021, he reached out to me for advice, stunned that they did this to him. “I didn’t have gender dysphoria,” he insists.

Richard’s extreme example demonstrates how completely desensitized so-called “gender specialists” are to the medical malfeasance they perpetrate. No matter how well intended, recommending genital surgery or breast removal to someone with serious mental disorders is torture only a mad scientist would think appropriate.

Furthermore, mental illness doesn’t magically dissipate but often persists after surgery. In a nationwide long-term follow-up study of adult transgender cases in Sweden, psychiatric morbidity, suicide attempts, and suicide deaths were highly elevated after sex reassignment.

Resolving the Trauma

People need appropriate treatment for psychiatric conditions first. Instead of diagnosing with “gender dysphoria,” strike out the word “gender,” and focus on dysphoria.

Dysphoria is a classic psychological term that describes generalized unhappiness, restlessness, dissatisfaction, or frustration. Dysphoria is a symptom associated with a variety of mental conditions, such as stress, anxiety, depression, and substance use disorders, themselves instigated by childhood experiences. As such, the issue is not gender “misassigned” at birth. The true concern is a broken core identity.

The way out of this medical misbehavior lies in acknowledging that transgender identification has deep roots in the psyche and evaluating gender distress through the lens of adverse childhood experiences.

I have been fortunate to learn what I know from thousands of transgender-identifying people contacting me for help to go back. What I have seen is that people who are disillusioned with the trans life and who want healing are willing to review the painful, buried events of their past.

Personal narratives are so powerful. To raise awareness of this hurting population, I gathered thirty representative stories from actual emails into the book Trans Life Survivors. The stories are heartbreaking, but they need to be heard as a counterpoint to the prevailing (and erroneous) narrative that everyone who follows the transgender path is happy and regret is rare.

The work of uncovering, acknowledging, and treating what happened is difficult and can take time, but it’s the only way to true healing and restoration.

Individuals who feel distress about their gender need the expertise of someone knowledgeable and trained in the treatment of adverse childhood experiences—a trauma therapist. A skilled trauma therapist will ask probing questions to help the client identify the disordered thoughts and discover the link to childhood experiences.