HP/De Tijd - DE TRANSITIE HEEFT MIJN LEVEN VERWOEST

SOURCE: JOHAN KLEINJAN

'Transition destroyed my life'

In the Netherlands, the number of people going to gender clinics with doubts about their sex is increasing dramatically. How many of them will later regret any surgery? HP/De Tijd spoke to Maarten, who went into transition at 16 to become a woman. Now he regrets his hormone treatment and facial surgery. “They never discussed self-acceptance with me.”

Published on: 31/10 | 2022

Written by: Jan Kuitenbrouwer & Renate van der Zee

“Going into transition was the stupidest thing I could have done. It turned out not to be the solution to my problems at all. It only made me feel worse. Before my transition, I had never seriously considered suicide, but after that, I was really afraid I would attempt it. I lived on the fourth floor, but luckily there is such a thing as the suicide prevention line.”

Maarten (23) is a “detransitioner”. He transitioned and then regretted it. Seven years ago, at 16, he was diagnosed with gender dysphoria – a painful discomfort with the sex he was born with. Guided by the gender clinics at the UMC Groningen and the VUmc in Amsterdam, he embarked on a path towards becoming a woman. Six years later, he realised that this transition made him more unhappy than ever. He now lives as a man again. With breast growth due to the female hormones prescribed and a significantly altered face because of “facial feminisation surgery” to make his face more feminine. Even his sexual functioning is not what it used to be.

Maarten: "I went to these gender clinics as a teenager with mental problems and an unrealistic image of myself," he says. "There, they confirmed that I was trans. Then I thought: so I must really be trans, because they are the experts, and otherwise they would never make that diagnosis."

Maarten is part of a boom, a wave of gender dysphoria. From 2012 on, the number of young people approaching gender clinics increased exponentially. In the Netherlands, between 2000 and 2012, there was an average of about 100 applications per year. In 2013, the number suddenly doubled; from then on, the line went up steeply. Now there are almost 8,000 people on the waiting list, including some 2,500 adolescents, more than two-thirds of whom are girls. The UK gender clinic for young people, Tavistock and Portman, received 136 referrals in 2010; by 2022, there were 3,600. In the US, there were two or three gender clinics in the year 2000; now, there are about 60.

So Maarten is one of the young male-to-female transgenders, which form about 30 per cent of all patients. Even when he was little, he sometimes felt it would have made more sense if he had been born a girl. "But it was double. On the one hand, I played with cars and other boys' toys; on the other, I wanted long hair, wore dresses and liked make-up. I lived in a tiny village. Everyone thought I was gay, and that was true, but it was not accepted. I was bullied a lot. I was also treated weirdly by adults sometimes."

Maarten's mother, Marian: "When Maarten told me he thought he was trans, it came as a total surprise to me. He had never given such signals in his childhood. Yes, as a toddler, he liked playing with my hair and dancing wearing a skirt because it swayed so nicely. But yes, a lot of children do that. That never struck me as anything exceptional. At one point, he told me he thought he was bi and then that he was gay. That didn't surprise me. However, he struggled to accept his orientation."

Maarten dismissed my concerns: after all, the experts had made the diagnosis, so it was correct.

Marian, mother of the detransitioner Maarten

Maarten: "When I was ten, my parents divorced, which was very difficult for me. My relationship with my father was problematic, and I had little contact with him. My mother tried her best but didn't know how to get through to me either. After a while, she started a new relationship. I felt left out and alone. Right at that time, the only friends I had left school. Then I freaked out. I was 14, and got depressed. I thought no one loved me and that I couldn't trust anyone because, sooner or later, they would abandon me anyway. I never went outside anymore and was always in my room gaming.

"As a child, I didn't dislike my body. I would have preferred to be a girl but was not unhappy as a boy. But puberty was scary to me, and I hated what it did to my body. Actually, I hated myself and projected that on how I looked and my gender.

"And then I saw a television programme where a boy talked about how he had transitioned and how happy he was now. Then I clung to the idea that I too was trans. I was looking for an answer as to why I was unhappy. And because I had always preferred to be a girl, I thought: this is what I have to do; otherwise I’ll be miserable for the rest of my life.

"On the internet, I watched YouTube channels of transgender people telling how great their lives were. There were also American psychologists - at least that's what they called themselves - offering help and claiming: if you doubt your gender, you are not ‘cis’ anyway. If you do doubt, you are ‘trans’." (“Cis” or “cisgender” means you have no problem with the gender you were born with - ed.)

One explanation for the trans boom is that it has made society increasingly open-minded about sex and gender, lowering the threshold for coming out with a different identification. The question is whether this adequately explains the explosion of trans cases. Something like social acceptance never suddenly changes, and why would this lowering of the threshold apply predominantly to teenage girls? Another explanation is that gender studies and queer theory have evolved into a subculture and ideology, ‘transideology’, which has spread via the internet and has a strong appeal to teenagers who are insecure, isolate themselves, get into that subculture online and turn on each other. It is cool to be trans, and trans is not a disease or condition, it is an identity, a “marginalised” identity, that has to fight for rights and recognition. More trans clinics, for example, and less medical “gatekeeping”.

Maarten: "On trans forums, I also talked to older trans women who had transitioned later in life and they said, ‘You are still young, you can still stop puberty. Look at me, I still look male; I only transitioned after puberty. You can prevent that, but you have to start as soon as possible.’ That got me worked up."

Those trans women were talking about a treatment for gender dysphoria in young teenagers developed in the Netherlands, the “Dutch protocol”. The idea is to use hormones to suppress puberty so that secondary sexual characteristics do not develop. Boys do not grow beards and Adam's apples; girls do not grow breasts or menstruate. So after transitioning, they can more easily resemble someone of the opposite sex. Nikkie de Jager - known for the popular YouTube channel NikkieTutorials - followed this treatment, for example. She has no beard growth, no deep voice, no Adam's apple. Another example is Dutch trans model Valentijn De Hingh.

This treatment is only for young people who have genuine gender dysphoria from early childhood on and are not plagued by other psychological problems. Maarten's puberty was already largely over when he joined the gender clinic at VUmc, so he was no longer eligible for the full course. He was briefly given androgen hormone to stop puberty for good, followed by the oestrogen treatment that would make him a trans woman. That Maarten also suffered from other mental problems raises the question whether he should have been treated like this.

“I was 16 when I ended up at the gender clinic of the UMCG, Groningen's university hospital, via my GP. During one of the consultations I had there, my mother came along. She said she didn't believe I was trans. That my problems had to do with other things, like my homosexuality and my parent’s divorce, but they didn't listen to her. I had the impression that they thought: that woman just doesn't want her son to be trans.”

Marian: “I said during the first interview at the gender clinic that I was worried that maybe other things were going on with Maarten. I asked: what are the checks that he won't regret it later? They replied that the procedures were careful, that they did extensive psychological testing and that regrets were very rare.

"During a later conversation, I mentioned that Maarten still did not want everyone to know, that he also did not wear girls’ clothes and make-up, and that I wondered if his problems were not because he did not accept his orientation and was highly gifted, which made him feel different from others. I said I was afraid that transitioning might exacerbate the problems. That was hard to say in front of Maarten. As a parent, I had a dichotomy: I wanted to support my child, but I also had my worries. I just wanted my child to be happy - as a boy or a girl; it didn't matter to me.

"I trusted that I could safely hand over my child and his problems to the experts. But we swam into a trap. Pretty soon, he was diagnosed with gender dysphoria. Maarten dismissed my concerns: after all, the experts had made the diagnosis, so it was correct."

Maarten: "The psychologists were friendly. Too friendly. They didn't ask critical questions. After only four or five conversations, I was diagnosed with gender dysphoria. For instance, they did not ask about my homosexuality, while studies show that many children who think they are trans turn out to be gay or bi when they grow up.

"I had to write down my life story, and I told them that I had a difficult relationship with my father, struggled with my homosexuality and was lonely. That I hated myself and felt that everyone hated me and that I was looking for what was wrong with me.

"At first, I thought I was bipolar, but that diluted after a while. Then I thought: I'm autistic, but that too got watered down. And then ‘transgender’ came along. I was young and unhappy, desperately searching for a solution, and this seemed so fitting. That was what I wrote down in my life story, and the psychologists only confirmed this. They didn't ask in-depth questions. They didn't ask: why do you hate being a man in the first place? The answer was that I didn't have good experiences with men. My father was aloof and boys always bullied me. But more than hating being a man, I hated myself because I didn't feel loved. There was some form of gender dysphoria, but that did not mean that transition was the solution for me. The gender dysphoria I felt as a child was exacerbated by puberty and my loneliness, but I would outgrow it; I know that now. But those psychologists apparently didn't think of that possibility.

"At a certain point, I moved and was transferred to the VUmc. There I was given testosterone inhibitors and oestrogen pills. That was the only form of treatment they suggested. I was eighteen at the time.

"Those testosterone blockers had all kinds of side effects. My resistance plummeted. Previously, I was rarely ill, now I was sick four or five times a year. And not just flu. Once I had two inflamed ears and a throat infection. That lasted for weeks. I was also always tired and sluggish. If I walked a lot, I got painful jabs in my joints. Inexplicable, they said. But I'm sure it was those hormones. Now that I no longer take those pills, those health problems are over.

"Officially, you have to live as the opposite sex for a while before you can start taking hormones. The ‘real-life phase’, they call it. I didn't dare to do that. I often talked about this with the psychologist. Then I said: if I wear women's clothes now, I feel like a man in a dress. Then I'd rather just be a boy. That should have set off an alarm bell with my practitioners. But instead, they gave me as a 'gift', they used that word, that I could start hormones without a real-life phase."

The trans movement says that “trans” is not a disorder but an identity, gender doctors and therapists are not allowed to question that identity. Trans care should therefore be affirmative. WPATH, the world organisation of trans practitioners, also states this as a principle. Non-affirmative therapy would be dangerous because it gives “distress”, and distress can lead to suicide. The exceptional suicide risk for transgender people is a myth, but a very persistent one. It is used to reinforce the demand for affirmative care. Parents who do not go along with the identification of their child are thus pressurised: "What do you want, a dead daughter or a living son?" (Or vice versa, of course.) Exactly how far Dutch gender clinics go with “affirmation” is not clear. In principle, it does not conform to the “Dutch protocol”, but the fact that Maarten got his real-life phase waived points towards affirmation.

Marian: "He was allowed to start taking hormones to encourage him to start living as a woman. I was dumbfounded by that. Because that meant they were deviating from their own protocol!"

Maarten: "It went well for a while, but after a few months, disappointment set in. I had hoped to look more feminine, but that didn't happen. Whenever I went outside, people would stare at me because they could see I wasn't really a girl. I started isolating myself and as a result, I lost friends.

"I decided to have surgery on my face, to get more feminine features. I thought: if I did that, I'll be really happy. After that surgery, I was no longer stared at on the street, but my problems had not gone away. I was constantly preoccupied with how I looked. I was always watching how people reacted to me. It was a kind of addiction. I always wanted that external validation. I wanted to hear a hundred times a day: you look good.

"When the dissatisfaction with my face was gone, I wanted breast augmentation. I thought my shoulders were too wide, and my hips too narrow. On the internet, I searched for surgeries that could fix that. Until I realised: this is getting too crazy. I realised that I would never reach a point with surgery where I would be satisfied with myself. At that moment, I knew: I have to accept myself as I am. I wondered why I had embarked on this in the first place. Yes, I preferred to be a woman and was not happy with my boy body. But I can’t just become a woman. I can only be a trans woman. And my life as a man was better than my life as a trans woman.

"That's hard to admit to others, but even harder to admit to yourself. For a very long time I thought: if I just continue on this path, it will get better. But it didn't get better at all. And then you have already come this far; can you still go back? And how is it possible that I am not happy, even though the experts have said I am trans? And if this isn't it, then what is?"

Marian: "Maarten was going to have a vaginoplasty, a sex-change operation, and we went to an information meeting about it. The risks were barely discussed, and the consequences were underexposed. Fortunately, Maarten cancelled that vaginoplasty at the last minute. I am grateful for that because I don't think he would have survived.

Maarten: "I was 22 when I decided to reverse things. I was just in time, because a month later I got a call that it was my turn for a sex-change operation. I was on the waiting list for that. I cancelled that, thank God.

"I am doing better now than in the past four years. I have had a lot of support from my mother. But it's a grieving process. The oestrogen gave me breasts; they can only be removed surgically. The hormones also made me less sexually functional. I hope that will come back one day. My face has changed so radically that people from before don't recognise me. I also no longer recognise myself when I look in the mirror, which is painful. I feel alienated from who I used to be. It's like my life has been cut in two."

Marian: "Maarten has been damaged for life. I'm so sorry I didn't listen to my feelings better and get cross with him. But I also wanted to support him, you understand? They need to be much more careful with children who suddenly think they are trans during puberty. They need to look much more closely to see if there are no other issues at play."

Maarten: "I'm in therapy now. My therapist was shocked that this could have happened under the supervision of psychologists. I think those psychologists should have said: you have such a complex past, first go into therapy to process all that and then come back. I wouldn't have liked that, but I would never have come back, I'm sure.

"There are other and sometimes better ways to treat gender dysphoria than with a medical transition. Psychotherapy, overcoming your fears, learning to accept yourself. But self-acceptance was never discussed with me. You have to look at individual cases: what does that person need? I went back to the clinic earlier this year to get redress. I said: I was a teenager; why did you go along with the unrealistic ideas I had about myself? You pretended I was an adult. They replied: you wanted it yourself. But how can a 17-year-old boy with all kinds of mental problems know what is good for him?"

The main question is: how typical is Maarten's case? How often people regret a gender transition is a hotly contested topic. There are few hard figures (yet). A 2018 study by VUmc Gender claims it is about 0.5 per cent, but it rarely mentions that at the end of the study period, 38 per cent of respondents were "lost to follow-up" - disappeared. And that's despite usually needing to continue hormones after transition and twice-yearly check-ups with your endocrinologist. Where did those patients go? So in the theoretical case that they all dropped out because of regrets, the detrans rate is over 38 per cent. But let it be half, that's still 19 per cent - also shockingly high for irreversible medical treatment. One thing is certain: that 0.5 per cent is totally unrealistic. How many it really is, we will see in the coming years. When people regret a gender transition, it usually happens five to 10 years later. Maarten and many detransitioners from his 'batch' are convinced they are the forerunners of a big wave, which will become visible in the coming years.

Maarten: "I hope this transgender law doesn't pass. That they don't make it possible for children to simply change their birth sex at the civil registry. Because the law will mean leading children down a path that may not be good for them. I hope they can grow up quietly first before making such drastic decisions. We know many children grow out of gender dysphoria, don't we? I have experienced that myself. I have now hired a lawyer. Transition destroyed my life, and I now have to rebuild it."

Marian: "In my innocence, I thought: they are experts; they can properly assess Maarten’s problem. That turned out not to be the case. It's as if when they make the diagnosis they think: if it's not right, that will show during treatment. But during treatment, they no longer look critically, because the diagnosis has already been made. We would have been better off going to a good psychologist. If only I had been more critical. Even more critical. Well, now it's too late. I wonder if I will ever be able to forgive myself."

So I really must be trans, I thought, because they are the experts, and otherwise, they would never make that diagnosis.

Maarten, detransitioner

A girl with a similar story to Maarten's is Keira Bell, also 23. At London's Tavistock gender clinic, she underwent a transition from woman to man. Her puberty was blocked; she was given testosterone, developed beard growth and gained a deeper voice. At 20, she had her breasts removed. Over a year later, she regretted it. Her femininity was not the problem at all, she realised. The transition solved nothing and she was forever trapped in the no man's land between male and female.

Bell sued Tavistock; the clinic should have protected her from herself. Her case received a lot of publicity; more details came out about Tavistock's failing trans care. The British government launched an enquiry, which turned out to be devastating for the clinic. Patients were put on puberty inhibitors without thorough psychological examination, sometimes for too long at a time, mastectomies were allowed too easily, and counselling left much to be desired, as did the registration of patient data. The findings were so shocking that Tavistock, the largest gender clinic in the world, was immediately closed down by order of the government. UK gender care will be organised completely differently from next year, with an emphasis on psychotherapy and 'watchful waiting'.

By going public with his story, Maarten hopes to achieve something similar in the Netherlands: that there will be more openness and discussion about what is now the best way to deal with all those thousands of young people who think they are 'trans'.

Maarten: "You can compare detransition to deradicalisation. It's like stepping out of a cult. Step by step, I fell away from the belief that transition is the only solution. I was then approached by trans people I knew from before. They tried to convince me that I did welcome my transition and that I should remain a trans woman. The trans community is now very hostile to me. They want me to shut up, because they say I am depriving people who do benefit from their transition of their happiness in life. But they fail to see that it is actually important to warn children and parents against an ill-conceived transition. Still, I do. Then maybe something good will come out of my mistake after all."

Maarten and Marian are pseudonyms; their real names are known to the editors.

Response gender clinics

Knowledge and Care Centre for Gender Dysphoria at Amsterdam UMC (location VUmc):

We regret that interviewees are dissatisfied with the treatment and outcomes. Due to privacy rules, we cannot and are not allowed to comment publicly on patient data. Amsterdam UMC's Knowledge and Care Centre for Gender Dysphoria (KZcG) offers multidisciplinary care in which many specialisms work together to explore with a person and their environment what they need to be themselves in terms of gender. It requires careful coordination to achieve optimal care. Scientific research at KZcG contributes to the further improvement of gender care and provides more insight into the wishes, gender feelings and gender development of these care users.

Throughout the treatment pathway, there is constant monitoring and fine-tuning to ensure patients receive the right and appropriate treatment. Different steps in the transition take place after multidisciplinary decision-making. We stand for customised care in which each patient is offered a personalised pathway. Some parts of treatment, such as gender-affirming facial surgery, involve risks. Patients are extensively informed about these risks and possible complications before the procedures. KZcG likes to evaluate with individuals who look back negatively on their transition so that care can be even better tailored in the future.

The UMCG gender clinic did not respond to our request for a response by the deadline.