Social Transition is a Dangerous Psychological Intervention

Social transition is not evidence-based but it is potentially harmful

• The gender affirming care model (GAC) has been the predominant intervention used to treat gender dysphoria, which is a mental disorder that occurs when a person has psychological distress about their biological sex.
• The first step in the GAC intervention is called social transition. The purpose of the GAC intervention and the social transition step have been described as a means for reducing psychological distress and preventing suicide (also referred to as “life-saving care” by proponents of such intervention).
• Social transition, along with the entire model of GAC, has been shown to be ineffective at impacting the purported outcomes, and the evidence used to support the intervention has repeatedly been deemed low quality.

Defining a psychological intervention and social transition:

The World Professional Association for Transgender Health’s (WPATH) standards of care, version 8 outlines the following changes as steps that the person who is undergoing the social transition intervention might undertake:

• Selecting a new name, pronouns, identification (e.g., birth certificate, identification cards, passport, school and medical documentation, etc.).
• Participating in sex-segregated programs and spaces.
• Changing hair and clothing style to match the psychological identity.
• Communicating one’s preferred gender to others.

• The American Psychological Association (APA) defines an intervention as an “action on the part of a psychotherapist to deal with the issues and problems of a client.” A clinical intervention is administered by a psychotherapist to improve health and is based on the willingness of the client.

Social transition is a clinical intervention, but it is not innocuous. It can have substantive effects on a developing child.

Without proper diagnosis, there will be confusion about who can apply an intervention.

Confusion about gender dysphoria as a mental health condition has made it unclear who is authorized to apply a psychological intervention like social transition.

Gender dysphoria and other psychological diagnoses contained in the Diagnostic and Statistical Manual for Mental Disorders are made by a qualified medical or mental health professional. This excludes those outside the medical and mental health profession (e.g., paraprofessionals, educators, and parties responsible for the care of minors).

• Good clinical practice starts with an assessment and a mental health diagnosis or a provisional one. This helps determine a treatment plan and the appropriate intervention(s).
• The Biden Administration confused the diagnostic process by taking administrative actions that treated the gender dysphoric experience as a protected class. This was seen in policy changes to section 1557 of the Affordable Care Act, Title IV and women’s sports, and foster care.

The protected class designation doesn’t make sense given:

Thoughts and feelings, even gender dysphoric ones, are mutable and should not be characterized as static traits or a fixed condition.

The growing population of people detransitioning from the social and medical transgender procedures (e.g., r/detrans) indicates that dysphoric feelings can change.

Social transition introduces new negative outcomes

• Children who are given basic support and/or left alone (without intervention) mostly come to embrace their biological sex at a rate that ranges from 65% to 94%. This means that there is a 65% to 94% success rate when no intervention or a supportive model is applied.
• Not only is non-intervention better at abating psychological distress than the GAC model, but nonintervention performs better than most psychological interventions associated with a DSM diagnosis (e.g., Leichsenring et al., 2022).
• Those who are encouraged to socially transition tend to go on to the more dangerous and physiologically invasive aspects of the GAC model (e.g., cross-sex hormones, surgeries) and may still suffer from dysphoric symptoms (e.g., Sweden, Finland, England, Denmark, U.S.).
• An emerging body of literature evidences that patients are reporting regret from GAC and are recognizing other substantive reasons that better explain their desire to transition.

Factors unaccounted for in the gac model

• Child development: Decades of cognitive research show that children in the preoperational and concrete-operational stages think in immediate, concrete terms and lack the capacity to reason through long-range implications.
• Children are suggestible to adult cues. Adults can influence how children come to understand themselves.
• When a child adopts a new name, pronouns, and social role, the adults around that child inevitably respond in ways that reinforce the new identity.

Comorbidities: There are known comorbid factors associated with those struggling with gender dysphoria. This area of research has been neglected despite an awareness of social and psychiatric factors (e.g., The Trevor Project) that might best account for the symptoms of gender dysphoria. Some of these factors include:

• Traumatic experiences
• Psychiatric issues
• Autism

• Other Considerations: The long-term psychological and sociological effects of engaging in social transition have not been researched. There is potential for this intervention to have a far-reaching impact on child development, the coherence of the minor’s identity through adulthood, and how they relate to others.
• There is also evidence that aspects of social transition can be physiologically damaging, which further supports the conclusion that social transition is a dangerous practice.

Clinicians and non-clinicians should not be using social transition based on the low-quality evidence and potential for negative outcomes. The intervention is easy to implement, and unauthorized parties have readily used it on minors with few repercussions. This practice must end.

A full report with policy recommendations can be found here.