There's a lot of discussion whether "trans is real," or, if "trans is real," whether detransitioners were ever "really trans." But before those discussions can meaningfully take place, there needs to be some kind of definition of, & agreement regarding, "What is trans?" 1/

From a medical standpoint, there is no diagnosis of "being trans." Everyone who wants to appeal to a medical diagnosis has only "gender dysphoria" to point to. Many people say, "I was diagnosed!" as if this points to rock-solid evidence of "being" something, "being" trans. 2/

What is gender dysphoria then? What is this thing that "doctors diagnosed"? If you go to the DSM-5 and look at the list of criteria, you'll see it's completely about the person's feelings and beliefs. It's all self-report. https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria 3/

The diagnostic criteria all hinge on words like "preference," "conviction," "desire" and "dislike." If you go to a doctor and express these things, all based on your own feelings and beliefs, the doctor will "diagnose" you with dysphoria. 4/

To make the point a bit more explicitly -- it's not the same as being diagnosed with a brain tumor or a broken bone. The doctor can't run a test or look at a scan and say, "There! There is the problem - the tumor! The broken bone! I can now recommend a treatment to help this!" 5/

So when people talk about being diagnosed with gender dysphoria, yes, they've told the truth about how they feel, but the diagnosis is simply, "This person told me how they feel. They are very unhappy about their body." The word "dysphoria" literally means "anguish." 6/

Check out the etymology yourself: https://www.etymonline.com/word/dysphoria  The doctor hasn't diagnosed you with something concrete, like being in the wrong body. She's diagnosed you with unhappiness, with anguish. 7/

The obvious next question becomes, "How do we treat anguish? What do we know about how to treat anguish? Is the first-line treatment for anguish a lifetime regime of hormones and surgeries?" 8/

I think it's not going too far out on a limb to say that the ***first-line treatment*** for anguish is a respectful exploration of and curiosity about where the anguish is coming from. 9/

In the past, in the 60s, 70s, 80s, 90s, it seemed to be well understood that hormones and surgeries were a last resort in the treatment of anguish, and not the first thing to try. 10/

But I digress: Gender dysphoria is definitely a real form of anguish, and many more people today than in the past are experiencing it. But is the diagnosis, is anguish the same thing as "being trans" -- and what could "being trans" mean? 11/

The simplest definition might be that someone who "is trans" is a person who had gender dysphoria, transitioned, and therefore "is trans." To be trans is to be a transitioning or transitioned person who underwent cosmetic changes in response to anguish. 12/

In that definition, "being trans" is simply a statement about the person's cosmetic choices, their chosen response to the anguish of GD. It's not the *same* as a diagnosis of GD. It's not a claim to metaphysically "being in the wrong body." 13/

But too often, we make a mental leap. People are genuinely diagnosed with GD. They are telling the truth & are really anguished. But we make an unwarranted equivalence between the diagnosis of GD & "being trans" meaning, "being in the wrong body and we must fix their body." 14/

So which definition will we use? It's important, because it drives all the discussions we can have about "being trans." If we mean "being trans means someone has transitioned in some way," well then, there's no argument. It's a statement about behavior. 15/

If we are going to use "a GD diagnosis means you're trans" definition, in the sense that "anguish about the body" signifies you're "in the wrong body," well, then we need solid evidence of that before we can proceed to discuss it that way. What is the solid evidence? 16/

What tests can doctors use? What scans can they run? Don't bring up the "brain scans" please, until you understand both neuroplasticity and the concept of overlapping normal distributions. I mean to ask, what test, what scan, reveals a "wrong body" diagnosis? 17/

To be fair it's an unfair question, unless you believe a person "is" a disembodied gendered soul which can be "in" a body. That's not how science understands it. You're not "in" a body. Your body *is* you. It just is what it is. If you have one you dislike, them's the breaks. 18/

If someone has a body they really dislike, they're in good company. Lots of people dislike their body in ways that are minor (coloring gray hair), medium (getting lipo) or major (having body dysmorphia, the belief that parts of their body are so wrong, they're disfigured). 19/

To me it seems that gender dysphoria, with transition as the solution, falls along this same spectrum of "ways in which people can be extremely unhappy about their appearance and try to feel better about it." It's a cosmetic solution to dissatisfaction or emotional distress. 20/

I would also suggest that cosmetic solutions all come with a cost-benefit attached to them. Coloring your hair is a pretty low-stakes change. You don't like it, change it back. 21/

Having mastectomies, orchiectomies, hysterectomies, genital surgeries, taking hormones with serious side effects for life -- these by contrast are very, very high stakes changes. You can't easily "change it back" -- in some cases you can't at all. 22/

It's common knowledge that high-risk procedures, such as chemotherapy, must be accompanied by high likelihood of a high payoff, a good outcome, like preventing you from dying from your cancer. 23/

But in the case of "transition," this set of high-risk and often irreversible changes is treated as quite literally the only reasonable "treatment" for the anguish of gender dysphoria. 24/

And I think that comes directly from widespread confusion about what it means to "be trans" and whether gender dysphoria is the same thing as "being trans." All the detransitioners who had (or still have) real GD can tell you it's not the same thing. 25/

As for every other condition in the world, we need a set of reasonable treatments for gender dysphoria that are evidence-based, accompanied by a crystal-clear understanding of what it *is* that we are even "treating." May 2020 be the year we figure that out. /Fin