When I was in sixth grade, I made a decision that changed the course of my life. I decided not to try out for the middle school swim team. I know that might not sound like a big deal, but it was. As a grade schooler I was a standout swimmer — strong shoulders and back, and well-muscled legs that powered me through the water with ease and speed. I was disciplined, obsessive. My form was excellent. My coach saw potential.
Had I stuck with it, my life might have turned out pretty different. I might have been a popular jock rather than a lonely weirdo. I might have become a varsity athlete who won admission to a top college rather than a barely graduated teenager who had to take remedial math at a community college to scrape my way into a not-very-competitive school.
I have been thinking about this decision a lot lately, because many of us have been forced, regardless of whether we want to, to think about children and the decisions we allow them to make, and what it might mean for them to regret those decisions. I am speaking, of course, about the ongoing war over transgender and gender-nonconforming children.
For people on the right who oppose gender transition at any age, the argument is simple: There are two genders, and people who think they are a different sex or gender than the one they were assigned at birth are delusional; indulging that delusion is wrong. Biological reality requires all people to simply live with the gender associated with their birth sex. (Unless they are intersex, in which case it is evidently OK for parents and doctors to decide and surgically alter a child’s body to conform with that decision without the child’s consent or even knowledge.)
For those liberals and progressives who fret about the rapidly changing gender landscape, the agonized argument over gender-affirming care for children is different. As this thinking goes, there is a small category of people who were born in the wrong bodies, and those individuals are entitled to express their identities. But when children say they are one of these people, we must be extremely careful and rigorous in being absolutely certain that their gender identities have been unearthed and verified through a lengthy medical and psychiatric inquiry before they are validated by social, legal and medical interventions. We must be sure that this is the pure expression of an immutable self, not simply the adoption of a fad or the byproduct of autism or bipolar disorder. The possibility that children might make irreversible decisions on this particular question that they later regret is, for many people, simply intolerable. Transition, to borrow a phrase, should be safe, legal and rare.
We allow children to make irreversible decisions about their lives all the time, ideally with the guidance and support of the communities that care for them. Sometimes they regret those decisions. The stakes vary, but they are real. So what are we saying, really, when we worry that a child will regret this particular decision, the decision to transition? And how is it different, really, from the decision I made to quit competitive swimming? To many people — I am guessing most — this question is absurd. How could you possibly compare something as fundamental and consequential to one’s life as gender to something that seems comparatively trivial, competitive sport?
Most Americans believe there is a clear and absolute binary between genders. In May, the last time Gallup polled on the issue, 55 percent of Americans said they believed changing one’s gender is “morally wrong.” It’s not hard to understand why. Man and woman make a dyad as old as time, written in our chromosomes, our religious texts, our myths and legends.
Many major identity categories, like race, gender and ethnicity, seem absolute and immovable. But dig a little deeper and quickly you realize how malleable and mutable they are. Indeed, the freedom to participate in the way you are viewed through these identities is a basic part of being a modern human. So is the right to change your mind about them over time.
For a binary identity that is supposedly so fixed and powerful, gender eludes and confounds us constantly. Efforts to define the terms “man” and “woman,” so popular on the campaign trail as gender identity has become a white hot issue in our politics, inevitably end in unsatisfying tautologies. Merriam-Webster unhelpfully defines a woman as “an adult female person.” Look up “female” and it says “relating to, or being the sex that typically has the capacity to bear young or produce eggs,” a description that is both imprecise (“typically”) and incomplete (what of women born without these capacities?).
Personally, I have never had much use for binaries. I was born to a Black African mother and a white American father, the beginning of a life that has included many identities and many hyphens, and doubtless will include more with the passage of time and the ever-gathering tumbleweeds of experience. I am Black but also mixed race; I am a woman but the way I look and dress means I’m constantly taken for a man; I’m American but also African, but not African American in the sense that that term is usually used; I am a lesbian but had happy (and unhappy) romantic relationships with boys and men in my youth.
Sorting humans into immutable identities has always been a fraught business. In South Africa, the apartheid state was so committed to its racial classification hierarchy that it employed bizarre tests to sort people into categories. The most absurd of these was the pencil test: If a pencil placed in a person’s hair fell out, they were not Black but some other, interstitial category. If their curls were tight enough to hold the pencil in place, they were Black, a designation with life-determining consequences.
In polite society, we don’t do this kind of sorting and ranking of identities anymore. But the last frontier in binary sorting is the first binary known to humankind, the one all of us experience in some form or another. The gender binary is the cornerstone of human existence. Troubling it in the way that young people are today is no small thing. To most people, changing genders is a big deal. The way to make sure you don’t regret it is to be really sure you know what your gender is. But that isn’t quite as simple as it sounds.
How do we know who we are? This may seem like a profound, philosophical question. The exhortation to know yourself is, after all, one of the most famous and ancient utterances in Western civilization. But it is also an interesting question to ask yourself in a more literal sense. Because what we discover, if we are really honest with ourselves, is that most of the time we know who we are because someone told us.
I discovered this when I was made aware of an immutable fact about my identity at the rather belated age of 10. It happened during gym class, in the heat of a game of dodgeball. My family had recently moved from Kenya to Minnesota, my dad’s home state. A boy shoved me and called me a racial slur. Our horrified teacher leaped into action, consoling me and sending the boy, who I now understand is white, to the principal’s office.
But I wasn’t upset. I was confused. What was this word that caused all this tumult, and what did it have to do with me? Growing up in Kenya, I was of course aware that my parents had different skin tones and that my light brown skin was a result of that mixture. I had many friends who also had mixed parentage, but the identity categories and hierarchies that held meaning for us were the countries or tribes our parents came from or what languages we spoke at home. So I knew nothing of the American binary between white and Black, the core identity concept of race.
To put it plainly, I did not know I was Black. This central identity, plain as day to any American who looked at me, was completely invisible to the 10-year-old classmate who apparently possessed it innately and inescapably. I assimilated this news into my consciousness with no rancor, just some confusion and bemusement. There was nothing wrong with being Black, I knew, whatever the white boy might have been trying to tell me. It sent me down a rabbit hole of belated discovery, reading books like “The Autobiography of Malcolm X” and “Invisible Man,” “The Color Purple” and “The Bluest Eye,” to try to understand this new identity that I now inhabited.
Much later in life, I learned that concern that just such a moment might happen was a preoccupation in the white, Midwestern milieu my father came from. This makes sense; my parents married less than a decade after the Supreme Court declared bans on mixed-race marriage unconstitutional. Mixed-race children — “tragic mulattos,” as they were known — were a common trope in American literature and film, portrayed as a byproduct of doomed love or evidence of the crime of rape. They were seen as something that, in an ideal world, should not exist, in the same way some see transgender children now.
In 1973, the year my parents married, just 29 percent of Americans approved of interracial marriage, according to Gallup. By 2021, 94 percent of Americans said they approved of interracial marriage. This transformation, which has taken place over just two generations, is a very good thing.
Race is not an exact parallel for gender identity, but as categories, we experience them in large part through the perceptions that others have of us, based largely on our outward appearances. Gender identity, many will argue, is fundamentally different, and medically or surgically altering your body to better align with your gender identity is a drastic intervention, especially for a child. But is it so different?
Lately I have been asking people this question: Do you remember the first time someone informed you of your gender? It’s a nonsense question, of course. No one remembers. Mine was first declared to me, and everyone else involved, in the birthing room. Nowadays, for many people, gender is given to them well before they are born, and perhaps even heralded with cannons of pink or blue confetti at a gender reveal party. Maybe that’s what makes it seem so immutable? It’s an early, definitive declaration.
As children, we are given many things — some are biologically inherited, like hair and eye color, while other things, like names, religion and folkways, are bestowed upon us by our families and communities. Some people find these things they were given regrettable, and some, even children, change those characteristics.
According to the American Society of Plastic Surgeons, in 2020, more than 44,000 people between the ages of 13 and 19 got a rhinoplasty, the most common surgical cosmetic procedure performed on teenagers. Thousands of kids went under the knife for chest surgery — 3,200 girls got breast augmentations and 1,800 girls got breast reductions, while 2,800 boys had surgery to remove breast tissue from their chests, presumably to help them conform better to their gender identities. Indeed, many if not most of these often irreversible interventions on children’s bodies are designed, in one way or another, to help children feel better about their appearances in a way that is inescapably bound up with gender.
In all, roughly 230,000 cosmetic procedures were performed on teenagers in 2020, 15 percent fewer than the year before, presumably owing to the pandemic. That drop was smaller than I expected. It underscores just how desperate these children were to change their bodies that even in the first, terrifying year of a deadly pandemic, when most of us were avoiding medical settings like the literal plague engulfing us, teenagers had, with their parents’ permission, hundreds of thousands of mostly elective medical treatments. Many of these were adolescent girls seeking the small, cute noses that fill our television screens and fashion magazines, chasing an ideal of feminine beauty that feels forever out of reach.
More than 90 percent of cosmetic procedures are performed on women and girls, but there has been a notable boom in several kinds of cosmetic procedures for adult men. Expensive and complex leg-lengthening surgeries that can add a few inches to a patient’s height are rising in popularity. ProPublica and The New Yorker recently published a long investigation into the boom in implants that can increase the size of a man’s penis but also can come with significant complications and side effects.
Cosmetic procedures can produce regret, sometimes famously so. The actress Jennifer Grey had a career-imploding rhinoplasty, which prompted years of cruel punchlines. Some famous young people who have these procedures later spoke of regretting them — Kylie Jenner has spoken of regretting a breast augmentation surgery performed when she was 19, and Bella Hadid of regretting a nose job at 14.
These are covered in the media as the ordinary stuff of human regret: A person made a choice and had complicated feelings about that choice in the aftermath. You live and learn. There has been no stampede to ban such treatments for children. Some might disapprove of these decisions, as some do of all cosmetic surgeries, but we rightly understand them as freely made choices of human beings who have the right to decide what they do to their own bodies. In the case of children, these decisions are made in a context of community, in consultation with parents and doctors. These procedures usually affirm the gender the child was assigned at birth, the one that, in most cases, matches the child’s sex as birth.
People who express regret about a gender transition are seen in a very different light. A handful of such people have appeared over and over again in news stories across the world, portrayed as the harbingers of a tsunami of regret that is always about to arrive because countless children are being carelessly affirmed by an ideologically driven activist community in their mistaken beliefs that they are transgender. In this telling, impressionable children, especially those assigned as female when they were born, are falling into a fad or being manipulated by the so-called gender ideology that taught them to reject womanhood. Most chilling to some is a mistaken belief that medical transition routinely causes permanent sterility, foreclosing any chance at parenthood. (Some treatments, including cross-sex hormones, can hamper fertility in a patient, but the effects are often reversible — plenty of transgender people, men, women and nonbinary people become biological parents.)
Statistics on gender transition medical care for children in the United States are not easy to find, but last year Reuters performed an analysis of insurance data to try to quantify the number of children receiving medication or surgery as a treatment for gender dysphoria. It found that the number of children accessing puberty blockers had risen, from 633 in 2017 to 1,390 in 2021. The number of children in hormone therapy had more than doubled, to 4,231. The analysis found evidence of 56 genital surgeries between 2017 and 2021. The number of children who underwent mastectomies as treatment for gender dysphoria in 2021 was 282, up from 238 in 2019.
Even if these numbers are significantly undercounted — the data do not include treatment paid for out of pocket — medical transition for children, an issue that has received a huge amount of attention from the news media and politicians, is very uncommon. You would not know that from the 590 bills targeting transgender people that have been introduced in 49 states as of the end of November. So far, 85 have passed.
The discrepancy between the number of children who medically transition and the attention paid to them in our politics is striking. But transgender children are just a subset of all children struggling with gender.
As the frenzy of medical treatment for people who think of themselves as cisgender demonstrates, and indeed the entire $430 billion beauty industry shows, most of us feel at least a little bit weird about our gender — how we wear it, how we show it, how we transmit it to those around us. As the scholar Kathryn Bond Stockton has said, gender is queer, even when we play it straight.
Girls and boys, women and men are enthusiastic and active participants in the construction of their gender identities, making small tweaks or wholesale changes to make the way they feel match the way they look. Maybe the way transgender and nonbinary people feel about their genders is no different from anyone else. It is confusing and contradictory. It feels deeply personal and yet built on the images and influences of our culture. It sets unreachable ideals and is subject to unpredictable variations that spread like wildfire. What is gender if not contagious? We catch it in the form of fads all the time, from the Beatles mop-top craze to Bama Rush.
Transgender and nonbinary people can have complicated feelings about their medical treatment, and may act on them, up to and including transitioning again. They may either go back to the genders they were assigned at birth or reject the binary entirely, and describe themselves as nonbinary, genderqueer or simply queer. It’s a mistake to dismiss these feelings as simply regret.
When the media fixates on the hypothetical regret of children who do transition — and when that fixation blocks treatment paths for others — are we actually debasing the kind of regret that might be felt by a child who wishes to transition but cannot? To borrow another phrase: A single mistaken transition is a tragedy. A million children denied care? That’s just a statistic.
The right claims that transgender people want to impose gender ideology on the world. But as the saying goes, every accusation is also a confession. We are already living under a gender ideology: It is called the gender binary, and transgender people are hardly the only ones suffering from its crushing weight.
Jules Gill-Peterson, a historian at Johns Hopkins University and the author of “Histories of the Transgender Child,” suggested to me that we might be thinking of the gender experiences of transgender people all wrong.
“It might be comforting and reassuring to imagine that trans people are fundamentally different,” she said. “But I think the real startling possibility is that they are not, and that we all depend on the generosity of strangers to give us our genders every single day.”
Maybe we should all learn to wear our genders, indeed, all of our identities, a bit more lightly. I have come to think of the institution of gender as something a bit like an arranged marriage. It is something your family does for you, usually with loving intention and in the interest of your community, that may or may not work out, or may work for a time but then break down. For most of human history, all marriages were arranged marriages, but in much of the world we’ve come to accept that most people want to choose their own life partners, even at the price of family and community cohesion. Why should gender be any different?
The notion that transgender and nonbinary people experience gender in the same way as everyone else is a surprisingly controversial one, not least among the queer community itself. The history of queer activism in the United States is marked by the same tensions as every other identity-based movement: Securing legal rights and protections almost always requires drawing a clearly defined circle around an identity group and the central trait as one that is innate rather than a choice.
For queer people, this notion has been especially fraught, because for much of the last two centuries, queerness was thought to be a disease. It wasn’t until 1973 that the gay rights movement was able to push the American Psychiatric Association to cease referring to homosexuality as a disorder. Queer people, like Black people had been for much of their history in this country, were thought to be defective compared with what was assumed to be the norm.
For gays and lesbians, social acceptance and legal protection came as Americans learned to see sexual orientation as an innate and immutable characteristic. When Gallup first polled on the topic in 1977, just 13 percent of Americans thought gay and lesbian people were born that way. Now roughly half do, and in many ways it hardly seems to matter anymore. The frenzied search for a “gay gene,” a very 1990s preoccupation, has petered out. Believing gay people had no choice but to be gay was a critical way station on the road to accepting homosexuality as just another way of being in the world, and no one talks much about it anymore.
I know plenty of gay and lesbian people who were aware from a very young age of their sexual orientation and who would describe themselves as always having known they were queer. I am not among them. I had a wonderful gay role model in my uncle Tom, who has been out his whole adult life and modeled what a happy queer life without shame and hiding could be. But like many queer people, I had many different romantic entanglements in my youth, and had I not met my wife in college it is not impossible to imagine that I might have ended up on another path. I certainly did not experience myself as being born any particular way.
Among people of my generation and younger, it isn’t all that uncommon for women who were once married to men to later in life end up in partnerships with women, and I certainly have known men in gay relationships who wound up in straight ones and vice versa. These people seldom describe themselves as having “lived a lie” in their previous relationships. I think most of us know intuitively that sexual orientation is not binary, and is subject to change over the course of our lives.
The notion that people who diverge from social norms under existing hierarchies deserve basic human dignity only if they have no choice about that divergence is fundamentally degrading. Undergirding it is the unspoken but clear judgment that this identity is regrettable but in a civilized country must be tolerated. I’m glad it has faded as a justification for rights for gay and lesbian people.
Given the astonishing ferocity of the legislative assault on transgender people right now, and the need to secure even the most basic protections, much of the activism around transgender issues has understandably focused on survival over liberation. The born-this-way narrative prevails in most mainstream organizations and institutions and dominates much of the discourse.
And yet. To many queer people, myself very much included, it feels like an incomplete account of their experiences, a simplification that shortchanges their lives. The writer and academic Grace Lavery, who has written with great clarity and wit about what she calls her “sex change,” describes this problem in her memoir, “Please Miss:”
“‘I always knew’ is an especially unreasonable standard by which to rank the legitimacy of various transitions, because it implies two things — (1) that it was always true; (2) that we have consistent access to truths about ourselves.”
Indeed, in the more radical corners of queer thought, a different conversation is unfolding. I came across one of the most striking examples of this thinking in a slim book published this summer called “Gender Without Identity.” It was written by a pair of queer psychoanalysts, Avgi Saketopoulou and Ann Pellegrini, and in it they argue that the born-this-way model of treating gender of trans and nonbinary patients ignores the vital role life experiences, including traumatic ones, play in shaping gender in all people. Pretending it is otherwise “sets the stage” for regret, Saketopoulou told me.
“To imagine that there was a way to live a life without regret is to sign on to a very particular understanding of human life as being interior, as being sovereign to itself, as having nothing to do with the social world, with the political world, with relationships with each other,” she told me. When it comes to gender, “there’s no way to make a mistake, and there’s no way to get it right. Meaning that you get it right enough. That’s what we’re all aiming for.”
We ended up with the born-this-way model because of the tension between the seeking of rights for an embattled minority and the broader search for liberation. But this tension is ultimately dialectical — it contains the seeds of its own destruction.
I still love to swim, and will jump into just about any swimmable body of water, in just about any weather. The strokes I worked so hard to perfect four decades ago remain embedded in my muscle memory, sending me gliding through pond, stream and sea.
There are times in my life when I’ve wished I hadn’t given up competitive swimming. You can’t step into the same river twice, as the ancient fragment from Heraclitus tells us. Neither you nor the river is the same. I guess that’s how I feel about the champion swimmer I could have been. It would have been another life. It does not impoverish the value of the wonderful life I’ve led to imagine what pleasure and pain might have come from living a different one, or foreclose another, future transition, whatever that might bring. I’m lucky that I got to choose. The gift is the choice, even if I haven’t always been sure I made the right one.
I understand the impulse to protect children from regret. The fantasy of limitless possibility is alluring — who wouldn’t want that for their child? To forestall, for as long as possible, throwing the switches that will determine your destination in life, is tempting. But a life without choosing is not a human life.
Transitions are hard, even when we know that they are coming. We all struggle to see ourselves clearly, and the notion that who we are depends on where and when we are feels deeply destabilizing. This is why the riddle of the sphinx, that ancient tale of Greek myth, stumped so many until Oedipus came along. The sphinx asked: What has one voice but goes on four legs in the morning, two legs in the day and three in the evening? The answer, of course, is us.
We all know what awaits us with age, and yet it is all but impossible for any of us to fathom the transitions our selves will undergo over time. Each of those transitions is a kind of little death — the end of one way of being and the birth of another. It is no surprise that the more unexpected the transition, the more deeply unsettling it is.
We are all hurtling, inevitably, toward that one last transition, across the one true binary, the one between life and death. And that binary is the true source of all our regrets, and our joy, too. Regret exists because we all get just one life.
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