Transition as Addiction. Why Not Move On?

If transitioning is like addiction, then we can’t expect detransitioners in recovery just to “move on”

When I decided to detransition, I had to face the matter of my digital footprint. I had an active Facebook account where I had announced my transition milestones to just about everyone who tangentially knew me. A few months in, I decided to rip off the band-aid and share an informational post from posttrans.com, briefly explaining my detransition. I was fortunate that all the comments I received on my announcement were kind and supportive, but in face-to-face interactions, an overtone quickly made itself clear. You may be supported in your detransition, but only if you remain unshakably supportive of transition and admit yourself to be different from “true” trans people. The validity of transition relies on those who detransition recanting their claim to the experience.

The issue is, we are not different. Through my detransition, I came to understand that transition does not function like an identity journey. It functions like an addiction. Much like any addiction, it’s difficult to have an accurate perception of your circumstances while actively in its throes. In recovery, even things that seemed mundane at the time have their darkness revealed. Even when you have been clean for years, the addiction doesn’t disappear. It would be ludicrous to claim that an alcoholic who has been sober for a long time was never really an alcoholic. How is transition any different?

Using the Four C’s of addiction recognized in healthcare, we can see that the culture and process of transition closely mirror addictive patterns. In his paper “The Nature of Addiction”, Dr. David E. Smith, an addiction specialist and psychiatrist, labeled these four C’s as Craving, Compulsion, Control, and Consequences. Though those in active transition may resent the comparison, detransitioners often recognize its accuracy precisely because experience and distance provide clarity.

Craving

Social and medical transition are pursued for a reason. The reasons are as varied as the experiences of the people themselves, but are most commonly rooted in trauma that leaves a person disconnected from their sex and the traits/experiences they attribute to it. In cases like mine, it may come from a deep awareness of the dangers of living as a woman and a history of childhood sexual assault. The longing for safety created a sense of identification with men and the perceived benefits they enjoy: a desire to become something new.

For others, the craving may come from a perceived benefit or from a connection to the opposite sex. For example, an effeminate gay boy who enjoys sewing and talking to his sisters may align himself more with the women in his life than men. He may have his interests belittled or questioned in a way that he would not experience if he were a woman with the same interests, and may see his attraction to men as a “feminine” trait. He may then believe that if he could live as a woman, he could be truly seen and valued, rather than critically scrutinized, for the traits he possesses.

These are only a couple of examples of the multitude of factors that may drive someone to crave gender transition. In the abstract, one may think changing your gender should help these feelings. Unfortunately, there is no magic wand. The science behind medical transition is, at best, under-researched and, at worst, influenced by profit motives at the expense of patients’ health and safety.

Compulsion

Transition culture fosters compulsion by presenting an escalating series of interventions, each framed as necessary for authenticity. You’ve socially transitioned? Consider a legal name change! You don’t really look like your name, though — have you considered hormones? You’ve been on hormones for a while. You should really consider surgery! That surgery was validating — why not do another?

Even in the best-case scenario, the goalpost constantly moves within the mind of the trans person. There is always something to be changed to better align them with the impossible image in their mind. Procedures exist to imitate the primary and secondary sex characteristics of the opposite sex, but it remains impossible to truly become the other sex. The very nature of being trans acknowledges that you are not the sex you aim to be seen as. This fact will continually fuel the compulsion to pursue further interventions to meet this impossible goal.

Control

Transition often creates an illusion of empowerment while gradually limiting a person’s real control over their body, health, and social relationships. Sometimes, addictions grow when a person feels it is the only thing in their life they can control. Eventually, they lose control over either the behavior itself or its consequences.

Several aspects of transition remain inherently uncontrollable: the physical impact of hormones, a body’s reaction to anesthesia, the unfiltered reactions of others to one’s appearance, and the physical and psychological effects of extreme physical and hormonal changes. The negative cultural response towards those who detransition or desist also contributes to a lack of control in one’s transition. Someone may transition for years, develop severe medical complications, and feel they have no choice but to continue for fear of social and political repercussions associated with desisting. Even if that person later recognizes they transitioned out of self-hatred or internalized homophobia, they may be treated as though their entire experience is invalid and be accused of serving an anti-trans political agenda.

Many detransitioners report being ostracized, doxxed, harassed, and receiving violent death threats when they speak about their experiences. The existence of this punitive culture reduces the control a person has over their own transition and hinders their ability to leave it. Much like a heroin addict may identify themselves with their addiction and the people they use with, and accept the negative impact on their life for the sake of the highs, a transition addict will push down any doubts or hard realities to remain in the culture and avoid confronting the inherent harm that comes with transition. Many trans people are encouraged to cut off friends and family members who don’t unquestioningly accept everything they say and do. This leaves them isolated and overly dependent on their trans identity and community for basic safety and social needs.

Consequence

The fourth C of addiction refers to continuing a behavior despite an awareness of the negative consequences it will bring. The popular trans slogan “Death before Detransition” is an excellent example of how ingrained this is in the culture, especially considering that the consequences of transition have led to death.

Cross-sex hormones can have devastating, disabling effects. In my case, I developed a unique gastrointestinal illness that led me to vomit multiple times a day for years, losing a quarter of my body weight and my ability to live a normal life. No doctor would investigate hormones as a potential cause until I put the pieces together myself and begged them to listen. The consequence of their lack of medical diligence (for fear of cultural crucifixion from the trans community) was the worsening of my condition and significantly prolonged suffering.

Surgical interventions to remove sex organs can leave someone entirely dependent on hormone replacement therapy for the rest of their life, whether or not they detransition. Living without sex hormones can lead to osteoporosis, depression, chronic exhaustion, sexual dysfunction, metabolic health issues, and more. This creates lifelong patients who are physically incapable of remaining independently healthy without intervention. They are physically and financially bound to this decision to the point that losing access would directly lead to rapid health deterioration in what would have otherwise been a healthy body. The complication rate associated with vaginoplasty is reported to be between 20% and 70% — an astonishingly high risk. Like any other addiction, these procedures take a healthy body and make it dependent. And this is only scratching the surface of the damage that can come with transitioning.

One of the most significant lifelong consequences is the lack of medical care and support for those who detransition. They are expected to go from a highly supported medicalized lifestyle to uncharted territory with no established support structures. I know several detransitioners who were denied care, surgeries, and support because they are detransitioners. Many of the medical consequences of transition do not go away with detransition and can require lifelong medical care. Though there was ample support to get into this situation, there are scant resources to help someone get out of it.

The consequences of transition are far-reaching and life-altering, and I have yet to meet anyone who has transitioned without some level of complication. Those who detransition are not uniquely impacted by negative side effects — we simply acknowledge the harm that the trans community collectively hides. With this in mind, how can a detransitioner simply ignore the impact of the culture of transition? How can we be asked to ignore the truths we have seen, lived, and been actively harmed by?

If transition mirrors addiction, then detransitioners are not traitors or anomalies —they are people in recovery. Asking them to “move on” without speaking about what they experienced demands silence where reflection is necessary and contributes to the stigma surrounding detransition.

Ginny Welsh is an artist and writer who spent her teen and early adult years enthralled with the world of transition. Though her medical transition would be seen as “successful”, the process was one of medical neglect and destruction. Disillusioned by the culture of delusion, lies, and inevitable health issues associated with transition, she finally began her detransition in 2024. She now lives as a happily married lesbian, deconstructing the industry of transition through her work.

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