Transition May Have Relatively Small Effects

On not expecting biomedical transition to do things it can't

There are few studies of the effect of biomedical transition on quality of life, and most are quite bad. (See here for the most recent systematic review I’ve seen.) In general, they show positive results, but we can’t draw very strong conclusions from the available evidence.¹

I… kind of don’t expect a big effect of transition on quality of life, even from large and well-conducted studies?

Biomedical transition is very limited in what it can fix. If you want to be a man, it can make you a man. It can’t get you a better job, or fix your relationship with your terrible family, or find you love.² After you transition, you still have all the problems you had before, you just have them while being a man.

Doubling your income increases your life satisfaction by about 0.5 points on a 1-10 scale. That’s not to say that money doesn’t matter: 0.5 points is actually quite a lot if a scale only goes from 1 to 10.³ But how good your life is depends on a lot more than how rich you are. If you are lonely, hate your job, have severe chronic pain that baffles all the doctors, and will never be able to achieve the things that matter most to you, being able to eat more delivery food or take a vacation will not be that much comfort.

Personally, having twice as much money would solve a lot more problems than being a man does. Being a man mostly solves the problem where I wanted to be a man and couldn’t, with some fringe benefits about physical strength and not being harassed on street corners and so on. More money would let me have a bigger house and another kid and a trip to Europe, not to mention saving the lives of a dozen children. So for me the effect of transition would probably be a lot smaller than 0.5 points. And yet it’s clearly worth it: I am very happy having transitioned and would never want to detransition.

Similarly, if you’re depressed because you drew a bad genetic hand, or because you’re poor and your life sucks, or because you experienced childhood trauma, you will probably still be depressed after transition. That doesn’t mean transition doesn’t work; testosterone is supposed to give you a beard, not fix your bad childhood.

The positive effects of transition are real, but very difficult to predict. Some trans people who experience depersonalization/derealization⁴ find that transition eases their symptoms. Some trans people have a more positive body image once they transition. Some trans people find that socializing is easier once they’ve transitioned: they fit in more smoothly with and feel less out of place among members of their identified gender.⁵ Some trans people have an easier time dating after transition, because they feel more comfortable with the romantic-sexual scripts of their identified gender. Trans women are sometimes happy that women aren’t scared of them anymore; trans men are sometimes happy that men don’t harass them on street corners. Some trans people feel like they have “permission” to do things they’ve always wanted—wear dresses or read romances or cry, for the girls; skip shaving or work with tools or be aggressive, for the boys—and while of course people of all genders can do those things it’s naïve to assume that transition doesn’t affect whether they do.

Even the direction of a positive effect can be unpredictable. I’ve known trans women who experienced great relief at no longer having an insistent male sexuality, constantly demanding attention. And I’ve known trans women who, now that they were comfortable in their bodies and their sexual role, suddenly discovered that they wanted to have sex twice a day, no, three times!

I’m not sure how you could come up with a single metric that encompassed all those different ways that transition is good for people, without also measuring wealth and sense of meaning and social support and everything else that makes a life good and that transition probably won't do much about. Even if you did, it’d wind up underestimating the effects of transition. If Alice had no social effects but is happy about her transition because she likes what she sees in the mirror, and Bob had no body-image effects but is happy about his transition because he finds male-dominated social circles to be more straightforward than female-dominated, then they might counterbalance each other and neither the social nor the body-image effects will be statistically significant.

My prediction is that a well-conducted study of biomedical transition will show a relatively small effect. If the sample size is small enough, the effect will be indistinguishable from zero. This does not mean that transition is useless and won’t improve people’s lives. It means that transition fixes one problem (not being the gender you want to be) and doesn’t fix everything else that’s wrong in your life.

1. See also.

2. Actually, sometimes it makes all those problems worse.

3. It’s 5 points on a scale from 10 to 100! 50 points on a scale from 100 to 1000! I kind of wonder how much the “money doesn’t matter that much” takes are literally because 0.5 seems like an Objectively Small Number.

4. Feeling like your body is a mecha you’re piloting, or like your memories belong to someone else, or like you’re living in a movie or a video game, or like everything is a dream.

5. Or, sometimes, around other queer/trans people.