This article is taken from the May 2022 issue of The Critic. To get the full magazine why not subscribe? Right now we’re offering five issues for just £10.

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“Joy”, “amazing”, “happiness”, “wholesome”, “freedom”, “light at the end of the tunnel”, “greatest day of my life”, “euphoria” and “bliss of fairy dust” — what do these words describe?

The answer is “top surgery” in a new Snapchat video called “What is Top Surgery Like For Trans Guys”, created by Pink News.

If you don’t know what that is, according to the video it is “a procedure that trans men and trans masculine people can choose to have, where breast tissue is removed and the chest is sculpted to have a more masculine appearance”. Put more simply, it is a bilateral mastectomy, given to women as a treatment for gender dysphoria.

The video paints an uncritical picture of top surgery, as you might expect from the first episode of a series entitled “Pure Trans Joy”. I am sure its positivity will be welcomed by trans men, which is clearly its purpose.

However, it made me uncomfortable. This is partly because I photographed and interviewed women for a feature in the Sunday Times who thought they were transgender, had “top surgery”, then went on to change their mind and detransition.

But although they reverted their names, pronouns and passports, flesh cannot be returned after a double mastectomy. The effects of testosterone cannot be undone, nor the removal of the uterus and ovaries, which some of these detransitioners also had, leaving them sterile, on hormone replacement therapy for life, and traumatised.

Lucy had been anorexic and had body dysmorphia. In addition, she was a lesbian and had experienced homophobia, which she internalised. At the age of just 23, she could not comprehend how doctors could remove her breasts, uterus and ovaries. “I feel mutilated,” she said.

Susana was sexually abused, which was compounded by the shock of discovering online porn at a young age, and also internalised lesbophobia. She was left feeling ashamed of her body: “For me, transition was a kind of self harm. I was trying to destroy the person I was.”

Sinead wished that the psychiatrist at the Gender Identity Clinic had given her a proper assessment for co-morbid conditions. “I’ve tried to talk about background issues with therapists, but because I was trans, gender dysphoria was seen as the cause of my problems, and not a symptom of them,” she told me. “Actually, I think my gender issues came out of mental health, not the other way around.”

The idea of having all my female anatomy removed mistakenly and then wanting it back, creates a horrifically unnerving sensation — nothing like euphoria and the “bliss of fairy dust”.

Social and medical transition can be the best outcome for some people with gender dysphoria. However, it’s not always clear who will benefit and who should delay, as “young people may not reach a settled gender expression until their mid-20s,” according to the interim report from the Cass Review, which is an independent investigation of gender identity services in the UK for children and young people.

There has been little effort to understand why so many young girls now experience gender distress

At the heart of gender identity ideology is the idea that gender identity is innate. Detransition disrupts this ideology by revealing that sexualisation, homophobia, body dysmorphia, sexual abuse and neurodiversity are some of the causes of gender dysphoria and that dysphoria can pass, given time. As a result, all the detransitioners I have spoken to told me that they had been vilified for speaking out.

Dr Cass has observed that the largest group of patients now referred to GIDs are female teenagers who first developed gender distress in their early teens. It has not always been the case. Dr Jessica Taylor writes in her book, Sexy but Psycho:

In 2009, seventy children were referred to the Tavistock and Portman Gender Identity Service as they wished to transition. In 2019, 2,590 children were referred into the same service. What is surprising however, is that in 2009, 75 per cent of the children were boys who wanted to present and live as girls — but by 2019, 70 per cent of the children were girls who wanted to present and live as boys.

This change in the case mix has not been given enough attention by LGBT campaigners or clinicians. There has been little effort to understand why so many young girls now experience gender distress. Trans activists have argued that the prevalence of trans people now is in part due to greater visibility and acceptability. This goes some way to explaining the increase in numbers, but not the change in the ratio of males to females.

Many women can recall some degree of discomfort with their body during sexual development. Puberty can thrust a girl’s body into being perceived as a woman before she is psychologically ready. Soraya Chemaly, the feminist activist and writer, wrote in the foreword to my book Bare Reality: 100 women, their breasts, their stories: “The moment a girl’s budding breasts make an appearance is the moment that her relationship to the world and the people in it begins to be redefined, even in her own imagination.”

The trans men in “What is Top Surgery Like For Trans Guys” evoke a freedom that some young girls might be seeking. They are open-shirted, shirt-free, and repeatedly use the words “free” and “freedom”. The excision of female flesh renders their bodies free from the sexual expectations conveyed upon young girls’ bodies, even if what they seek to convey is freedom in their new gender.

As Dr Jessica Taylor said to me, “girls are sexualised in our culture from a young age. It would make sense that they seek to escape from their sexuality and femininity, and this offers a legitimate medical escape hatch.”

“When I hear psychotherapists saying that if a girl wants her breasts removed it is a sign of her gender dysphoria I wonder if they know anything about sexual trauma, because you hear it all the time in sexual trauma,” said Taylor. “The video made me really uncomfortable. It almost looks like a marketing video. It deliberately glosses over pain, infection risk, the recovery period. No one says anything about what it feels like to have a mastectomy. It positions life changing and high risk surgery to healthy young women as euphoric and sensationalist and that it will solve their problems.”

She posits in her book that as girls grow up in a society that frequently sexualises, objectifies and traumatises them, a trauma-informed perspective would argue that it is rational for girls to wish to escape femininity, and their female bodies. It would make sense that they feel safer if they present to the world as non-binary or masculine.

According to the Advertising Standards Authority, bilateral mastectomy is likely to fall under the definition of cosmetic intervention under new rules that prohibit the targeting of cosmetic intervention ads towards under 18s. These rules, which come into force this month, are aligned with the GMC’s own guidance for doctors who provide cosmetic interventions, which also contain a provision on targeting cosmetic interventions advertising at children and young people.

The Pink News video is editorial, not marketing, and does not fall under these rules. But its situation on Snapchat is a key concern. Girls aged between 13 and 17 years old are the biggest demographic group on the platform, accounting for 12 per cent of the total audience. Overall, its audience is young and female.

Instagram has made body image issues worse for one in three girls

The new ASA rules would restrict cosmetic surgeons advertising on Snapchat and other social media because of the young audience. I searched for videos about breast enhancement on Snapchat. They may be there, but Snapchat do not float them to the top of the search results, which instead clunkily yielded chicken and duck breast recipes. “Gender” seems to lend a magical status to bilateral mastectomies that breast augmentation or reduction surgery is denied. If this video contained the same style of testimony about boob jobs, the reaction would be angry and censorious.

It’s vital for Snapchat and other social media platforms to be responsible. The imagery, video, scrolling and crucially, the selfie filters, have a particularly intoxicating effect. Dr Tijion Esho coined the term “Snapchat dysmorphia” after he was increasingly approached by people who wanted to look more the filtered versions of themselves. In his case, he declined them surgery and referred them for counselling.

These feelings don’t exist in a vacuum, but social media makes it worse. According to internal Facebook research which was leaked to the Wall Street Journal, Instagram has made body image issues worse for one in three girls and in one Facebook study of teenagers in the UK and the US, more than 40 per cent of Instagram users who said they felt “unattractive” said the feeling began while using the app.

Social media offers a window display for some “top surgeons”. The account for the US McClean Clinic is now set to private after a righteous backlash to some very disturbing content. In one post, a plastic surgeon who performed top surgery held two medical waste buckets labelled “breast tissue”, presumably in a celebration of transition. Like many, I felt sick. This tasteless image could not have said more plainly that female flesh is trash.

Internet trends reveal an increase in demand for top surgery, as well as an increase in interest in detransition. When I wrote about “The Detransitioners” for the Sunday Times there were 27,000 gofundmes for “top surgery”. There are now 41,582 results for “top surgery” on gofundme crowdfunding platform. In a parallel world, at the beginning of April 2019 there were 1,300 subscribers to the Reddit Detransition Subreddit. By April 2020 later there were 11,000. In March 2022, there were nearly 27,000.

Top surgeons display before and after photographs on Instagram. The nipples in the before photos are covered with digital modesty stickers. Female nipples are freighted by sexualisation, deemed obscene and must be censored by social media standards. In the after photos, the same nipples are bare, hovering above long scars, transformed into non-sexualised, acceptable and “free” body parts. The girls are freed from sexual connotation when they are freed from their feminine flesh.

The role of social media in gender dysphoria has been explored in controversial research by Dr Lisa Littman, in her emerging hypothesis of rapid-onset gender dysphoria (ROGD). The internet cannot “turn” you transgender, but Littman believes that trauma, mental health conditions, or even simply puberty, can be initiated, magnified and spread by social and peer contagion. Littman believes that insights about the role of peer contagion in eating disorders can be applied to the development of gender dysphoria, through friendship cliques and group dynamics, and analogous “inspirational” websites and Youtube videos.

The Pink News video is the latest in a plethora of social media content affirming the benefit, the “euphoria”, of gender transition. Content about eating disorders and self harm is banned on Snapchat, but the transgender counter culture is both welcomed by the social media platforms, and welcoming to the gender dysphoric. This video, like other transgender social media content, contains no balance, caveats, words of caution or warning. There is no doubt. Only joy and certainty. And that seems dangerous.

I caught up with Sinead. She told me she still has stubble and “a baldy bit” on her head, but says that if she makes “an effort I am taken for a woman, and I never thought that would happen”.

“For a long time I couldn’t shower without a T shirt because of the mastectomy scars. I wish it hadn’t happened, but I don’t hate my body anymore,” she told me. “But for the rest of my life I will always be bewildered that this was allowed to happen. I was dealing with unaddressed trauma from sexual abuse. I needed therapy and help, not a bilateral mastectomy.”

We discussed “What is Top Surgery Like For Trans Guys”. “That was a fucking train wreck,” she said:

The thing that sticks out to me was they glitter up the language. It’s deceptive. It’s a bilateral double mastectomy. They don’t keep it clinical and factual, they make it seem like the best thing you can do for yourself. They have chosen a platform which is full of young, vulnerable girls. Even if it’s not meant to be malicious it is irresponsible. At the very end it says with top surgery you are not going to be stuck feeling uncomfortable for the rest of your life That is such a dangerous thing to say to a teenage girl because it means if you don’t do it you will be unhappy with who you are for the rest of your life.

Women’s sports, prisons, even the basic question of what a woman is, have become a uniquely modern battlefield. Detransitioners bear the literal scars of this battle. Amidst all the furore, the government has reached the only correct decision on the issue of conversion therapy for trans people. Before undertaking irreversible treatments, young people must be offered serious, legitimate therapy and the medical profession must not be stymied into solely following an “affirmative” pathway.

The problem is that young people are affirmed and groomed before the first doctor’s appointment by euphoric and unbalanced content on social media. One trans man’s pure joy may be another woman’s pure regret.

I contacted Pink News to ask if they had any information about the demographics of their followers on Snapchat, how they would define the audience for this episode, how it had been received so far, and if they had any concerns that it could influence girls who are not necessarily trans, but are grappling with other body image issues or trauma, whether it could initiate feelings of gender dysphoria through social/peer contagion.

A Pink News spokesperson replied:

Tens of millions of people engage with PinkNews content on a variety of platforms every single month, including across 17 different Snapchat channels. Pure Trans Joy is just the latest of our shows and, while it’s still in its early days, making it difficult to say what its impact will be, it has thus far received overwhelmingly positive feedback from members of the LGBT+ community and allies who engage with our content. It’s simply not true that the show will be focused exclusively on the experiences of trans men and non-binary people who have made the decision to have top surgery; future episodes will showcase a range of topics, covering the full range of trans and non-binary experiences, celebrating trans people, their lives and their bodies in a media landscape that is increasingly hostile towards the trans experience.