I found @marisa's reply Why I Transitioned: A Response to @Fiora Starlight's post Why I Transitioned: A Case Study to be very well argued, articulating the biological basis for gender dysphoria and the issues affecting those who it afflicts better than I could ever hope to. Both posts are incredibly insightful explorations of the MtF (male-to-female) transgender perspective, one that I will admit is more relevant (per capita and politically) than the reverse. Regardless, my own experience as an FtM (female-to-male) transgender man may be of interest.

In this post, I will attempt a review of each post, with my own thoughts added, tell the story of my own transition (this portion is quite long-winded, so feel free to skip), briefly speculate upon the biological basis for gender dysphoria, and explain how respectability politics is relevant to the afflicted's quality of life.

In the interest of protecting my privacy, some personal details, particularly those related to my location, will intentionally be left vague.

A Brief (and Probably Biased) Review of Previous Posts

On November 1st, 2025, @Fiora Starlight published the post Why I Transitioned: A Case Study (I recommend you read it; it is quite well-written). She begins with the assertion that "trans people tend not to have great introspective clarity into their own motivations for transition" and speculated that such was the case because transgender women transition due to social pressure or a pervasive sexual fetish and deceive themselves about the reason, in accordance with the theory of of controversial researcher Ray Blanchard. While the possibility of "arcane neuro-psychological phenomenon" is acknowledged, she dismisses it on the basis of reports from her friends.

Fiora then pivots to her personal experiences, explaining her reason for transitioning. Her story begins at fourteen; she is "a total social outcast" with an interest in anime and similarly ostracized friends. "[T]rapped in a downward spiral of bad online role models", she desired human connection, but had no guidance or idea how to improve her life. Shows featuring the lighthearted antics of "adorable" animated girls (Fiora cites K-On! and My Little Pony: Friendship is Magic) provided contrast to the bleak storylines of popular anime and the equally bleak life prospects of the audience. Associating the cuteness of the female characters with the connection she desired, Fiora became enamored with the fantasy of being an attractive, lovable girl. Upon being introduced to the concept of a gender transition through the anime community, Fiora realized this fantasy was attainable; such was reinforced through online "egg" communities, which featured many of the same desirable anime characters driving her fantasy. Fiora ends her post by speculating that socially awkward men transition due to a desire to be loved as women are, and expresses regret.

While I do not doubt the veracity of Fiora's experience, it certainly does not apply to everyone who transitions. For one, Fiora admits that she was mired in an isolated subculture, whose experiences and perspectives likely deviate significantly from that of the general public; accordingly, the experiences and perspectives of her and the people she surrounds herself with may not be reflective of everyone afflicted by gender dysphoria. More glaringly, transgender men, who compose at least a third of those who are afflicted with gender dysphoria, are not addressed anywhere in the piece. While Fiora's post is introspective, the conclusions she makes based upon the anecdotal experiences are broadly, and in my opinion, incorrectly, applied to all transgender people.

Addressing the flaws in Fiora's post, on January 19th, 2026, @marisa replied with a post of her own: Why I Transitioned: A Response. (Highly recommend you read this one as well; it is very articulate and well-argued.)  Marisa begins with a review of evidence for a biological basis for gender dysphoria, synthesizing the reports of various LLMs to conduct a literature review regarding twin studies. While she concludes that gender dysphoria does have a significant genetic factor, she does not attempt to identify the particular cause. 

With a mention that many with gender dysphoria view such studies negatively, she segues towards a discussion of the "transgender community" (which does not encompass all sufferers of gender dysphoria; I will explain below), explaining why many afflicted with gender dysphoria are hesitant to accept a narrative of biological cause despite (and perhaps because of) dependence on medical recognition. To quote Marisa directly, "many trans people need medical treatment, but find the psychological threat of medicalization and eradication intolerable." In-group dynamics exacerbate the issue; ignorance regarding the biological basis of gender dysphoria was strongly incentivized, as discussing such risked hurting the feelings of someone who claimed membership in the community (particularly those who identified as non-binary or along a "xenogender") and the ostracization that followed. Consequently, the transgender community enforces radical acceptance at the expense of optics and an accurate perception of reality.

Finally, Marisa provides her own experience with transitioning. Upon reaching puberty in middle school, Marisa began to resent her development, as well as the social role she was expected to assume as a young male. As such, Marisa became socially ostracized and developed depression; her parents were supportive, homeschooling her when she was bullied, taking her to psychologists, and allowing her to grow out her hair. Similar to Fiora, Marisa became enamored with anime featuring girls being loved and cared for, but it did not cause her to imagine becoming a girl. Seeking to improve herself, Marisa cut her hair and actualized as a man; upon learning of transitioning in college, she believed "it was too late for me... I resolved to never transition, and attempted suicide soon after", but was able to recover and live a relatively normal life until her thirties, when "the strain of repression became unbearable" and she transitioned. Marisa is much happier after transitioning, and attributes such an improvement to the resolution of biological dysphoria. She concludes by suggesting that one ought to consider whether transitioning will improve their life rather than questioning the cause or validity of their transition.

Ultimately, while Marisa's experience shares some similarity with Fiora's, they come to different conclusions regarding the cause of gender dysphoria and have different levels of satisfaction with their transition. Notably, Marisa attributes her dysphoria to biology, and is satisfied with her transition, while Fiora attributes her transition to psychosocial phenomena, and regrets her transition. Marisa also goes into greater detail regarding the role of the transgender community in the perception of gender dysphoria and its affects on individuals' decision to transition. The perception of the transgender community and the social dynamics discussed by Marisa played a significant role in my decision to transition, as demonstrated below.

In the Case of Character#2736

I was eleven years old when I first began to seriously consider suicide.

It wasn't yet a fully formed plan. Just a simple "Would I be better off dead?" coupled with that persistent sense of disquiet that had begun to follow me since I began puberty^[1]. Now, there was no reason for me to have such thoughts; my parents were (and continue to be) wonderful people who were able to provide a charmed childhood, I had plenty of friends at school, I was academically successful, and I enjoyed the hobbies and extracurriculars I was involved in. I certainly was not being abused, nor was I experiencing any particular hardship. 

Regardless, these thoughts continued to grow in prevalence; by the time I was twelve, they occupied my mind for several hours a day. I have a particular memory of thinking, very methodically, of climbing to the top of the school building and becoming a splat on the concrete for an entire eighty-minute math lesson. Of course, nobody knew; I acted the same as any slightly socially-awkward middle-schooler would. (My social awkwardness did not preclude me from finding friends; in elementary school, I had fallen in with a group of artsy kids, where a bit of weirdness was tolerated, if not encouraged.) I continued to have fun with my friends, succeed academically, and generally enjoy my childhood. By this point, I had identified a particular dislike for my body, though I did not in any way connect those with my suicidal thoughts; I despised the fat of my legs and the the way my chest developed. (For all the perverts reading this, shutter your imagination; even now I wouldn't crack an A-cup^[2], and, until I began taking testosterone, I was always underweight according to the BMI scale.) However, I figured that this must just arise from the natural impulse every preteen girl has to be skinny and curvy at the same time; this was the late 2010s, and lecturing girls about the dangers of women's beauty standards, social media, and eating disorders was all the rage. I never found my body discomfort - or my suicidal ideation - unusual; I figured the former was a common experience and that latter was unworthy of consideration.

Twelve was a big year for me in general. It was the year I first heard of the existence of transgender people, for one. My parents were discussing the topic in the context of politics, complaining that the Democrats^[3] were becoming ridiculous and would allow Trump to walk back into office in the next year's election. I questioned what they were talking about, and was told that if I were transgender, I would have told them already. It was also the year I got a cell phone, and consequently a Reddit account, where I proceeded to rot my brain with memes and debate politics and religion with strangers on the internet^[4]. (Every time you feel the urge to slap a thick-skulled commenter over social media, remember that you could be arguing with a twelve-year-old.) During this time, I began to question my gender; while I couldn't articulate much beyond "I don't feel like a girl" (and hadn't connected such feelings to the suicide ideation or the body issues), I had some awareness that something was off. Before then, I had always been a sort of tomboy, and disliked feminine clothing, much to the chagrin of my parents, but had never connected my preferences with my gender. When I poked my head out of the closet and mentioned my suspicion to my mother (over text; even then I was smart enough to be cautious), phrasing it like a passing curiosity, her response was such that I backpedaled all the way to Narnia and shut down any future thoughts on the matter.

Twelve was also the year that COVID-19 happened; my last years of middle school were spent in Zoom class, where the teachers gave us leeway due to "outstanding circumstances" and we all ate snacks, scrolled on our phone, and played video games off-frame. (I'm aware it wasn't all peaches and cream for everyone, but my family was stable and loving, so I largely remember the period fondly.) In the meantime, my suicidal ideation got worse, and the discomfort of my body turned to outright disgust. I hated the useless lumps of fat on my form and the pip-squeak sound of my voice. Regardless, I still had as much fun as one could during lockdown, and nobody could tell that anything was amiss. When I was fourteen, high school began, and we went back to school in person. All my art-kid friends had become entirely different people in my absence, and the lockdown had turned my slight social peculiarities into full-blown awkwardness. I was never a complete outcast; I was well-liked by my peers, and could almost always find social activities when I wanted to. Regardless, for multiple hours a day, I mulled over whether it would be better to not be alive anymore; twice a day, I passed a particular out-of-the-way balcony that tempted me to jump off.

My situation was peculiar in that I sought hormone-replacement therapy (HRT), and gender-affirming surgery, particularly a double mastectomy, before I acknowledged that I was transgender. The period in between was textbook example of denial and rationalization. Just before I turned fourteen, I began to wish I could yank out my uterus (and throw it at a wall) and pull off my chest; shortly after, I first remember articulating the words "double mastectomy" and "hysterectomy", as well as a desire to deepen my voice through HRT. I even thought up a name "just in case". Despite this, I refused to call myself a man, and would shun any website that claimed wanting to change my physical reproductive characteristics made me transgender. Cleveland Clinic? Disreputable and outdated internet garbage with an agenda. Poorly formatted blog from 2004 that implied that cisgender (not transgender; normal) women might want to bind their chest for personal comfort while playing sports? This wonderful medical authority, on par with the world's top ranked medical journals, confirms that yes, it IS completely normal to want to complete a gender transition without being one of those people, and who could ever think otherwise? I vividly remember seeing a meme at fourteen that read, "I wish I could be the opposite gender, but I'm not transgender so I can't" and thinking, "I'm going to have to deal with this... Maybe in a few years." It got to the point where I would search up "double mastectomy for cis women" and be confused and a little miffed when the results all talked about cancer and reconstructive surgery rather than the routine cosmetic double mastectomy that plenty of completely normal women desired. 

I would like to note that, while I was, and continue to be, a Christian, my religion never played a role in my ~creative takes on reality~. I never held the belief that transgender people are sinners, that the Lord loves them any less (which would not be true even if they were any more of sinners than the rest of us), or that being transgender was evil or worthy of discrimination. I will explain the source of my delusion shortly; in the meantime, you'll have to suffer through the rest of my personal journey^[5].

When I was fifteen, the hoops I had to jump through to deny reality had finally become too ridiculous to ignore. My watershed moment was remembering that text conversation with my mother and realizing that I was more introspective at twelve than at the moment. Telling my parents was not an option; while they were not explicitly hostile to the idea of transgender acceptance in general, they were certainly not fond of such people. You might be thinking, "It's different when it's your own kid!", but that cuts both ways; for each feel-good story of ambivalent parents becoming supportive after their child came out, there was an account of a newly homeless teenager who mistakenly hoped that their moderate parents wouldn't give them trouble. There are two ways to fall off a fence, after all. I initially placed the probability of acceptance at 30%, sustained hostility (without being kicked out) at 50%, and homelessness at 20%. In other words, while "homeless and disowned" was by no means the most likely result, for which I am thankful, it was too great a possibility to ignore. My prediction skewed further into the negative after I applied various "tests"; my mother ridiculed an openly transgender classmate I had mentioned, my father threw a fit when I mentioned cutting my hair above the shoulders (it was over three feet long when this occurred), and both were strongly opposed to informed consent. Even if they had approved, there was no way I could have transitioned; in my home state, it is illegal to do so while under twenty-one.

Upon connecting my suicide ideation and the disgust I had for my reproductive characteristics and promptly realizing I couldn't do anything about either due to the people in my life, I became quite resentful. My mental health was at its lowest point, and to be completely honest, I became kind of an asshole, becoming resentful of government control over medicine, as well as other facets of life, for the sake of "public or personal good", the prejudices of those around me, and anything to do with femininity^[6]. The month before I turned sixteen, I had planned to commit suicide, having selected a sufficiently high spot to jump and a sufficiently spiteful note to leave (deleted years later when I realized how cringeworthy it was), but, for lack of a less embarrassing way to phrase it, I simply forgot on the appointed day^[7]. When I remembered, two days later, I came to my senses, reasoning that, if those in less fortunate nations could endure a lifetime of violence and extreme poverty, I, a privileged American, could cope with some minor mental illness for three years until I turned eighteen. My college prospects were decent, so I figured I could secure acceptance to somewhere in a more accepting state and transition, and should I fail to do so, then I would kill myself. There is not much more to say about the period of my life following my aborted suicide attempt; my suicide ideation returned to passivity for the time being, I worked on becoming a less resentful person, and, as desired, I attained acceptance to a college in a liberal state. Coming out to my parents was a stressful affair, but, surprisingly, after an initial period of hostility, both tolerate my transition. My mental health has since improved greatly; my suicide ideation has dropped off to the normal amount (biweekly) and the magnitude of my dysphoria has lessened.

My experience diverges from that of Fiora and Marisa in a few ways; I was never involved with the anime community, I was never a social outcast, and I largely viewed a gender transition as negative rather than something to be desired. The former I ascribe to personal interest, and the latter two to age; being in her thirties, Marisa is at least a decade older than I, and, based upon the media Fiora describes enjoying as a teen, I am likely significantly younger than her as well. Bullying was less acceptable in the mid-2010s than decades past, and I was exposed to the modern "transgender community", which did not exist during their adolescence. I also never desired to be "cute" or "cared for", and notions for such never influenced my gender presentation, likely owing to the expectation of men to be strong and independent. Similar to Marisa, I went through a long phase of denial which slowly became too much to ignore, though increased social acceptance likely shorted the time it took for me to acknowledge reality.

The Basis of Gender Dysphoria

I would like to briefly digress and remark upon the biological basis of gender dysphoria; while Marisa demonstrates that one likely exists, she does not attempt to explain what it is. I will attempt to summarize the leading hypothesis regarding the biological cause of gender dysphoria here using a few illuminating studies on the matter. Before doing so, I would like to acknowledge that, in Marisa's words, I am a non-expert who is "cherry-pick[ing] individual papers", and the cause of gender dysphoria is an active area of study; accordingly, hold my summary as a layperson's conjecture rather than settled fact.

The first major study regarding the basis of gender dysphoria was published in 1995 (not exactly a time when academic bias would have favored transgender individuals) found that, a sexually dimorphic portion of the brain known as the BSTc took the form of a cisgender woman's in transgender women. Sexuality and the presence of sex hormones were controlled how; homosexual men had BTSc's similar to their heterosexual counterparts, and cisgender men and women with hormonal disorders did not diverge from their normative counterparts.

As imaging techniques improved, a litany of studies regarding sexually dimorphic parts of the brain continued to support the notion that the brains of those with gender dysphoria resembled that of the opposite sex. Examples include the 2008 study asserting that the INAH3 volume of transgender people resembled that of the opposite sex, beyond what could be explained by hormonal imbalances, and the 2011 study concluding that the white matter microstructure of transgender men who had not yet pursued hormone therapy was generally closer that of cisgender men than cisgender women; a simple web search will turn up many more. (I tend to avoid articles written after 2015, as it can be said that recent articles have a bias favoring the validation of transgender individuals. Regardless, they come to the same conclusions.)

The effectiveness of HRT and surgery amending one's reproductive characteristics, collectively referred to as "gender-affirming care", is generally effective in treating gender dysphoria. A 2025 literature review confirmed that "moderate to very low certainty evidence... suggests gender-affirming care may improve quality of life... No studies identified significant negative outcomes or harms." Although gender-affirming care is certainly not for everyone (as seen in the case of Fiora), it significantly improves the outcomes of many who pursue it (as seen in the case of Marisa and myself).

Taken together, one can speculate that gender dysphoria is an endocrine disorder in which sex hormones and the reproductive characteristics which follow from them are not aligned with the various endocrine receptors in the brain, which takes a form closer to that of the opposite sex; this misalignment causes a persistent sense of unease and disgust which, over time, may drive the afflicted to suicide.

Respectability Politics and the Transgender Community

As discussed by Marisa (seriously, read her post), the mainstream transgender community is subject community dynamic in which anyone who questions the validity of one's "gender identity" (a ridiculous term in and of itself) or offends someone in any manner is ostracized, removing what may be the only source of support for someone with gender dysphoria. Exacerbating such dynamics, gender dysphoria is fortunately quite rare, while hypochondria, attention-seeking behavior, and adolescent foolishness are unfortunately not; as such, when gender dysphoria entered the public consciousness, actual sufferers of gender dysphoria were liable to be drowned out by confused and narcissistic individuals^[8]. As it began to fill with people who did not suffer from gender dysphoria, members were disincentivized from offending them, and those insisting on any level of introspection were rejected, the transgender community became dominated by people, many of whom do not suffer from gender dysphoria, who are quite detached from reality. 

For this reason, many transgender people, myself included, do not associate with the mainstream transgender community^[9], and the mainstream transgender community does not necessarily represent the interests of transgender people. Many of their assertions, such as the notions that gender is an "identity" or a choice and that medically transitioning (or having the desire to do so) is not necessary to be transgender, are actively harmful to those who have gender dysphoria, as they minimize the importance of treatment that is necessary for the afflicted. Common recognition of the biological basis for gender and medical recognition for gender dysphoria upsets those who insist upon calling themselves "genderfluid", "genderqueer", or identifying along a "xenogender", so the transgender community opposes it. Notions that gender dysphoria is optional, a fashionable choice, alongside ridiculous "identities", trivialize and mock sufferers of gender dysphoria, ensuring that they are not taken seriously.  

Why did I refuse to accept that I was transgender for three years? Why did my parents, and why do many around me, see gender dysphoria as an illegitimate trifle? How did those suffering from a rare endocrine disorder find themselves a target of nationwide prejudice? It certainly isn't because of religion, or some nebulous hatred, though I don't doubt that such may be factors under specific circumstances. The sheer ridiculousness of the mainstream transgender community, which dominates the public's view of gender dysphoria, is responsible for alienating reasonable people, who might have otherwise been sympathetic, or at least tolerant. 

How can those with gender dysphoria attain such tolerance? An example can be taken from the gay community, which used respectability politics to gain acceptance through the late twentieth century. Homosexuals who practiced an socially acceptable wholesome lifestyle were emphasized, while those who did not have a favorable appearance - drag queens, sex workers, and transgender people, to name a few - were marginalized. In the modern day, where homosexual marriage is legal and the LGBT community faces significantly less prejudice, activists might complain about the harms of exclusion, but individuals marginalized by the twentieth-century gay community benefited in the long run alongside the rest. The transgender community ought to do the same; present only their reasonable, eloquent, and respectable constituents, and let everyone else benefit once there are benefits to be had. 

How do I, and a few other people on LessWrong, effect such change? I don't know. All I can do is present the best version of myself and hope for the best.

1. ^{^}

   I mark that occasion by the onset of menstruation the year before; not knowing anything about such, when my abdomen cramped and my pants were saturated with blood for the first time, I thought I was dying, and ran to the nurses office, where I was provided with a dusty pad from the bottom of the nurse's purse. When my parents found out, my mother had dragged to the doctor while screaming about hormones in cow's milk the whole car ride there, and my father refused to speak to me for a few days.

2. ^{^}

   Feels disgusting just typing that.

3. ^{^}

   My parents were (and continue to be) the sort of establishment Democrat who didn't care for anything disruptive; guns were unacceptable, as was hate speech, or any sort of speech that might offend someone or be somewhat controversial. Homosexuals, people of other cultural backgrounds, and other non-conformers were okay, as long as they conformed to the appropriate degree and didn't try to get to close

4. ^{^}

   The latter actually had some marginal benefit; I became a much more independent and critical thinker, developing the libertarian framework I hold today over a period of six years. After a brief period of questioning my faith, I became far more knowledgeable and far more confident in my conviction to Christianity; my younger sister, who did not go through such a period of doubt, recently lapsed in her faith.

5. ^{^}

   Or not; I can't stop you from scrolling.

6. ^{^}

   Yes, I am aware of how being resentful of femininity, which is generally associated with women, is a stone's throw from the prejudice of misogyny. I was aware then, too, but too spiteful to care.

7. ^{^}

   My personal belief is that God had removed the idea from my head for some unknown reason, but this will not hold much significance with the largely atheist readerbase here.

8. ^{^}

   For a more clear-cut example of such, consider the explosion of TikTokers claiming they had dissociative identity disorder in 2020.

9. ^{^}

   There are alternatives, most notably the transmedicalist community, but they are small and have problems of their own.