The controversy

The abovementioned author points to social contagion and maladaptive coping mechanisms, as well as parent-child conflict, as possible explanations for the sudden dysphoria, which should be explored. She adds, "The findings of this study suggest that clinicians should be cautious before relying solely on self-report when youths seek social, medical, or surgical transition. Adolescents and young adults are not trained clinicians. When kids diagnose their own symptoms based on what they read on the Internet and hear from their friends, they may well come to the wrong conclusions. It is the duty of the clinician, when faced with a patient seeking transition, to perform his or her own assessment and differential diagnosis to determine whether or not the patient is correct in his or her self-assessment of his or her symptoms and conviction that he or she would benefit from transition. This is not to say that the patient's convictions should be discounted or ignored. Of course, some may benefit from transition. However, careful clinical examination should not be neglected either. The fact that the patient's history is significantly different from the parents' account of the child's history should serve as a red flag that further evaluation is needed and that other sources should verify as much information as possible about the patient's history" (^{Littman, 2018, p. 37}).

Littman's paper proved controversial right from the start, to the extent that her own university (Brown University) withdrew it from the repository and the journal revised it a second time including a correction the following year (^{Littman, 2019}), in the face of pressure from transgender activism. While its removal by the University deserves all reproaches according to the former dean of Harvard Medical School (^{Flier, 2018}), the second revision involved no substantive change other than improved contextualization of the study (^{Bartlett, 2019}; ^{Littman, 2019}).

Objections to the study focused on three aspects: the hypothesis of social contagion and the role of associated psychological problems, alleged methodological flaws, and lack of clinical evidence of ROGD. In relation to the first, the objection is surprising for proposing hypotheses about the findings of an exploratory study. These hypotheses are otherwise entirely plausible and are in fact supported by the exponential growth of the phenomenon, the concurrence of other previous disorders and the new phenomenon of transition regret and detransitioners (^{Entwistle, 2020}; ^{Littman, 2021}; ^{Vandenbussche, 2021}). For example, repentant individuals speak of influences that led them to a precipitous transition (^{Alsedo, 2022a}; ^{Bell, 2021}; ^{Dagny, 2019}). Regarding the alleged methodological flaws, they in no way invalidate the study, which, in fact, remained practically intact (^{Bartlett, 2019}; ^{Littman, 2019}), showing in the end that its methodology is consistent with that used in the field of gender dysphoria, as demonstrated by the author in response to her critics (^{Littman, 2020}).

A social phenomenon

Regarding the lack of evidence of ROGD as a clinical entity, the truth is that it has no clinical entity, nor does it claim to have one. And, to put it bluntly, neither does the gender dysphoria/incongruence included in the diagnostic systems DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) or ICD-11 (International Classification of Diseases, 11th edition). (Nor should it claim to have a clinical entity). Not only should ROGD not be included in future diagnostic systems, but gender dysphoria/incongruence should be removed from the current catalogs of mental disorders or illnesses. However, the so-called ROGD is still a new social phenomenon in the context of transsexual and transgender history, in view of its growth of thousands per cent in a few years, the change in the female-to-male ratio as opposed to the other way around as in the adult sphere and the occurrence at increasingly younger ages (^{Bonfatto & Crasnow, 2018}; ^{Errasti & Pérez-Álvarez, 2022, p. 195}; ^{Kaltiala-Heino et al, 2018}; ^{Zucker, 2019}).

The objections to Littman's study, beyond the discussion that all scientific work deserves, respond to ideological motivations related to the hypotheses of social contagion and the role of other problems. These hypotheses are in contradiction with the supposed innate, natural, and unmodifiable condition of felt identity as queer ideology wants to present gender incongruence/dysphoria. The truth is that what is known as ROGD is a new social phenomenon.

The mother of the lamb

To see it from the perspective of the parents, it is understandable that they may be disconcerted by the statement-undoubtedly sincere, heartfelt, and long-suffering-of a girl who says she feels, and is, in reality a boy (or the other way around) and who also wants to be called by another name from now on, since she is no longer who she was until then.

Parents will soon see that the change is neither sudden nor lacking in firmness. The girl is clear, and well versed, about what to say in the face of any parental reticence and remarks, including saying that if they don't support her, it is a sign that they don't love her, or that she may commit suicide. Parents will also see that the change may have already been happening at school, in the peer group, and in social networking communities, where the girl has probably already chosen a new name and pronouns. The parents will also see that in the health center, where they will most likely go, the professionals (pediatricians, endocrinologists, psychiatrists, psychologists) are already up to date on what to do in gender dysphoria. Professionals will probably end up telling parents that they have a son instead of a daughter or the other way around. And the parents will eventually see that it is better to have a transgender child than a dead one, as is often stated. Thus, we come to the mother of the lamb.

Unlike how parents were at the beginning, schools and health centers have an official policy: self-determination of gender identity by feeling (felt identity) and affirmative therapy consisting of affirming the felt identity with no acceptable option other than accompaniment for the purpose of gender transition.

The trans train

The transition can have four phases. Briefly, these would be as follows: social transition of changing name, pronouns, and appearance, puberty blocking (around 11-12 years, depending on development) with gonadatropin-releasing hormone analogs that suppress the production of sex hormones (testosterone or estrogen), cross-hormonal treatment (around 16 years) based on testosterone for girls and estrogen for boys, and gender affirming surgery (from 18 years of age, but if done earlier it would not be the first time). Gender affirming surgery may include mastectomy, vaginectomy, and phalloplasty for female-to-male (transgender male) change, and vaginoplasty consisting of penile reconversion into a vaginal cavity for male-to-female (transgender female) change, in addition to other complementary plastic surgeries (^{Claahsen-van der Grinten et al, 2021}). Table 1 presents the surgical procedures for natal males and females.

It is not necessary to go through all of the above phases to consider oneself a transgender person. It may not even be necessary to go through any of them, as the self-affirmation of feeling trans may be enough for some. Social transition, however, is part of a whole conveyor belt or train that takes the majority of people to the next phase. This majority continuity of phases-starting with social transition-does not necessarily occur because the feeling was firm and definitive from the beginning (although this is not ruled out). It may also occur because social transition itself promotes hormonal blockade and orients the individual in that direction, and from there to hormonal cross-treatment, and then on to surgical interventions. All of this constitutes a psychosocial process, as well as a biomedical one, which involves and commits the person in a certain direction, rather than supposedly revealing a crystalline feeling. It will be seen that before the affirmative policy was established (as of 2013) most dysphoria remitted on its own. However, since this policy has been in existence, the likelihood of an individual who enters one phase moving on to the next is almost one hundred percent, particularly from social transition to puberty blocking and from puberty blocking to hormone treatment. The newly emerging phenomenon of regretters and detransitioners suggests that the policy of affirmation is going too far for some, as will be seen.

In the end, even without being aware of the road ahead, parents will realize that they have no choice but to affirm and accompany their son or daughter. Thus, some parents become more affirming than anyone else, while others feel abandoned by the system, if not doomed to lose their "parental authority" or even to go to a psychologist themselves (^{Alsedo, 2022b}; ^{Ekman, 2022, p. 280}).

The self-determination and affirmation that are now obligatory for all derive from the gender ideology that queer activism has managed to impose on institutions as official policy. They do not derive from research or scientific consensus. Scientific consensuses are actually ideological statements such as those of the AAP and the APAs (^{Cantor, 2020}; ^{Errasti & Pérez-Álvarez, 2022, pp. 223-229}). The "Standards of Care for the Health Care of Trans and Gender Variant People" (7th edition) of the World Professional Association for Transgender Health (^{WPATH, 2012}) are usually taken as a reference. However, this guide, like the others that are inspired by it, cannot be taken as a "gold standard" as it is considered, due to the poor assessment of its quality in important domains (^{Dahlen et al, 2021, p. 8}). Pending the 8th edition of the WPATH standards, trusting that it will be more science-based than ideology-based, there does not exist an ethically and scientifically grounded consensus as has been called for (^{Clayton, 2022}; ^{Gómez-Gil et al, 2020}; ^{Griffin et al, 2021}; ^{Levine, Abbruzzese, & Mason, 2022}).

Clinicians on a knife's edge

To the extent that ideology prevails over science, prudence, and common sense, education and health professionals are failing not only parents, but children and adolescents themselves. Schools are failing to the extent that indoctrination prevails over knowledge. Health professionals are failing as well, to the extent that children and adolescents with gender dysphoria do not receive the same standards of clinical care, assessment, and support as any other child or adolescent accessing health services, due to the constrictions imposed by affirmative therapy. Clinicians are on a knife's edge: either they risk being accused of transphobia if they explore the case, or they remain silent while attending to the uncontrolled experiment of affirmative therapy (^{Griffin et al, 2021, p. 297}).

Children and adolescents as a battlefield

What has happened? Where has trans childhood emerged from? The official version says that greater visibility and tolerance bring to the surface gender dysphoria or incongruities that were already there. However, this does not seem to be the explanation according to what has been said and what will be said later. If scientific research does not force us to think otherwise, it is possible to think that trans childhood, more than an underlying reality that is now uncovered, would be a battlefield where the war of genderism is being waged. The problem is not in childhood or in the body, but in society with its still stereotyped gender roles, and in the transgender activism that naturalizes them, elevates them to a political category, and turns them into law. In this sense, children and adolescents become the canary in the old coal mines: a sign that something is wrong with the system. What is wrong with the system? The prevalence of ideology over science.

Dogmatic implementation of affirmative therapy as the only acceptable option

Ultimately, affirmative therapy is not as self-evident as it is made out to be. The evidence reviewed by the National Institute for Health and Care Excellence (NICE) on puberty blockers shows that it is difficult to draw conclusions from the existing studies, because they lack a control group, they are small, and they do not describe what other physical and mental health problems a young person may have in addition to gender dysphoria. Ultimately, the review found no evidence of goodness of treatment (^{NICE, 2020a}). Although puberty blockers as a routine intervention for children and young people are associated with few known medical risks, Bernadette Wren, associate director of the British health system's Gender Identity Development Service (GIDS), is quick to acknowledge potential unknown consequences, adding, "It is well known that rigorous longitudinal trials are lacking and the available evidence is of limited quality, although many leading doctors write in favor of it." (^{Wren, 2019, p. 208}). In particular, one study followed the evolution (at least one year) of 44 adolescents (aged 12-15 years) with persistent and severe gender dysphoria treated with blockers. Although the participants generally reported a positive experience, no improvements in psychological distress, quality of life, or degree of gender dysphoria were observed (^{Carmichael et al, 2021}). A 2015 study had already shown that puberty blockers were no better than psychological support in reducing psychological distress (^{Biggs, 2019}; ^{Costa et al, 2015}).

In relation to cross-hormonal treatment, a NICE review found that the evidence for the clinical effectiveness and safety of gender-affirming hormones was also of "very low" quality. As it points out, any potential benefit of gender-affirming hormones must be weighed against a hitherto unknown long-term safety profile (^{NICE, 2020b}). A Cochrane Library systematic review concludes, "We found insufficient evidence to determine the efficacy or safety of hormonal treatment approaches (estradiol alone or in combination with cyproterone acetate or spironolactone) for transgender women in transition. The evidence is very incomplete, demonstrating a gap between current clinical practice and research" (^{Haupt et al, 2020, p. 11}).

On the other hand, even though affirmative sex reassignment surgery shows short-term (one or two year) beneficial effects, unfortunately, the long-term benefits at ten-year follow-ups disappear. A 10-year average follow-up study conducted in Sweden on 324 transsexuals who, over a thirty-year period (1973-2003), received affirmative surgery shows that they have considerably higher risks of mortality, suicidal behavior, and psychiatric morbidity than the general population. Compared to the general population, patients who underwent surgery had a rate of completed suicide that was 19 times higher, nearly three times the rate of all-cause mortality, nearly three times the rate of psychiatric hospitalization, and nearly five times the rate of suicide attempts (^{Dhejne et al, 2011}). A recent Swedish study shows that affirmative surgery does not actually improve the mental health of transgender people compared to transgender people who did not undergo surgery (^{Correction to Bränström & Pachankis, 2020}; ^{Van Mol et al, 2020}), contrary to the authors' optimistic conclusions in an early version of the article (^{Bränström & Panchankis, 2020}) that they had to correct.

A long-term retrospective study of 8,263 patients referred to the gender clinic at the University of Amsterdam between 1972 and 2017 found that the annual rate of completed suicides among transgender subjects was "three times higher" than the general population. The incidence of suicide deaths was almost equally distributed across the different stages of transition. In other words, neither social nor medical transition reduced the suicide rate (^{Wiepjes et al. 2020}). Importantly, the mean time between commencing hormones and suicide was 6.1 years for natal males and 6.9 years for natal females (^{Wiepjes et al. 2020}). An earlier study had already shown this delayed effect. Thus, in a sample of 1,331 transsexuals followed for an average of 18 years, while there were no suicides in the first 2 years, there were 6 after 2 to 5 years, 7 after 5 to 10 years, and 4 after more than 10 years since cross-sex hormone treatment (^{Asscheman et al. 2011}). The results suggest that short-term or even medium-term studies overlook the phenomenon of suicide.

These findings do not imply that hormonal or surgical treatment causes suicide. This occurs because transgender people suffer a high incidence of "comorbidities" that correlate with suicide (depression, self-injurious behavior, anorexia, autism spectrum, trauma), as well as discrimination, disrespect, and violence (^{Biggs, 2020}; ^{Zucker, 2019}). What these results show, at least, is that neither hormonal nor surgical affirmation solve all the initial problems, nor do they solve them completely. Moreover, these individuals do not seem to be on the path to a healthy life, contrary to the enthusiasm and haste with which the transition is promoted.

From the perspective of these studies, the purported "new evidence" supposedly supporting affirmation surgery-based on a general survey that, incidentally, merely shows lower odds of psychological distress in the past month, and of smoking and suicidal ideation in the past year, compared to transgender people without a history of affirmation surgery-is not justified (^{Almazan & Keuroghlian, 2021}). Also not justified is the emphasis in favor of affirming medication based on short-term improvements, which, on the other hand, also cannot be ruled out as being due to other things, such as possible psychiatric medication and family support that the authors themselves acknowledge (^{Tordoff et al, 2022}). The best help for children and adolescents does not start with getting them directly into affirmative therapy (^{D'Angelo et al, 2021}; ^{Griffin et al, 2021}; ^{Levine et al, 2022}; ^{Marchiano, 2021}; ^{Zucker, 2019}).

Nor is the haste with which a pediatric clinical guideline recommends affirmative therapies justified on the assumption that, if "they are delayed excessively or there is no affirmative social intervention to support these minors, there could be an overall increase in psychopathology and other undesirable situations" (^{Moral-Martos et al, 2022, p. 3}). As the guideline itself acknowledges: "Although experience in the management of hormonal and surgical treatments is increasingly extensive, the scientific evidence is weak and relatively scarce due to the lack of methodologically adequate studies that assess long-term results, especially for treatments initiated in the peripubertal stage; however-as the guideline continues-there is evidence that demonstrates the benefits of both pubertal blocking and gender affirmation treatment on the health of trans people" (^{Moral-Martos et al, 2022, p. 3}). In this regard, the guideline cites as evidence four studies (^{Chew et al, 2018}; ^{López de Lara et al, 2020}; ^{T'Sjoen et al, 2019}; ^{Turban et al, 2020}), which themselves are, curiously, examples of studies that are methodologically inadequate to assess long-term outcomes, due to their acknowledged or readily demonstrable low quality and certainly no long-term follow-up. Table 2 shows what these studies contribute.

It is inconceivable that a pediatric guideline would take the supposed evidence for affirmative therapy so lightly, or be so naïve, as will also be discussed below.

Self-diagnosis as if children were wise

Felt identity and affirmative therapy imply "self-diagnosis" with no other options for the professional than accompaniment and a “one-size-fits-all” approach (^{D'Angelo et al, 2021}). On the other hand, the presence of psychological disorders is well known in adolescents with gender dysphoria, including depression, anxiety, self-injurious behavior, suicidal ideation and behavior, eating problems, and autism spectrum (^{Kaltiala-Heino et al, 2018}).

It is understood that a professional knows more than a child or adolescent. Children and adolescents are not wise, and-like other people-their feelings are not exempt from social influences. To provide the best possible help, the professional needs-of course-to study and understand the different aspects involved in people's suffering. Psychology has the knowledge and resources to understand people in order to know what is happening to them and to make the best decisions. The professional relationship is based on respect and empathy, but respect does not necessarily consist of affirming everything the client or patient says, as if he or she were a customer in a department store. Nor does empathy consist of merely agreeing, but rather it consists of taking seriously what we are told in accordance with our professional knowledge. In fact, agreeing to everything could be disrespectful, even more so in a scientific, ethical, and professional context.

Consider these situations. In the context of psychotherapy for depression, anxiety, autism spectrum, anorexia, or self-injurious behavior, the client says she is a boy. Has the psychotherapy ended here? Does the newly stated gender dysphoria/incongruence explain everything? Should the practitioner focus on the initial problem apart from the dysphoria? Should the practitioner include dysphoria in the ongoing psychotherapy? By including it, does he/she not run the risk of being accused of supposedly applying "conversion therapy" instead of the mandatory affirmative therapy? In the context of accompanying affirmative therapy, problems of depression, anxiety, autism spectrum, anorexia, or self-injurious behavior emerge. Should these problems be left aside and the affirmative therapy continued? Should they be treated in parallel? Should we simply assume that these problems derive from gender dysphoria and expect that affirmative therapy will solve them? What if these problems predate the dysphoria and everything seems to indicate that the dysphoria derives from them? These are dilemmas to which the policy on gender dysphoria leads, contrary to the knowledge and procedure applicable to all other problems.

It is argued that the application of psychology to dysphoria would be tantamount to pathologizing it. Apart from the fact that no such connection-psychology-pathologizing-can be made at all, the irony is that nothing amounts to greater pathologizing than a pharmaceutical-surgical therapy such as affirmative therapy. If gender dysphoria/incongruence is considered to be a psychosocial discomfort with one's own body (since no one is born in the wrong body), affirmative therapy becomes a psychotherapy with a scalpel that turns a healthy person into a patient for life.

Hasty transitions leading to the new problem of de-transitions

Whilst there is no denying that transition may be the best option for someone, the new phenomenon is also true; that of individuals who regret the transition undertaken and would like to de-transition when there has already been irreversible damage (^{Shrier, 2021}). Although the transactivist movement attempts to deny or minimize its existence, the fact is that the case of regretters who want to go back is a new phenomenon that has been underestimated until now. At present, there are no predictors that allow us to know in advance for whom transition would be the best option. There is a dilemma here between the suffering of waiting if transition does not happen now and the irreversible damage due to rushing into transition. Transactivism seems to favor the first option. However, waiting may bring the solution or lead to the requested option from the age of 18, while irreversible damage is forever. There are no predictors, but there is a growing rate of regret and detransitioners. According to a study conducted in the United Kingdom, 6.9% of people treated with affirmative therapy were detransitioners within 16 months of starting treatment, and another 3.4% had a pattern of medical care suggestive of detransition (^{Hall, Mitchell, & Sachdeva, 2021, p. 6}).

Another study also from the United Kingdom found that 12% of those who had started hormone treatments either detransitioned or required further evaluation, and 20% ceased treatment for a variety of reasons. As the authors conclude, "The rate of detransition found in this population is new and raises questions about the phenomenon of overdiagnosis, overtreatment, or iatrogenic harm as found in other medical fields." (^{Boyd, Hackett, & Bewley, 2022, p. 13}).

A study conducted online, with the purpose of describing a population of people who experienced gender dysphoria, chose to undergo a drug-surgical transition, and then dropped out, recruited one hundred participants, 69 natal females and 31 natal males (^{Littman, 2021}). The study was interested, among other things, in the reasons for both transition and detransition. Table 3 shows some of the reasons for transition and Table 4 for detransition.

Another online study, in this case with the purpose of analyzing the specific needs of detransitioners, recruited 237 participants, of whom 217 (92%) were natal females and 20 (8%) natal males (^{Vandenbussche, 2021}). Table 5 shows excerpts from experiences of exclusion from LGBT+ communities reported by detransitioners.

Similarly, the study shows negative medical experiences during detransition ("When I first mentioned to my doctor that I wanted to get off testosterone, they were very dismissive and condescending about it;" "As soon as I 'detransitioned' I was discharged from all gender services, despite asking for help in dealing with sexual dysphoria in case it resurfaced," etc.) as well as difficulties in finding therapists that are friendly to detransitioners (^{Vandenbussche, 2021, p. 11}).

After the enthusiastic support for the transition, the abandonment of people who repent and want to de-transition leads them to form self-help groups, an initiative that is also undertaken by groups of parents. Table 6 lists some of these self-help groups. Beyond these aids, "clinical guidelines" are required for detransitioning according to its typology if it is motivated by the cessation of transgender identity or for other reasons (^{Boyd et al, 2022}; ^{Expósito-Campos, 2021}).

The prevailing narrative about detransitioning says that most people who detransition will transition again and that the reasons for detransitioning are discrimination, pressure from others, and non-binary identification (^{Turban et al., 2021}). Although that does also occur, case studies shed light on a broader and more complex range of experiences that include a variety of psychological problems, worsening mental health after transition, reidentification with natal sex, and difficulty separating sexual orientation from gender identity (^{D'Angelo, 2020}; ^{De Celis Sierra, 2021}; ^{Expósito-Campos et al, 2022}; ^{Levine, 2018}; ^{Pazos Guerra et al., 2020}; ^{Withers, 2020}). It is crucial to study each case if we want to understand and recognize the reality of this suffering (which involves multiple dimensions) and offer help and solutions tailored to the individual beyond the “one-size-fits-all” approach imposed by affirmative therapy.

What to do instead of affirmative therapy?

What all clinicians do in all cases: evaluation, exploration, functional analysis, clarification, questions, confrontation, common sense, prudence, attentive waiting, help according to needs and problems. No "blanket approach". The issue should probably be not so much about diagnosing whether one is actually transgender or not, but more about helping according to the issues, including transition support. The drive to diagnose whether or not someone is actually trans involves a double bias-essentialist and biomedical-which does not correspond to the fluid, nonlinear dynamics of gender identity development (^{Pullen Sansfaçon et al, 2020}), including desistance (^{Steensma et al, 2011}). Properly informed consent should be a process rather than an event (^{Levine et al, 2022}; ^{Wren, 2019}).

However-incredible as it may seem-everything that clinicians do regarding the other problems is forbidden here, under the accusation of "conversion therapy." Fortunately, conversion therapy is not applied today, even though it is used as a disqualification for everything that is not affirmative therapy. According to Roberto D'Angelo et al, exploratory psychotherapy, which is neither affirmative nor conversion therapy, should be the first line of help for children and adolescents with gender dysphoria, thus avoiding invasive and irreversible medical procedures (^{D'Angelo et al, 2021, p.13}). If only for the Hippocratic principle "First, do no harm", affirmative therapy should be the last resort, not the first.

Like bamboo

There is an accumulation of proximate and ultimate conditions intermingled. Nothing comes out of nowhere or suddenly. Like bamboo, the ideology of queer/trans genderism has grown fast, but it has taken its time to take root in the shade. The proximate conditions in the shade are those roots that suddenly surprise us with their growth. But it all depends on a propitious soil and climate: its ultimate conditions.

In relation to ultimate conditions, we have to situate ourselves in Western society, open, democratic, cosmopolitan, and affluent, even though neither wealth nor well-being are equally distributed. This open society is also a liquid society with a particular spirit of the times characterized by subjectivist, expressive, and narcissistic individualism, which is embodied in a floating (liquid, flexible, fluid) individual. Fluid sex and gender are not alien to the liquid society we live in. Felt gender identity is not something independent of subjectivist individualism, no matter how much it may seem to each one that it springs from his or her primal nature, his or her true self, or something like that. Ideology is in charge of making people believe it.

In this context, one would not fail to cite the declining birth rate (^{Douthat, 2021}), the decline of sexual relations (^{Herbenick et al, 2022}; ^{South, & Lei, 2021}), or the irrelevance of biological sex (^{Ekman, 2022}; ^{Miyares, 2022}; ^{Stock, 2022}) as a breeding ground for transgender ideology, which in turn feeds back into it. More specifically, subjectivist individualism-expressive and narcissistic-is characteristic of neoliberal capitalism, which is characterized precisely by the creation of desires as if they were expressions of natural essences that one carries within oneself. And here, to the astonishment of history, this subjectivist individualism is the raison d'être of the identitarian left, which turns desires into rights, such as gender dysphoria, which curiously satisfies neoliberal capitalism with its pharmaceutical-surgical industry. Unlike the classical universalist left that believed in science, truth, and universal rights, and highlighted the contradictions of capitalism, the identitarian left has become the best ally of neoliberal capitalism. We are before an example of "how theories or positions that at first were thought to be progressive and left-wing, have not only shown their political ineffectiveness, but have been successfully assumed by neoliberalism” (^{Rodríguez Magda, 2021a, p. 20}).

The queer/trans ideology has social justice and human rights as its banner, so presumably it has the approval of everyone. It is difficult to find anyone who is not in favor of social justice and human rights. However, not everything is as it seems. The social justice of the queer movement has become a "new religion", a secular religion hostile to reason, to falsification and to any disagreement other than its own truth, a truth based on the "lived experience" of marginalized people and groups, who by the fact of being marginalized are "enlightened" and declare others incapable of understanding anything. We are no longer speaking of a universal social justice capable of understanding the objective conditions of reality, but of an experiential and tribal social justice, according to the tribe to which one belongs (^{Errasti & Pérez-Álvarez, 2022, ch. 6}; ^{Malo, 2021, ch. 6}). With regard to human rights, it is not easy to see whether they are taken seriously, or whether they have a partisan (judging by the abandonment in which the detransitioners are left, as has been seen) and strategic use, as will be said. It is certainly easy to be on the queer side, because it is supposed to be the good side and lends itself to virtue signaling, a form of ethical posturing.

However, we would not get here without the proximate causes - how the roots suddenly sprouted - referring in particular to the trans lobby. Not to mention the social networks, without which nothing would be the same. As far as we are concerned, suffice it to recall the strategies of transgender activism, while still "following the money".

Activist strategies

The strategies of transgender activism are described in the paper uncovered by James Kirkup (^{Kirkup, 2019}; ²⁰²¹) that was produced by the law firm Dentons, the Thomson Reuters Foundation, and the International Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Youth and Student Organization (IGLYO) entitled "Only Adults? Good practices in legal gender recognition for young people" (^{Dentons, Thomson Reuters, & IGLYO, 2019}). Table 7 lists lobbying tactics to change laws so that self-determination of gender identity with no age minimum prevails over what parents and professionals say (^{Dentons et al, 2019, p. 15}).

With regards to "following the money," there are corporations and billionaire families funding queer genderism (^{Bilek, 2018}; ²⁰²⁰; ^{Contra el Borrado de las mujeres [Against the Erasure of Women], 2020}; ^{Miyares, 2022, pp.113-115}). Far from being marginal, the queer movement is now a rich and powerful lobby.

None of this denies the good intentions of the activists. But intentions do not guarantee that the best is being done. According to the well-known phrase of Nobel Prize-winning physicist Steven Weinberg: "Religion or no religion, good people do good things and bad people do bad things. But for good people to do bad things, you need a religion".

You might think of it as progressive

One might think that gender identity is a progressive and liberating idea. But it is actually backward and oppressive. It is backward because of the following:

It is oppressive because of the following:

What to do?

It is appropriate to consider the Statement on LGBTIQ+ issues from the International Psychology Network on Lesbian, Gay, Bisexual, Transgender, and Intersex Issues (^{IPsyNet, 2018}). There is agreement on a variety of proposals, including increasing psychological knowledge of human diversity on issues of sexual orientation, gender identities, gender expressions, and on applying this knowledge in support of well-being and the full enjoyment of human rights; there is also agreement on depathologizing LGBTIQ+ people, differentiating between sexual orientation and gender identity, as well as rejecting both conversion therapy and the reinforcement of gender stereotypes. However, the assumptions that the IPsyNet Declaration adopts and the inconsistencies it incurs cannot be ignored.

The Declaration adopts what are known as the Yogyakarta principles, which are neither based on scientific knowledge, nor should they have more relevance than the private proposal of a pressure group. At the very least, their definition of gender identity as a "deep inner feeling" is highly debatable, which, as has been said, implies an essentialist conception that does not correspond to the changing process and fluidity of gender identity. Not to mention the expression "sex assigned at birth," which is entirely ideological, as well as counterfactual. The Declaration is blatantly inconsistent. If, on the one hand, it states that identities and orientations "do not require therapeutic interventions to be changed" (point 3), on the other hand, it goes on to support "affirmative approaches" and, in point 4, it calls for access to "available treatments", again referring to affirmative transition which, as is well known, includes irreversible pharmaco-surgical interventions. In general, the Declaration is oriented towards affirmative therapy. Its rejection of conversion therapy, which, it seems, includes anything but affirmation, overlooks the fact that between affirmation and conversion there are a variety of alternatives. Given the insistence on affirmation it might be suggested that the greatest conversion therapy is in fact affirmative therapy, known to leave no room for potential desisters that have always existed and knowing the new phenomenon of repenters and detransitioners.

Another inconsistency is found between the stated differentiation between sexual orientation and gender identity and their continued use as if they were on a par. It also states that "sexual orientation and gender identity remain fairly constant throughout life," only to add that "changes in orientation and gender identity may occur across developmental stages within the life course. Finally, the Statement assumes that the psychological difficulties associated with gender incongruence occur solely because of stigma and discrimination, without considering the possibility that the identity distress itself may result from a variety of prior psychological problems.

Given their more judicious and thoughtful consideration, four ideas taken from the Ethics Group of the Catalan Society of Family and Community Medicine (^{Grup d'ètica CAMFiC, 2022}) are proposed: