From transsexuality to gender diversity. Hacking’s looping theory as an explanation for the sharply increasing number of adolescents seeking gender affirming medical care

New publication in peer reviewed journal Filosofie & Praktijk, Volume 46, Issue 1, apr. 2025, p. 42 - 68

Authors: Jilles Smids and Peter Vasterman.    

ABSTRACT

Over the past decade there’s been a surge in the number of young people seeking medical treatment to change their gender. What makes looking for explanations difficult is the problem that concepts such as transgender are moving targets: they are constantly changing. This study tries to solve this by applying Ian Hacking’s ‘looping theory’ on the historical development of these concepts. Hacking examined how classifications and labels influence self-perception and behavior, and vice versa, how the classified people fight for acknowledgement and a change of labels. Four socio-historic periods are identified, describing the interactions between political institutions, medical and health organizations, academic centers, advocacy groups, (social) media and the people involved. This study shows that the increase in medical transitions can partly be explained by the changing concept of trans into a non-medical identity label, with self-identification as the single defining characteristic. The result was a broadening of the eligible population.

Keywords: transsexuality, transgender, looping theory, medical transitions.

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Content

Introduction

Theoretical framework

    The looping effect

    Joel Best’s social problems theory

    Transgender identities and looping effects

Methodology and research questions.

    A grid for socio-historic analysis

    Research questions

    The empirical research

Transgender identity as result of the interplay between social actors.

    1920-1980: Conceptualizing a rare phenomenon: transsexuality

    1980-1997: Contested medicalization.

    1997-2012: The medicalization of transgender adolescents.

    2012-2024. Further expansion and emerging criticism

Discussion: explaining the increased referrals with Hacking’s model

Conclusion

Literature

Introduction

    Over the past decade there’s been a surge in the number of young people (age 10-24) seeking medical treatment to change their gender, commonly described as transgender.  Despite the significant increase in capacity of gender clinics in the Netherlands, several thousands of young people are on slow waiting lists (Kwartiermaker Transgenderzorg 2022, p. 2). Besides this strong increase, there is also a striking reversal in sex ratio with natal female adolescents now largely outnumbering natal males (Arnoldussen et al. 2022, p. 2542). Comparable increases are reported in many other countries (Cass Review 2024, p. 24; Kolk et al. 2023, p. 13). The number of people identifying as gender diverse, transgender, or non-binary has also risen, largely driven by Generation Z females (Government of Canada 2022; U.S. Transgender Survey 2024; De Graaf et al. 2023, p. 28).