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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PREVIEW
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).
To date, there is no satisfactory and convincing explanation available for this striking increase of transgender people, let alone for the remarkable shift in sex ratio in a very short time frame. It is important to study what causes these changes, because they may have medical, ethical and policy-related implications. A much discussed question is whether current transgender health care is still appropriate for the changing population of young people (
De Vries 2020;
Cass 2024)? This study will not go into those questions but focus only on finding explanations for the changes, to help informed and nuanced dealing with these issues.
According to a recent government-commissioned report by the Radboud University of Nijmegen with the aim to explain the increase, it is difficult to determine whether there is an increase of transgender people, because reliable historic data are lacking (
Das et al. 2023, p. 3). It might seem that there are more transgender people than before, but as a result of increased acceptance they may only have become more visible, wrongly suggesting an increase.
The problem overlooked by the Radboud report is the fact that classifications such as transgender are moving targets: they are constantly changing. And on top of that: these concepts are not only descriptive but also prescriptive: they show people what it means to be transgender. And people interact accordingly.
This dynamic of chancing concepts, labels, and classifications and their impact on the people described is the main focus of the so-called ‘looping theory’, developed by the Canadian philosopher Ian Hacking in the nineties of the past century (
Hacking 1986; 2007; 2000). Classifications not only impact the self-perception of the people classified, but also affect how they are perceived and treated by others, which further guides their self-perception and behavior. Looping happens when the classified people change so much that the original classifications need revisions. Moreover, the people involved are not just passive objects, but also active subjects, trying to adapt and renegotiate the established classifications and therewith their societal status and legal recognition. Because that is part of a societal struggle, it is important to look into the dynamics of the way social problems are defined and put on the political agenda. Sociological theories about these dynamics will be used to enhance the looping analysis (
Best 2015).
This approach offers new perspectives on the increase of young people seeking care at gender clinics by explaining how and why the original conceptualization of transsexuality as a psychiatric diagnosis for a small group has evolved into the current ‘transgender’ functioning as an umbrella concept, encompassing various gender identities.
