Buck Angel was a pioneering porn star — the only trans man to ever win Transsexual Performer of the Year at the AVN Awards — and today he’s a sex educator, motivational speaker, and entrepreneur. Helena Kerschner is a 22-year-old woman who lived as a man on hormone therapy for several years before detransitioning. Buck’s transition saved his life, while Helena’s transition was a bit of a calamity, but they share a resistance to the dogma of the trans activist community and speak forcefully and elegantly against it.

You can listen to the episode right away in the audio player above (or click the dropdown menu to add the Dishcast to your podcast feed). Read the full transcript here. To hear four excerpts from my conversation with Buck and Helena — on the cult-like behavior of many trans activists; on the risks of puberty blockers; on the profound effects of testosterone; on how the hormone caused Buck, a former lesbian, to become attracted to men for the first time — head over to our YouTube page.

This episode is part of an ongoing Dishcast series on the lives of transgender people and the debates surrounding one of the most polarizing subjects of today, especially when it comes to kids transitioning. Our previous episodes welcomed two happily transitioned and brilliant women, Dana Beyer and Mara Keisling, both of whom pushed back against my views, with followup debate led by readers here and here. More to come. I have tried to get today’s more typical trans activists on the show, but they won’t respond to my emails. If you know a trans person both committed to the full-on trans position and willing to enter dialogue with a critic, please get in touch: dish@andrewsullivan.com.

Here are some pieces we mentioned in this week’s conversation:

* Helena’s tweeted photos showing her social worker assessment. “This took less than 30 min and cleared me to take testosterone w/ no blood work or further assessment,” she writes. She also points to “Tweets with my medical records showing that I was prescribed testosterone (at an unusually high dose) with no blood work on the first visit.”

* “Gender identity is hard but jumping to medical solutions is worse,” an Economic piece written by Carey Callahan, a detrans woman, about her experience working at a clinic in California (not Chicago, as Helena put it)

* A 9-year-old trans kid asking Elizabeth Warren a question at a televised town hall (not a 6 year old, as I mistakenly said)

* “When Sons Become Daughters, Part III: Parents of Transitioning Boys Speak Out on Their Own Suffering,” the latest in an ongoing series by Quillette.

* “The He Hormone”, my 2000 NYT Magazine piece on testosterone

Mentioned in the main Dish today, here’s the full story from the reader who “recently lost my 21-year-old mentally ill, heroin-addicted, trans nephew whom I raised during his teen years”:

As a young girl, my niece literally had no friends and couldn’t find her way in the world. Incredibly smart, beautiful, and funny, she was a lost soul and couldn’t make sense of her life. There was so much mental illness in her family, including her parents.

In high school, she founded the Equality Alliance Club and became fascinated by the trans kids. Pretty soon, I found boy’s underwear in her laundry. We had a talk and I got her in therapy. From there, things moved way too fast and before I knew it, her mom okayed testosterone treatment — like six months into the process. It just didn’t fit the kid I knew. And he never found happiness and ended up addicted and homeless.

I appreciate your thoughtful analysis of this important issue. Anything under the age of 18 needs to be dealt with slowly and carefully and definitely with second opinions.

From another parental figure:

Thank you so much for “A Truce Proposal in the Trans War.” As the parent of a 20 year old who identifies as trans male, I can say that so much of your piece perfectly resonates with my observations — I may just reference it directly when asked, “What do you think?”

For me, the trans identity, or any feelings of non-alignment with externally defined gender designations, has never been an issue. My wife and I adore our son, as he is, and support him any way we can, no strings attached. We are fully supportive of him constructing his own life, defined as he wishes.

Nevertheless, that doesn’t mean we are required to agree with every one of his decisions. Because of the ideological forces you describe in your article, our thoughts on gender issues are not requested or welcomed. We are always under threat of being lumped in with people who are cruel or indifferent in the type of catch-all thinking you describe — either believe it all or be ostracized to the sideline.

Our son is brilliant (quite literally) and has always been extremely independent. However, no amount of raw intelligence or independence can substitute for the wisdom of age and, importantly, the final maturation of the brain. This latter idea — brain maturation — is where I have a minor dissent from your piece.

You laudably attempt to distinguish between the experiments we perform on children and those that adults choose to perform on themselves. You follow the societally determined age of adulthood as being the critical line. However, you are also attempting to ground your thinking in real science, and I suspect you have only acquiesced to 18 for convenience. The age of 18 is far from being a useful determinant of adulthood or final maturation. In fact, current research suggests that the human brain finishes maturing somewhere around 25 years old. (Here’s just one popular article.)

What’s still happening between the ages of 18 and 25? Critically, it’s the development of the prefrontal cortex which regulates behaviors related to risk and long-term planning, to name two key areas. Those seem sort of important here.

So I am primarily concerned with medical interventions, such as hormone therapy and permanent alterations (e.g., breast removal), made prior to final maturation of the brain — and 18 has no actual basis in science. Cultures vary in where they draw these lines, while the biology couldn’t care less.

I do not have the expertise to define the “right” age, nor do I even feel like there is a perfect age for all individuals. If we admit that there are both genuine trans and trans curious individuals (even that objectively true statement is begging for a fight), and we acknowledge our extreme ignorance about the long-term impacts of some procedures, isn’t genuine caution warranted here? Don’t we have an adult responsibility to retain some stake in the conversation after our child suddenly and instantly becomes an adult on their 18th birthday?

As it stands, my wife and I chose not to fight or attempt to interfere in our “adult” (now 20) child’s health decisions. We were essentially hostages in this non-negotiation, with only two choices: maintain a relationship or not. So instead of being partners in our kid’s heath-care choices, we are sideline observers who can’t help think that one day a host of negative health repercussions will emerge and our son will rightfully ask, “Where the f**k were you?” Good question.

Yet another parent is very relunctant to allow their child to seek hormone therapy or more:

I am a mid-40s, straight, white, Christian, conservative male with a wife and two children. However, I like to think of myself as fairly open minded and the rest of my extended family would tell you that I’m over-the-edge liberal.

My oldest child, a 15 year old who was born female, recently told us that they were self-harming and needed help. We immediately sought crisis intervention, therapy, and psychiatry. During therapy they let us know that they were trans. They also let us know that their boyfriend was cis female and in the process of transitioning.

My wife and I have known our child their entire life and we know them well enough to know they can’t decide whether or not they like hot dogs (true story, it switches every couple months). We know that there is a strong possibility that this is due to influence from a group of friends who all identify as trans but have accepted our child into their circle. We don’t know if our child is truly trans or not, but we do know they are not in a good place to make life-altering decisions.

Of course, the counterargument is that if we allow hormone therapy, the depression may go away. It could — or it could get worse. I often wonder if I am being overly Christian conservative with all this, even though we have allowed the name change, clothing style change, hair change, etc.

In years to come, we will know whether or not we have made the correct decision. It may be that our child is truly trans and we have delayed their happiness a few years and will be hated because of it or it may go the other way. Either way we will always love our child and are doing our very best to parent from a position of live and to teach them that no matter what, love others and everything else will work out.

Another reader suggests that waiting until early adulthood to transition better enables certain trans people to still have children:

I am a post-op transwoman in a second marriage to a woman, and also a parent and grandparent. (I also have a partially completed Master of Research with a focus of transgender health care.) So the question of fertility for trans people has a personal resonance for me because I cannot imagine myself not being a parent. I cannot imagine needing to make a choice between transition and having children, when in my mid twenties and even later. But then I am an older transitioner and an early Boomer, so there was nothing available in the airwaves or in popular print media in the ‘60s about gender identity or transitioning.

This next reader also touches on the topic of fertility and makes several other interesting points:

Many people ignore a huge elephant in the room as to why some trans people are unable to pass. It isn’t simply because they aren’t allowed to transition early enough; it’s that gender dysphoria, especially for many trans women, doesn’t appear until sometime around puberty when changes are already happening. This is in the DSM — the distinction is drawn between early onset and late onset gender dysphoria, since different people experience dysphoria for different reasons.

Trans activists hate this theory, because apparently the characteristics of early onset dysphoria in children assigned male at birth correlates strongly with other kids who are not trans and grow up to be cis gay males, whereas the characteristics of late onset dysphoria in teens assigned male at birth correlates strongly with heterosexual cis men who have an erotic or romantic cross-dressing fantasy. The explosive nature of that “two types” model, and especially the second type, is what led to the harassment of scientists by trans activists that was documented in Alice Dreger’s book, Galileo’s Middle Finger.

Accordingly, there isn’t actually any solution where if we “catch” gender dysphoria early enough, everyone is going to be able to transition before puberty and pass. In fact, many people don’t get dysphoria until puberty and it doesn't reach the point when they want to transition until far later in life, when the dysphoria becomes so intense that they decide they need to become the woman that they love so much and fantasize about. In addition to the DSM, you can find the data backing up these claims in the scholarship of Ray Blanchard, Michael Bailey, Debra Soh, and others.

The folks who are driving this activist train are mostly late onset gender dysphoria trans women. They are people who (1) identify as women and (2) are themselves unable to bear children. The fact that these people have a very different life story than the teens they are advocating for is a real problem. They are speaking for teenage trans boys who have the capability to bear or breastfeed children and who might very much regret such a sacrifice later in life. If you take reproductive ability away from someone who later wants to bear a child, that has to be traumatic. You think Keira Bell isn’t suffering trauma?

When I got a vasectomy, at age 25, I was required to fill out all sorts of forms by the HMO and assure several doctors that I was making an intelligent decision and understood I was giving up my ability to have children. And that’s despite the fact that vasectomies are often reversible!

None of that is an argument against medical transition for people who really need it. But it underscores how folks are demanding that teenagers be able to rush into medical transitions that have serious long-term consequences of the sort that doctors traditionally felt required a great deal of guidance even when the patients were adults.

Also, I am so sick of the talking point that we don’t debate or compromise people’s human rights. The Civil Rights statutes of the 1960s were filled with compromises — they didn’t apply to the smallest businesses, for instance. Thurgood Marshall NEVER said “I don’t have to debate my human rights.” He did it, all the time, for decades.

This isn’t because we’re all a bunch of racists and transphobes. It’s because (1) you have to convince people who don’t agree with you or have doubts; and (2) there are some competing interests involved. There were even competing interests involved in race discrimination — we ultimately, as a society, decided that the freedom to refuse to associate with Blacks had to yield. But the argument was made, and it was defeated on its merits. Sex discrimination laws had to make accommodations for single-sex schools. Masterpiece Cakeshop doesn’t have to bake wedding cakes for gay couples because of the owner’s religious beliefs. We balance these interests.

This position of “I don’t have to debate or negotiate” is just a convenient excuse to never have to deal with dissent. And I would argue that it, rather than scientists who study ROGD or pundits like you who try to seek compromises, is a much bigger threat to trans rights. Because if trans activists never debate or negotiate, you get more transphobic legislation like the bathroom bills and sports bills we’ve been seeing.

There’s no way any movement can get everything it wants without hearing contrary views and persuading people and, yes, sometimes compromising. The alternative isn’t a clean victory — it’s defeat.

Our in-tray is always open for more debate and dialogue and personal stories: dish@andrewsullivan.com.

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