Trans Identities and Addiction

Evelyn Ball presents her addiction theory of trans identity at the 2026 Detrans Awareness Day conference

In her speech at Genspect’s Detrans Awareness Day, therapist and teacher Evelyn Ball discussed how an addiction framework can help in understanding and responding to the adoption of a trans identity by young people. Her perspective is explicitly supplementary. The reasons why individuals identify as trans are multifaceted, she says: “There is no single lens that can fully explain this phenomenon, but for many it may function much like an addiction”.

There are numerous similarities between the function of substance use and trans identification. One of those is that, where there is a perceived lack of other options, addictive behaviour initially offers what appear to be positive rewards in the form of highs, relief, and escape from stress and suffering.

The Addictive Society

Addictions are omnipresent: substance abuse, porn and sex addiction, internet, gambling, and gaming addictions. The list seems endless and keeps growing. Is this just another case of the inflationary use of a mental health label familiar from critiques of the ever-expanding DSM? Or could an addiction framework offer complementary insights into the experience of transgender identification alongside other approaches?

A recent Guardian article on extreme physical workouts highlights striking parallels with Evelyn Ball’s observations. “Luke Tyburski was a man of extremes”, the article begins. For him, training and racing create “an escape, and the highs are extremely high”. Privately, however, he says he was dealing with depression, “related to a loss of identity after the end of his footballing career” (a major life transition). Running looks like you are going somewhere, but Tyburski came to see it as an escape. He experienced deep lows after an extreme bout of training because he realised he wasn’t running anywhere in particular, but running away from something.

Exercise addiction, if there is such a thing, appears to be related to body dissatisfaction. But there is also an emotional element: using exercise “to get rid of unwanted and uncomfortable feelings”.

The rewards offered by a trans identification can be similar to those offered by other addictive behaviours. And, as detransitioners repeatedly tell us, escape from uncomfortable thoughts and feelings, emotional highs in the early phases of transition, followed by lows and a sense of going nowhere fast, are all familiar aspects of their experience and stories.

The initial relief that a trans identification can provide exerts an irresistibly powerful psychological pull. The nervous system (as in the training example) begins to organize around it, which makes it extremely difficult to question or give up. The reinforcing substance can be chemical, but (as Evelyn Ball explains in this video) in the case of trans identification, it is primarily the ideation, the identification, and the affirmation that offers a type of high and relief and “a promised exit from overwhelming confusion, depression, shame”.

Conditioning

Addictive behavioural patterns can be pharmacologically reinforced. Some females who have detransitioned, says Evelyn Ball, describe the early effects of testosterone as energizing and rewarding, increasing libido strength and a sense of confidence. But the addiction pattern Ball describes in this talk consists primarily of a behavioural reinforcement loop of ideation, identification and affirmation that organizes a person’s experience. With reinforcement, including the unreliable intermittent reinforcement that can be procured on social media in particular, there is a growing dependence on the new identity that becomes necessary for continuing emotional stability. The substance in this case is the sought-after affirmation. Trans-identified youth get hooked on external signals of validation to strengthen their sense of worth and belonging. As in exercise addiction, “there is the same need for an external source to come inside and regulate the internal turmoil.” But affirmation neither challenges nor builds the strength, maturity, and resilience needed for real growth. It merely goes along with immediate desires.

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Just as substances can initially bring deep relief from inner turmoil, so can behavioural addictive patterns. They can work for a time as a way to manage and survive overwhelming, complex feelings. Those feelings can be about gendered expectations, unprocessed sexual assault, internalised homophobia, exposure to highly sexualised content, body image issues, an adolescent sense of inadequacy or self-consciousness in a transitional phase of life, and much, much more

Failure to Resolve Underlying Pain

The addiction framework interprets trans identification as an escape from realities that the young person is not yet able to face. But after the high comes the low. Then the immediate impulse is to intensify the behaviour and to seek more of the same. Dopamine rises in anticipation of reward. This anticipation (the expectation that transformation, belonging, and a new life will arrive soon) nourishes the promise of the next step. Evelyn Ball recounts how one detransitioner described how she experienced this anticipation phase: “First it was, How about this surgery? Then this next surgery? Then how about this other surgery?”

But when the behavioural pattern fails to resolve the underlying pain there can come the realization, as so often with addiction, that it isn’t helping, that the cost is higher than the payoff. The trans identity is not freedom, not an authentic self, but dependency. Many young people—who at one point during puberty may have vocally demanded cross-sex hormones—realize that they have been going through a deep adolescent crisis, that they couldn’t come to terms with their homosexuality, or that anorexia lay behind their desire not to have breasts. Or the burden of imposter syndrome becomes too heavy, and they can no longer avoid awareness of the great trans taboo—that the body will always remain the same sex, no matter what hormones are used or what surgeries are performed.

Concealment

Substance use often involves concealment and distortion, “hiding behaviour, denying harm, minimizing consequences, misleading and silencing those who try to help, seeking collusion and enabling from loved ones, and sometimes escalating to lying, manipulating or even cheating and stealing,” explains Evelyn Ball. With trans identification, the concealment takes another form. Instead of the behaviour being confronted, the surrounding environment (family, schools, institutions, clinicians) often mirrors, affirms and reinforces the newly adopted identity. Concealment as depsychopathologization involves turning away from the underlying conflicts driving the trans identity, which is not questioned, but encouraged and celebrated. Mainstream media and institutional values laud the trans identity and ignore the pain that makes young people desperate for an escape route. The genuine value of authenticity (which Cori Cohn describes as “living life, by having struggles, by making mistakes”) is reduced to the banality of young people’s supposedly privileged access to knowledge of their own developing selves. Similarly, healthy exercise is socially validated (“in a way that, say, a gambling addiction is not”), but even “exercise addicts” will win plaudits on social media and be put on a pedestal with only those closest to them knowing that “they couldn’t stop, and if they stopped, there was a loss of control over who they were.”

The concealment of denial means that the alternative option to intensifying the behavioural addiction pattern, which is to turn and face what lies underneath, is rarely applauded.

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Costs of Detransition

We know from detransitioners’ stories that the route back from a trans identification is hard-going and the costs are high. Detransitioners and desisters are often treated far worse than others who cast doubt on trans ideology. They can find themselves “isolated, alienated, with no map, no resources”, as Evelyn Ball puts it. Which, as she emphasises, is why the support and connection that Genspect’s Beyond Trans network offers are so important.

Detransition is not only socially costly but also requires that detransitioners take a deep look at themselves and confront feelings and discomfort they may have been trying to avoid, for which a trans identification may have provided temporary relief. This involves asking hard questions of the self: “What was I trying not to feel? What was I needing not to know? Why was I so vulnerable to this? Why did I need this certainty? What was going on in my life, relationally, developmentally, mentally, psychologically, that made this thing the thing I held on to?” It is then that detransitioners need massive support to explore themselves, rebuild relationships, and find a way of living without the need for this particular escape.

Unlike addiction recovery, there is as yet very little in the way of a social, clinical, or medical infrastructure to support detransitioners. Institutions that have affirmed trans identities fail to allocate resources to the detransitioners who now need help. This is partly an ideological failing and partly due to factors such as the lack of applicable medical codings. Things may be about to change, however. On June 5, the Cleveland Clinic, one of the largest hospitals in the U.S., reached a settlement with the Department of Justice in which the hospital not only committed to cease performing gender-affirming surgeries for at least twenty years, but to provide $2 million to support de-transitioners. A similar settlement has also been reached in Texas.

Evelyn Ball’s addiction framework may help fill in some gaps in our understanding of the experience of trans-identifying young people. It is by no means the only interpretive lens (others include trauma frameworks, attachment, developmental vulnerability, obsessive processes, and more). The addiction framework can help to develop responses that are more sensitive, patient and wise in terms of development, and that recognise the urgency of building the kind of recovery infrastructure that is already recognised as necessary for substance abuse.” Detransition deserves the same recognition and support, including from a media otherwise eager to delve into ever-more manifestations of addiction, yet is still beholden to the taboos of gender exceptionalism.

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