So, Discovery Institute's blog "Evolution News" has published a lengthy series of essays on transgender people, and the diagnosis and treatment of transgender youth in particular. It's 7 or so essays, each one probably a good 1,000 words or more. I'm not going to dissect each essay in detail. There is so much twisting of both the science and the realities of how treatment progresses that I only need to take one apart to give you a flavour for how bad these really are. The following essay has been selected in part because it seems representative of the level of twisting going on.
Evolution News: Some Effects of Transgenderism
Let's get started, shall we?
Lie #1:
In 2019, psychologists Richard Bränström and John Pachankis published a study of 9,747,324 Swedes. The goal was to determine whether “gender-affirming [cross-sex] hormone and surgical treatment” improved the mental health of people with gender incongruence.
Bränström and Pachankis found no evidence of improvement from cross-sex hormones. But they concluded that the evidence “lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.” Critics objected that this conclusion was not warranted by the data. So the authors revised their article. The journal editor published a correction, stating that “the results demonstrated no advantage of surgery.”
First of all, the study itself is extremely broad, and it starts off asking the question whether someone who has had gender affirming treatment has less need for mental health treatment. That's an extremely broad question with so many confounding factors in it, I'm surprised the authors even proceeded with it. Gender affirming treatment relieves anxiety specifically about one's gender and physical sex. It has very little to do with anything else.
When I mentioned confounds, there are a whole bunch of things that can cause the statistics to skew. First, having experience with mental health practitioners means that transgender people are more likely to access those services when they are having difficulties. Second, we should not underestimate the consequences of minority stress on transgender people, and the long term anxieties that can emerge as a result of trying to function in society that is generally unsupportive of transgender people.
To be clear, I am not saying that the study is invalid, rather I am cautioning anyone reading it to recognize that there are enormous question marks that the study is unable to adequately explore and address. Therefore, drawing absolute conclusions about gender-affirming treatment from it is hugely problematic.
Lie #2:
A 2020 study surveyed 20,619 transgender Americans between 18 and 36. They were asked if they had ever wanted puberty blockers as adolescents. About 17 percent said yes. Of these, only 2.5 percent actually received the medication. The goal of the study was to compare “adult mental health outcomes” of those who received puberty blockers with those who wanted them but didn’t get them. The authors adjusted the data to account for age, biological sex, and household income, among other things. They concluded that giving puberty blockers to teens who want them reduces the risk of suicidal thoughts.
The journal that published the 2020 study also published some comments about it. One comment, by pediatricians Scott Field and Den Trumbull, was very critical. They pointed out that the data were collected by survey. So “there is no way of knowing how many would-be participants in either group actually succumbed to suicide.”
Again, it's important to recognize some of the confounding factors at play here. First of all, the transgender community is notoriously hard to get people to participate in studies. That in itself is a confounding factor. That the sample size is over 20,000 for this study is impressive. Surveys are also known to be problematic for a variety of reasons, including respondents being self selecting, and potentially telling the researchers what they think the researcher wants to hear.
Again, the lesson here is that drawing conclusions from a study like this is probably not ideal. It makes observations that are interesting, but much more rigorous studies need to be conducted to draw any kind of conclusions. Of course, the writer of the essay on Evolution News wants us to conclude that puberty blockers are ineffective in treating gender dysphoria. I would be very cautious about drawing such a conclusion.
Lie #3:
A total of 6,793 people visited the gender clinic of the Vrije Universiteit Amsterdam from 1972 to 2015. A 2018 study reviewed their medical records for regrets about having “bottom surgery.” About 0.6 percent of the males regretted having their testicles removed. About 0.3 percent of the females regretted having their ovaries removed.
This evidence seems to suggest that regret is rare. But the evidence comes only from medical records kept by the professionals who recommended and performed the sex reassignments. How likely is it that sex-reassigned people would later report their regrets to those professionals? We don’t know. How much follow-up did those records include? We don’t know. So the quantitative evidence pertaining to regret is quite thin.
Yet there is growing anecdotal evidence for it.
Now we get into the whoppers. The evidence cited clearly doesn't show what the author wants to show - namely that "a lot of people experience regret" after surgery, so he throws in at the end a snipe about anecdotal evidence.
Anecdotal evidence is important in research because it helps identify questions that should be asked. That said, anecdotes are individual stories, not population-wide data. Sub-1% regrets hardly seems like a huge "put on the brakes" problem. In fact for most medical treatments, failure rates in that range would be considered beyond fantastically good.
Lie #4:
In 1983, after 16 years of marriage, Heyer went to see a gender therapist. On his second visit, the therapist gave him a prescription for estrogen. The therapist also gave him an authorization for sex-reassignment surgery. He trusted the therapist, so he divorced his wife and had sex-reassignment surgery soon afterwards. He lived eight years as a woman, but he regretted having transitioned. At the age of fifty he “de-transitioned.”
Okay, speaking of whoppers, every time the subject of "regret" comes up, this guy gets trotted out as the "expert". Walt Heyer is no expert. In fact, I think it is far better to view Walt Heyer as a poster child for how not to conduct a gender transition. For those interested, I wrote a lengthy essay some time ago about Walt Heyer and his story: Walt Heyer, Detransition, and the WPATH SOC.
Using Heyer's own autobiography as a source, there is precious little evidence that he actually lived full time as a woman. Concluding anything from his story is perhaps better seen as an exercise in
Lie #5:
The idea that the other 0.02 percent should routinely have genital surgery was promoted by sexologist John Money. The idea that “gender” is different from biological sex also owes its popularity to John Money. The idea resulted in tragedy for David Reimer, though Money never publicly admitted it.
This is the last of the whoppers, and it's truly a doozy. The anti-transgender crowd should really understand that using Dr. Money and David Reimer as cannon fodder for their hatred is utterly stupid.
First, let me start off by saying that what happened to David Reimer was an utter tragedy, a failure of both professional ethics as well as a deeply flawed understanding of human development.
There are a number of reasons why using this case to bolster an anti-transgender position is guaranteed to fail:
1. Dr. Money's hypothesis
Dr. Money was working from a perspective that can be broadly understood as "tabla rasa" (or blank slate). His idea was that gender identity is largely based on learned behaviours, and when the David Reimer case came to his attention, he persuaded the family to participate in his experiment, which was to raise David as a girl after a botched circumcision destroyed infant David's penis. His experiment failed, with tragic results.
2. David Reimer was not transgender
Let's be abundantly clear, David Reimer wasn't transgender when a circumcision destroyed his penis. Nor was he even subject to any known intersex condition. In other words, we have no evidence that David had anything in common with any transgender child prior to Dr. Money's involvement.
It is perhaps a bit of an irony that Dr. Money may have _made_ David into a transgender person by having him subjected to GRS as a child, and David proceeded to gravitate towards being masculine even when pressured enormously to be feminine.
3. The Result of Dr. Money's Experiment
Although the long term outcome of the David Reimer story is profoundly tragic, from a purely experimental perspective, it actually demonstrates some important points:
- The blank slate hypothesis is fundamentally false. There is more to gender than a series of learned behaviours. This is something which transgender people have argued for years on the basis of their lived experiences.
- There are aspects of gender which are set long before we are able to express them.
- David's persistence that he was not a girl when being raised as one is exactly parallel to the experience of many transgender people. They know they don't really belong to their birth-assigned sex even as they live that role.
4. Impact On Transgender Treatment and Research
Dr. Money's ideas haven't been significantly influential among transgender researchers for decades. The impact of the Reimer case was more keenly felt among the Intersex community who for years were subjected to "corrective" surgeries as a result of the initial reports.
Citing Money as if he defined how transgender people should be treated is completely missing the point. There are others whose work was much more influential and important.
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