Skeptic.com: The Contradiction at the Heart of Gender Debates

Over at Skeptic.com(*), we find an article titled "The Contradiction at the Heart of Gender Debates".   This is one of those cases of the author writing something which is so far out of their expertise that they completely mischaracterize things.  To be fair to the author, their bio states that they are a PhD Geologist - that's nothing to sneeze at.  But, it doesn't exactly make them overly qualified to opine on the issues around gender dysphoria and its treatment. 

*Skeptic.com wants you to be a paid subscriber to comment.  

References

There are a number of issues with the essay, and the first is that every single reference link is broken.  So, I have taken the liberty of chasing all of the references down.  

1. Levine, S. B., Abbruzzese, E., & Mason, J. W. (2022). Reconsidering informed consent for trans-identified children, adolescents, and young adults. Journal of Sex & Marital Therapy, 48(7), 706-727. Retrieved from: https://www.tandfonline.com/doi/pdf/10.1080/0092623X.2022.2046221
2. Levine, S. B., Abbruzzese, E., & Mason, J. W. (2022). Reconsidering informed consent for trans-identified children, adolescents, and young adults. Journal of Sex & Marital Therapy, 48(7), 706-727. Retrieved from: https://www.tandfonline.com/doi/pdf/10.1080/0092623X.2022.2046221
3. Wallien MS, Cohen-Kettenis PT. Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry. 2008 Dec;47(12):1413-23. doi: 10.1097/CHI.0b013e31818956b9. PMID: 18981931. Retrieved from: https://www.jaacap.org/article/S0890-8567(08)60142-2/abstract
4. Zucker, K. J. (2018). The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’theories about transgender and gender non-conforming children” by Temple Newhook et al.(2018). International Journal of Transgenderism, 19(2), 231-245. Retrieved from: https://www.researchgate.net/profile/Kenneth-Zucker/publication/325443416_The_myth_of_persistence_Response_to_A_critical_commentary_on_follow-up_studies_and_%27desistance%27_theories_about_transgender_and_gender_non-conforming_children_by_Temple_Newhook_et_al_2018/links/5b0e88414585157f8722b622/The-myth-of-persistence-Response-to-A-critical-commentary-on-follow-up-studies-and-desistance-theories-about-transgender-and-gender-non-conforming-children-by-Temple-Newhook-et-al-2018.pdf
5. Meador, H. (2024, August 15). The Real Chloe. Retrieved from:
6. https://www.afa.net/the-stand/culture/2024/08/the-real-chloe
7. Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L., Långström, N., & Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PloS one, 6(2), e16885. Retrieved from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885&utm_source=mandiner&utm_medium=link&utm_campaign=mandiner_202101
8. Swaab, A. G. F. D. F. (2009). Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation. Pediatric Neuroendocrinology, 17, 22-35. Retrieved from: https://www.researchgate.net/profile/Alicia-Garcia-Falgueras/publication/40442895_Sexual_Hormones_and_the_Brain_An_Essential_Alliance_for_Sexual_Identity_and_Sexual_Orientation/links/0a85e53982948f307f000000/Sexual-Hormones-and-the-Brain-An-Essential-Alliance-for-Sexual-Identity-and-Sexual-Orientation.pdf
9. Bell, K. (2021, April 7). Keira Bell: My Story. Retrieved from: https://www.persuasion.community/p/keira-bell-my-story

In reading the essay, I noted several areas where the author made claims that should link to appropriate references, but failed to do so.  This doesn't necessarily make the author wrong, nor am I accusing them of plagiarism.  In this context, it is my opinion that the author likely as not lacks a sufficient background in the subject matter to necessarily recognize the sources for certain claims or observations. 

Incomplete Analysis

Perhaps one of the most disturbing problems in the author's analysis arises in using individual narrative stories from people who have detransitioned.  In itself, this isn't necessarily bad, but in the way it is done here, the author ends up elevating individual anecdote and opinion to the same level as carefully conducted research.  Are the stories of those people interesting and important?  Yes, absolutely.  Do those stories mean that the opinions about treatment and their experiences of treatment are definitive?  Not even close.  I want to be clear here - professionals working with this population have been concerned about those that we now call "detransitioners" ever since the days of Harry Benjamin.  

The essay cites both Zucker and Levine as "experts", yet he fails to recognize that both men are outliers in the broader consensus around transgender youth.  I'm not going to go into a deep critique of each here, but I think it is important to understand that their opinions are not broadly held within the treatment world, and both men are working from models that are not well backed by evidence.  Levine, in particular, argues that treating depression and other mental health issues first will result in gender issues fading into the background.  While he may believe that, I haven't seen a whole lot of evidence that supports the contention.  Similarly, Zucker's so-called "watchful waiting" approach for working with trans children has been criticized for being overly passive, and other aspects of his work have been criticized for looking distressingly close to conversion therapy techniques.  

Similarly, the so-called "Swedish Study" (Dheine, et al, 2011) is cited in a context that implies that its authors have "concerns" that going to hormones too quickly will mask other mental health concerns that may be present.  First, Dheine and colleagues don't say any such thing.  They do point out to post-surgical mortality rates being elevated in the population, but beyond saying "we need to do better in supporting transgender people after surgery", they do not make any such claim.  

The author's analysis of the situation is replete with gaps and misunderstandings.  At one point, the author alludes to the story of David Reimer.  David Reimer's story is worthy of a detailed analysis in its own right.  It is NOT, however, a detransition story as the author's use of it suggests.  In retrospect, not only does David Reimer's story completely demolish the "tabula rasa" (blank slate) theory of identity development, it arguably provides a concrete (and tragic) example of the consequences of trying to force someone to live a social and sexual role that their brain isn't built for.  David Reimer is an example of what the anti-transgender movement would impose on every transgender person - someone forced to grow up and live in a gender and role that is fundamentally wrong for them.

He also speaks at length about "ethical dilemmas" that practitioners face.  Those "dilemmas" are, quite frankly mostly rooted in what many denizens of the Internet would call "concern trolling".  Opponents raise these issues and ignore evidence and frameworks that allow those topics to be addressed.  It's a bit like arguing with a Flat Earther - they will swear up and down that you're wrong, even when presented with coherent evidence to the contrary.

Discussion

At its core, the author's argument is largely that we need to weigh both the biological and social aspects of gender.   The reality going on here is that gender identity has both biological and psychological/social components.  He implies that because the medical profession looks at things through a medical lens, that somehow that's the only lens in play here.  It isn't, and hasn't been for decades.  Had he read either the WPATH SOC v7 or v8 documents fully - and understood the content - he would have realized that those very considerations have long been part of the discussion. 

If he wants to encourage open discussion on the matter, the author would do all of us a favour by encouraging others to become more informed about the breadth and depth of the literature involved.  A greater depth of understanding would have enabled him to realize that his sources aren't necessarily reflective of the current state of things.