The FTB Ethics Committee Statement

So, I interrupt that thrilling if admittedly glacially slow trawl through the errors in one conservative Christian’s attempt to write about transgender therapy, to bring you this post on an entirely different topic.

In response to events of recent days, of which many of you will already have heard a great deal, there has been a very great deal of discussion on the FreeThoughtBlogs backchannel about the issue of how we should handle allegations of gross misconduct in one of our members. This is ongoing, and you will hear more about it with time (and can read more about it now on other blogs). For the moment, however, we have drawn up a statement which we are posting on our various blogs to make our feelings known about this topic. Herewith:

Freethought Blogs unequivocally condemns any behavior that threatens the safety of atheist community members, including particularly marginalized groups. Freethought Blogs also recognizes the role of sexual harassment as one of numerous barriers for women that limits access to and participation within atheist conferences and spaces.

When the recent allegations against Richard Carrier were made public, Freethought Blogs initiated a process to investigate these claims and formalize its policy concerning the conduct of its members. The FtB Ethics Committee received several reports of Carrier’s behavior and was in the process of reviewing them when Carrier chose to leave the network. A thorough review of the allegations against Carrier cannot be completed by Freethought Blogs without his cooperation.

As part of our commitment to equitable access to freethinking spaces for all, Freethought Blogs members who violate our commitment to social justice by creating or maintaining barriers to participation will be removed from the network as a matter of policy. All reports submitted to us in furtherance of this policy will be kept in the strictest of confidence, unless the accusation was made publicly or in the event we have express permission to reproduce the complaint.

-The FtB Ethics Committee

That is (for the moment) all. We now return you to your regularly scheduled mishmash of, well, all the stuff we blog about.

Fact-checking transgender treatment myths, Part 2 – the David Reimer fallacy

In my last post, while discussing an inaccurate claim about transgender treatment recently made by Lenny Esposito on the Come Reason blog, I promised to come back to his past post Today’s Snake Oil Includes A Scalpel: The Damaging Treatment of Transgenderism for some much-needed fact-checking. In that post, Esposito claims that gender reassignment therapy is ‘a dangerous falsehood that many times proves deadly to the patients that should have been helped’, and goes on to cite various pieces of evidence to make a superficially convincing case for this claim. However, this is extremely misleading; Esposito’s post not only contains several significant errors and fallacies, it also ignores all the research that actually shows gender reassignment therapy to be beneficial overall for nearly all the people who opt for it. Some proper fact-checking is clearly sorely needed here and, with apologies for the delay in getting back to it, here we go.

There’s quite a bit in his post to discuss, so I plan to break it down into several short posts dealing with each point separately. First up, his discussion of David Reimer’s story.

[I]n 1967 he [Dr John Money] sought to change a two-year-old boy whose genitals had been damaged by a botched circumcision into a girl, reassuring the parents that the child would grow up never knowing the difference. But, as the Los Angeles Times reported, “the gender conversion was far from successful. Money’s experiment was a disaster for Reimer that created psychological scars he ultimately could not overcome.” David Reimer committed suicide at the age of 38.

While it’s not clear to what extent Reimer’s suicide was a response to his history of gender surgery and to what extent it was related to other significant problems in his very troubled life, there is no doubt at all that the gender conversion attempts performed on Reimer were, indeed, psychologically disastrous for him and contributed hugely to the distress in his life, and it is very likely that they played at minimum a significant role in his final tragic end. However, there’s a big problem with using that as an anti-gender reassignment argument: Reimer wasn’t transgender.

As Esposito himself states, Reimer was a boy who was reassigned to be raised as female after a badly botched circumcision operation destroyed his penis and John Money (who was hugely influenced by his wish to prove his particular theory about gender fluidity) convinced his family that raising him as a girl was the best way to salvage the matter. There were never any claims that Reimer was transgender. From a very early stage he clearly knew he was male and wanted to be male.

Now, of course, Reimer’s situation was unique and there are limits to how much of a conclusion we should draw from that one story; but it does strike me as notable that what we have in Reimer’s story is the story of a person being raised as female who knew all the time, on some level, that he should actually be male.  In other words, the experience that a transgender man [a person born into a female body but with an inner gender of male] grows up with. And he found it devastating and destroying. That really doesn’t strike me as a good argument for trying to convince someone who identifies with one gender that they’re actually the other.

Of course, I have little doubt that Esposito and his followers would argue that a transgender man’s experience of distress over growing up in the wrong body shouldn’t be treated in the same way because he isn’t ‘really’ a male (by which they would mean that he’s not chromosomally male, or possibly that he wasn’t born with a penis – I’m not quite sure what, specifically, their criterion is). But, whichever way you look at it, it strikes me as pretty illogical to take an example of someone who found it deeply distressing to grow up with an assigned gender that his own inner certainty was telling him to be wrong, who could not refuse his need to live as the gender that matched his inner knowledge of himself – and use that to bolster your claim that people who are deeply distressed at growing up with an assigned gender that their inner certainty tells them is wrong should not be allowed to live as the gender that matches their own inner knowledge of themselves.

Misinformation about gender reassignment therapy (part 1)

One topic that’s shown up on Christian blogs a lot lately (because it’s been in the mainstream news a lot lately) is that of transgender people and gender reassignment surgery. I’ve been reading a lot of dubious claims from these sorts of articles, which have been ringing my Fact Check Alert bell big-time. I don’t know a great deal about transgender issues, but, as a GP, I do know that medical opinion supports the availability of gender reassignment as a treatment for gender dysphoria. So, when non-medical groups with a heavy religious-based agenda in the matter try to claim that gender reassignment is bad for transgender people and we should be banning it in their interests, that rings alarm bells for me and I want to look at the evidence.

The latest such post that I saw was Bloodletting and the Modern Trans Movement, on the Come Reason blog by Lenny Esposito. Esposito argues that because doctors once used to believe in treatments such as bloodletting which are now discredited we should therefore assume that medical advice to provide gender reassignment therapy for transgender people is similarly incorrect. Or something like that, anyway. That of course is just a logical fallacy (by the way, if anyone knows the official name for that logical fallacy feel free to shout out – I don’t keep track of logical fallacy names myself) but the bit that hit my Fact Check Alert button in this post was this:

I’ve pointed out before how we have fifty years of data under our collective medical belts on gender reassignment surgery and we know that the suicide rate for those suffering from gender dysphoria is as high after sexual reassignment surgery (SRS) as it is prior to transitioning.

The link Esposito gave there is to a post he wrote last year titled Today’s Snake Oil Includes a Scalpel: The Damaging Treatment of Transgenderism, which rang my Fact Check Alert bell several more times and needs a post or several of its own to discuss, which I fully plan to do. In the interest of speed and clarity, I’m going to leave that to further posts rather than try to cover everything here. What it did not do, even with the cherry-picked and misleading evidence it cites, was support Esposito’s statement that suicide rates are as high after gender reassignment therapy as before. The post cited one study showing much higher suicide rates among transgender people post-reassignment than in the general population (though without pointing out that these high suicide rates were seen a few decades ago when anti-transgender bias was worse than it is now, and that they don’t show up in recent years), but nothing comparing rates of suicide in transgender people pre- and post-gender reassignment. So, whatever Esposito may have convinced himself he ‘knows’, he hasn’t in fact demonstrated anything of the kind.

So, I did a bit of digging around to see whether any such statistics do exist, and, as far as I can find out, they don’t. I did find this report on rates of suicide attempts in the transgender population overall, which is frightening; transgender people were almost ten times as likely as the general population to have attempted suicide at some point. Not surprisingly, this was strongly linked with experience of discrimination, bullying, rejection by family, or even outright violence, making it clear that, for those of us concerned about suicide risk among transgender people, one of the most important things we can do is to work to increase transgender acceptance. (Which, frankly, doesn’t seem to be a strong point among conservative Christians such as Esposito.) And this article cited studies also indicating markedly increased suicide rates in the transgender population (and, again, cited evidence that showed this to be linked to experiences of discrimination and family rejection).

However, I couldn’t find anything giving comparative figures for suicide rates, or suicide attempt rates, in pre-transition and post-transition transgender people. Which isn’t too surprising, by the way, since it’s the sort of question on which it’s hard to get data; but it does mean that it is not correct to state that we ‘know’ the suicide rates to be as high after gender reassignment as before. We know nothing of the kind.

So what information is available on how gender reassignment affects transgender people? Looking, I found this article reviewing the existing evidence as to how gender reassignment affects the mental health and quality of life of transgender people overall. According to the abstract, the authors of this summary found 28 studies that followed transgender people through gender reassignment therapy (surgical and/or hormonal) comparing their mental health after the procedure with before. What they found was that, psychologically, the majority of people were better off after gender reassigment.

Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68–89%; 8 studies; I2 = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56–94%; 7 studies; I2 = 86%); 80% reported significant improvement in quality of life (95% CI = 72–88%; 16 studies; I2 = 78%); and 72% reported significant improvement in sexual function (95% CI = 60–81%; 15 studies; I2 = 78%).

So, no matter how hard conservative religious groups or other anti-transgender groups try to spin evidence to make it look as though it supports their cause, the evidence is in fact that the best thing to do to help transgender people is a) to eliminate prejudice and discrimination against them, and b) to make gender reassignment available for those who, after counselling, want it.