There was a bit of a shock recently when Science-Based Medicine published a positive review of Abigail Schreier’s godawful conservative anti-trans book, Irreversible Damage, by Harriet Hall. It was surprising that such poor science could get a good review on a usually reliable science site, especially when the typical review pans it as “full of misinformation”.
Good news, though: Hall’s terrible article has been yanked from the site (don’t worry, Freezepeachers: it’s still available on Michael Shermer’s wacky libertarian skeptic site), and now Novella and Gorski have written a strong rebuttal. Here’s just their conclusion, and they also promise some further details in follow-up articles.
Abigail Shrier’s narrative and, unfortunately, Dr. Hall’s review grossly misrepresent the science and the standard of care, muddying the waters for any meaningful discussion of a science-based approach to transgender care. They mainly rely on anecdotes, outliers, political discussions, and cherry-picked science to make their case, but it is not valid.
Most significantly, they warn about medical interventions for children, citing mainly the notion that children are not able to make such choices at such a young age and will likely change their minds, regretting their decision because their gender identity is still developing. However, the age group for which they cite (fatally flawed) statistics do not receive medical interventions, and the age group that is eligible are not likely to change their gender identity. This is a statistical bait-and-switch.
The standard of care waits until children are at an age where their gender identity is generally fixed, and then phases in interventions from most reversible to least, combined with robust psychological assessments. Further, regretting these interventions remains extremely rare, and does not support the social contagion hypothesis.
At this point there is copious evidence supporting the conclusion that the benefits of gender affirming interventions outweigh the risks; more extensive, high-quality research admittedly is needed. For now, a risk-benefit analysis should be done on an individual basis, as there are many factors to consider. There is enough evidence currently to make a reasonable assessment, and the evidence is also clear that denying gender-affirming care is likely the riskiest option.
I suspect that, like Freethoughtblogs, SBM gives their writers considerable autonomy, since they can generally trust everyone in their group. Every once in a while, though, something yucky will slip through, and then you have to do some retroactive peer review. I’ve been there. We’ve had a few dramatic incidents here, too. In this case, they announce that “Dr. Hall still remains an editor of SBM in good standing”. Here’s where we differ — if someone on FtB published something like that, there’d be a week or two of shrill in-house and public battles before the offending writer got the boot.
How is it possible to publish a piece in Science-Based Medicine that is both antiscientific and antimedicine, and still be considered “in good standing”? If the editor-in-chief had any backbone, Hall would be out the door before her coffee got cold.
This is just the latest tactic of the anti-trans crowd.
To claim that people who transition end up regretting it.
It’s just wrong.
Various studies in various populations show detransition rates of 1-5% or in a larger population, 0.47%. This is quite a low rate.
I’m sure a few people regret transitioning.
Anyone who has nothing to regret about their life decisions can speak up right now.
They will be the first ones in the history of the world.
My god, I just read the full Novella & Gorski piece. I don’t see how they can stand by Hall at all. Yes, she has been a major contributor to SBM, but her piece here was beyond terrible.
At one point, they call Hall out for claiming “We are starting to see desisters (those who stop identifying as transgender) and detransitioners (those who had undergone medical procedures, regretted it, and tried to reverse course). No statistics are available on how often this happens.” As Novella & Gorski point out, we can’t “start to see” events for which there are “no statistics”. And it’s especially egregious since, as they also point out, it is simply not true. There are several studies, including a large one of 22K people, reporting on this precise matter. This isn’t just a matter of differing opinions, this is blatant misrepresentation of the literature in support of transphobic bullying. So why is Hall still in good standing?
John-Henry Beck says
That bit about Hall still being “in good standing” rather stood out too.
Are they actively trying to undermine that science-based reputation? That wasn’t some simple error or reasonable difference of opinion. That was actively publishing science-denialst bigotry under their name.
Those UK stats are also from a country with a notoriously bad medical system for trans people. Do 3+ year long waitlists impact detransition rates? Do poorly-informed doctors impact rates? Develop a system that makes transitioning as painful as possible, and then act shocked when people decide it’s not worth it. As long as these extremely hostile systems are in place, detransition rate panic is flawed.
David Klopotoski says
Regarding Harriet Hall’s “good standing” with SBM, my sense of Dr. Novella’s attitude over the years at least is one of over-extending charity. He refuses to burn bridges with former allies and only condemns the very worst. He is completely open to the very stern and damning public rebuke as seen here, but does not delve into attacks on people. I think what he’s trying to avoid by dismissing Dr. Hall from SBM is the accusation that they are attacking her personally and publicly. I don’t doubt that behind the scenes there is certainly a lot of tension between Dr. Hall and the powers that be at SBM. For the sake of protecting their work and reputation they are keeping it as a double-secret-probation situation. At least that’s my guess having followed Novella and his public output over the years.
Matt G says
They pulled the article pretty quickly. They said it was NOT because of the reader comments, but because of concerns about its quality. There were many trolls, but they got shot down.
PZ Myers says
It’s a problem. I sympathize — I went through all kinds of agonies when Ophelia Benson, a long time supporter of this network, revealed herself as a TERF. Kicking someone out is a major change, and I, for instance, was reluctant to do so. There’s always the hope that the offender will just shut up about their bad take, and if they won’t you get to take all the bad press of asking them to leave…or the drama of seeing them flounce. This piece was so strongly targeted against her opinion that maybe they’re hoping she’ll just leave.
Hall has a long history of regressive attitudes. I wouldn’t want to be on the SBM board right now.
Andreas Avester says
A possibility that a person might later regret their decision cannot be used as an excuse to infringe somebody’s bodily autonomy or deny their right to make their own life choices. People get divorced all the time. They regret their career and education choices. We even regret that impulse purchase from last time there was a sale in the supermarket. People also regret plastic surgeries, tattoos, etc.
Yet pro-life activists and transphobes and all kinds of bigots use potential for regret as an excuse to deny people abortions, sterilization surgeries, or procedures that will help them live as their real gender. That’s just bigotry. How comes it is OK for me to get breast implants but not OK for me to surgically remove my breasts? After all, people may regret literally any decision they have ever made in their lifetime. Yet people’s ability to decide for themselves gets selectively limited only in some specific cases where their decisions contradict bigots’ ideas about how everybody must live.
Well, funny how a woman who is most famously “just a skeptic, not a skepchick” suddenly becomes neither when the conclusions match her prejudice
Leo Buzalsky says
PZ @8: “Hall has a long history of regressive attitudes.”
Yeah…didn’t she harass (or taunt) Rebecca Watson and other members of Skepchick for the latter daring to speak out against men behaving badly at atheist and skeptic conferences??? That name certainly sounds familiar. I associate a memory about a not so subtle t-shirt (maybe at TAM?) with that name.
raven (#2) –
And how many of those who later conformed to cishetero binary appearance (“detransitioned”) did so because of social, government, and religious pressure, rather than personal choice? That’s something I never see answered.
It was Amy Davis Roth she harassed. Yeah, that famous T shirt…
I’m just wondering (nah, actually I’m not) how people like Benson, who back then criticised Hall and stood up for Rebecca and Amy are dealing with this now, finding themselves in,line with all the nasties… But I’ve noticed that they become more and more reactionary themselves, like former friend and commenter Josh becoming a Covid denier.
Well it’s a rebuttal all right. But not a very strong one in my opinion. More a bit of smoke and mirrors.
The issue raised by Schreier’s book deals not with all transgender individuals but specifically with an apparent spike in AFAB adolescents identifying as transgender. The references and statistics cited by the Gorski & Novella rebuttal (at least most of the ones I checked) that they use to rebut Dr. Hall’s review do not distinguish adults from adolescents or AFAB from AMAB. In fact in one study that does (the study claiming that the ratio of (adult + adolescent) FTM and MTF has been growing and now approaches to 1:1) specifically mentions that among adolescents seen in that particular clinic since 2014, there were four times as many FTM (12) as MTF (3).
SC (Salty Current) says
Giliell @ #13:
Josh, Official S-G-?
SC (Salty Current) says
Well, that’s depressing as all hell. Today really fucking blows.
Hj Hornbeck says
Exsqueeze me?! If repeatedly peddling medical misinformation won’t get you booted from SBM, why do they even exist? Do they only care about some forms, or all of them?
The impression I got back when all that ‘not a skepchick’ T-shirt mess happened, was that Hall was Hall’s feminism pretty much stopped at ‘first wave’. She’d proven it could be done for a woman to make it to her position, and she didn’t see the need to make it easier for anybody coming after her by removing any of the other structural barriers in the way. Not sure she pulled the ladder up behind her so much as she kicked it down and then pretended it didn’t exist. She could take the heat, if you can’t get out of the kitchen.
Not a scientific study, but from what I heard while interacting with people who organize support groups for transgender youth and their families, they said that there are more AMAB among the participants in groups catering for the very young (under 10 year olds), more AFAB in groups serving preteens and teens, and then again more AMAB in groups serving young adults (college age). From my experience as the parent of a transgender person and from my interactions with parents my hypothesis is that at different ages there are different factors that make gender dysphoria more salient – and it so happens that factors that trigger gender dysphoria in AFAB people show up more around puberty and in the following years than at other ages.
Hj Hornbeck says
I’ve had a chance to read the full post, and… it’s pretty good! I have some minor quibbles (I’m still shaking my head over the paragraph I quoted), but they’re mostly over form rather than substance. Overall it’s a damning critique of Shrier and Hall, backed by research and arguments at least as good as my attempt.
A big ail. Because her existence makes me sick.
For the sake of accuracy, please everyone be aware that the book’s author is Abigail Shrier and not Schreier or Schrier.
WMDKitty -- Survivor says
Just going to note that Ms. Hall also promotes the idea that cannabis causes psychosis.
@ 14 chris61
Lol. I encourage people to look for themselves how comprehensive it is. Smoke and mirrors my arse.
As is pointed out in the “smoke and mirrors” one cannot assume a spike in referrals equates to a spike in “adolescents identifying as transgender”. That’s covered in great detail.
In any case the claim there is some new cohort of trans people unlike previous trans people has been studied and been found to be without evidence:
The gender flip is expected. Famously, in 2014, Time magazine declared a “transgender tipping point”. Being trans has gone from being perceived as a mental illness, to something natural and acceptable (albeit with a concomitant backlash of unprecedented transphobia). In a sexist society, “feminine males”/”sissy boys” have always been more stigmatised than “masculine females”/”tomboys”. So we expect, under the “mental illness” paradigm, more AMAB people to be pathologised and referred to treatment. But also, under the “natural and acceptable” paradigm, more AFAB people being willing come out and declare themselves trans. It’s just blatantly obvious that to this day trans women are vilified and stigmatised much more than trans men.
@ 22 Intransitive
Must you? You have a trans woman co-blogger on this very network of the same name.
@ 25 Me
In case it’s not clear what I mean by “the gender flip”, much is made by transphobes of the fact that not only has there been a steep increase in both AMAB and AFAB people seeking to transition, in the past is was mostly AMAB people, now it’s mostly AFAB people. This has lead to a conspiracy theory that “girls” are transitioning to escape sexism. Never mind that 1) sexism is hardly a new thing, and 2) that’s not at all how trans men describe their experience.
PZ, far be it for me to call upon your banhammer powers, but surely chris61’s perpetual misrepresentations and bad-faith arguments in favour of transgender oppression have him pretty damn close by now.
His latest vomitus called Novella & Gorski’s rebuttal “smoke and mirrors” and attacks it for mixing statistics from adolescents and adults when in fact they were pointing out this flaw in Hall’s review and referenced two important papers that address this shortcoming.
He selectively quotes one of N&G’s references to represent it as saying the opposite of what it actually says (hint: the paper analyses the increase in FTM transgender presentations and shows that the most likely explanation is increased awareness and availability of treatment options; let’s be clear, THIS PAPER DOES NOT SUPPORT SHRIER’S CLAIMS AND CHRIS61 IS DISSEMBLING BY PRETENDING IT DOES; unfortunately the meat of the paper is behind a paywall, but if you have library access you can very quickly see just how badly the paper has been distorted.)
You can also judge chris61’s intellectual integrity by his statements that he didn’t find N&G’s references persuasive “(at least most of the ones I checked).” Well guess what? N&G provided a total of TWO references on the specific subject of changing transgender demographics. (This is the second paper, btw.) Let’s just imagine an honest investigator talking about “most of the ones I checked” with regard to TWO fucking papers, one of which was misrepresented.
@chris61: is fifteen people a big enough sample size for that ratio to mean anything?
I’m glad you posted this. I had stopped reading the SBM website after Harriot’s article because it was so anti-SBM, and hadn’t seen their rebuttal.
Ariaflame, BSc, BF, PhD says
I saw on twitter a post where someone showed the ‘incidence’ of left-handed people over a significant time frame, where it dipped significantly for a time and has now risen to a more stable level as a parallel to the ‘increase’ in trans people. it’s not that there are more people who are trans, it’s that they were starting to be less repressed and more confident about expressing who they were.
If society will stop persecuting trans people, the way that left-handed people are no longer forced to write with their right hands (mostly), then that too will level out at whatever is the average percentage of trans people in the population.
There’s also going to be a guest post on Friday from a doctor (Rose Lowell maybe?), who made really useful comments under the retraction, about her practical experience treating transgender youth. I’m really looking forward to that as she sounded like she really knew what she was talking about and she has a clear writing style.
By itself, no. But it is consistent with other data indicating an increase in FTM diagnoses in adolescence.
I ‘selectively’ quote one of N&G’s references as saying exactly what it says. 12 out 15 adolescent patients presenting to the authors’ clinic during the years 2014 to 2017 are FTM. Moreover the ratio of FTM to MTF show a consistent increase over the years. All of which is consistent with what Schier describes as a spike in adolescent AFAB individuals presenting at gender clinics. This is not controversial (again as acknowledged by N&G). What is controversial is the explanation for this observation.
And no, neither N&G nor the authors of the paper they cite show the most likely explanation is increased awareness and availability of treatment options – both groups suggest this as a possible explanation. Just as Schrier suggested an alternative explanation. Neither side has strong evidence for their hypothesis because… and N&G acknowledge this … there isn’t very good data available. Which is pretty much what Hall said.
John Morales says
Leaving aside I give much (much!) more weight to what chrislawson writes than to what you write (I’m familiar with both of your postings), arguendo, if this is the case, that the vast bulk of rants by anti-trans propagandists focus almost entirely on MTF is yet another indication of their weak grasp of reality.
(and the data on that is not just “very good”, but indeed is compelling)
@35 John Morales
blockquote>that the vast bulk of rants by anti-trans propagandists focus almost entirely on MTF is yet another indication of their weak grasp of reality.
True, but off topic. The topic of the OP is Novella & Gorski’s rebuttal of Hall’s review of Shrier’s book which is most emphatically NOT about MTFs.
John Morales says
It’s at least related.
Point being, you concede it is true that anti-trans propagandists are, by all indications, adrift from reality.
@37 John Morales
Anti-trans propagandists, yes. Schrier and Hall, no. So it’s not really related.
Schrier is hilariously detached from reality
WMDKitty -- Survivor says
Schrier and Hall are both light years away from reality.
@ 38 chris61
You got that John? He means anti-trans propagandists, not the author of Irreversible Damage: The Transgender Craze Seducing Our Daughters. Lol. :-)
Hey chris61, here’s some more reading for you: Abigail Shrier’s Irreversible Damage: A Wealth of Irreversible Misinformation.
John Morales says