Don’t Do This, Skeptics


Science is not kind to minorities. Discrimination can make them difficult to identify and count, which combined with the minority’s relative rarity makes it nearly impossible to gather accurate statistics; convenience samples are the norm. Their rarity mean few people are researching them, so the odds of minority overcoming their discrimination and surviving academia to become a researcher are very small. Conversely, the few number of researchers means one bad apple can cause quite a bit of damage, and there’s a good chance researchers buy into the myths about this minority and thus legitimize discrimination.  A lot of care needs to be taken when doing science writing on the topic.

If you want to learn how to do it properly, read Dr. Harriet Hall’s recent article on gender dysphoria in children and do the opposite of what she does.

Politics and the Meta Game

Before writing on the subject, take some time to familiarize yourself with the relevant politics. For instance, gender dysphoria in children is a major obsession of TERFs. This guarantees that people will have strong opinions on the topic, and there will be a lot of bullshit and bad science floating around. It doesn’t help that TERFs and some transphobes try to invoke science to justify their bigotry, like the recent argument over “rapid onset gender dysphoria.” If you aren’t confident you have the knowledge to cut through the noise, don’t bother weighing in, and even if you are confident think carefully about the toes you could be stepping on.

Dr. Harriet Hall has an excellent track record on alternative medicine, but there’s nothing in her background to suggest she has knowledge of the politics around gender dysphoria, let alone dysphoria in children. It shows in her writing:

The history of gender reassignment surgeries is marred by the disastrous story of David Reimer. He lost his penis at the age of 8 months in a circumcision accident. Dr. John Money believed that gender was merely a social construct, a matter of nurture rather than nature, so he advised that David be surgically altered to resemble a female and raised as a girl, Brenda. Things did not go well. At 14, he began the process of reassignment to being a male. He married a woman, suffered from depression and drug abuse, and committed suicide at the age of 38.

David Reimer has turned into a political football; TERFs invoke him to prove that sex is permanently burned into you from birth, while trans* people argue he proves gender dysphoria exists. As luck would have it, one of my women’s studies textbooks went into several pages of detail on Reimer’s case. If my memory is correct, there were allegations of abuse by Dr. Money as well as Reimer’s parents, which is a major confounding factor for any conclusions we could draw from his reaction to the surgery.

Not that we are likely to draw much evidence from a single case, anyway; is the history air travel marred by the disastrous story of Jennifer Riordan, who was almost sucked out an airliner’s window? Is the history of birth control marred by the disastrous story of Fallan Kurek, who was killed by blood clots thought to be caused by her birth control? Is the history of Canada’s National Parks marred by the disastrous story of Taylor Mitchell, who was torn apart by coyotes? Someone who’s said “Scientists know that the plural of anecdote is not data” should not be using anecdotes to make her case.

Did You Ask Them?

The people who know the most about gender dysphoria are trans* people, by definition. If you’re planning on writing about gender dysphoria, make sure to include their writing on the subject. Gender Analysis is an excellent source, followed closely by The TransAdvocate. Shiv’s blog has been very insightful for me, and in general there is no shortage of trans* bloggers out there pumping out content. Just on the claim that 80% of gender dysphoric children grow out of it, in fact, Shiv can point to blog posts and writing by Zinnia Jones, Brynn Tannehill, Sam Hope, Mercedes Allen, Monica RobertsDr. Kelley Winters, Cristan Williams, Julia Serano, and of course herself.

Guess how many trans* writers Dr. Hall quotes? Zero. Instead, she relies on an article by Richard Friedman, one that’s been roundly criticized as transphobic and a misrepresentation of the science. Dr. Hall is happy use Walt Heyer as a source, who as part of his Christian ministry “travels extensively to share his story of redemption [from being transgender] at conferences, churches and universities.” There’s also an article from Anne Lin of Eternity News, published by “Bible Society Australia,” and Lin’s primary source has “stereotyped trans youth as mentally ill.” Dr. Hall also references an article by Josephine Bartosch, “director of the campaign group Critical Sisters,” which is a TERF activist group campaigning against British laws on gender identity.

Critical Sisters are proudly secular and gender-critical. We stand in opposition to man-made beliefs; be that religious faith or the ideology of gender. No Gods. No Gender.

Dr. Hall ignores the voices of transgender people, preferring instead to elevate transphobes and TERFs. Still, I will give her partial points for being secular about it.

Do Your Homework

When I touched on gender dysphoria in children, I dived into a study by Strang et. al (2014).

So they brought out the experts for everything but gender dysphoria? And they didn’t ask the kids what they thought of their own gender, but instead queried their parents? To recall prior behavior they’ve seen in their kids, when we’ve known human memory is fallible for decades? When the parent’s beliefs may be coloured by “religious wisdom” or “common knowledge?” To add further salt to the wound, the Child Behavior Checklist [which they used to assess gender dysphoria] wasn’t designed for gender dysphoria. […] Only two of its questions could plausibly deal with gender dysphoria. A quick Google Scholar search shows no-one has validated its ability to assess gender dysphoria either; contrast and compare with the Sexual Experiences Survey. This invalidates the paper’s methodology and makes the data moot.

Shiv pointed out another flaw I glossed over (emphasis in original).

The DSM-3 work group made a distinction between nonconformity with respect to gender roles and the physical phenomenon of gender dysphoria. Under these diagnostic criteria, a GID diagnosis maps much more closely to a particular trans experience–otherwise binary identified, responds well to Hormone Replacement Therapy and sometimes Gender Reassignment Surgery, “knew all along,” experiencing significant anxiety from one’s sexed attributes prior to treatment, etc. etc. […]

Again, it should be noted that after CAMH sexologists became part of the Gender Identity Disorder Workgroup, the distinction between the transsexual and gender nonconforming experience was purposefully removed. […]

Having erased the distinction between gender role and gender identity, Dr. Zucker & co. can now claim that all their patients are “trans” as children. But early feminists validated the experiences of trans folk by understanding our experience was not merely one of expectations of society (the gender role) but also of a complex relationship with our body. Without the distinction, non-transgender (i.e. cisgender) children who called poppycock on gender roles were considered the same as children experiencing anxiety from their sexed attributes. Then the children who were mostly dissatisfied with gender roles, not experiencing anxiety with their sexed attributes, did not grow up to pursue Hormone Replacement Therapy or any kind of transition-related surgery, which Zucker & co. claimed meant they ceased believing they were trans.

Thus, the methodology that you can force “trans kids” to “adopt to their anatomical sex” was born. It wasn’t that 80% of transgender children “desisted”, it was that 80% of children entered into this kind of system never would have needed to transition.

Some of these studies may rely on two contradictory assumptions: gender non-conformity and gender dysphoria are equivalent, but only people who undergo a medical or surgical transition are gender dysphoric. By applying the overly broad criteria to the children, and the narrow criteria to the adults, any such study could rig the stats to make it seem that most children with gender dysphoria will “grow out of it.” Shiv listed eight other people who’ve made similar points, as I quoted above, but I’d like to reference another article by Dr. Kelley Winters.

(1) Evidence from these studies suggests that the majority of gender nonconforming children are not gender dysphoric adolescents or adults.

(2) It does not support the stereotype that most children who are actually gender dysphoric will “desist” in their gender identities before adolescence.

(3) These studies do acknowledge that intense anatomic dysphoria in childhood may be associated with persistent gender dysphoria and persistent gender identity through adolescence.

(4) Speculation that allowing childhood social transition traps cisgender youth in roles that are incongruent with their identities is not supported by evidence.

(5) These studies fail to examine the diagnostic value of Real Life Experience in congruent gender roles for gender dysphoric children.

You’d have no idea of those complexities if you read Dr. Hall’s piece; she takes a “he said, she said” approach, which glosses the details but gives more time to the people arguing in favor of high desistance rates. Here’s what she has to say about Dr. Winter’s presentation, in full:

A presentation to the 23rd World Professional Association for Transgender Health Biennial Symposium, Feb. 16, 2014, Bangkok questioned the methodology of those studies. It questioned the selection of subjects, some didn’t fit the diagnosis and some had undergone treatment. It said follow-up was not long enough, retrospective evidence was ignored, and unwarranted assumptions were made. It concluded that:

  • The evidence shows that the majority of gender nonconforming children are not gender dysphoric adolescents or adults.
  • The evidence does not show that most truly gender dysphoric children will desist in their gender identities before adolescence.
  • The evidence shows that intense anatomic dysphoria is associated with persistence.
  • The evidence does not support the speculation that allowing childhood social transition will trap cisgender youth in roles incongruent with their identities.

Dr. Winter’s name isn’t even mentioned, unlike the researchers arguing in favor of high desistence. There’s no evidence Dr. Hall has tried to understand the arguments, on the contrary she does a quick copy-paste-rework job to save herself from comprehending the counter-arguments.

Further evidence for laziness comes from what immediately follows after.

Some have speculated that being transgender is more acceptable to Christian ideology than being gay or lesbian. […] And it’s not just Christian ideology. In Iran, they execute gay people but pay for sex reassignment surgeries.

What is this doing in the “children will grow out of it” section?! Yes, if you click on the link I left in you’ll read “Penny White” complain that her daughter was misled by Tumblr and YouTube into thinking she was transgender, when she was merely lesbian, but Dr. Hall still makes that mysterious right turn into religion. Worse, she does nothing to explain why Christians or Muslims may be more accepting, an odd claim given the existence of Christian and Muslim bigotry against transgender people.

Things changed [in Iran] largely due to the efforts of Maryam Khatoon Molkara. Molkara was fired from her job, forcibly injected with male hormones and put in a psychiatric institution during the 1979 revolution. But thanks to her high-level contacts among Iran’s influential clerics, she was able to get released. Afterwards, she worked with several religious leaders to advocate for trans rights and eventually managed to wrangle a meeting with Ayatollah Khomeini, the “supreme leader” of Iran at the time. Molkara and her group were able to eventually convince Khamenei to pass a fatwa in 1986 declaring gender-confirmation surgery and hormone-replacement therapy religiously acceptable medical procedures.

Essentially, Molkara, the Iranian religious leaders she worked with, and the Iranian government had reframed the question of trans people. Trans people were no longer discussed as or thought of as deviants, but as having a medical illness (gender identity disorder) with a cure (sex reassignment surgery).

“The Iranian government doesn’t recognize being trans as a category per se, rather they see trans individuals as people with psychosexual problems, and so provide them with a medical solution,” says Kevin Schumacher, a Middle East and North Africa expert with OutRight Action International, a global LGBTIQ-rights organization. The policy is based on Islamic notions that gender is binary and that social responsibilities should be split between men and women.

When you do your homework, you realize most of Iran is not accepting of trans* people, at all. Instead, some effective activism leveraged the assumptions behind their bigotry. Despite that success, transgender people still receive a lot of hate in Iran.

Making The Sensible Seem Ridiculous

If you want to know the best standard of care for trans* people, the most authoritative resource is the World Professional Association for Transgender Health. Since 1979, they’ve been issuing guidelines for medical care, and the seventh edition’s recommendation for gender dysphoric kids is based on the Dutch Protocol.

The Dutch approach on clinical management of both prepubertal children under the age of 12 and adolescents starting at age 12 with gender dysphoria, starts with a thorough assessment of any vulnerable aspects of the youth’s functioning or circumstances and, when necessary, appropriate intervention. In children with gender dysphoria only, the general recommendation is watchful waiting and carefully observing how gender dysphoria develops in the first stages of puberty.

It’s quite gentle, allowing children plenty of time to change their minds, and only invokes medical treatment once the child shows certainty and professional councilors sign off. Children are even allowed to experience the early stages of puberty, in case that changes their mind about transition. The protocol has stood up well under scientific scrutiny, and is increasingly becoming the standard of care worldwide. Contrast this with how Dr. Hall describes the Dutch Protocol:

  1. Puberty is blocked with gonadotrophin-releasing hormone (GnRH)
  2. Hormones of the opposite sex are given (estrogen and testosterone)
  3. Gender reassignment surgeries.

Dr. Hall is straight-up misrepresenting clinical protocol! She pours even more oil on the fire by arguing that puberty blockers may do irreversible damage. Think about that for a second: most forms of birth control involve altering hormone levels, and hormone replacement therapy is a common treatment for menopause symptoms. Hundreds of millions of people have artificially altered their hormone levels, leading to a consensus that it’s safe when done in consultation with a doctor. What are the odds that children are any different? Pretty damn small. It takes a lot more than one article from a religious news service to overcome this prior.

Conclusion

There’s some similarity between Dr. Harriet Hall and Carol Tavris. The latter, however, has the excuse of at least knowing something about memory research, which if you squint reeeaaaally hard can look relevant to sexual assault. Dr. Hall, in contrast, seems to have relied directly on information provided by transphobes and TERFs, rather than her own training. She is badly distorting the science, promoting misinformation, and violating her oath “to abstain from doing harm.”
[HJH 2018-09-13: Caught some minor formatting issues, a missing link, and typos. Also, while I’m here, I see I implied Brynn Tannehill and Kelley Winters are transgender women. I did a little more digging, and I can’t find any confirmation or refutation.]