The Reviews Are In

And they paint a rather different picture of Shrier’s book.

The author’s incantation of the First Amendment does not sufficiently emphasize her red-blooded passion for true democracy, but for the seductive image of a hermetically sealed and patriarchally sound America, one regressively nostalgic for midcentury convention, order, and heroism. Irreversible Damage is Shrier’s own simpering cry to Make America Great Again. And as far as she is concerned, the beneficiaries of free speech’s historic privileges — shabbily enforced where trans voices have been concerned — can only be cisgender. In this dismal and limiting cognitive space where the First Amendment matters — but Shrier’s access to it matters most — the author can write as she pleases: baselessly and brutishly.

Sarah Fonseca. The Constitutional Conflationists: On Abigail Shrier’s “Irreversible Damage” and the Dangerous Absurdity of Anti-Trans Trolls, Los Angeles Review of Books. January 17th, 2021.

This review in particular had the biggest impact on me. I thought that Shrier’s book was primarily evidence-based, for loose definition of evidence. In reality, it sounds like Shrier’s book is best thought of as a “military action” of the “culture war.” Much as with abortion, the goal is to provide a secular mask to religious arguments. What little evidence Shrier brings is really an afterthought, a light window-dressing to distract from the core arguments. In essence there’s two separate layers of arguments going on here, and by focusing on only one I’m giving the impression that I have no rebuttal to the other.

Whether intentional or not, the engine of the “culture war” is a shift from an empiric epistemology, where evidence is weighed to determine the truth, to a form of cultural authoritarianism where the opinions of authority figures are weighed instead. Hall’s 2018 article is a good example of this. She presents the discussion over the healthcare of transgender youth as a he-said, she-said affair. On one side is Dr. Kelly Winters, who has been part of a WPATH advisory panel, presented academic papers on health care, and been awarded for her promotion of the health of transgender people. On the other is Walt Heyer, a preacher who detransitioned and has been an outspoken critic of affirmative care. It makes no sense to put these two on equal footing if we arrive at the truth via evidence and reason. Preachers and media talking-heads carry quite a bit of cultural authority, however, more than an obscure scientist would. Hence why Hall not only places similar weight on the opinions of both, she mentions Walt Heyer by name but not Dr. Kelly Winters; the former carries more weight than the latter, after all.

That review shifted my entire approach to Shrier’s book and Hall’s writing, and I’m glad I read it before going any further on the subject.

As a physician and a researcher who has dedicated my career to taking care of and understanding transgender youth, I recognized the book as bizarre and full of misinformation. I assumed it wouldn’t gain much traction. I was wrong.

I should have realized the internet has dramatically changed the way politically charged misinformation spreads. Online, it often doesn’t matter what’s actually true. The book, full of irresponsible journalistic practices and outright falsehoods, has taken off.

Dr. Jack Turban. “New Book ‘Irreversible Damage’ Is Full of Misinformation“, Psychology Today. December 6th, 2020.

This other review pointed out something rather important. For instance, you’d think that if you’re writing about transgender youth you’d want to talk to transgender youth, right?

Shrier’s book tells the stories of several young people who came out as transgender to their parents. The book claims that these adolescents and young adults were not actually transgender, but actually just confused. The problem is Shrier didn’t actually interview any of these people she wrote about.

The author’s note points out that she only interviewed their parents, who uniformly did not accept their children’s transgender identities. Many of them were estranged from their kids because the children were so hurt by their parents’ rejection. To actually understand the psychology of these young people, one would need to talk to them, not simply rely on stories from parents with whom they do not speak.

To make things worse, the author’s note explains that Shrier changed details in the book to ensure the transgender people she wrote about would not be able to recognize themselves. In doing so, she ensured they could not provide their side of the story or point out any inaccuracies in her reporting.

It’s ROGD all over again! Ask bigoted people for their opinions on subjects they’re bigoted about, and you’ll get bigoted and distorted answers. Summarize those answers in a scientific paper or an in-depth book, and you give false legitimacy to those bigoted beliefs.

Full disclosure: I didn’t stumble on these reviews on my own. Remember how Novella and Gorski of Science-Based Medicine promised a part two on the healthcare of transgender youth? They delivered, by giving Rose Lovell a guest post to discuss the book. She’s a doctor with relevant clinical experience, and she ended her review by pointing readers to the two reviews I shared above. Unsurprisingly, she reaches similar conclusions:

In total, I simply cannot recommend this book to anyone honestly seeking to understand transgender science and medicine. Shrier has written a book in an attempt to prove her specific point, not to explore the nuances of a complex field. While there may be some legitimate concerns (e.g., that of how to support those who choose not to continue to transition or to detransition), the overall narrative in Shrier’s book is so tainted by biased language and misinformation that it throws into question its own legitimacy. I am also very concerned that this book, and others like it, will continue to be used as a primary source in efforts to prevent transgender youth from accessing desperately needed medical care.

Rose Lovell. “Abigail Shrier’s Irreversible Damage: A Wealth of Irreversible Misinformation.” Science-Based Medicine, July 2nd, 2021.

Lovell goes into two arguments of Shrier in depth, then gives a quick gloss over a dozen-ish others. One of those caught my attention:

“Biology is a binary and differences of sex development (DSDs) are vanishingly rare”. False. DSDs are as common as 1 in 5,000 births, and increase to 1 in 200 or 1 in 300 if you include hypospadias and cryptorchidism. Biology is very, very well known to be a spectrum.

Ah, the sex binary. I’ve been on that beat for, what, seven years now? Others agree that sex is not a clear-cut binary.

Consider the multiplicity of features relevant to sex determination: chromosomes, genitalia, gonads, hormone levels, reproductive capacity, and so forth. In order to say that a transsexual after genital reconstruction surgery has under-gone a “sex change,” we must discount other features, including chromosomes, and select genitalia as definitive. But consider a person who has an XY karyotype and is morphologically female due to complete androgen insensitivity syndrome. It’s not clear whether this person is male or female. Indeed, there doesn’t seem to be a factual basis on which to arbitrate the question. But postoperative transsexuality seems exactly analogous. In both cases, there’s no fact of the matter as to what sex or gender the person belongs to.

Bettcher, Talia Mae. “Trapped in the wrong theory: Rethinking trans oppression and resistance.” Signs: Journal of Women in Culture and Society 39.2 (2014): 383-406.

It’s telling that Shrier asserts that sex is binary, even though it isn’t necessary to make her case. It underlines that her true focus is not the health of transgender children, but a cultural rollback to a more patriarchal time. Listen to her in other interviews, and she’ll make arguments about the damaging nature of smart phones and the internet, how LGBT terminology is confusing, and that parents should have primacy over decisions relating to children. Transgender children are being used as a wedge for a grander cultural project, much as opposing abortion is used as a wedge for opposing contraception. This is what the aforementioned engine is pushing.

I’m rambling a bit, though. I found all three reviews quite interesting, and can recommend them if you’d like to read more.