Published February 6, 2023
Contrary to the claims of transgender activists and their allies, the science was never settled. The body modifications of so-called “gender-affirming care” have not been shown to be the best treatment for those suffering psychological distress over their embodiment as male or female. And some voices in corporate media are starting to admit this truth.
For example, a recent Atlantic piece headlined, “Take Detransitioners Seriously.” Despite a lot of pro-transition throat-clearing, the article not only concedes that detransitioners are real but confesses that many of the studies cited to dismiss them are weak or non-applicable to current debates. As the authors admit, “data are relatively scarce, and anyway the cultural context for trans people has since evolved so much and so quickly that older studies may not adequately predict outcomes for today’s … population.” That is to say, studies of carefully screened European adults are almost certainly not applicable to the essentially unscreened American adolescents currently rushing to gender clinics.
The authors of the Atlantic piece add that the “existing research has major gaps” and conclude that “Ultimately, nothing is certain from these data except that more information is necessary.”
Now they tell us.
This piece follows The New York Times published articles giving readers permission to question transgender orthodoxy and joins other critical murmurings in the corporate media. It seems that some liberals are realizing that the demands of maximalist transgender ideology — from putting male rapists and murderers in women’s prisons to sterilizing healthy children — are indefensible and unpopular. Thus, though they are not surrendering, they are looking to retreat to a more sustainable position.
Unfortunately, many powerful people, including the Biden administration, are still pushing for the maximal position. And even the newly chastened seem unwilling to support real limitations on the transgender agenda. Consequently, The Atlantic article reads like a concession made to take the heat off, allowable because “The LGBTQ community today … is also at a moment of unprecedented cultural, institutional, and political strength.” Their hope is that by backing away from the worst excesses of the transgender movement, they will be able to cement the rest of their agenda.
That tells us that we need to keep pushing, hard. Though we should welcome any retreat from the most egregious follies of transgenderism, we need to continue to press the case against transgender ideology as a whole. An essential part of this case is explaining that it is not just the research on detransitioners that is lacking, but that the general case for transition is incredibly weak.
Transgender activists and their allies have tried to create an illusion of overwhelming scientific consensus by stacking weak studies together. For instance, several years ago, I examined one prominent effort along these lines (the What We Know Project) and found that it was stuffed with studies suffering from a multitude of problems, from small sample sizes to subject pools that self-selected on the internet. Even the better-designed, long-term European studies still often had problems such as unduly restrictive definitions of regret or atrocious response rates.
Likewise, a 2021 review of studies on transgender regret had many of the same weaknesses. I looked into that research after it was cited by a New York Times piece arguing against any screening before medical transition, and I found that, among other problems “Of the 27 studies used in their analysis, the review authors ranked only five as “good” and only four as having a low risk of bias.” Those are not the sort of studies that settled science is made of.
The truth is that there is almost no high-quality, long-term research on those who identify as transgender, and the best studies (mostly from Sweden) are far removed from the current American context. Consequently, those trying to build a case for transition tend to cite a lot of studies that are junk — e.g. consisting of self-selected online samples recruited by trans activist groups — or that are just dishonest. Furthermore, almost all of these studies are conducted by those already committed to medical transition, and who have a lot to lose if it is shown to be bad medicine.
These failures extend to the research used to justify transitioning children. There are significant problems with the work used to establish the so-called Dutch protocol in which children are subject to a regime of puberty blockers, followed by cross-sex hormones and surgery. As a recent evaluation noted, “Three methodological biases undermine the research: 1. subject selection assured that only the most successful cases were included in the results; 2. the finding that “resolution of gender dysphoria” was due to the reversal of the questionnaire employed; 3. concomitant psychotherapy made it impossible to separate the effects of this intervention from those of hormones and surgery.” Worse still, even the modest guidelines established by the Dutch researchers have been ignored by American gender clinics and their allies, who are feeding children to the transition machine as fast as possible.
Furthermore, new research is not improving the case for transitioning children. For instance, a recent report in the New England Journal of Medicine was a disaster for those who want to give adolescents cross-sex hormones. Despite a favorable sample, the two-year study had 2 participants out of 315 commit suicide (a suicide rate far above the national average), found no mental health improvements in males given cross-sex hormones, and only minor, self-reported mental health improvements among females given testosterone (and those may be due to data cherry-picking on the part of the research team). Yet the authors spun this as a positive result, and many in the corporate media promoted this study as demonstrating the benefits of transitioning children.
The more people look at the science, the more they realize it does not support transgender claims. The gender ideology movement has only gotten as far as it could today by exploiting initial confusion and ignorance about its lack of scientific support and its medical risks. That this information is now getting out — and that there are cracks in the pro-transition media wall — is welcome news, but critical voices on gender ideology are still the minority, and many liberals are unwilling to go nearly far enough in rejecting transgender ideology.
In the face of this recalcitrance, we must begin by protecting children. The best studies show that most children will desist from gender dysphoria if only given time to grow up and mature. But when a kid is confused about gender, parents have been relentlessly told that they must disfigure and dismember their child’s body, or else their child will commit suicide. This emotional blackmail must end, and children must be protected from those who would mutilate their healthy, natural physical development.
Nathanael Blake is a Postdoctoral Fellow at the Ethics and Public Policy Center.