The very first sentence of this response to my article describing adolescent transgender ideation contains four refutable claims: “The medical care of transgender adolescents has become a flashpoint for ideological battles in recent years. Certain commentators and groups have put forth misleading narratives about transgender youth, disregarding clinical evidence to raise unfounded concerns about imaginary harms.”
The first is that this is an ideological battle. Well, it might be for those in thrall to an ideology. However, for those of us concerned for our children’s wellbeing, it is a pursuit of truth. Second, the claim that my article is a “misleading narrative” is plain false. What is in the narrative that is misleading? Also false is the claim that clinical evidence is ignored, although it must be said that what evidence there is has been described by NICE as being of low quality. There has been no longitudinal study of adolescents who claim a transgender identity. So, an equally valid response to this claim would be to ask, “What evidence?”. Third is the claim that concerns are unfounded – well that is brazen! Ask any parent of a child with transgender ideation if they think their concern that their child might pursue medical interventions is unfounded, and the answer will be emphatic. And this ties in with the fourth claim, that the harms resulting from such medical interventions are imaginary. I am sure the likes of Chloe Cole, Keira Bell, Abel Garcia, Ritchie Herron, Cat Cattinson, and Prisha Mosley (I could go on) would testify that the harm are real and significant.
The next sentence starts with the claim that my arguments are made in “bad faith”, which is an ad hominem fallacy. This emotional appeal is attempting to discredit the notion that adolescent transgenderism is a social contagion (it is) and that gender dysphoria is pretend distress (which, if you read my original piece, is not what I said). It also seeks to spike the idea that activists are manipulating susceptible children into mistaken transgender identities. I did not raise that specific point, but now that it has been mentioned, this grooming of vulnerable teens does occur, and I have heard countless parents testify as much. When this grooming takes place online a target victim is described as an “egg”. Placing the word susceptible in scare quotes is just risible. You can call them vulnerable, or cite the co-morbidities of transgender ideation, either way, these susceptibilities are established facts amongst those working in the field. It is true, though, that proper research needs to be done for those who require an academic paper before considering the veracity of this claim. Without such research, I would point the curious to the parent testimonies published by Parents with Inconvenient Truths about Trans (PITT).
And then we have the accusation that we are advocating against best practice guidelines. Well, who decides what is best practice? Presumably those promoting transgenderism would cite WPATH whose guidelines have been used as a shield by those attempting to justify the medical malpractice of opposite-sex imitation and are now widely discredited. On the other hand, best practices could be applied to the Florida Board of Medicine which has been in the forefront in turning the latest research into solid patient safeguarding.
At this point, we really must take time out to notice which way the wind is blowing. Finnish psychiatrist Riittakerttu Kaltiala has recently described how her views have developed in a piece entitled: “Gender-Affirming Care Is Dangerous. I Know Because I Helped Pioneer It”.’
The next sentence begins with “In reality”, if what follows was reality, there would be no need for this preface. The claim is that “extensive research confirms gender dysphoria is a serious condition”. This claim links to a page on the American Psychiatric Association website that includes a note that it was reviewed by Jack Turban. Turban is a known activist and ideologue, and his work has been soundly discredited, for example in this piece in the Wall Street Journal. There is extensive research that makes claims for the nature of gender dysphoria. A lot of this research is activist led and poor quality, and this is confounded by a lack of high quality, objective research. Having said that, one of the best papers that questions whether gender dysphoria is a legitimate diagnosis: “What is gender dysphoria? A critical systematic narrative review” is published, ironically, in the journal Transgender Health. Let me not be accused of suffering from confirmation bias in my research!
The problem here is that a great deal of the work that has been done in the field of transgenderism in recent years has been conducted by those with a vested interest in seeing that ideology prevail. There has been widespread capture of professional bodies established to uphold standards. This situation will take time to unravel. For example, the American Association of Pediatrics has been championing the bad science of “gender affirmation” for years, but it has recently announced plans to conduct a systematic review of evidence (after a very effective campaign led by Our Duty) . These organisations must be allowed to row back their mistakes with some dignity. Although the increasing number of lawsuits will add some pace and embarrassment to this process.
In the following section, it is implied that my article supports the notion that feelings of dysphoria (or their pretence) is ‘rapid onset’, in fact I report that they arise after prolonged rumination.
Questions of persistence need to recognise the different cohorts of people claiming a transgender identity. There are five main classes, and each needs to be treated as a separate cohort. One of the biggest mistakes made by advocates of transgenderism is to assume that presentation and aetiology are the same across cohorts. Transgenderism is not homogenous. The five main classes are:
- Prepubescent children (majority boys, with a 10–12% persistence rate)
- Adolescent girls via social contagion (no longitudinal data)
- Adolescent boys via social contagion (no longitudinal data)
- Homosexual Transsexuals (boys who generally desist shortly after adolescence)
- Autogynephilic men (rarely desist)
It should be obvious to any observer that the data collected, and hence research published, for middle-aged men with a paraphilia is not applicable to teenage girls with social anxiety issues.
The claim that “the most robust longitudinal studies make clear that transgender identities are not a social fad” must be taken in the context that there have been zero such studies of the adolescent cohorts. That claim, therefore, has no validity for the cadre of patients with which we are concerned.
Parent testimonies (see PITT, and in my article about what happens in schools) will contradict the claim that “There is no credible evidence of nefarious influences pressuring kids into false transgender identities.” The testimony of detransitioners, and the existence of easy-to-find YouTube “influencers” further undermine that assertion.
The aetiology of transgender ideation is being investigated. However, there is no evidence that anyone has a gender identity beyond a social choice, and certainly no evidence that any claimed identity is innate or biological. As for describing sex as “assigned”, that is clearly an expression of faith. Sex is determined at fertilisation and observed later.
Some might conflate so-called gender incongruence with body dysmorphia, but not me. But body dysmorphia is a common precursor to transgender ideation. The attempt to describe the difference between body dysmorphia (dissatisfaction with one’s morphology) and gender dysphoria (dissatisfaction with one’s sex) is not clear for me. And the glib assertion that individuals who receive (presumably gender affirming) care can live happy lives does not consider that they might also live unhappy ones. And we do not know the proportions of each because there has been no longitudinal study. What we do know however, is that an unmedicalized person will be healthier.
Is the notion that transgenderism is an invention of activists a ‘common refrain’? The word was popularised by Virginia (née Arnold) Prince in the 1960s. He was an activist, and certainly pushed the concept on broader society, which includes youth.
The idea that transgender people have existed across history and cultures must be challenged. This is a field that I would term quack-anthropology, and merits its own long article. Native Canadian elders have dismissed the concept of two-spirit. The frequently cited Faʻafafine of Samoa are effeminate homosexual men, Hijra of India include those with differences of sex development. Such people have always existed, yes, but to label them ‘transgender’ is just inappropriate. This is forced teaming, and homophobic.
Clinical research will bring facts to light – let’s have more of it.
In my view it is harmful to describe adolescents with transgender ideation as ‘transgender youth’, this is because these young people are not diagnosably transgender, they merely think that they are. This might seem to be splitting hairs, but it is a most important and foundational point. There is no evidence that transgender people exist as a readily definable, testable, category of human. If anything is a social construct, it is the transgender person.
Adolescents with transgender ideation do require compassionate and evidence-based care. The so-called ‘gender affirming’ model is not that.
The assertion that “social transition” – described by Dr Hilary Cass in her Interim Review as “not a neutral act” – and puberty blockers can lower the incidence of suicide is just false. Instead, the complete opposite is true. A Canadian study highlighted that those whose transgender ideation is affirmed and medicalised are up to 7.6 times more likely to attempt suicide. A similar study in Sweden reports a 19-fold increase in risk.
We then must look at whether there is any evidence that supports the claims that averting medicalisation is deleterious to mental health. There is no evidence on this cohort. What we term desisters are completely absent from the literature. Maybe it is because they go on to live happy, normal lives and so are of no interest? Who knows. We do know that the mental health outcomes are not as clear-cut as described. Furthermore, it is worth reiterating that the physical outcomes are singularly negative, and there have been no longitudinal studies on the adolescent cohort (hopefully, this is the last time I have to make this important point).
The statement “withholding medical care until adulthood causes needless suffering” is just a baseless assertion. I could equally well assert the opposite – ‘providing medical care before adulthood causes needless suffering’ and I can invoke the testimony of detransitioners to uphold the veracity of that. Which brings us to the ridiculous claim that detransition is exceptionally rare. The Reddit website has a “channel” r/detrans with over 50,000 members.
I resent the implication that my desire to promote a contemplation on transgender ideation is a ‘manufactured controversy’, it is merely pushing the debate forward based on emergent knowledge.
I commend the statement “decisions on appropriate care should be guided by scientific evidence and input from the adolescent, parents, and doctors – not ideologically-biased assumptions”. It is good to find a locus of agreement in this debate. Who would not wish for this to be the case?
There is scant evidence concerning the adolescent cohorts. This is unsurprising given the relative novelty of the phenomenon, we need much more. Desistance and detransition are in desperate need of thorough research. I’d put money on the best outcomes being found amongst those who desist, but good odds are not the same as absolute certainty.
And did I mention that we need high quality longitudinal studies on the adolescent cohorts?