It's All Our Fault

Medicine's warning to the media

Creative Commons/Pixabay

In a rather extraordinary paper that was published today in the JAMA Network Open, “Association of Media Coverage on Transgender Health With Referrals to Child and Adolescent Gender Identity Clinics in Sweden,” doctors in Sweden seem to be accusing the media of making access to healthcare harder for kids who identify as transgender. They found that when there was a “negative media event”—like the Trans Train documentary series, which detailed the rise in detransitioners and some children being harmed by gender-affirming care—referrals decreased.

Their conclusion?

…an event of negative media coverage on transgender-specific health care was negatively associated with access to health care for transgender children and adolescents; therefore, nuanced and accurate media coverage, as well as increased awareness of these mechanisms among key stakeholders, is essential.

I couldn’t agree more on the importance of nuanced and accurate media coverage. That’s the very reason I started this newsletter! But I’d argue that The Trans Train series is just that: required viewing for anyone writing about this subject, or for the family of any young person considering medical interventions for gender dysphoria. Nuance doesn’t mean “the media protects you.” It means covering multiple sides of a complex story. Trans Train was created by Mission:Investigate, an investigative series on SVT, Sweden’s equivalent of the NPR or BBC (though apparently with more journalistic freedom than those other institutions). And its findings were important—the same findings most of us who’ve gone deep into this world have discovered: Some kids are being helped. Others are being really, really hurt.

An invited commentary, published with the paper, called “Negative Media Coverage as a Barrier to Accessing Care for Transgender Children and Adolescents”—further admonishes the media for daring to uncover what Trans Train did.

“…when it comes to reporting that pertains to the health of TGD [transgender/gender-diverse] young people, who are, after all, one of the most vulnerable subgroups within our society, perhaps our media should recall one of the core tenets of health care and ensure their stories ‘First, do no harm.’”

Well, that’s not the mantra of journalism, nor should it be. And even if it were, the Trans Train documentary series uncovered many instances of harm! It’s almost as if they’re saying, “Don’t cover our fuck-ups, it makes it harder for us to keep going unchecked as we have been all these years.” This comes not long after the World Professional Association of Transgender Health (WPATH) implemented a ban on its members talking to the media.

I am reminded me of a paper in Pediatrics last year, which found that a little more than 9% of kids had some kind of creative way of describing their gender (used here to mean a “sense of self” and not “expectations based on sex,” as it means to feminists). This group used words like “girl” “boy”—though not always in connection to being male or female—along with “trans girl,” “trans boy,” "genderqueer," "nonbinary," and "another identity.” This was a racially and socioeconomically diverse cohort, which made the authors wonder why the cohort at gender clinics was so overwhelmingly wealthy and white. We must increase access to medicalization, they concluded, and bring all those kids to the clinic.

There is an assumption in both these papers that gender-diverse kids must medicalize, that it’s the most direct route to improved psychological function, despite the fact that medicalizing is a long and winding road with no guarantee that it ends at Shangri-La.

Neither of these papers considers that being gender diverse doesn’t always require medical or psychological intervention. The first new JAMA paper also assumes that a decline in referrals is a bad thing, instead of an indication that parents are realizing that gender clinics aren’t always the safest places to bring their gender-dysphoric youth, and that there may be a number of sources for the dysphoria. Maybe they went the traditional therapy route instead. After all, that’s how WPATH suggests we start.

The “Association of Media Coverage” paper explains the explosion of referrals to gender clinics in recent years this way:

“Several explanations that could influence care-seeking behavior among individuals with GD have been proposed, including enhanced availability of information on gender issues on the internet, decreased stigmatization and increased acceptance in society, and more accessible health care, as well as increased attention of transgender issues in media.”

Note that, despite the widespread cultural acknowledgement that social contagion, Tik-Tok-style, is linked to girls identifying as having multiple personality disorder and mysterious tics, the possibility that the same thing could, on some level, be happening with gender dysphoria is not even considered. They cite a paper showing that increased positive portrayals of trans kids on TV is linked to an increase in social acceptance.

“…exposure to transgender narratives reduced the influence of viewers’ political ideology on their attitudes. The attitudes of more conservative viewers became increasingly positive as they saw more media portrayals of transgender individuals. These findings highlight the potential for entertainment narratives to influence attitudes toward marginalized groups, and they demonstrate the importance of emotion in the context of divisive topics.”

But this is not seen as social contagion but rather as evidence of why positive representation matters. In fact, the JAMA invited commentary explicitly debunks this idea.

“…some have suggested that the growing number of referrals to such clinics is not owing to greater awareness of gender diversity and empowerment of TGD young people but is instead being driven by other factors such as peer influence, while others have warned that the use of gender-affirming hormonal interventions in TGD young people represents an undue risk.”

Last year, The Guardian reported on a completely opposite warning from Paul Conrathe, the lawyer for detransitioner Keira Bell, who temporarily won a case against England’s NHS gender identity development service (GIDS), which had prevented anyone under 16 from getting referrals to puberty blockers and cross-sex hormones without a court order. (The case was overturned last year).

“If you read Keira Bell’s story, she says at various points: ‘I had my doubts but I gained courage from the internet,” Conrathe said. “I think there is a need for safeguarding guidance on protecting children from information that will encourage them down an experimental medical pathway.”

One group says the media is to blame for overly promoting medical transition. Another says it’s to blame for discouraging it. I’d say if the media is covering multiple viewpoints, then we’re doing our job. But rarely is anyone in the American media doing so.

I don’t understand the insistence that there are no problems with gender-affirming care—in what area of healthcare are there no problems? In fact, after the Trans Train series, and a review of the evidence, several hospitals in Sweden radically altered their approach to treating gender-dysphoric youth, so that only kids in clinical trials can access blockers and hormones.

I can only assume that those urging the media to stand back aren’t listening to the whistle-blowers, the detransitioners, the desisters, the parents who have lost their children because somehow we interpreted the research which shows the importance of parental support to mean “cut off parents who are skeptical of immediate medicalization.” When in fact, that leaves you with the opposite of support.

Our job in the media is not to cover up stories that disrupt a narrative. Our job is to explore many sides of the story, and reveal abuses if we find them. Like a private investigator said to the Sheriff in a recent episode of Ozark, “Do your fucking job…PLEASE.”