Less Than Zero

The burden of proof about gender-affirming care is on us

[NOTE: If your child was socially transitioned at school without your knowledge or approval and you’re willing to talk—anonymity fine—please contact me.]

Flickr/creative commons

Here’s something that won’t surprise you: I wrote another op-ed. This one is about the science of gender-affirming care, and how it has been politicized by both the right and left, to the detriment of everyone involved. The right tries to ban it and the left lies about it in an effort to salvage it. The bottom line is this: the research on transitioning children shows very mixed results; we don’t follow the protocol of that research in this country; and it applies to a completely different cohort than the one showing up at gender clinics today. I loaded the piece up with citations and made the case that liberals—including the most experienced clinicians and many trans people—are just as concerned about what’s going on as conservatives. It has nothing to do with politics. It has to do with both the science and the lived experience of children and families that have been hurt.

I sent it first to a venerable liberal newspaper, and an editor read it and agreed to a meeting with me. It did not go well. She asked how many people had gotten hurt. I replied that we don’t have any numbers. We don’t know how many kids are getting helped or hurt. We don’t have any numbers on those medicating, or socially transitioning, and of those how many are improving or getting worse. The research that shows some positive results is on a population completely different from today’s gender dysphoric youth, who are receiving a very different protocol.

This swayed the editor 0%. Less than zero. Without numbers to prove it, the assumption is that the population getting hurt is so small it’s not worth reporting on. I explained that the issue has been so politicized by the Left that parents are afraid to speak up, for fear of losing their kids emotionally or legally. We can’t collect information from people who are silenced. This brought me down to about -65 on the believability scale; I sounded like a conspiracy theorist. “What do you mean by ‘the Left?’” the editor asked, skepticism drawn over her face. Well, I meant all the media pieces claiming that anyone concerned about medicating gender dysphoria immediately with hormones and surgeries is a bigot, that all objectors are right-wing. Most are liberal. They just think their kids need more time and space to figure out what’s causing them so much pain.

She told me they would be publishing a piece arguing the opposite of what I’d suggested about the research, but that they would forward my piece to the writer. In other words, even though we have very little evidence of the efficaciousness or safety of the gender-affirming approach, the burden was on me to prove it didn’t work. And despite my long list of citations, I failed to do that. They suggested another topic to me, which I have been working on for the last week. But it will be a miracle if they take it.

Another venerable newspaper, with an opposite political bent, rejected the piece, too, because the burden of proof was on me to prove that anyone was helped by these medical interventions, even though the research shows that some young people have benefitted. Neither of these media outlets would budge. Neither would let this information through to the public without 100% ideological adherence (or, as the conservative fellow said, a more coherent argument).

This is a failure of the media.

Other outlets I pitched: SciAm, The Guardian, Time (which said no, but the magazine published a piece the same day about this “life-saving care”), Washington Post, CNN, LA Times. Only one person bothered to write back to me. Even editors I’ve worked with many times did not respond. Then a brave and even-handed editor at Newsweek, committed to ideological diversity, took the piece, and it was published today. (Please give props to Newsweek opinion for its open-mindedness.)

It was great to have a win, but I wonder how many people speaking up it will take to move this mountain? I have no numbers but I have heard the testimonies of those who’ve cut off their breasts or testicles and realized they were gay or anorexic or depressed, or permanently altered their bodies with hormones and realized that this was not the solution. I’ve talked to parents who’ve had CPS called on them for not complying with their children’s requests for immediate medicalization (and read about a parent dealing with CPS because of being overly eager to comply.)

I’ve also talked to trans adults who changed their bodies and feel so much better walking around in the world—but most of those I’m talking to are very concerned for the kids cavalierly choosing this, or being groomed to choose it, because these are serious psychological and medical interventions that past research suggested one needed to be already mentally stable to handle.

If you’re a grown up and want to take hormones, or even get gender nullification surgery, go for it. But teaching young people that there is something wrong with their bodies or names or pronouns because they are sad or uncomfortable or different from many people of their same sex? Marketing mastectomies to vulnerable young people? This is not about bodily autonomy, but about a massive zeitgeist shift that has taken hold of an entire generation. Some of it is about being liberated from gender norms, and some of it is about coercing people to change in ways that aren’t right for them.

The stories I’ve heard are the juiciest and wildest I’ve ever come across, and I can hardly push a single one through. There are thousands of parents in various support and advocacy groups. We need to create an environment in which they feel safe telling their stories so that all children gets the proper help, whatever that may be.

Almost every day I talk to these parents—and their kids—and am encouraged that I’m doing the right thing by continuing to try, despite how hard it is to get paid and how low the success rate is. Their gratitude powers me on. So few people are listening to them. One woman said to me last week, “Thank you for your curiosity. So few people in the media are curious.” The number of kids with gender dysphoria jumps 4000% in 10 years and nobody’s curious? This, too, is a failure of the media.

I don’t agree 100% with many of these people (maybe more like 82%) and that’s one of the best things about working with them. The demand for ideological purity is part of what’s gotten us into this mess. The vast majority of these people are liberals and there are many trans people among them—and yet this is still presented as a right/left battle. This, too, is a failure of the media.

Last week, I spoke to a psychologist who was instrumental in exposing the scandal of false memory syndrome. Then, too, she said, the entire media was captured, as was the court system and the mental health community. What stopped it? Lawsuits. And those are beginning. I wonder why the Freedom from Religion Society has not sued schools and government institutions for teaching three-year-olds that they have a gendered soul, independent of their bodies—and that their bodies must be fixed to match their souls. These are religious ideas. And like many religious ideas, they bring great solace to many people, and have taken deep hold in our society. I can’t argue that these ideas are wrong because they’re religious or because I might not share them; but I can argue that labeling everyone who disagrees with them a bigot, and insisting that everyone must accept religious beliefs as truths, is indeed wrong.

I know that I have a varied readership and some people don’t know much about this, or don’t care, or disagree. But among the people who’ve subscribed are those whose kids have complex mental health problems that have been overlooked because of the way the medical and mental health communities are approaching gender dysphoria. I am trying to tell your stories—not to ban anything, not to oppress anyone, not to hurt anyone, but because your side of the story has been suppressed, and because in order to make sound policy we need to understand the full complexity of the issue. I ache for the way these people have been treated, and because almost all of them have to hide. I ache for the non-free press. I ache for the gaslighting. And I ache for how few people understand what they are supporting. I just want everyone to see the full picture.