The Corrections

What NYT opinion essays about gender keep missing

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Like many liberals, I grew up revering The New York Times, and have never felt prouder than when they’ve accepted my op-eds in the past. But these days, their gender-focused pieces have been almost (but not completely!) uniformly in one ideological camp. Tenets of that camp include that “boy” and “girl” are social, not biological, categories; that each person has a gender identity, or gendered soul, independent of the body; that sometimes the body must be fixed to match that gendered soul; and that the science of pediatric medical transition supports those fixes. Another tenet of the ideology is that anyone who questions these assertions is a bigot—perhaps that’s why the NYT doesn’t question them.

However, I have sent in many, many pieces to them that interrupt this ideology, that ask why the same research used in other countries to question the safety and efficacy of medical intervention is used here to avow them. I’ve tried to tell the stories of detransitioners and desisters, or scientific dissenters, or the overreach of schools stepping in to perform psychological interventions on kids without parental consent. That last one was actually the suggestion of a NYT editor! I wrote it, but they didn’t run it.

I send these pieces in hoping they’ll be published so that more of us, especially on the left, can have the same store of information. We need all the information to have informed consent. But I also do it so that editors cannot claim plausible deniability. They know the story is more complicated than they’re making it out to be. They know that not all dissent is rooted in hate.

But I’m not sure if they know that the claims many of the opinion pieces make are either problematically skewed or demonstrably false. So I’ve taken it upon myself to either correct of complicate some of those claims. A recent piece, published after I’d sent in this piece about the uncertain science (that is, they published a piece claiming the opposite despite having read mine weeks earlier) was just too much for me to fact-check, but if anyone else cares to take a stab at it, please post corrections below. Forgive me—it’s long. There are a lot!

Where in the World Are All the Trans Children? Everywhere.

“Research shows that there are a set of trans people who first identify with their gender by the toddler or preschool years and continue to do so throughout their lives.”

Historically, those kids have mostly desisted in having gender dysphoria and identifying as the opposite sex, and most turn out to identify as gay. Gender development takes time—not until about 6 or 7 does the idea of “gender constancy”—that your category is based on your body, not your relationship to stereotypes, and will not change—develop.

“As far back as historians like me have found evidence of transgender people,” she recently wrote in The Times, “we have found transgender children.” 

There was no concept of transgender or gender identity, so this can’t be technically true, though there have been gender nonconforming children, or sometimes children distressed about their membership in their biological category because they didn’t fit the norms associated with it. But the modern concept of transgender did not exist, and with norms and mores so different in different eras, we cannot apply this modern label onto people in the past.

 I read about the long history of people living outside the gender binary in cultures around the planet, including the hijra of South Asia, the fa’afafine of Samoa and the “Two Spirit” people in Native American cultures.

The hijra and fa’afafine are androphilic, feminine males—gay, feminine men. Two spirit is a late 20th century term, but generally native American cultures with more than two gender categories were those with strict gender roles; more equitable cultures didn’t have a need for them. For the most part, these third gender categories tend to be evidence of the relationship between homosexuality and extreme gender nonconformity.

Republicans Have Found Their Cruel New Culture War

“It doesn’t matter if those youth are pleading for this kind of help or have already begun receiving it and found it to be lifesaving. It doesn’t matter if their parents, having wrestled hard with the situation and done extensive research, believe that therapy is crucial.”

The narrative about suicide, and that this care is life-saving, is contested and unclear.

The push to ban “conversion therapy” means that many for whom therapy would be crucial are not getting it—and there is no real research on conversion therapy for gender identity; the term applies only to sexual orientation and should not be used in this context.  

“There’s no evidence being presented, no evidence being pretended,” Mara Keisling, the founder and executive director of the National Center for Transgender Equality, told me.

There’s quite a bit of evidence that, well, the evidence is unclear. It comes in the form of detransitioners. There’s the UK’s review of the evidence that called it “very low quality certainty.” There’s France, Sweden, Finland , all saying the evidence for transition isn’t clearly there.

When Senator Rand Paul, a Kentucky Republican, grandstands in a Senate hearing by comparing surgery elected by trans people to the “genital mutilation” — a phrase he used repeatedly — of girls in cultures that seek to subjugate women by stamping out their sexual pleasure, that’s not an honest policy debate.

Girls may indeed lose sexual function, and there are high complication rates.

How Trans Children Became a Political Football

But the study, which PLOS One corrected and apologized for, was sharply criticized as methodologically flawed and ideologically motivated, and the condition is not a term recognized by any major professional association. 

The correction was minimal, the methodology similar to most of the other recent research in this field, and the term was only meant as a neutral descriptor, not a diagnosis. Those are the same criticisms as most of the research quoted in NYT opinion essays, which is based on convenience samples with methodological flaws that appear to be ideologically motivated.

Estimates for the proportion of people who de-transition range from less than 0.5 percent to as high as 13 percent. (The numbers may vary depending on the kind of transition, which may or may not involve puberty blockers, cross-sex hormones or surgery, the last option almost always restricted to adults.)

We have no idea. We have absolutely no idea. Here’s a recent tiny study with a 6.9% detransition rate noting, “Detransitioning might be more frequent than previously reported.” And another small recent study with a 10% detransition rate. With no long-term follow-up of this new cohort, we simply cannot say.

the well-documented benefits of gender-affirmative care with the risks of medical intervention. 

The benefits are not well-documented, except in research as flawed as the ROGD research. We don’t have long-term follow-up studies, especially of this modern, never-before-seen cohort.

Keeping Trans Kids From Medicine Doesn’t Make Them Disappear

Trans people have been part of human history for as long as there has been history, and for as long as there have been humans.

Gender identity is a very recent, and western concept, so this is not verifiable. But gender nonconforming people seem to appear in most cultures, and, as noted several times, their nonconformity is often correlated in some way to sexuality.

early medical interventions, including the prescription of puberty blockers for younger trans people, are both beneficial and safe.

Nobody knows for sure about either of those statements. Blockers are associated with poor physical outcomes—so much so that Sweden stopped using them for the most part after 13 “healthcare-related injuries.” Their benefits are unclear. Some studies show benefits, others no change or deficits.

Puberty blockers keep trans kids from suffering the permanent damage of adolescence in the wrong gender. They have been shown to lower the risk of suicidal thoughts, and it buys them time, should any be needed, to become more certain of the path they’re on. The effects of these medicines are reversible if treatment is suspended.

They’re not necessarily reversible; you’ll resume endogenous puberty if you go off them, but may endure permanent damage to brains, bones—we don’t know for sure. The suicide research doesn’t show causation, so you can’t say they lower the risk; you can say they seem correlated in some way to a lower risk. While you will go through endogenous puberty if you go off them, we don’t know if the effects are reversible, but given the way countries like Sweden and Finland have stopped using them because of injured children, it seems clear that it’s possible for permanent harm and much more research needs to be done.

Treating trans kids isn’t the experiment here. 

Well… Doctors are prescribing blockers for off-label use. Surgeries are removing healthy body parts. We have very little long-term research or research with control groups, and what we have shows different outcomes, some good, some bad. If this is meant to mean there is no official experiment going on, or no studies with control groups—which are needed to establish correlation—then this statement makes sense.

In 2014, research published in the journal of the American Academy of Pediatrics found, in a longitudinal study of 55 trans people who had received puberty suppression treatments during adolescence, that treatment radically improved patients’ lives. The study concluded that years later, after gender reassignment, their “well-being was similar to or better than same-age young adults from the general population,” giving them “the opportunity to develop into well-functioning young adults.”

The conclusion of the study was “A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.” Meaning: a lot of evaluation, not just blind affirmation, can lead to a good outcome. One transfemale died after vaginoplasty, “owing to a postsurgical necrotizing fasciitis.”

This is pretty good data. That is, it is long-term, follow-up with actual patients. It shows that with very careful assessment and well-trained clinicians, young people with sex-reassignment can do well up to seven years after beginning medical intervention, and one year after surgery. But the average time for regret to set in, per one study, is over ten years. And, again, these are a very different cohort than those appearing today. Meanwhile, the entire methodology of this study has been called into question and it’s not clear if the reported improvement is due to medical interventions or if the data are the result of how the questions were posed. For more on that, listen to two episodes of Gender: A Wider Lens and scour this important paper on informed consent for minors.

And anyway, these data are not all rosy, even if they were reliable. “Over time, transmen showed reduced anger, anxiety, and CBCL/ABCL externalizing T scores, whereas transwomen showed stable or slightly more symptomatology on these measures,” the authors noted. So, an increase in negative symptoms for transwomen. Or: “Quadratic effects revealed decreases from T0 to T1 followed by increases from T1 to T2 in depression .” Sometimes depression increased. It’s a mixed bag! Why report it as all good?

Authors also note: “These individuals, of whom an even higher percentage than the general population were pursuing higher education, seem different from the transgender youth in community samples with high rates of mental health disorders, suicidality and self-harming behavior, and poor access to health services.” In other words, these carefully screened young people were doing better than many who answer questions in convenience samples.

Moreover, a different study published in the same journal last year found that kids who are treated when they’re younger face significantly lower risk of self-harm, depression and attempted suicide. In other words, it is not the care, but its absence, that puts these kids at risk.

What this study actually shows is that kids who are reporting gender incongruence later tend to have more mental health problems—78% here. “Depressive and anxiety disorders were reported by 40.0% and 44.3% of youth, respectively. Approximately one-third (34.7%) of youth had engaged in self-harm, 12.3% endorsed current suicidal ideation, 47.3% had considered suicide, and 14.0% had attempted suicide. A total of 31.3% of youth were taking psychoactive medications.”

The authors are not able to attribute this to gender dysphoria. “…we can identify associations but not cause-and-effect relationships,” they note.

But they do note that the distress these adolescents felt was more than the younger kids, who’d had GD longer, felt. “…we found that older age and later pubertal stage at the time of presentation to GAMC are associated with increased rates of psychoactive medication use and increased rates of mental health problems (depression and anxiety), respectively.” Meaning: kids with late-onset GD had more mental health problems and distress.

The kids are likely at risk because they have complex mental health problems.

Transgender Childhood Is Not a ‘Trend’

In my research, I found stories of other transgender children like Val who were able to transition and go to school despite living in times when their identities weren’t commonly acknowledged.

There was no concept of gender identity; it would be impossible to know what motivated someone to live as the opposite sex, whether it was about sexuality or access to some way of life when gender roles and rules were so much stricter.

Perhaps the most literal example is Lisa Littman’s coining of the phrase “rapid onset gender dysphoria” (ROGD), for a supposed condition in which children “suddenly” become transgender because of peer influence and experience gender dysphoria without any warning — to their parents, that is.

ROGD is not a formal mental health diagnosis, and the journal that published Dr. Littman’s article issued a correction and an apology after an outpouring of criticism from doctors and advocates.

Turban’s research has also been corrected. ROGD was never intended to be a formal mental health diagnosis. Hundreds, maybe thousands of parents, have had nearly identical experiences that match the description in Littman’s paper.

“I guarantee you if this bill passes, children will die.”

This has only been offered here for 15 years. Where are the bodies from the previous 400 years? How many teen suicides are noted on the Transgender Day of Remembrance? How is it possible for such a sentence to make it into The New York Times?

Hannah Is a Girl. Doctors Finally Treat Her Like One.

Over the past few years, it has become clear that if we support these children in their transgender identities instead of trying to change them, they thrive instead of struggling with anxiety and depression.

Not clear at all. Facilitating social transition is seen by some as conversion therapy because it can lead to kids who might have been gay to being straight, trans kids—and if the goal is to treat gender dysphoria, the protocol would be quite different than affirming their trans identities. Social transition is a contested practice with unclear results.

Hannah is using a puberty-blocking implant and getting ready to embark on the path of developing a female body by starting estrogen. 

Not a female body, but a body with the simulation of female secondary sex characteristics. Female is a sex category, not an aesthetic.

Transgender youth during this time suffered high rates of depression and anxiety. By young adulthood, nearly half had attempted suicide.

What the report actually says: “The 2015 U.S. Transgender Survey (USTS), which is the largest survey of transgender people in the U.S. to date, found that 81.7 percent of respondents reported ever seriously thinking about suicide in their lifetimes, while 48.3 percent had done so in the past year. In regard to suicide attempts, 40.4 percent reported attempting suicide at some point in their lifetimes, and 7.3 percent reported attempting suicide in the past year.”

Nearly half had seriously thought about suicide. Just over 40 percent reported that they attempted suicide, but these are self-reports, unverified. The entire survey is a convenience sample, so it is not representative of the population at large. And meanwhile, that suicide rate is the same or lower than that of kids with other mental health problems.

A long-range study—that is, better quality—in Sweden found a suicide rate of .06 percent. The UK’s Gender Identity Development Service reports that “suicide is extremely rare.”

But this year researchers at the University of Washington published a study based on 63 transgender youth who were allowed to socially transition. They found that their levels of anxiety and depression were just about indistinguishable from their non-transgender peers.

What it actually says: “Transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers (p = .311), and they reported marginally higher anxiety (p = .076). Compared with national averages, transgender children showed typical rates of depression (p = .290) and marginally higher rates of anxiety (p = .096). Parents similarly reported that their transgender children experienced more anxiety than children in the control groups (p = .002) and rated their transgender children as having equivalent levels of depression (p = .728).”

That is, they had more anxiety, and the same amount of depression (not less). But, per the authors, these anxious kids were less anxious than trans kids who had not socially transitioned, who were even more anxious. Social transition is associated with increased gender dysphoria at puberty, thus may make the condition it is ostensibly reacting to worse.

Critics point to flawed studies that suggest that roughly 80 percent of prepubescent children ultimately change their minds about being transgender.

There are several studies that show very similar statistics—that the bulk of young children with gender dysphoria desist and the majority of those who do are same-sex attracted. Some people believe that social transition is itself a form of conversion therapy, since social transition tends to increase persistence (see above), when the former method of watchful waiting tended to result in desistance. If we’re going to argue that studies are flawed because of those who conducted them, then that would go for the author’s own research, which has been labeled as “very low quality certainty” by an apolitical, scientific evidence review.

Once transgender youth hit puberty, their gender identity is unlikely to change. 

Actually: “…virtually nothing is known regarding adolescent-onset GD, its progression and factors that influence the completion of the developmental tasks of adolescence among young people with GD and/or transgender identity. Consolidation of identity development is a central developmental goal of adolescence, but we still do not know enough about how gender identity and gender variance actually evolve. Treatment-seeking adolescents with GD present with considerable psychiatric comorbidity. There is little research on how GD and/or transgender identity are associated with completion of developmental tasks of adolescence.”

In a Dutch study of 55 transgender people who were given puberty blockers during adolescence, however, none changed their minds and none regretted treatment. All went onto cross-sex hormones around age 16 and later gender-affirming surgery. Psychological functioning improved steadily over the treatment period, and by the end, metrics of happiness and quality of life were on a par with those of the general population. Larger studies are underway in the United States, and early clinical experience agrees with the Dutch results.

Some believe that the fact that 100% of kids on puberty blockers went on to cross-sex hormones shows that medical interventions beget medical interventions, and that social transition leads to persistence whereas watchful waiting did not. The Dutch study was of carefully evaluated young people without other psychological problems.

Coming Out as Trans Isn’t a Teenage Fad

What they are getting instead is a bogus new diagnosis — Rapid Onset Gender Dysphoria. The inventors of this spurious term claim that R.O.G.D. is not a real trans identity but the product of social pressure.

R.O.G.D. is not a clinical term. It’s a political one, designed to undermine the validity of these young people’s transitions.

It was a neutral clinical descriptor of a certain kind of almost-never-before-seen patient.

The term originated a few years ago on three blogs with a history of promoting anti-trans propaganda. There has been only one study on it, in the journal PLOS One. But the study isn’t about the children in question; it’s about their parents, who were recruited for the study by ads placed in the conservative blogs that had invented the concept of R.O.G.D. in the first place.

There has been only one study because it’s become so heavily politicized by the left that it can’t be studied. Parental reports are a very common way of gathering data about children. The participants were recruited from websites where such parents could be found—a convenience sample, just like all the research from the U.S. Transgender Survey, which similarly recruited from specific websites where the kinds of people who would say what some researchers might want them to say could be found. It tells you about the population surveyed, but not necessarily about the entire populations.

An abundance of scientific research makes clear that gender variance is a fundamental truth of human biology, not some wacky dance craze.

Yes, gender variance is normal and natural—that is, being of one sex and performing the role and stereotypes associated with another is perfectly acceptable. Gender variant kids need to be loved and supported and told that their bodies are perfect and beautiful and their differences are their strengths.