The Difference Between Trans People and Trans Activism
Why some trans people, and parents of trans kids, are speaking up about it (and the usual conflating of the two by The New York Times).
Hello, readers. Continuing my ongoing commitment to nuance/pissing everybody off equally, this week I’ll be focusing on the difference between trans activism and trans people—a difference many people seem unable to discern.
How, I want to know, can we support trans people, while moving away from gender identity ideology—the ideas that biological sex is not real, or easily mutable, while gender identity is immutable? (Or is it fluid? Hm.) Many find these tenets not only unscientific, but damaging to trans people and non-trans people alike.
I have a great guest op-ed going up tomorrow, which will explain more about that. Later in the week, I’ll post an interview with the mom of a trans son who has focused on this distinction, and the harms that these ideas, and the activism around them, are doing to trans folks.
Substacker Christina Buttons posted the nifty graphic above last week, which I think can help us understand the difference between trans people and trans activism. Many of the trans people I’ve been speaking with don’t believe in the ideology of gender identity, don’t agree with what’s being taught in schools, and are deeply concerned about what’s happening with the medicalization of gender dysphoric youth. The mainstream media rarely platforms them, or makes the distinction between trans people and trans activist narratives, giving the false impression that all trans people think and believe the same things. When GLAAD demanded that The New York Times make sure trans voices are heard, I thought that was perfectly reasonable—as long as they inject some ideological variety into those being listened to.
A perfect example of platforming activist trans people promoting misinformation: This weekend’s NYT op-ed by Dr. Marci Bowers, a trans woman and surgeon who performs vaginoplasty, among other procedures—which seems to have an extremely high complication rate. Bowers combed over some data to suggest that detransition is rare and that the science shows that these medical interventions are safe and effective. Technically, she’s not lying. There are studies suggesting those outcomes, and even a literature review which combs over the conclusions of those studies—but doesn’t examine the quality of them, as is done in a systematic evidence review.
This is the same research that Finland, Sweden, and the UK pored over in actual systematic evidence reviews and found to be of such low quality that they couldn’t rely on it. Rather, they needed to start better quality studies with long-term follow-up. They saw a higher rate of detransition than expected, which alarmed them, and a cohort of young people seeking interventions, who had never been studied, and to whom existing low-quality research didn’t apply. Rather than deny that detransition is an important issue, as Bowers does, these other countries’ governments (which control their healthcare) created strict new guidelines. They chose science over politics.
Bowers, a trans woman herself, is doing the opposite, and thus making it harder for the medical community to acknowledge and listen to those who’ve gotten hurt. Many trans folk are concerned that their hard-won acceptance has already evaporated as these radical voices have taken over the conversation, inciting the backlash we see in censorship laws and medical bans. What many on the Left don’t realize is that these legislative responses rein in radical ideas and practices when schools and medical organizations won’t do so themselves. They’re filling the vacuum left by the politicians and clinicians who’ve chosen politics over science. Activist trans doctors create this void; Republican politicians, perhaps seeing an opportunity for political gain—but also perhaps also actually listening to those who’ve been hurt—fill it in. (Nobody has taken me up on the suggestion to form a bipartisan committee on youth gender medicine, to require clinics and clinicians to do long-term follow-up, to get the data, and then create guidelines based on reality.)
It’s not crazy, or even conservative, to suggest that people should only get “sex changes” in adulthood, or that we shouldn’t teach the theory of gender identity to preschoolers. Nor do I personally think any child needs to be read to by a drag queen (though I don’t care if someone wants that for their kid). But rather than reconsider our approach to these issues, we liberals and lefties have dug in our heels on them. We’ve drowned out or ignored measured trans voices, or forced them underground, because they don’t want to face activists’ wrath.
We’ll do a Wednesday thread about the topic, for paid subscribers. And please leave any comments you have about the general topic below.
—Lisa
Dr. Bowers opposes state legislation that will limit medicalized gender care to counseling in the case of minors. Why? Because, she claims, research overwhelmingly demonstrates the positive effects of transitioning upon those suffering from gender dysphoria (Indeed, she claims studies show a "consensus" on this.) And therefore, Dr. Bowers argues, "hormones and surgery" should be available to gender distressed minors to "make [a future, prospective] transition easier."
This argument fails on several counts.
First, Bowers' evidence of positive medical transition outcomes is weak. The literature review she cites itself states that the lack of control groups - gender dysphoric people treated only by therapy vs. by drugs or surgery too - limits its findings. Further, as Emily Bazelon noted in the New York Times, the literature review cited by Bowers looked at a different transgender demographic - transgender people with early, longstanding gender dysphoria, not the huge influx of individuals presenting with comorbid psychological conditions and short dysphoric histories, today.
The second problem with Dr. Bowers' NYT piece is that she ignores the short- and long-term health risks and effects of medicalized transitions - risks that, due to low quality research, are still not well understood. The known short-term risks alone make the medicalized transition of minors irresponsible - and avoiding consideration of those risks, as Dr. Bowers does, is unconscionable.
Third, Dr. Bowers' claim of medical "consensus" is false. As Bazelon noted, in the US, disputation has broken out among doctors - dispute we can now see among parents and politicians too. Meanwhile, outside the US, European countries that compassionately pioneered gender medicine have taken stock of the low quality studies and spiking gender dysphoric population - and, consequently, have sharply limited the medicalized treatment of youth gender dysphoria.
The emergent lack of consensus among Democrats in particular is demonstrated by the NYT Bazelon piece. Nine out of ten NYT readers identify as Democrats. As the huge outpouring of positive comments on Bazelon's piece demonstrated, liberals across the Democratic Party political spectrum are challenging prevalent gender medicine protocols - from the right liberals who voted for Hillary Clinton, to the left liberals who support the economic- and class-oriented politics of Bernie Sanders.
Thank you!!
And yes, if you read what some of the MD's are doing and realize what the medical socieities aren't doing, then you realize legislative responses are needed.
There's a great thread on the (inadequate) regret studies quoted by Bowers, who doesn't seem to know how bad the evidence is. https://twitter.com/somenuancepls/status/1642654109382656002
also a response in the journal in the research literature (https://journals.lww.com/prsgo/fulltext/2021/11000/letter_to_the_editor__regret_after.29.aspx) and at Genspect (https://genspect.org/at-what-point-does-incompetence-become-fraud/ ).
Bowers also seems to have forgotten to mention that most with childhood onset outgrow gender dysphoria unless socially or medically transitioned and that you don't know who won't, and that for adolescents it is unknown.
That NYT article was so full of inaccuracies. unbelievable. Thank you for speaking up!