Science & Tech

Baseless, Activist Scholarship on Gender Dysphoria

People protest Trump administration’s reported proposal to narrow the definition of gender to male or female at birth outside City Hall in New York City, October 24, 2018. (Brendan McDermid/Reuters)
A New York Times article is full of inaccuracies regarding ‘transgender children.’

When discussing transgenderism, moral and scientific certitude are too often conflated. This is presumably why activist agendas, strong on assertions and flimsy on evidence, are being promoted by people who really ought to know better. Yes, of course, the rights and feelings of those who experience gender dysphoria, and those who are transgender, should not be trampled on. Yes, obviously, compassion is key. But this includes the right to receive accurate medical information — the right to informed consent.

Take, for instance, the recent New York Times article by Perri Klass, M.D., in which she “misstated” that youth with gender dysphoria have “triple the rate of suicide.” The Times has since corrected that. And in journalism, which is Klass’s profession in addition to pediatrics, honest mistakes are sometimes made. Nevertheless, her article stands as a textbook example of the tendency in the mainstream media to report on gender dysphoria with pithy slogans, half-truths, and non sequiturs, all presumably justified by the broader cause of making life easier for trans people (and why would you oppose that?). Klass writes:

“Gender identity is a brain thing, it’s your sense of whether you’re male or female in your head; it is independent of your body parts, it is independent of who are you attracted to,” said Dr. John Steever, an adolescent medicine specialist and assistant professor of pediatrics at the Icahn School of Medicine at Mount Sinai.

But what does Steever mean by it’s a “brain thing”? Mike Laidlaw, M.D, an endocrinologist in California, tells National Review:

Obviously the brain is a body part. So is it a “brain thing,” or is it independent of the body? This of course is deliberately left ambiguous. There have been desperate attempts to try to show that genetics or magnetic resonance imaging can somehow prove that a “girl brain” is inside a “boy’s body.” However, none of these studies show such a thing. The issues comes down to a mental state of being. In other words, the feeling that a boy with a boy’s body is, “deep inside,” a girl is simply that — a feeling.

Meanwhile, Kenneth Zucker, a world-leading psychologist who has studied gender dysphoria for 40 years and whose work is among the most cited in the field, tells National Review:

“Gender identity is a brain thing” — that’s a beautiful example of liberal biological essentialism. I have no quarrel with the idea that there are biological factors that predispose people to having gender dysphoria, and I’ve done biological research myself, but it does not explain 100 percent of the variance because if it did, then you would find that if you had a set of young people that meet the diagnostic requirement for gender dysphoria, they all should persist when they grow. If it’s a complete brain thing. So this is an example of binary, either-or, simplistic thinking.

Notwithstanding, Klass in the New York Times continued:

The new A.A.P statement [i.e., the American Academy of Pediatrics’ official endorsement of the transition-affirming approach] tries to dispel a variety of myths about growing up with gender identity questions, Dr. Breuner said, such as the idea that parents should assume this is only a passing phase. “And still, colleagues look at me askance, say, ‘Isn’t this something they grow out of, I was taught that in medical school,’” Dr. Breuner said. “So was I. It’s incorrect.”

Strikingly, “it’s incorrect” and a “variety of myths” are unusually confident statements for the field of science. But Zucker, who is also editor in chief of the prestigious journal Archives of Sexual Behavior, has read and written thousands of research papers in the field and is amazed at how baseless the AAP statement is.

He explains that it is “shockingly bad scholarship” and “so skewed, and omitting of counter-evidence, that I think it’s very misleading.” (More on that here, here, here, here, and here; or check out Jason Cantor’s fact-checking article over at Sexology Today! where he suggests that the “references that AAP cited as the basis of their policy instead outright contradicted that policy, repeatedly endorsing watchful waiting.”)

Again, stigma is harmful; common sense decrees that it can cause undue stress. But to what extent is that causing mental-health problems among trans-identifying children? According to Klass, Breuner explained that “mental health problems in these children arise [note: not “can arise”] from stigma and negative experiences and can be prevented by a supportive family and environment — including health care.” But this, in conjunction with inflated and misapplied suicide statistics, is misleading for parents.

Zucker explains that though children with gender dysphoria have a higher rate of mental-health problems than do children without gender dysphoria, there are multiple reasons for this; and, besides, their suicidality is not necessarily higher than that of children with other stress factors.

Perhaps most striking section in Klass’s article is her coverage of hormone treatment. “The pause button” — a.k.a. puberty-blocking drugs — is a healthy course of action for youth with gender dysphoria, suggest the doctors cited by Klass. Yet the risks of this treatment are skimmed over. Which is odd because, of course, all drugs have risks. Moreover, the full range of side effects, from fertility to cancer, remains largely untested and hence unknown. Probably worth mentioning that. And is it not curious that the AAP, which urges caution on tattoos for youngsters, is full steam ahead on such an experimental treatment?

Susan Bradley, a child psychiatrist with 40 years’ clinical experience, co-founded the gender identity clinic at the Centre for Addiction and Mental Health in Toronto. She tells National Review that the AAP’s approach is based on activism rather than evidence and that “now the activists would have us believe that they know better than parents who have raised their child and who may know that child the best.” Several pediatricians and AAP members who prefer to remain anonymous contacted National Review with similar concerns — as have over a thousand parents. Yet the doctors quoted by Klass have the following advice for parents:

If parents are looking for health care for a child who is gender-diverse, Dr. Breuner said, look for a clinic that pays attention to the details of affirming the child’s identity: The providers ask what pronouns the child uses, the bathrooms are all-gender, and when you check in, they ask what the child wants to be called.

Nice though these touches are, they can hardly be said to be the most important criteria when selecting treatment. Should parents of children with gender dysphoria also look for clinics with soothing whale sounds and fresh aloe vera? Or might they be better advised to prioritize treatment that is compassionate, child-specific, and evidence-based?

Editor’s note: We’ve updated this piece to clarify that Susan Bradley is a co-founder of the gender-identity clinic at the Centre for Addiction and Mental Health in Toronto.


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