ScienceVs revisits the issue of gender affirming care for children with gender dysphoria.

This “re-appraisal” of the evidence is as biased and irresponsible as their earlier episode.

A few years ago, the podcast ScienceVs recorded an episode focusing, in part, on the treatment of children with gender dysphoria. I’ve listened to a lot of ScienceVs podcasts (my wife and I listen to them during many of our frequent drives to visit grandkids), and that one was – at the time – far and away the worst, most biased, most poorly reasoned, and most shoddily researched of any I had heard.

In that episode, ScienceVs concluded that the cleverly named form of treatment commonly referred to as Gender Affirming Care (GAC) has been shown to be beneficial to children with gender dysphoria, and that there are no serious questions or controversies regarding its use. [Briefly – GAC involves socially transitioning children with gender dysphoria, giving them puberty blockers at about age 11, then treating them with cross-sex hormones and eventually surgery]. I wrote to ScienceVs at the time to inform them of the myriad ways in which the episode failed to reflect what was then the current state of knowledge regarding GAC effect. I’ll post a copy of my email correspondence with them in a second posting on this topic in a couple of days.

A few months ago, ScienceVs revisited this issue (in an episode titled “Trans Kids Health Care: Are We Getting It Wrong?”), prompted by the release in Great Britain of The Cass Review, a systematic review of research on the effects of GAC. Contrary to the conclusions reached by ScienceVs at the time of their first episode on the topic, the Cass Review concluded that GAC should only be used as an experimental form of treatment because, at the present time (the review concluded), there is not good evidence for its efficacy.

I would love to be able to say at this point how impressed I am with ScienceVs for being willing to take a new look – in an unbiased manner – at the evidence regarding the harms and benefits of GAC. I’d love to be able to say that – but I can’t. Their new episode is, if anything, actually worse than the earlier one with respect to the level of bias in their assessment of the state of our knowledge about GAC. My criticisms of the new episode range from minor through “no reasonable human being could conclude THAT unless they were unethically desperate to maintain a belief that children with gender dysphoria should receive GAC”. I really have only one criticism that fits within the latter category, but of course, that by itself is easily enough to discredit the whole episode, so I thought I would focus this posting entirely on that segment of the podcast -- and then discuss my other criticisms of the episode in my second posting in a few days.

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The episode’s “through the looking glass” discussion of detransitioning

The episode concludes with a discussion of the phenomenon of “detransitioners” – individuals who consider themselves trans at one point in time but then later decide that they are not trans (and at that time re-adopt the gender identity that matches the biology of the body they were born into). If you access the transcript of the episode, this discussion is listed as Chapter 5: How often are people "retransitioning"? (I don’t know why they use the term “retransitioning” instead of the more commonly used term “detransitioning” – but whatever). I’ve copied sections of this chapter of the transcript below in italics: WZ is Wendy Zuckerman, the lead host of ScieneVs podcasts, MH is Meryl Horn, a senior ScienceVs producer, and Stephen Russell (SR) is a professor in the Department of Human Development and Family Sciences at U. Texas at Austin, and the discussion below focuses on a longitudinal study he conducted of stability and change in gender identity in a group of teens who, at the beginning of the study, identified as trans.

MH Stephen Russell! So he just did this study where they followed hundreds of people, they were 15 to 21 years old, for over 3 years, and they asked them again and again and again - how do you identify? To see whether their gender identities shifted over time. And what he found was that it was actually super common to see all sorts of things, people going from cis to trans to cis, just all sorts of different things.

SR I was like, oh my gosh, that's amazing. And who knew? Like every, I'm constantly amazed by the data that tells me how old I am or how —

MH — out of touch?

SR Out of touch. That like, there's that much change happening in gender.

MH: And, and so were you surprised when you saw that there were a big chunk of kids who identified as trans at one point, but then ultimately identified as cis by the end of the study?

SR: Yeah, I was. I wasn't expecting as much change.

MH So if you took everyone who identified as trans at the start of the study and then looked at what happened, half of them still identified as trans by the end of it — but half of them identified as cis.

WZ Oh interesting. So then I guess what does this mean for this big fear that kids are going to be on medicines that they don't need to be on… is that happening?

MH Right. Yeah. So that's the question, right? But Stephen looked at that. He asked everyone whether they were on hormones or puberty blockers.

WZ Great

MH He saw that while most of the people who identified as trans the whole time were taking hormones, it was actually really rare for the people who started identifying as trans and then later switched to identifying as cis, it was really rare for them to be taking hormones.

WZ Ohhh

MH It was actually only one person out of 32.

WZ: Oh, interesting.

MH And none of them were on puberty blockers. And the results from Stephen’s study were actually, like, remarkably similar to another study looking at this, which came out earlier this year. So that one was from a pediatric gender clinic in Western Australia. So in that study, there were 29 people who switched from identifying, from trans to cis, and only two of them were on any kind of medication.

It’s worth reviewing the findings from the Stephen Russell study before discussing its implications for the treatment of teens with gender dysphoria:

The study focused on 15- to 21-year-olds who considered themselves “trans”. Over the course of the next three years, exactly half had changed their gender identity from trans to cis, that is, they had “detransitioned”. In almost every case, those who detransitioned over the course of three years had NOT been given puberty blockers and had NOT been placed on a regimen of cross-sex hormones. On the other hand, those who remained trans HAD been placed on a regimen of cross-sex hormones.

As context for the discussion of these findings, it is also important to keep in mind that (contrary to claims made by ScienceVs as part of the earlier trans kids episode AND earlier in this episode) there is good evidence that giving children puberty blockers can have long term harmful effects. Perhaps more importantly, the individuals in Russell’s study who continued to identify as trans who had been placed on a regimen of cross-sex hormones were (like all trans individuals who begin a regimen of cross-sex hormones) on track to irreversibly become adults who: (1) would be completely infertile, either as males or females, (2) would be unlikely to be able to experience a normal sexual orgasm, and (3) would have to continue to take hormones for the rest of their lives – that is – they will have become lifelong medical patients. In addition, they are likely to submit themselves for complicated major surgeries (castrations, mastectomies, surgeries to create an artificial – and not fully functional– simulcrum of a vagina or penis) that carry with them significant risks. Of course, none of the individuals in the study who detransitioned (having never taken hormones) will experience any of those serious biological/medical issues.

Given this context, the most reasonable (I would argue, the ONLY reasonable) conclusion to be drawn from the findings from this study is that gender dysphoric teens should NOT be placed on puberty blockers or cross-sex hormones. The (I think obvious) reason for this conclusion is that, in this study, those gender dysphoric teens who were not given these powerful drugs ended up eventually accepting who they were biologically – able to live a normal adult life without having become a lifelong medical patient and without having biologically healthy parts of their bodies mutilated by major surgeries.

So of course, that’s what ScienceVs concluded, right! Just kidding. The transcript continues with Wendy Zuckerman’s comments about the findings:

WZ: MMMmmmm. I mean, it is fascinating because it shows that when people say things like, oh, you know, they're just kids, it’s just a phase… I mean for some kids there is some truth in that, I mean saying it’s just a phase might feel derogatory, but they're just exploring who they are. But then what the data is telling us is to take that argument further and to say, and therefore say we should not allow any trans kids to be on medication, that is wrong. Right? Like according to these two studies, at least, that we have, the trans kids that are going on medications, far and away — they are not in that exploratory phase, like, they are sticking with that identity.

MH Yeah, exactly. And if we do look at that group of people who are changing things … identifying as trans and then cis - the vast majority of them are not on these meds … over 90%.

WZ: Right right. And while that study was on teens, there's actually data from younger kids... that seems to show if you socially transitioned when you're like around 8 years old ... you are much less likely to be switching up your identity. So yeah the data does not seem to be backing up this idea that there’s all these people who are taking these meds and then later not identifying as trans anymore.

This is a just plain bizarre take on the findings from the study. Instead of focusing on the fact that HALF of those who identified as trans at the start of the study had detransitioned by end of the study, and instead of acknowledging the very serious harmful effects of an individual being placed on cross-sex hormones, and instead of noting that the study also included a mental health assessment and found that the two groups of trans individuals did not differ on that measure (in other words, there was no hint in this study that being placed on hormones reduced rates of depression), Zuckerman focused on the fact that those who were placed on hormones did NOT detransition – and therefore – she says – it’s not fair to say that a lot of gender dysphoric teens who are placed on hormones will detransition!

OK – true enough – but let’s be clear. THAT IS NOT THE ISSUE – and surely Zuckerman (and the rest of the ScienceVs production team) knows that. The important question here is whether it is in the best LONG TERM interests of gender dysphoric teens to put them on a regimen of puberty blockers followed by cross-sex hormones, and this study gives a clear answer to that question – and the answer is NO.

Only someone already deeply committed to concluding that GAC is advisable could reach any other conclusion. What Zuckerman is literally saying (in a rather celebratory “game, set, and match” tone – just listen to the podcast if you doubt that) is that those who oppose the standard GAC model ARE WRONG, because THIS study shows that most of those put on puberty blockers and hormones will not detransition (or, at least, not within 3 years of the beginnings of treatment). BUT — the study also shows that those who are NOT receiving GAC probably WILL detransition — and therefore will not become infertile lifelong medical patients who can’t orgasm. Isn’t that a preferable outcome (a rhetorical question obviously)? First do harm, eh.