ScienceVs: Trans Kids Health Care: Are We Getting It Wrong? (II)

Some additional reasons why I think the ScienceVs podcast on this topic was shamefully biased and misguided.

My previous posting on this topic (a couple of days ago) focused on the podcast’s discussion of a recent study of detransitioning by trans children and young adults. Before commenting on other claims made in the podcast, I wanted to mention that in my previous posting, I noted that the podcast used the term “retransitioning” rather than the more commonly used term “detransitioning” to describe individuals who consider themselves trans at one point in time but then, at some later time in their lives, no longer identify as trans. I noted in that posting that I had no idea why the more commonly used term for the phenomenon was not the one used in the podcast.

Now, however – after giving the matter a little more thought – I’m pretty sure I understand why the podcast used the term “retransition”. A subtle implication of the use of the word “detransition” is that being “cis” is the normal or “default” state of functioning for human beings (which, of course, it is); accordingly, when an individual adopts a trans identity and then gives it up, that person is simply reversing the transition they had engaged in when deciding they were trans. Within trans ideology world, however, thinking like that is blasphemy. Fundamental to trans ideology is the contention that there is no default form of gender identity for any individual. Accordingly, there is no conceptual difference between transitioning from cis to trans vs changing from trans to cis. From this perspective, one needs to use the term “retransition” to convey the idea that transitioning from trans to cis is not “undoing” something; rather, it is just another transition in gender identity.

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OK – back to commenting (well – for the most part, criticizing) other aspects of the podcast.

1. As was the case when ScienceVs first discussed this topic in a podcast back in 2022, all of the so-called “experts” that ScienceVs interviewed on the more recent episode are strong and outspoken supporters of gender affirming care (GAC). No one was interviewed who questions whether this is the best form of treatment for gender dysphoric children. There are, of course, lots of people the show could have included who would have been able and willing to discuss weaknesses in the pro-GAC evidence, the evidence for GAC harms, and the reasons why more and more countries are banning the use of puberty blockers, cross-sex hormones, and sex-change surgeries for children. They could have discussed the topic with Jesse Singal. They could have invited James Esses. But they didn’t – for the apparent reason that they wanted to present only one side of a highly controversial and contentious issue.

2. At no point during the episode was there even the slightest questioning of any element of trans ideology. Instead, the entire episode operated with all elements of trans ideology as a given.

For example, the episode included no discussion of the concept of gender identity. What exactly does it mean for someone to have a “gender identity”? (Full disclosure – I no longer believe there is such as thing, separate from our preferred interests, behavior patterns, and preferred social roles). According to trans ideology, our gender identity is not made up of those aspects of our functioning. It to some degree produces those aspects of our functioning, but gender identity itself is some kind of transcendent characteristic. And yes, I know – if I were to ask Wendy Zuckerman or Stephen Russell what gender identity IS, they would be very likely to say that it refers to the degree to which someone “feels” like a male or female (or neither?). But what exactly does that mean — other than having a set of behavioral and social role preferences? And if, as Russell’s study (discussed in my previous posting on the topic) found, gender identity can be very fluid, what is it that is changing? I would think that trying to break the circular reasoning involved in discussions of the nature of gender identity would be an important and very helpful part of a discussion of treatments for children with gender dysphoria. But obviously, ScienceVs would not agree.

A second, and perhaps more significant, element of trans ideology that is infused throughout the discussions in this podcast is the idea that being cis is no more natural or normal or preferable as a state of functioning than is being trans. It is clear that Wendy Zuckerman and the rest of the ScienceVs team have unquestioningly incorporated this assumption into their views of the nature of sex. Indeed, it is their acceptance of this assumption, combined with their complete denial that GAC might have ANY harmful effects of any kind, that underlies the show’s gushingly triumphant tone when discussing the evidence (discussed in my previous posting about the show) that it seems possible to dramatically reduce rates of detransitioning by trans teens through the expedient of giving them puberty blockers followed by cross-sex hormones.

My guess is that most people would consider that the dictum “first do no harm” would direct those treating gender dysphoric children to avoid prescribing cross-sex hormones and to avoid removing healthy body parts (that is – to avoid lopping off healthy breasts of girls or castrating boys) unless the evidence is overwhelmingly clear that these “treatments” are necessary to prevent even more serious harm. However, that is not how trans ideologues interpret “doing no harm”; for them, turning children into lifelong medical patients and removing healthy body parts (breasts or testicles – resulting in sterilization and an inability to experience normal sexual functioning) does not involve any to-be-avoided harm. Accordingly, for those, like Wendy Zuckerman and the rest of the ScienceVs team, the evidence that such treatments can prevent detransitioning is prima facie evidence that any child who desires to be medically transitioned SHOULD BE medically transitioned. It is, frankly, a rather monstrous claim.

3. The episode spends a lot of time discussing another study by Stephen Russell that found evidence of beneficial effects of GAC. I’ll copy from that discussion (in italics below), and then offer my own comments about the study. [MH is Meryl Horn, a ScienceVs producer, WZ is Wendy Zuckerman, the ScienceVs episode host, and SR is Stephen Russell, who conducted the research study being discussed].

MH Exactly, so that’s the question, right? Would it be better to kind of discourage this? Or should we just support kids anyway? And Stephen actually did this study that really helps answer this. Um, it focuses on this one specific part of social transitioning - which is changing your name … so this is like if your parents named you Michael… but you’re realizing that like no, actually, I’m a girl, you probably want to change your name, right, to something that fits you better.

WZ Right right

MH And this can be a big step, and Stephen wanted to look at what might happen after someone decides to do this. So he did this study a few years ago …

SR And so this was before we were talking about pronouns even. And so I just thought, well, we should just ask about whether kids can use the name they want.

WZ Oh, so how did he study this?

MH All right, so he surveyed almost 130 trans and gender nonconforming teens and younger adults, and he asked them – do you have a preferred name that’s different from the name you were given at birth? And if they said yes, then the survey asked them – and this is the important part – how many people in your life actually use that name?

SR It was like, well, are you able to use it at home, at school, at work, and with your friends?

MH And he also asked them about their mental health. And he wanted to know, like, if there are people in the person’s life that are using that name — is their mental health better??… And he wasn't really expecting that he'd see much in the data — but then his colleague knocked on his door —

SR She came in with the results and was like, Stephen, you're not going to believe this. Oh my gosh, oh my gosh, it, it worked. It's like, it's real.

MH: The people who said yes, I get called my chosen name in at least just one place, that lowered their risk of suicidal behavior by 56%.

WZ Oh my gosh, 56%?

MH I talked to Stephen about that.

MH Oooof.

SR Yeah. It's dramatic.

MH So it could mean the difference between life and death for someone?

SR Well, yes, absolutely. Absolutely.

MH The more people in their lives used the person’s chosen name, the more their risk for suicidal behavior dropped.

WZ: That's so- that's such a dramatic finding. Like I don’t know, it's a bit surprising?

MH I don’t think it is actually, like, Stephen was like, oh, no, this makes sense.

SR I feel like it's that amazing possibility to be seen or heard. Like, and maybe for the first time. You know, it's so deep when you think about it. That you can imagine that if, if you're a queer trans kid that feels like Susan is not who you are, but Stephen is, and you, you get to, there's at least one place where people will call you Stephen. Um, it's gotta be amazing. When kids can use their name, it transforms them.

I read the published paper. A few comments:

– These results certainly seem quite dramatic. A 56% decline in risk for suicidal behavior sounds like a life saver. I will also note that the results mentioned here refer to effects AFTER taking a measure of social supports into account – which makes the results even more impressive, because one would think that having others use an individual’s preferred name would be a component of “social support”. Nonetheless, Russell found what seem to be very large effects of name use even after statistically partialing out individual differences in perceived social support.

– This was, of course, a correlational study, and while correlational evidence can be thought of as being consistent with, and even supportive of, causal conclusions, one must always be careful about having too much confidence in causal conclusions based on correlational evidence alone. Almost all research in this area IS correlational in nature, for the obvious reason that it would be both impractical and unethical to run a randomized control trial of these kinds of effects. Nonetheless, when drawing conclusions about the advisability of GAC, it would seem appropriate to maintain an attitude of caution regarding how certain we can be based on correlational data alone.

– Without going into too much detail – the way in which the authors presented their data makes it difficult to extract information about baseline levels of their different variables. In particular, it is not clear what a “56% decline” really means in absolute terms. It might be that it’s a 56% reduction from a very high to a moderate level of “risk for suicidal behavior”, or it might involve a reduction from very low to very very low levels. I don’t doubt that Russell would send those data to anyone who asked for them (he’s a widely published and accomplished and well-respected researcher), but I was a bit surprised at the way he presented his findings, given how careful and cautious he was in the way he analyzed his data.

– Relevant to the findings from this study regarding risk for suicidal behaviors is that parents of gender dysphoric children have commonly reported that they have been told that GAC is necessary to prevent their child from committing suicide (“would you rather have a live son or a dead daughter”). However, the evidence that GAC reduces rates of actual suicides is not strong (the topic is discussed at length here, here, and here). Accordingly, it is hard to say how large the real world importance of the findings reported here might be.

– Even if one takes the findings reported here at face value, and even if one interprets the findings regarding reductions in risks for suicidal behavior to reflect a dramatic reduction in the likelihood of actual suicide attempts and successes – wouldn’t the most direct conclusion to be drawn from the study be that, rather than giving gender dysphoric children puberty blocker and cross sex hormones -- and rather than lopping off their healthy body parts – and even rather than encouraging them to fully socially transition – one should start by simply letting the children select an alternative name and then encourage those they interact with to use that name?

Wendy Zuckerman argues that the findings from this study are so strong and dramatic that the findings argue for treating gender dysphoric children with the full GAC regimen. But if the effects are really that strong, don’t they argue for treating gender dysphoric children in a very limited, and non-irreversibly-life-altering, way — by starting with nothing more than a name change (perhaps along with therapy to help them feel more comfortable in the male or female body that they have)? Apparently, it never occurred to the ScienceVs team that these findings most directly suggest that a minimal degree of social transitioning might be what matters most in terms of reducing suicide risks — rather than going full-on-GAC. I suspect that oversight by the ScienceVs team is because they seem (once again) to have approached the whole topic already convinced that the whole GAC regimen is necessary — and any evidence is to be interpreted as supportive of that view.