More on Abigail Shrier, Harriet Hall, Science-Based Medicine, Jesse Singal, and transitioning

July 3, 2021 • 11:00 am

Yesterday I reported on the site Science-Based Medicine’s defense of their “deplatforming” a book review written by one of their own editors, Dr. Harriet Hall. Hall had written a favorable review of Abigail Shrier’s book Irreversible Damage, itself about the dangers of transsexual adolescents undertaking medical treatment prematurely or without proper guidance. Hall approved the book, but the editors, including Steven Novella and David Gorski (N&G), summarily removed her review (it was reposted by Michael Shermer and Skeptic magagzine). N&G asserted said it was not removed because the review was ideologically impure or that there was a social-media pushback, but simply because Hall’s review was full of inaccurate statements and bad science.

I put up N&G’s response, and since I hadn’t yet read Shrier’s book (I am beginning it now), I simply reported that two well known skeptical scientists and doctors had objected to Hall’s review and to Shrier’s contentions. I still think that N&G should NOT have removed Hall’s review, but left it up with their own response. That, after all, is what free speech is about. But I’m not yet (and may never be) acquainted sufficiently with the data to pass judgement on these dueling views. But I will note further exchanges in this disparity of opinions.

One of these, pointed out by a reader, was a series of tweets by Jesse Singal, who writes for The Atlantic as well as New York Magazine and other outlets, and has some expertise in scientific and sociological studies of transgender transitioning (see here and here). He’s also written an article below in the July Spectator about how the media distorts what little good data exists about the psychological outcomes of transitioning. (The data appear to be far scantier than one would think from the vociferous claims of transgender advocates.)

First, though, Singal fired a fusillade of 16 tweets in response to N&G’s attack on Hall and Shrier, and I’ll reproduce these here. As always, judge for yourself, and dig further if you’re unclear or intrigued. I’ll reproduce them all as they’re a quick read, and they should be perused along with Singal’s Spectator piece at the bottom.

The Spectator piece mentioned in the next tweet is linked to and discussed at the bottom of this post.

Gorski’s tweet at Rowling above is clearly out of line here, and in fact is gratuitously nasty.

One gets the impression from these tweets, many of which are summarized in detail in Singal’s article below (click on screenshot), that N&G were firing from the hip, making unsubstantiated claims about the literature that verge on distortion. The problem with all of this is that everyone is so polarized on the issue, whether rightly so because of the data or because of ideological bias, that it’s hard to know whom to trust. However, Singal’s article below does show that he’s read many of the original studies questioning the supposed “safety” of puberty blockers and the claimed suicide-reducing effect of transitioning. Both claims are “problematic,” i.e., we really don’t have good data. Read and judge for yourself. I’ll give a few quotes from Singal:

Singal’s piece makes several points. First, although some U.S. gender clinics adhere to what we’d see as proper care for gender-dysphoric children and adolescents, many do not, and few seem to come close to the standards used in European countries.

Second, many of the studies cited by the media to show that transition is safe—beginning with the administration of puberty-blocking hormones, are flawed, and, in fact, we have no good information about the safety of these blocking hormones. Further, studies cited to show that transitioning reduces the risk of suicidality in transgender children are flawed to the point that we have no idea whether this is true. The patterns we see could have other explanations, like clinics not taking on children with serious mental problems.

Third, the mainstream media, which by and large adheres to the ideology of unreserved advocates for transitioning, generally refuses to report any of the incomplete data, false assertions, or problematic claims. That, says Singal, is because the media has an ideological bias on this issue, something I don’t doubt.

I’ll give a few quotes from Singal’s article, and. though it’s long (if your attention span is short), it’s well worth a read.

First, on the disparity of European versus American treatments:

In 2007, the Dutch Protocol, as it is known, was brought to the States, initially to Boston Children’s Hospital. These days, blockers and hormones are available in many more American youth clinics, though access varies considerably by geography.

There are some crucial distinctions between the Dutch approach and how some US youth-gender clinicians currently practice. For example, because, as the Dutch clinicians Annelou de Vries and Peggy Cohen-Kettenis wrote in a 2012 article describing their protocol, ‘most gender dysphoric children will not remain gender dysphoric through adolescence’ (a finding that has emerged at multiple clinics), the Dutch clinic has historically discouraged childhood social transition, while also discouraging parents from shaming children for gender-nonconforming behavior. Clinicians there promote the practice of ‘watchful waiting’ until the onset of puberty, at which point, if the GD persists, it is taken as a useful indicator that blockers might be the right choice.

Further reflecting the clinic’s cautious approach, youth with significant mental health problems or a lack of family support (or both) have not been eligible for physical transition. So when we look at the Dutch-protocol data, we’re looking at a subset of kids and teens who were carefully assessed, over a long period of time, to ensure they had clinically significant gender dysphoria and that other mental health problems could be ruled out as the primary drivers of their distress. They all had good family support when they began transitioning.

. . . The lack of outcome data for gender-dysphoric youth who physically transition is one reason there has been a steady drip of news, mostly out of Europe, reflecting growing unease about these treatments. The UK has seen a complicated, slow-boiling controversy at the National Health Service’s sole provider for youth transition services, the Gender Identity Development Service at the Tavistock Clinic in London. Staffers there raised concerns about the quality of care; some argued children were being fast-tracked toward blockers and hormones in part as a result of activist pressure. Complaints from a young detransitioner who insists that she was not properly assessed, and who had a double mastectomy she regrets, culminated in a High Court ruling declaring that under-16s are unlikely to be able to consent meaningfully to blockers or hormones, making it much harder for this group to access treatment. An appeal is underway; in the meantime a convoluted process will still allow some young people to access these services with parental permission.

This spring Sweden banned youth medical transition outright at a number of gender clinics, including one at the famed Karolinska Institute, except in approved research studies. And in June last year the body that recommends on treatment methods in the Finnish public healthcare system published guidelines that emphasized the need for thorough assessment prior to the administration of blockers or hormones — stating that blockers may only be given ‘on a case-by-case basis after careful consideration and appropriate diagnostic examinations’.

These steps seem to reflect a growing realization that the holes in the research on youth medical transition are too big to ignore. Three major reviews of the literature conducted by government agencies in Finland, Sweden and the UK found an alarming lack of data supporting early treatments.

On how the media distorts the data:

Journalistically, the proper response to this issue is to give the details in all their complexity — not to leap to some extreme in which we pretend, for the sake of our political agenda, that there are zero legitimate questions about youth transition. Unfortunately, though, that’s what just about every major American media outlet has been doing. To be fair, this trend started well before the GOP state laws were introduced, but it is getting worse. The threat posed by these laws is often deployed as an excuse to not ask too many questions about extremely unsettled areas of medical research centered on very vulnerable populations.

I mean, what are you, anyway? One of those transphobic Trump supporters? This attitude underpins how these transition stories are framed and what news gets ignored entirely. Apart from the occasional fleeting reference neither CNN nor the New York Times nor the Washington Post nor Vox, all of which have offered near-blanket coverage of the proposed bans on youth medical transition, covered the NICE evidence review [the NHS’s National Institute for Health and Care Excellence] or any of the Tavistock controversy or the Karolinska decision. These outlets routinely repeat activist claims which should be given serious scrutiny and which sometimes defy basic, generally agreed-upon facts. ‘There is no consensus criteria for assigning sex at birth,’ explained CNN in a news article published in March, though editors there later struck that bizarre statement.

Mainstream coverage of this issue is a buffet of sanctimonious overclaiming. It says authoritatively that kids in the US can’t go on blockers or hormones prior to lengthy, in-depth assessment (false). That no one under 18 is getting surgery (false). That the worldwide rise in referrals to youth GD clinics is almost entirely the result of reduced stigmatization (no one knows). That GD [gender dysphoria], or the perception that one has GD, can’t spread through adolescent social networks (almost certainly false on the basis of anecdotal evidence and any familiarity with developmental psychology). That it’s a ‘myth’ that significant number of kids who believe themselves to be trans will later feel differently (false, according to all the existing data). That only a tiny percentage of people detransition (we have no data at all on this in the context of youth gender care in the States).

The last paragraph sums up in a nutshell what we don’t know but what is asserted to be true by liberal media.  I won’t go further except to say that Singal, who is no opponent of guided and informed transitioning, emphasizes our ignorance:

Most reporters don’t have much experience covering this issue.  When they take it up, they reach out early on to an activist organization, which in turn recommends media-friendly ‘experts’ who happen to be on the vanguard of this issue; i.e., seeking to break down the final vestiges of the ‘gatekeeping’ of trans youth. They will earnestly confide in the journalist that among real experts (like themselves), there are no legitimate concerns with the safety of medical treatment of very young trans youth. People who feel differently are transphobes. Simple.

This is a comfortable storyline, but it’s just not true. We desperately need better data on trans youth healthcare. But we don’t have it yet — in many ways, everyone is flying blind, especially families of kids with later-onset GD. Parents deserve every scrap of information that can help them understand not just the potentially profound benefits but also the risks and unknowns of blockers and hormones. American journalists, from an understandable but misguided desire to position themselves on the right side of an emotionally taxing and fraught issue, are hindering their ability to get it.

I’m well familiar with the ideological bias of liberal American journalists, and am prepared to believe that, since they’re not scientists, they want to be on the side of the angels. But this debate will continue, and it will continue until we have sufficient data to settle the medical issues. We appear to be a long way from that.

31 thoughts on “More on Abigail Shrier, Harriet Hall, Science-Based Medicine, Jesse Singal, and transitioning

  1. I think a significant upstream factor in this problem – that seems completely ignored – is the *developmental* influence of so-called “endocrine disruptors” or “environmental estrogens”, as modulated by strength and cumulative exposure at specific developmental stages, especially in the brain. The most notorious one might be BPA – bis-phenol A. That compound is not appearing so often now, but that does not mean plastics are made to some higher standard – they just write “BPA free” so they sell. Adults might be fine AFAIK but *developing* children have higher potential for such compounds to interfere with development.

    See books by Leonard Sax, MD, PhD e.g. Girls on the Edge or Why Gender Matters. Those titles made me take the issue seriously.

  2. SBM have now put up a replacement for the Harriet Hall review of Shrier’s book, this one written by Rose Lovell, who very much takes a pro-trans-ideology line.

    The flavour of the review can be judged from the early statement: “Shrier’s book is a fear-filled screed, full of misinformation, biological and medical inaccuracies, logical fallacies, and propaganda”.

  3. “Gorski’s tweet at Rowling above is clearly out of line here, and in fact is gratuitously nasty.”

    Indeed. I just noticed Jerry responded to me on a previous thread asking for examples of Gorski’s negative online behaviour….well, I guess that is one example. And there are other examples like this where he smugly takes on PZ’s attitude and defends his anti-science views with insults and abuse. All the while insisting he is one of the “good guys” or proper humanists.

    Novella refrains from online drama, but he is clearly willing to carry water for the new True Believers and their new anti-science cult.

  4. I’m also puzzled by Dr. Gorski’s seeming endorsement of puberty blockers, given how much he’s written in the past concerning Lupron (a widely used puberty blocker) and autism quackery. For example:

    https://respectfulinsolence.com/2006/02/23/why-not-just-castrate-them-1/

    One of the supposed “cures” for autism involved stopping testosterone development because it “binds with mercury “ or some such nonsense. He first describes it as a “powerful drug,” then writes

    In my book, if you’re going to give a potent drug like Lupron to children, a drug that can almost completely shut down the synthesis of both male and female steroid hormones, you’d better have damned good evidence that it’s likely to help to make it worth the risk.

    Yes. I think he’s right.

    1. That’s an interesting connection. This series of essays at Quillette has lots of carefully described anecdotal evidence of a connection between ASD and MTF transition in youth.

      https://quillette.com/2021/06/18/when-sons-become-daughters-its-time-to-admit-that-reflexive-affirmation-has-been-a-mistake/

      IDK much about how those things could be causally related to each other (or associated with some other cause). And lots of reasons to be cautious about the meaning of those anecdotes. But it does seem to warrant careful study. One would think the SBM folks would be interested in that and support doing that research.

      1. I think both sides of the debate agree that there’s a strangely high correlation between being on the autism spectrum and identifying as transgender — not just for boys, but for girls as well. The explanation for this generally falls into two camps:

        1.) This could well be good evidence that a mismatch between one’s sex and gender identity has a genetic/neurological component similar to autism, thus providing more evidence that being transgender is brain-based and putting it more firmly on a scientific basis. More studies will doubtless bear this out and eliminate any idea that there’s so-called “social contamination” involved.

        2.) Children and teens on the autism spectrum tend to feel uncomfortable in their bodies, be socially awkward, and consider themselves strangely odd or different than the other kids. The transgender storyline provides an easy, simple explanation — “you’re just in the wrong body” — while also giving them an easy, simple solution — transition — along with likely validation and acceptance from others. Autistic kids are also prone to becoming focused on an interest or idea, and persistent and insistent when they are.

        I don’t know which explanation will prove itself over time.

        1. Your #1 does not explain the recent spike in young girls identifying as transgender, whereas #2 does.

          1. @Jay yes, that’s true I think. But a simple combination of genetics plus a recent increase in acceptance of gender-nonconforming behavior in girls could account for that spike.

            @Sastra there is good evidence and a well-developed theory for ASD and schizophrenia as diametrically opposite syndromes affected by many of the same genes but with alleles of opposite effect. A caricature of the theory is that if you get a few of the alleles that are associated with ASD then you’re a highly-focused mathematician, or a few of the alleles associated with schizotypy then you’re an intuitive relationship expert, but too many alleles of either group and you’re autistic or delusional (and with neurotypical behavior in the middle for the majority of people who get only a few alleles of each group).

            I wonder what that theory means for the understanding of transgender individuals and their neurobiology. If transgender is an unusual or extreme phenotype associated with ASD, then what is the other or opposite phenotype associated with schizotypy? The theory predicts there should be one.

            1. Haven’t looked for data but some discussion in various sources around schizotypy that individuals are often asexual, avoidant of relationship. Whereas trans identity tends to be associated with very strong feelings about desire and being desired? I am speculating though.

            2. Mike, in your response to Jay’s point, you suggested societal acceptance plus genetics could explain the dramatic rise in the number of young girls transitioning. But if societal acceptance was all that was needed, why don’t we see a dramatic rise in transition across demographics, including age? For example, we don’t see a dramatic increase in middle aged women transitioning. My theory is that most adult women had a chance to come to accept themselves and their bodies because transition wasn’t an option when they were young and more uncomfortable with their bodies (and more impressionable).

  5. I had a miserable time as a teenager. I had a poster of the Led Zeppelin Swan Song logo on my wall and used to think “lucky bugger. I’d gladly trade my genitalia for wings!” Reading all this makes me think I was on to something. Also makes me envious of asexually reproducing organisms. What nonsense we supposedly wise apes put ourselves through. Teens can’t drink beer but they can juice themselves with all sorts of hormone-blockers. And of course it’s fine to mutilate genitals in the name of religion, so now we have a secular reason to do so. How bizarre. But whatever. I’ve got no foreskin in the game. Just wake me up when science figures out how to trade my wiener for wings.

        1. There is a certain irony in my obsessive love of Led Zeppelin and my utter embarrassment over puberty. Their music had so much power for me at a time when I felt utterly powerless. Of course today they would be canceled.

          Completely off-topic of the post…
          There’s a great yootoobes channel, Led Zeppelin Boots, if you’re into live stuff.

  6. What’s particularly infuriating is how people who would surely claim to be trying to protect the interests of the young people in question in this issue are actually using them merely as grist for their ideological mills. It should be easy to respond to someone’s claim that “you” are transphobic if you express caution by saying, “No, what I actually am is very much in support of transgender people and people with any number of issues or concerns, some of which can overlap, or coincide with, or complicate their gender questions, and which can be made WORSE by reckless interventions. It’s perfectly natural to feel the URGE to do something, ANYTHING, in a difficult situation, but that’s usually likely to do more harm than good unless one is very, very careful. If you REALLY care about trans people, or anyone dealing with similar or related issues, you will want to protect them from being manipulated or railroaded into doing something that might not be in their best interest, but which serves a narrative…and/or also serves the bank accounts (literal and ego-related) of transition specialists.”

  7. How can we help those poor souls who suppose that they were “born in the wrong body” as animals, because they feel themselves, in the inner core, to belong to the plant rather than the animal kingdom? Is the best we can do to direct them to Olaf Stapledon’s “The Star Maker”, which includes a race of beings who alternate between animal and vegetable modes of life? Modern medicine has not yet progressed to the point of making this transition possible—-although I find that prolonged exposure to American radio programs almost does the trick.

  8. I was very disappointed in that article on SBM. I stopped reading after it stated one of the fallacious claims to be that sex was binary. If you can’t see that there are two sexes there’s not much hope for any clear thinking on the subject after that. I really enjoy SBM and Steven Novella and I hope they both get back to rationality on the subject.

    Edited for spelling.

  9. One possibility is that the desire to be a member of the opposite sex is just an extremely strong desire, and that’s all the ontology of it. Not a disorder, not genetic or neurological basis, just a desire that can last a few years or your entire life. I don’t think that there is any evidence that tdesire is essentially different from other desires, like to be a rock star, or a saint. Nothing that can be solved by science.

  10. I have no doubt at all that Novella is biased toward the activist SJW side of current issues.
    One episode of Sceptics Guide to the Universe had Novella ‘describing’ the Central Park birder incident only in terms of a racist Amy Cooper and an innocent black birder.

    I sent him an email complaining of the lack of balance in his assessment in failing to describe how the black birder tried to entice the dog to him with a treat and how he told Amy Cooper he might do something she wouldn’t like. Such that even a white birder doing the same thing may have induced similar fear in Amy Cooper.

    There was definitely two sides to the story which is why Amy Cooper won in court, but Novella ignored it and doubled down in his response to me and I haven’t listened to their podcast again.

    The general media also seemed to ignore her side of the argument too.

    1. Amy Cooper refused to put her dog on a leash. The birder (Harvard educated and on the Board of the Audubon Society) knew that unleased dogs were a problem, and he offered a treat to try to force her to leash the dog. She was totally in the wrong, both in having an unleased dog in the park and in calling in a false report on the birder. She did not win in court – she went through anti-racism counseling and the charges were dismissed. You need to get your facts straight before accusing Novella of bias. https://www.nytimes.com/2021/02/16/nyregion/amy-cooper-charges-dismissed.html

    2. Amy Cooper didn’t win in court. However, I agree with you that in the setting of just the two of them being present, she not unreasonably, construed his comment as a physical threat and responded in a panic. To give both of them the benefit of the doubt, the birder may not have considered that his comment might be taken as a physical threat and Ms. Cooper in her concern for her own safety and that of her dog may not have stopped to consider that her call to the police might represent a physical threat to the birder. Had the incident not happened on the same day that George Floyd was killed by a policeman kneeling on his neck I think her side of the story would have garnered more sympathy.

    3. I used to listen to SGU very regularly but stopped a few years ago, what on earth has that news story to do with any of the stuff the podcast is about?

  11. Between Gorski’s woke enforcer-like attack on JKR and Singal’s critique of G&N’s analysis of Hall’s review, it does, sadly, seem very likely that this is a case of capture by woke ideology of two stars of the Skeptic movement. I thought they were done with kowtowing to woke bullshit when Rebecca Watson left the SGU podcast and was replaced by Cara Santa Maria, a very reputable science communicator, but this incident seems to be a significant step backward for Gorski and Novella. I’ve read Dr. Hall’s excellent autobiography “Women Aren’t Supposed to Fly”, based on that, I would credit her intellectual honesty over that of Gorski and Novella when examining this incident. I hope they will receive enough push-back to consider the wisdom of pulling back from this abhorrent policy of sucking up to the woke mob.

  12. I’ll be surprised if Hall isn’t chased off SBM. Apart from this departure from woke dogma, she once made a Skepchick cry by wearing a shirt that said she was a “skeptic, not a Skepchick.” And Gorski loves him some Skepchicks.

  13. I think, first of all, by looking at the implications of treating men as women as the default position rather than the position requiring extraordinary evidence, we must see that women are being asked to pay a heavy price for the uncertainty. Women are being asked the following:

    1. Lesbians are being asked to accept that they are not really lesbians, that their attraction is to a gender identity rather than to a sex. They are being told that if they don’t want sex with penis people they are guilty of transphobia and that is now a social crime with a greater penalty than homophobia.

    2. Woman and girls are being asked to accept that penis people in the locker rooms have a right to be there, and if they are freaked out by a woman’s flapping penis on it’s merry way to the shower, that they are perverts for looking. By implication, Louis C.K. could have saved his career after being exposed for exposing himself, merely by declaring himself a trans lesbian and that the women he exposed himself to were not being harassed, but merely did not accept him as “one of the girls.”

    3. Not so flippantly, women are being held in prison with men who have self-declared their female gender identity. So, now they not only have to face the prospect of being raped and assaulted by the male guards with authority over them, but men who claim to be women. If prisons are not safe for men, why do we put men with women. Rape is not a legal punishment. Imagine the terror of a woman in prison for killing an abuser in self-defense, now having to sleep with an abuser in the top bunk.

    4. Women are being no-platformed from speaking at universities because the schools are committed to providing a safe space for trans and non-binary people. Women are also not given a safe space in schools when they want to use the restroom, which was previously a relatively safe space for them. There’s a bit of incongruence here.

    5. Women were beat by Antifa when they protested that a man in a Koreatown Spa was using the women’s facilities and the response to the women’s peaceful protest was met with violence. A commenter declared that such men should be given their allowance to pretend they are women, so that we can “live and let live.” The LA TV stations covered this as a “skirmish over trans rights” but made no mention of women’s rights.

    6. Women are being told that they need to allow trans women to examine them gynecologically, or to assist a gynecologyist in order to validate the trans woman, and if they don’t want it they are bigoted. The gynecologist’s is not considered to be a “safe space for women.”

    7. Laurel Hubbard is probably going to win a gold medal in the Olympics, taking the honor and glory from a woman. This is framed as the “right” of trans identifyng women, to compete in sports. The thing is, they don’t lose the right to compete if they are not included in the class of their “identity” in sports. They lose the right to dominate, They can still compete with men, but they probably lose out on medals that way. So sad.

    This is already too long and boring for most men who are not affected and think we need to give equal weight to “both sides.”

    I’ve been called transphobic and hateful, because I think that women’s and gay rights do deserve to be placed first before the “rights” of trans-identifying males to impose on their spaces and in their sex lives. I have always been clear that I fully support the freedom and rights of gender non-conforming people to be treated with dignity and good care when they need help, but that does not mean that I think that gender identity gets primacy over actual phsyical sex when it comes to dismantling sex based oppression. Mangling science to justify putting men in women’s places has the effect of diminishing the rights of girls and women in service to men, and, well, that’s pretty much been the state of things for, like, ever. Only now it’s being justified by the silly statement “trans women are women” and imprinted as faux feminism with “feminism is for all women.

    “Extraordinary claims require extraordinary evidence” is a skeptic mantra, and SBM being a leading skeptic source, is choosing flimsy evidence for a poorly defined position while shoving women’s concerns aside. I’m glad that Singal is addressing their position, and I agree with Jerry that Hall’s original post needs to be restored.

    (Edited for spelling and clarity.)

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