A long and pretty objective discussion of trans issues at Reuters

November 21, 2022 • 11:00 am

It’s articles like this one from Reuters (click on screenshot below), as well as a recent one in the November 14 New York Times, that give me hope that the debate about transgender and transsexual youths (or adults) might be getting more sensible and less polarized. It’s not that either article is “transphobic”, or devoted to highlighting the dangers of transitioning. Rather, the articles are balanced, giving examples of successful transitions as well as those who regretted transitioning. They discuss the view that that therapy shouldn’t be completely “affirmative, but empathic and directed towards finding the best way to resolve gender dysphoria. This is a LONG article, but worth reading. Indeed, if you follow this debate, you’re not going to see all sides in a short piece.

Like the other article, there are stories from both sides of the fence. Here’s one example of where several sides are examined:

Thousands of children who, like Kulovitz, were assigned female at birth have sought gender-affirming care in recent years. And for reasons not well-understood, they significantly outnumber those assigned male at birth who seek treatment.

As Reuters reported in October, a growing number of the children receiving care at the 100-plus gender clinics across the United States are opting for medical interventions – puberty-blocking drugs, hormones and, less often, surgery. And they are doing so even though strong scientific evidence of the long-term safety and efficacy of these treatments for children is scant.

That has led to a split among gender-care specialists: those who urge caution to ensure that only adolescents deemed well-suited to treatment after thorough evaluation receive it, and those who believe that delays in treatment unnecessarily prolong a child’s distress and put them at risk of self-harm.

The outsized proportion of adolescents seeking treatment to transition from female to male has sparked parallel concerns. Professionals in the gender-care community agree that treatment of all transgender children should be supportive and affirming. The question, for some, is whether peer groups and online media may be influencing some of these patients to pursue medical transition, with potentially irreversible side effects, at a time in their lives when their identities are often in flux.

Corey Basch, a professor of public health at William Paterson University in New Jersey who researches health communication and teens’ use of social media, said she fears that some adolescents are susceptible to making faulty self-diagnoses without adequate input from medical professionals. “Teens are so incredibly vulnerable to information overload and being pushed in one direction,” Basch said. “They could be lacking the analytical skills to question who is giving this advice and if their advice is valid.”

I’m not going to summarize the piece, but merely call it to your attention. But I do want to mention one of the piece’s major issues: why, compared to not long ago, are so many more biological females choosing hormonal treatment and “top surgery” (removal of breasts, much more common than “bottom surgery”). By the way, the discussion of the way some surgeons advertise this treatment in a tacky way will make you queasy.

Here’s the sex-ratio conundrum:

Adolescents assigned female at birth initiate transgender care 2.5 to 7.1 times more frequently than those assigned male at birth, according to the World Professional Association for Transgender Health (WPATH), a 4,000-member organization of medical, legal, academic and other professionals. Several clinics in the United States told Reuters that among their patients, the ratio was nearly 2-to-1, and similar phenomena have been documented in Europe, Canada and Australia.

Not all of these patients receive medical treatment. Their gender-affirming care may entail adopting a name and pronouns aligned with their gender identity. It may include counseling and therapy. But an increasing number are opting to take hormones and have top surgery.

The article offers three explanations, and I’ll quote them (bold headings are mine):

1).  A reduction in sexist attitudes.

Advocates of transgender rights and clinicians who treat adolescents see nothing out of the ordinary in the trend. While transgender children face significant prejudice and threats of violence, they say, increasing social acceptance of transgender identity has encouraged more children to seek treatment. At the same time, this reasoning goes, society is generally less accepting of what it deems an effeminate boy than of a masculine girl, and the greater stigma that those assigned male at birth face may make them less likely to pursue treatment, reducing their share of the patient population.

2). The “refuge effect”: seeking male privilege.

But other gender-care providers and some parents are skeptical. In interviews with Reuters, they expressed worry that some adolescents assigned female at birth may be dealing with significant mental health issues in addition to questions about their gender identity, or may be seeking to transition as a refuge in a culture of internalized misogyny, body hatred and early sexualization of girls.

3.) Sex differences in response to puberty (combined with male privilege).  

“Girls have a harder time with the physical and emotional changes that come with the onset of puberty,” said Dr Erica Anderson, a clinical psychologist, transgender woman and former board member of WPATH. “And I think there is an element of truth that males have it better in many quarters of society than females.”

The first hypothesis does explain the rapid rise in biological women/girls seeking to transition to males, rather than the other way round, But the second and third ones don’t, since presumably difficulty with puberty and male privilege have been ongoing for decades. One would have to invoke a change social climate that favors transitions to explain why, all of a sudden, female-to-gender transitions have become predominant.

At any rate, the piece also goes into the unknown long-term effects of hormone treatment and other issues that we’re familiar with.  The fact that these can be discussed openly in two respected journalism sites—and would have been taboo (“transphobic”) before—is a good sign.

24 thoughts on “A long and pretty objective discussion of trans issues at Reuters

  1. 2 and 3 are explanatory if you reverse 1 – that is, there is an *increase* in sexist attitudes.

    If you consider FTM as the result of non-acceptance of gender nonconformity in girls it makes much more sense.

    1. It’s been pointed out that, given the way our culture assigns so many common and positive traits to men (rational; active; competitive, athletic), there are going to be more girls who are “masculine” than boys who are “feminine” (emotional, passive.) That would mean that the percentage of kids who would consider the possibility they were trans would be higher in girls than boys.

      1. Certain demographics may only treat characteristics commonly associated with men as ‘positive’ – but I am more familiar with society-at-large claiming that male-associated and female-associated traits are each positive in their own right. Of course, it still reinforces gender stereotypes that we should be moving away from. Someone who exhibits characteristics associated with another sex/gender should not view that as a sign of being trans.

      2. I find it truly disheartening that, even in 2022, there is very little leeway for boys and men to stray even a tiny bit outside what various cultures consider “masculine” norms.

        Anyone who grew up male in the United States knows precisely what I’m talking about. The playground ethic screams, “Do NOT show any vulnerability in any way, or you will be attacked (verbally, sometimes even physically). Do NOT demonstrate any behavior that any boy out here in the jungle can remotely consider ‘feminine’ or ‘sissy,’ or you will be attacked.”

        If you ask me, these idiotically rigid gender roles — which have only gotten more rigid in recent decades — and the (mostly) Christian anti-gay movement bear considerable blame for the current transmania.

        If nosy parkers would stop shaming and belittling kids (or adults) who happen to have other than hetero sexuality, perhaps we wouldn’t see so many boys and girls desperately trying to avoid the awful “fate” of being gay by falling into fantasies that they can magically change into the other sex.

        Meanwhile, if society would just back the *&^%!! off and let people, all people, express themselves as they are, sexually, gender-wise, and any other non-sociopathic personality trait you can come up with, be who they are, we’d all be better off.

        I’m a mostly straight, masculine, married guy who has spent his entire life hearing that my love of colors, or the fact that I like to talk and “process feelings” and enjoy therapy, and wear my hair a little longer, means I’m not *really* masculine enough.

  2. Thanks for the link. Good article. I liked this, “Social media may lead some youths to mistake mental health problems or uncertainty about their identity for gender dysphoria,” because many clinicians (e.g., Turban) assume that gender dysphoria causes mental health problems, but it’s likely to often work the other way around.

    The three proposed explanations for the sex-ratio conundrum could all be real. But they still fail as explanations for the phenomenon of trans. If we could eliminate discrimination against effeminate boys (or misogyny or body shaming) and everyone could express their “gender identity” freely, what would be the expected or true frequency of trans people “born in the wrong body”? To get that number, one would need a mechanism that causes some people to be trans and others not. Instead the whole trans conversation focuses on symptoms (sort of like the DSM) not mechanisms. It’s an empty conversation.

  3. I don’t know whether Jerry correctly assesses the potential value of the three hypotheses for the sex imbalance of the adolescents getting treatment at gender clinics.
    To explain the change in the sex breakdown of the adolescents who get medically treated, we need to invoke a factor that has changed. (Change cannot be explained by invoking constants only.)
    I take it that the big change recently has been that gender transitioning of adolescents by means of medical intervention has gained some acceptance.
    That change can then interact with factors that are specific for each sex (and which can have been constant). For instance, according to the first hypothesis “society is generally less accepting of what it deems an effeminate boy than of a masculine girl.” I would like to see some data for this claim. It sounds somewhat plausible. But is it really true?
    I don’t agree with Jerry’s claim that the second and third hypotheses for explaining the sex imbalance cannot work. Jerry may have written that because he did not see what changing factor these explanations invoke (if there isn’t any, then the explanations can’t work). The changing factor is the same as in the first explanation: gender transitioning of adolescents by means of medical intervention has gained some acceptance. This factor then interacts with a variable on which the two sexes score differently (perceived misogyny and amount of discomfort with a changing body during puberty).

  4. “One of the false narratives is that young people are being lured in and directed somehow against their will to become transgender, which is not at all the case,” said Dr Dan Karasi

    I’ve never seen any skeptics propose that kids are being forcibly “trans-ed” against their will, yet claiming that this is what skeptics think is a common claim from proponents. It’s called a Straw Man.

    On the contrary, social contagion (which can come from peers, media, literature, authorities, and professional organizations) often works by the influenced feeling as if they’re personally discovering something they’ve always known about themselves. That’s also how it works when converting to religion or believing you’ve been abducted by aliens. It’s pretty clear that the transgender phenomenon is a culture-bound syndrome, with real anguish and desire to matter being channeled into this particular form.

    Any article that tries to balance the sweeping narrative of trans identity with cautious criticism always seems to suffer a split personality. Every child in the article who identifies as trans is automatically stylistically affirmed — “he was assigned female at birth” — even though it goes on to quote experts who are pondering the wisdom of automatic affirmation since they “do not believe that we have an obligation to accept at face value everything a young person says to us.”

    1. The January 2022 issue of Skeptic (the magazine, edited by Michael Shermer) contains 4 articles on the transgender debate. One of them by the psychologist Carol Tavris. She was born in 1944 and is 78 years old now. So she has been around the block a few times (in addition to her being a respected scientist). Her article begins like this:

      American culture is prone to psychological and medical contagions. An idea catches fire, seeming to be a plausible and important explanation of a familiar problem — depression, anxiety, eating disorders, sexual dissatisfaction. The idea outruns evidence. Experts emerge to treat people suffering from the problem, exploiting the most credulous. They open clinics. They give prestigious lectures and write books. They make fortunes. They blur the diverse possible origins of a person’s difficulties, attributing them all to the latest explanation.

      Throughout the 1980s, the hot explanation was childhood sexual abuse: you have an eating disorder? Your father (or grandfather, or uncle, or close family friend) probably molested you. You don’t remember that? You repressed the memory. In the 1990s, it was Multiple Personality Disorder: your other personality remembers the bad stuff; let me give you a little sodium amytal to bring it out. In the 2000s, it was PTSD (Post Traumatic Stress Disorder), said to apply to all traumatic experiences from war to an unwanted touch on the shoulder. Tearful sufferers tell horrific personal stories, and who could doubt them? Who wants to be accused of being misogynist, antifeminist, or simply cold and heartless?

      https://www.skeptic.com/reading_room/transgender-reality-i-didnt-know-there-was-another-side/

      1. You forgot to mention ‘Anorexia nervosa’, self-starving of girls unhappy with their bodies. I think there is a good parallel to sudden onset gender dysphoria (SOGD). Note, I did not find that out for myself, it was Abigail Shrier who pointed that out. But it fits very precisely.
        Let me put it more strongly: I think those surgeons carrying out ‘gender affirming’ surgery, without a long-term psychological evaluation of SOGD victims, are quacks, and should be stricken from the roll. And the same for those hormone peddlers.
        The article is pretty good, but I strongly object to the ‘assigned male/female at birth’ formulation. A baby is unequivocally male or female (in 99+% of cases), that is a fact of life, a binary. Babies don’t suffer gender dysphoria.

        1. What’s actually “assigned” is gender, when the new baby is given a pink or blue hat, a ruffled dress or football jersey onesie. She may not grow up to like frills; he may not grow up to like sports. They would then be “trans-gender,” or gender non-conforming & all the rhetoric about personal gender identity would make sense. But no. They mix that up with basic reproductive categories.

  5. RE the “sex-ratio conundrum” (sex imbalance among adolescents seeking medical treatment for gender dysphoria):
    According to the first explanation (using Jerry’s words):

    society is generally less accepting of what it deems an effeminate boy than of a masculine girl, and the greater stigma that those assigned male at birth face may make them less likely to pursue treatment, reducing their share of the patient population.

    I don’t get this. Aren’t effeminate boys the ones that would be more likely to seek treatment (compared to non-effeminate ones)? The postulated stronger stigma they face should make them more likely to seek transition, while the claimed greater social acceptance of masculine girls should make them less likely to seek transition (less likely than effeminate boys).
    Am I getting something wrong here? I’m looking at this from the point of view of what could push an adolescent to seek treatment. The hypothesis reported by the Reuters journalists seems to look at it from the point of view what could pull a gender dysphoric adolescent to seek treatment. Both perspectives seem valid but they give different answers.

  6. I don’t know why more children assigned female are seeking to change gender, but I see no reason why it should be 50/50 either. We really just don’t know what is going on here.

    1. It seems to me that if there was some biological cause, it ought to be roughly 50/50. But that’s just a layperson’s heuristic, I suppose.

      1. Autism skews heavily male, and psychosis/schizophrenia skews heavily female. The genetics is complicated, but something like it could account for whatever it is that is “being trans”. Agree with Mark people really have no idea what is going on mechanistically.

  7. I can’t help but wonder if the fact that puberty is starting earlier and earlier (NYT article from this past spring here: https://www.nytimes.com/2022/05/19/science/early-puberty-medical-reason.html) has something to do with this trend. Correlation doesn’t equal causation, but I can see girls being emotionally unprepared for these changes in their bodies, and wanting to retain a more youthful shape. (Note: I haven’t read the linked articles yet, so if they cover this, I apologize.)

  8. In a very retrograde step in the UK, according to The Daily Telegraph:

    Staff at the Ministry of Justice (MoJ) have been told they should not use the terms “gender critical” and “protecting women and girls” in order to be trans allies, The Telegraph can disclose.
    […]
    In order to “be an active ally”, staff were given a glossary titled “recognising transphobic coded language”, which contained 35 everyday phrases that it claimed were “turning what would be considered overt discrimination into covert behaviour”.

    The list of “coded language” includes the phrase “gender critical”, which is used to refer to campaigners who believe biological sex is binary and immutable.

    However, the document claims it is a “self-selected label to denote holding anti-trans views, it’s a term used to make anti-trans discrimination sound palatable or a respectable opinion” and warns staff to look out for social media accounts that hold this view.

    Also listed is “protect women’s spaces/protecting women and girls”, which it says “relies on equating trans women with being predatory men, to play on unfounded fears and convince people that supporting trans inclusion threatens their safety”.
    […]
    The glossary was shared from the official justice.gov.uk email

    “Ministry of Justice officials warned that talk about ‘protecting women’ could be transphobic” https://archive.ph/sqpWm

      1. It’s always interesting to observe that women are definitely at the bottom of the Intersectional Hieracrchy. Depending on what you need them for they can either be fragile victims or hideous Karen’s.

  9. You know one thing that severely worries me about the conversation surrounding transgender and a myriad of other issues today is the immediate go-to that is offensive and belittling to even suggest that people outside of society’s mainstream may have a mental illness. I say this as someone who has struggled all of his life with mental illness and faced the severe lack of resources available to that community here in America. The more we underplay the prevalence of mental health issues in the world in order to spare personal feelings and normalize every outsider group, the more we will return to the days of mental illness being stigmatized and ignored, and sadly even more grossly under treated than it is now.

  10. “Assigned X at birth” is really such a silly formulation, even according to the supposed standards of trans activists (I think).

    The “sex” that is apparent at birth, based on morphology and perhaps more (DNA, for example) is not “assigned.” The sex of a newborn is rarely, except in a vanishingly small number of cases, in doubt.

    So when the activists convince everyone to start talking about “assigned X at birth” what they actually seem to be talking about is *gender*. And I’m not sure many doctors waste a second’s time wondering, “Hmmm, I wonder how this X infant will express its gender as it grows older.”

    It feels like one of these linguistic hoops many feel pressured into jumping through, to demonstrate their decency or whatever. But as with insistent claims such as, “ALL X are Y, dammit!” this feels like a bit of social coercion into speaking something that really isn’t true.

    I put myself in the Rowling camp: I support trans people’s right to decent and equal treatment, not just under the law, but by everyone, at all times. But I do not necessarily agree with every assertion/dogma pitched at me by the most vocal trans activists.

    If that makes me a crank, well, I’m in good company.

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