Jesse Singal fact-checks Science-Based Medicine again

July 18, 2021 • 9:30 am

The battle between Jesse Singal and the site Science-Based Medicine (SBM) continues. SBM originally hosted a positive review of Abigail Shrier’s book Irreversible Damage written by one of their editors, Harriet Hall, and then two other editors, David Gorski and Steven Novella (G&N), removed Hall’s review and replaced it with three pieces critical of Shrier’s thesis about the possible social origins of rapid onset gender dysphoria (ROGD) and the possible dangers of treating the syndrome with hormones and surgery when it starts in adolescence. (See the whole story in these posts.)

Although G&N claimed that they removed Hall’s review because it contained scientific errors and also glossed over Shrier’s own errors, I suspect it was also pushback from those who deemed Shrier’s book “transphobic” (it’s not).  Jesse Singal, who’s read a lot about gender dysphoria has published a critique of G&N’s stated reasons for the censorship, arguing that G&N played fast and loose with the literature themselves, mis-citing papers, engaging in confirmation bias, and so on.

Now, in four further tweets, Singal has accused A. J. Eckert (AJE), one of the people whose posts replaced Hall’s on SBM (Eckert wrote two of them), of fabricating quotes from Shrier’s book that don’t appear in it. Here are the four tweets. While these made-up quotes aren’t as potentially damaging to SBM’s reputation as is Singal’s long critique, it still shows a lack of care in SBM’s methods—something one doesn’t expect on the site, which has been careful and a valuable asset. Now, however, it may well be slanted by wokeness.

The first one deals with a phrase that, says Eckert, is used repeatedly by Shrier to characterize the social environment that, she says, pushes adolescent girls towards ROGD. Eckert says, among other things, “These [factors] are characterized as a ‘woke gender ideology,’ an oft-recited phrase that is never really defined.” In fact, Singal found that Shrier doesn’t use the phrase even once.

Singal’s second tweet notes that it was supposedly only one quote that was fabricated, but that AJE said it was “oft-recited.”

Then Singal discovers two things. First, Eckert attributes to Shrier the phrase “radical trans ideology” as characterizing what the Internet instills in some adolescent girls that get ROGD (third tweet). That phrase doesn’t appear in Shrier’s book, though AJE puts it in quotes.

Second, AJE apparently grossly mischaracterized the treatment of Lisa Littman’s study of the etiology and manifestation of ROGD published in PLoS ONe (underlined bit below).

No, Littman’s study wasn’t pulled; in fact, it’s still up at the PLoS ONE website. What happened was that the editors required some tweaks in the original version, which were made. What was pulled was a Brown University press release promoting Littman’s study. (Littman works at Brown.) And that retraction, as well as perhaps some of the changes suggested by PLoS’s editors, may have come from social-media pressure.

This last claim about pulling the study, combined with the fabricated quotations, show a lack of care of AJE and SBM, and perhaps the editors, in describing the work. I won’t call these lies or deliberate fabrications, but they do show a disturbing lack of care from a site that has spent much of its time debunking others for carelessness and duplicity.  And I’m not sure if it’s “potentially libelous”, though Eckert/G&N really should issue a couple of corrections for the site.

Judge it as you will; your mileage may vary. There will, of course, be more to come. In the meantime, Shrier’s book, now a year old, is still selling rapidly on Amazon because of all the attention that the ACLU and people like G&N give it. It’s the Streisand Effect.

h/t: cesar

The American Booksellers Association apologizes for mailing out Abigail Shrier’s book, calling it a “serious, violent incident”

July 17, 2021 • 11:15 am

It’s a sad day when not only people in the ACLU call for banning Abigail Shrier’s book Irreversible Damage: The Transgender Craze Seducing our Daughters, but then the American Booksellers Association, self-described as “dedicated to free expression”, grovels to the mob and apologizes for sending out Shrier’s book in a batch of sample books dispatched to 750 bookstores.

First, though, let’s refresh you on Chase Strangio, the ACLU staff attorney in charge of gender issues, who emitted two tweets asking for “stopping the book’s circulation.” That’s a call for censorship. Here are the tweets.

And of course we’ve talked a bit about Shrier’s book, which I’ve just read. It is neither transphobic nor full of hate; it simply raises issues connected with “rapid onset gender dysphoria” (ROGD), an exponentially increasing condition among adolescent girls in which they decide they want to be boys and, with the help of compliant parents, therapists, and doctors (and often without proper vetting) begin taking puberty blockers and then have hormonal and often surgical treatment. Shrier’s point was that this phenomenon may partly stem from social-media pressure and the valorization of being “trans”, which brings you attention you wouldn’t get if you simply declared yourself a lesbian. It may often be associated with mental illness, and in many cases may go away on its own.  Further, ROGD is often not treated according to rigorous standards promoted by some medical associations.

Shrier’s point, and that of Jesse Singal, whom we discussed yesterday, is that we have little data on the form of gender dysphoria which comes on quickly in adolescent girls (it’s much rarer in boys), and before we go injecting hormones and cutting, we need much more extensive medical and psychological data. Shrier’s book is valuable because it calls attention to a phenomenon that needs attention, and should promote not only discussion, but the necessary research.  Shrier’s book is thus a valuable contribution to a discussion.

But many trans activists don’t want that discussion. Like Chase Strangio, they want Shrier’s book banned, arguing that simply bringing up the issue is itself a case of “transphobia.” That’s as far from the truth as you can get, for if you read Irreversible Damage, you’ll see that Shrier is sympathetic to the plight of transsexual people and only wants to ensure that those with ROGD are treated properly.

Strangio isn’t the only one who is deeply offended by Shrier’s book. As Sykes reports:

After receiving two Twitter complaints, Target stopped selling the book (a decision they later reversed . . . and then reversed again). Hundreds of Amazon employees signed a petition demanding the company stop selling the book.

And yes, I just checked the Target site; Shrier’s book, once reinstated, has now been eliminated again. But it’s still on Amazon, where it’s selling like hotcakes.

Which brings us to the American Bookseller’s Association (ABA). According to Charlie Sykes’s column, which you can read for free below (click on the screenshot), the ABA is dedicated, as all such associations should be, to free expression. Yet the story of the ABA and Shrier’s book belies that promise (read more details in the story at Publisher’s Weekly).

Here’s the ABA statement noted by Sykes, and it still appears on the ABA’s webpage (click on screenshot):

Well, they didn’t adhere to these principles of free expression after booksellers who received Shrier’s book in their sample box pushed back HARD.  Here’s what Publisher’s Weekly reports:

At Brooklyn’s Greenlight Bookstores, book buyer Casey Morrissey was the first person in the store to open the box. Morrissey shared their reactions on Twitter, and other booksellers quickly joined in, echoing their comments.

@ABAbook I’m seething. I was excited to open our July white box, and then the first book I pulled out is “Irreversible Damage.” Do you know how that feels, as a trans bookseller and book buyer? It isn’t even a new title, so it really caught me in the gut. Do better. pic.twitter.com/VYb1ZKrv9A

— Casey (@CaseyBookEater) July 14, 2021

Needless to say, Casey Morrissey’s Twitter account is now restricted.

And there was this (from PW):

Among booksellers, however, there was little disagreement about the content of the book. “As longtime @ABAbook members with beloved staff across the gender spectrum, we’re extremely disappointed and angered to see the ABA promoting dangerous, widely discredited anti-trans propaganda, and we’re calling for accountability,” the Harvard Book Store wrote on Twitter.

No, Shrier’s book is neither dangerous nor “widely discredited.” So much for the Harvard Bookstore.

After a few reactions like this, the ABA issued a groveling apology. Get a load of this:

The “anti-trans” book was Shrier’s. Note how the ABA (which itself has now restricted its tweets), notes that merely sending out the book was a “serious, violent incident”. No it wasn’t: there was no violence involved, and sending it out did not violate the ABA policies. It’s absolutely pathetic that the ABA has to grovel and mewl like this. The debasing of the word “violence”, making a peaceful act sound warlike, continues.

But of course apologies are never good enough for the Woke, which suggests that you should never apologize for something you did if you were expressing your honest views. Here’s what Publisher’s Weekly adds:

But booksellers said the statement fell short, calling out the organization’s use of the passive voice in the opening sentence. They also demanded greater transparency about how the decision to include the book was initially made, and called for demonstrable steps to restore trust with trans book workers and authors. Some called on the ABA to offer promotions for trans authors’ books at no cost.

ABA Diversity, Equity, and Inclusion committee member Luis Correa, who works as a bookseller at Avid Bookshop in Athens, Ga., was first made aware of the issue when fellow booksellers emailed him Morrissey’s tweet. Correa identifies as a queer, Latino, and fat-bodied person, and said he thought the apology was flawed.

“I’m disappointed with the use of the passive language at the beginning of the statement and the shift in blame. They really should say that ‘we included this book,’” Correa said. The DEI Committee is comprised of ABA member booksellers and does not consult on the selections for the white boxes.

They don’t like the passive voice in the first sentence, apparently wanting the ABA to say “WE included an anti-trans book in our July mailing to members”!  Now the wording of apologies has to be perfect as well!

There were further apologies. From PW:

Separately, the ABA board of directors, all of whom are booksellers, weighed in with an email to members.

“These incidents harmed booksellers, ABA board members, and ABA staff who identify as LGBTQIA+ and/or BIPOC, as well as the wider community. They also added to a toxic culture overall,” they wrote. “We are not the ABA of two years ago. These actions are antithetical to the values we are working to promote in our organization under the strong leadership of our CEO, Allison Hill, and COO, Joy Dallanegra-Sanger. This is not acceptable behavior and goes against the bylaws changes instituted last year.”

**********
UPDATE: The ABA, as reader Coel notes below, has issued a second and even more cringeworthy apology. It’s unbelievable; have a look:

“Horrific harm”? “Traumatized and endangered members of the trans community.” How, exactly, did people get endangered?

***********

No, nobody was “harmed.” People might have been offended, but damaged? I doubt it. And, as Stephen Fry points out repeatedly, being offended is not an argument; it’s an emotion.

Apparently the “new” ABA is in favor of restricting free expression.

But there are some who still stood up for free expression on Twitter. One of them was, of course, Shrier herself, though the tweet she references is now hidden. I do take some satisfaction in feeling that all this brouhaha about Irreversible Damage can only be good for Shrier by getting people to read her book. It’s a literary Streisand Effect, and shows why campaigns like the ABA’s are ineffectual. The book is now #75 on Amazon, and it’s been out for over a year.

And a few more gems reproduced by Sykes:

But this is my favorite:

h/t: Steve, Barry

Jesse Singal: Science-Based Medicine has put its foot into it

July 16, 2021 • 9:45 am

The site Science-Based Medicine (SBM), renowned for debunking quackery and insisting on a firm evidential basis for medical treatments, has put its foot into it, and by “it” I mean the controversy about Abigail Shrier’s new book dealing with “rapid onset gender dysphoria”.

It started, as I’ve described before, with a favorable review on the site by physician (and SBM editor) Harriet Hall, assessing Abigail Shrier’s recent book Irreversible Damage: The Transgender Craze Seducing our Daughters. Shrier’s book, which I’ve now read, describes a phenomenon that she and others call “Rapid onset gender dyphoria” (ROGD). This is a phenomenon of recent origin in which young pre-puberty women (almost never boys) suddenly decide that they are really males, and, often with minimal advice and supervision, take hormone blockers to stave off puberty, followed by hormone treatment (and often surgery) to remove breasts and (rarely) construct surgical penises.

Shrier’s thesis was that these transitions are often motivated more by social pressure than innate feelings that one’s body doesn’t match one’s gender, and by transitioning, many of these girls gain affirmation and approbation from their peers, often on socia media. Further, Shrier maintains that these transitions are often poorly supervised and, if the girls weren’t given medical treatment but therapy, most would not transition but develop into adult women. Her book is largely a series of stories, largely because the ROGD is so recent that its origins—and whether medical treatment should be used (as well as the psychological and physiological outcomes)—haven’t been subject to rigorous scientific study. We know very little about how to deal with those who manifest ROGD.

Thus, rather than proving her thesis, which wasn’t Shrier’s intent, she wanted to raise red flags about a phenomenon that could have its origin in social pressure and lead to irreversible harm in adolescents who are often psychologically disturbed. The upshot is that we clearly need more research on this phenomenon before we start giving hormones to girls who, in their teens, decide that they’re actually boys. Hormonal and surgical treatment is, after all, irreversible.

Shrier doesn’t deal with the kind of gender dysphoria that manifests itself in early childhood and continues for a long period, or that is taken care of long after puberty in people like Caitlyn Jenner. She’s concerned with adolescent girls who suddenly declare that they’re boys and take immediate action to fix the situation. Their numbers have increased rapidly, raising the question about the origin of the phenomenon. Shrier’s book is neither shrill nor unempathic: she has deep sympathy for transsexual people who are heavily invested in being a member of their non-natal sex. Rather, she wants to call attention to the phenomenon of ROGD and to question whether surgery and hormones are the right answers for a temporary affliction, exacerbated by the climate of social media and physicians and parents who are told to do “the right thing” (facilitate transition), and who don’t hesitate before “affirming” gender change and supporting medical treatment.

I thought Shrier’s book, while not definitive, was well worth reading, and certainly not worthy of banning, a ban for which ACLU staff lawyer Chase Strangio has argued. It should start a conversations about the phenomenon and inspire the collection of data that don’t yet exist. But of course Shrier has been called a transphobe and has been widely demonized by the transsexual communty. One simply can’t question the Received Wisdom in this area.

Under the leadership of Steve Novella and David Gorski, SBM removed Hall’s review from their site, claiming that its egress was due not to social pressure but to Hall’s review (and Shrier’s book) being full of bad science and poor scientific judgment (you can still read Hall’s review at Skeptic Magazine). Novella and Gorski then posted a defense of the removal (replacing Hall’s review with three articles opposing Shrier’s view), citing several papers that I hadn’t read. Summarizing their defense, I listed six assertions by Gorski and Novella about why Shrier’s claims (and their defense by Hall) were bogus. Unable to evaluate them, as I wasn’t familiar with the literature, I just asked readers to judge for themselves.

Now, however, someone more qualified than myself, and more qualified than Gorski or Novella, has evaluated the data and their own claims. That person is Jesse Singal, who has read all the relevant literature cited by Shrier, Novella, and Gorski, and has published widely in respectable venues about transsexualism.  He concludes that not only should Hall’s review have been allowed to stay on the site, but that Gorski and Novella have behaved badly—indeed, unscientifically—in rushing to damn Shrier’s book and Hall’s review. One can conclude, if Singal be right, that Gorski and Novella are behaving in a woke-ish fashion, mis-citing data as well as accepting results that confirm their views and rejecting those that don’t—for no good reason. In fact, Singal’s indictment of Gorski and Novella’s reading of the literature is pretty damning, implying cherry-picking, confirmation bias, and distortion of the existing data, which is not about ROGD, which Gorski and Novella imply, but dysphoria that starts early in childhood or comes to fruition in adulthood.

Singal’s piece was 40 pages long when I printed it out in 12-point type, so it’s a long read. I’d still recommend it, especially if you’re interested in transgender issues or SBM in general. You can read Singal’s article for free by clicking on the screenshot below, though he would appreciate a donation for his work.

To my own credit, which isn’t substantial, I did pick out some of the same problems as Singal does with the Novella and Gorski piece—for example my asking, despite their claim that medical organizations had very high standards for facilitatating transition, whether those standards were actually used very often (it seems that they’re often flouted). And I questioned whether the change of gender dysphoria from a “disorder” in the DSM-IV to “not a disorder” in the DSM-V was meaningful.  Singal shows that it’s not.

But Singal’s analysis, or rather destruction, of Novella and Gorski’s defense is pretty damning. I urge you to read it for yourself. All I’ll do in this post is highlight, in Singal’s own words, the major problem with their claims. His words are in bold and indented, any comments I have are flush left.

First, Singal’s disclaimer:

I should re-emphasize that I’ve said repeatedly I think banning youth gender medicine is a terribly bad idea. The evidence for those “positive outcomes of early medical interventions” come from research that, as we’ll see, leaves a lot to be desired. But it does suggest that for kids with intense, persistent dysphoria who have been well-evaluated, who have any other mental-health problems under control, and who have have good family support, puberty blockers and hormones are likely to lead to the amelioration of what would have been a great deal of suffering. (I include these conditions because we simply can’t say much about the effectiveness of these treatments under different circumstances.) I do not trust legislators to override doctors’ and psychologists’ decisions in a context like this. But again, the evidence here is thin and low-quality, so at the very least it is imperative that any truly ‘science-based’ outlet communicate this uncertainty to readers. Science-Based Medicine has failed to do so.

Having mental health problems “under control” is key here, for it could have significant bearing on the claim that transitioning by adolescents reduces suicide and suicidal ideation. This is frequent claim for which there appears to be almost no evidence. The correlation could work the other way around: only those adolescents who have had therapy and thus low suicidal ideation are the ones who are allowed to transition.

But let’s proceed to Singal’s beef against Gorski and Novella. Again, if you have the time, I’d urge you to read his piece for yourself. He cites a lot of data, something Gorski and Novella don’t do.

Below I summarize Singal’s paragraph headers; each of which is followed by a substantial explanation in the article.

Problems in “The Science of Transgender Treatment” by Steven Novella and David Gorski

1). Novella and Gorski misinform readers about the difference between the DSM-IV and the DSM-5 entries for “gender identity disorder” and “gender dysphoria,” respectively.

2) Novella and Gorski argue that there is widespread adherence to the standards of care for youth gender medicine without providing any evidence that this is the case, other than referencing ‘countless’ interviews they neither quote from nor link to. They also misrepresent the World Professional Association of Transgender Health’s Standards of Care for the administration of hormones to adolescents.

3) Novella and Gorski badly misunderstand the nature of the desistance debate [JAC: “desistance occurs when adolescents grow out of their transgender identity as they age] and communicate a great deal of misinformation and undue skepticism about the desistance literature to their readers.

4) Novella and Gorski badly misunderstand Hall’s concern about regret.

What they mean is that the data on whether transgender people regret transitioning comes from a different group from the one that Shrier and Hall consider (adolescent girls).

5) Novella and Gorski write off Lisa Littman’s study of rapid onset gender dysphoria as “bad science” without explaining why or engaging with Littman’s own rather credible defense of her work, and they engage in some methodological cherrypicking in order to do so.

6) Novella and Gorski falsely report the result of one study and ignore the fatal weaknesses in another.

These problems involve citing studies of gender-affirming outcomes in adults as if they had anything to say about gender affirming outcomes in adolescents with ROGD.

7) Novella and Gorski conclude their article with a profound exaggeration of the available evidence for youth gender medicine that is completely out of step with what the evidentiary reviews conducted by major medical institutions in multiple countries have found, and make no attempt to explain how they came to such a different, more optimistic conclusion.

So, according to Singal, who gives a lot of the data that contradict Gorski and Novella’s claims, there are problems with their analysis of data, with selective citation, and even with ignoring data they don’t like. Singal makes a compelling case, and he ends with these words:

When it comes to hormones for gender dysphoric youth, it’s pretty remarkable to compare the assessments of Steven Novella and David Gorski with those of NICE.

Novella and Gorski: “[T]here is copious evidence supporting the conclusion that the benefits of gender affirming interventions outweigh the risks.”

NICE [the NHS’s National Institute for Health and Care Excellence]: “Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria.”

What evidence are Novella and Gorski drawing upon that NICE missed? They should explain this striking discrepancy. And they should transparently correct their article where corrections are warranted, as well as add numerous points of elaboration and clarification. If they don’t, they will mortgage even more of their site’s long-term credibility than they already have.

This, of course, is not the end of the issue. Neither Gorski nor Novella are shrinking violets, and I’m sure they’ll defend themselves vigorously. But what they can’t do is produce data that don’t exist.

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.

Steven Novella and David Gorski defend their removal of Harriet Hall’s book review (the book: Irreversible Damage by Abigail Shrier)

July 2, 2021 • 9:15 am

On June 22, I reported here that the site Science-Based Medicine (“SBM”) had removed from its site a book review written by one of its editors, Dr. Harriet Hall. I characterized this removal as an “unfair deplatforming” and suspected that the review, of Abigail Shrier’s book Irreversible Damage (about the dangers of medically treating young children—mostly girls—to affirm their new gender identity as boys), had been removed because of public pushback.

The explanation below for the removal, by SBM founders Steven Novella and David Gorski, takes issue with those reasons for removal, and spends most of its space defending the removal on the grounds that, by making erroneous scientific statements (many based on Shrier’s contentions), Hall’s review had violated the strict scientific/medical standards of the site. (Hall’s review is still available at other sites, like this one.)

I haven’t yet read Shrier’s book, but I did read Hall’s review and this post by Novella and Gorski, and so we’re left with dueling opinions.  I don’t really have a dog in this fight (my main concern about transgender issues involve law and ethics, not medicine), and so I’ll suspend judgment for the nonce, even after I do read Shrier’s book. The issues at hand involve reading many, many scientific papers as well as having some medical expertise; the first I am unwilling to do and the second I don’t have. There will be at least one more installment of this SBM “explanation” involving more arcane medical issues.

I recommend that readers read Shrier’s book for themselves as well as the upcoming series of SBM articles, which take serious issue with Shrier’s claims.

Ultimately, this is an issue that the public and the courts must make, but one that must rest heavily on medical and psychiatric data. Whatever you conclude, I think that the publication of Shrier’s book and of Hall’s review were useful for two reasons. First, some of their claims might be correct; even Novella and Gorski agree with Shrier and Hall that much of the research on treatment for transgender children is anecdotal and needs more rigorous studies. Second, it’s only this type of back-and-forth that will clarify the empirical issues under contention, and (I hope) ultimately lead to their resolution. I note, though, that this hope may be vain given the ideological maelstrom around the topic.

But let’s proceed: click on the screenshot to read.

First, Novella and Gorski argue that Hall’s piece was published without review because she was one of the site’s editors (and remains so), but concerns were raised by themselves and other editors that ultimately led to the retraction:

Two weeks ago, one of our editors published a book review that raised concerns with Dr. Gorski and me, as well as at least one other editor, soon after it published. Reading it, we both feared that this book review had probably strayed beyond evidence or expert opinion and thus required a robust response. This was a review of a book by Abigail Shrier titled Irreversible Damage: The Transgender Craze Seducing Our Daughters. This particular book discussed a complex area of medical practice that also happens to be one embroiled in heated political debate. Because of the context of this topic, we believed it especially critical that SBM be perceived as a politically neutral and reliable source of information about the relevant science. Unfortunately, Dr. Hall’s fellow editors were concerned that the review in question did not achieve this goal.

Our first step was to carefully review the article and then discuss our concerns directly with Dr. Hall to hopefully find a solution. The challenge here was that, while we had enough background knowledge to immediately see there were serious problems with the review, none of us are topic experts. Reviews outside SBM by those with expertise in this area seemed to be making valid scientific criticisms of the opinions and claims in Ms. Shrier’s book, which the review took at face value.

Clearly what we needed was time to do a deeper dive on this complex controversy, to wrap our heads around the published evidence, and to vet the claims and arguments on both sides. This is something we would have preferred to do prior to publication, but we no longer had that luxury. Giving an immediate half-baked analysis would not do SBM readers justice. Ultimately, we decided to hit the “pause” button, to withdraw the review for a time while we consulted outside experts and did our own internal review. Since Dr. Hall indicated she would publish her article on an alternate site (and immediately did), we saw no pressing need to leave the article on SBM while this review was underway.

Novella and Gorski (N&G) are highly respected men, and I have no reason to doubt this explanation, so I won’t argue that pressure for social media had anything to do with the retraction.

And here are the claims that Novella and Gorski make about Shrier and Hall’s (S&H’s) putative errors. The characterization of their criticisms are mine, as well as the comments.

a.) S&H argue that the recent rapid increase in the proportion of adolescents seeking transgender transitioning is due to social contagion. That is, S&H claim that it’s become more acceptable to declare that you’re a transgender person, for which you get a lot of affirmation and support, than to say (if you’re a girl) that you’re a tomboy or a lesbian. 

N&G deny the social contagion hypothesis, and say that the increase (which they deny is higher than fourfold) can be solely attributed to both better diagnoses (like autism or ductal carcinoma), and to the number of children and adolescents reporting to gender clinics. This is possible, but I do not rule out social contagion as a contributing factor, especially when one sees the strength of “affirmation” when you say you’re transgender.

b.) S&H neglect the rigorous “standards of care” for children claiming gender dysphoria. And indeed, the World Professional Association for Transgender Health has a list of standards (reproduced in N&G’s piece) that seem rigorous and reasonable, with the possible caveat that use of hormone blockers to stall puberty may not be “fully reversible”. Otherwise, they seem reasonable, so long as the adolescent (and there must be an age limit for medical intervention) has been fully informed of the benefits and risks of medical transition rather than simply subject to affirmation. Similar standards are, say N&G, promulgated by The Endocrine Society.

I have no issue with the standards, though we have to be mindful of what even N&G say:

Of course, these are standards, and not every practitioner adheres perfectly to the standard of care in any aspect of medicine. But we don’t take outliers and use that to criticize the standard or pretend it is typical or common. Interviews with those involved in transgender care indicate that adherence to rigorous standards as outlined above are the norm.

But the question is really how many practitioners adhere to these standards? Shrier, I believe, argues that there are too many exceptions, and I simply cannot judge, nor can anybody. Given the fact that some transgender children get puberty blockers or hormones on the black market, it would be hard to answer this question.

As for whether puberty blockers are “fully reversible”, as the medical standards insist, I’m not so sure about that. Here’s an except from a recent NYT article on puberty blockers (I haven’t listed all the possible harms described in the article, and note of course that there are the psychological benefits of transitioning):

What are the risks?

Puberty blockers are largely considered safe for short-term use in transgender adolescents, with known side effects including hot flashes, fatigue and mood swings. But doctors do not yet know how the drugs could affect factors like bone mineral density, brain development and fertility in transgender patients.

The Endocrine Society recommends lab work be done regularly to measure height and weight, bone health and hormone and vitamin levels while adolescents are taking puberty blockers.

A handful of studies have underscored low bone mineral density as a potential issue, though a 2020 study posited that low bone mineral density may instead be a pre-existing condition in transgender youth. Treatment with gender-affirming hormones may theoretically reverse this effect, according to Endocrine Society guidelines. . .

The impact of puberty blockers on brain development is similarly hazy. The Endocrine Society guidelines point to two studies: A small one published in 2015 showed that the drugs did not seem to impact executive functioning (cognitive processes including self-control and working memory), while a 2017 study of rams treated with GnRH agonists suggested chronic use could harm long-term spatial memory. (Of course, rams are not humans.). . . . .

c.) Gender dysphoria is not a “disorder” like anorexia. N&G argue that, unlike anorexia, gender dysphoria shouldn’t be seen as a psychiatric disorder because the word “disorder” implies that the condition should be cured—and not by allowing gender transitioning. Frankly, I don’t care what you call gender dysphoria, nor do I think that it automatically has to be “cured”, for surely many children do have a deeply ingrained feeling that they are in the wrong body, and many feel better when they do something about it. But using the DSM (the Diagnostic and Statistical Manual of the American Psychiatric Association), which reclassified gender dysphoria from a disorder to “not a disorder” between the DSM IV and DSM V, doesn’t reassure me. The DSM is a pretty subjective and arbitrary way of “diagnosing” mental conditions. I’ve read a fair amount of it and am not speaking from ignorance.

And there are the comorbidities of gender dysphoria: mental illness that often goes along with the condition, both before and after transitioning. These may be correlates and not causations, but it’s worrisome that these conditions often go together. And even if they are merely correlated, one cannot automatically (as many do) argue that gender-dysphoric children must transition because otherwise they’ll kill themselves, or that, after transitioning, a higher rate of suicide among transgender people is evidence that they’ve been harassed to the point of suicide.

d.) Hall’s claims about the proportion of children who “outgrow” gender dysphoria conflates prepubescent children with adolescents. Based on what N&G say, this is a fair criticism. Hall does this conflation, they say, when asserting that some transgender children “outgrow” their desire to have a new gender identity.

e.) S&H, claim N&G, exaggerate the number of adolescents who regret having transitioned.  N&G say the incident of “regret” is 1% or less.

f.) N&G argue that overall, people who transition between sexes are generally happier. They cite several studies showing “a significant improvement in psychological functioning” after a year, as well as a decrease in suicidal ideation and improved quality of life.  I have no quarrel with this, and it’s an important finding.

N&G have a long discussion which goes into other issues, but I think I’ve hit their main issues above. I am trusting that they are fairly representing the literature rather than just citing data that support their claim that transitioning is a good thing that should generally be supported. Because I don’t know the literature, one should leaven this trust by reading Shrier’s book and looking at her own references.

In the end, I have no issue with applying accepted standards of care to adolescents who wish to transition, as well as waiting until they’re of a proper age of consent. I don’t know what that age should be, but it can’t be 2 or 4 years old, and if it’s after puberty, say 16-18, it’s already too late for a nearly full medical transition. The British High Court recently ruled that children under the age of 16 are too young to give informed consent for the use of puberty blockers unless they have parental consent.

In the end, this argument is above my pay grade, though I’ll continue reading about it. In the meantime, the “agreement” between N&G and S&H comes down to this:

Where we agree with Dr. Hall is that the current state of this evidence is far from ideal. Mainly for practical reasons, most of this research is not blinded or controlled. To put this into context, however, most surgical interventions are not studied in blinded trials, and sham surgical interventions are rare. You cannot blind a trans individual to whether or not they received a gender affirming intervention.

But we do agree that given this reality, we need to continue to study and monitor such interventions for both medical and psychological outcomes. This is where an informed medical and ethical discussion should take place, balancing the risks and benefits of interventions given the limitations of the research. There is also a meaningful ethical conversation to be had about the proper age of consent and balancing that with risks vs. benefits of gender-affirming interventions.

In other words, it’s the familiar ending of science papers, “More work needs to be done.” But that’s cold comfort for children who have gender dysphoria now. And it does say that some of Shrier’s contentions are credible and worth investigating.

 

h/t: Jay

Are we playing into the hands of the Right by criticizing the excesses of the Left?

June 29, 2021 • 11:15 am

Gallup poll: American’s view on the rights of transgender people

June 28, 2021 • 11:30 am

I suspect that this new Gallup poll is evidence for an increase in morality—at least in the legality of transgender people serving in the American military. Although the month-old Gallup survey below shows a slight decrease in favoring that ability between 2019 and 2021, I’m betting that the “favoring” figures would have been much lower several decades ago.  This change in attitudes, if I’m right about what I just said, mirrors the increasing acceptance of gay people serving in the military, not to mention Americans’ increasing approval of the legality of gay marriages.

Click on the screenshot below to read:

Serving in the military (data below): Except for Republicans, most Americans favor openly transgender people being able to serve in the military. Liberals, of course, favor it more, and women more than men. As expected, the older one is, the less likely one is to favor military service of transgender people. Transitioning is largely a modern phenomena, and is increasing rapidly among the young.

The question is why in every group save Republicans the degree of favoring has gone down a bit in the last two years. I don’t understand why, but Gallup says that they have “routinely found shifts in public opinion, particularly among political independents, during presidential transition periods — as has been the case for approval of the Affordable Care Act and support for labor unions.” But if this decrease is a sour-grapes reaction to Trump’s defeat, why did the Republican figures remain unchanged while Democrats lost one percent and independents 12 percent? Gallup adds that this level of support is similar to that seen for gays and lesbians serving in the military between 2004 and 2010, before the “don’t ask, don’t tell” policy was repealed.

Click on all screenshots to enlarge them.

Sports participation by transgender people. The data are below. Here the sentiment runs against transgender athletes being able to play on teams that match their gender identity and in favor of playing on teams that match their birth gender (they mean “birth sex” here), except among Democrats, who favor gender-identity participation by 55%. Again, older people tend to favor participation matching your birth sex, while Democrats and independents are more pro-transsexual participation than are Republicans—and the difference is large.

I think this question could have been asked in a better way, and in two senses:

a. Should transgender women be allowed to play on sports teams that match their current gender identity (i.e., women’s teams) rather than their birth sex?  After all, that is the big question. (You could also ask this for transgender men playing on men’s teams.)

b. Should medically untreated transgender women (or men) be allowed to play on sports that teams that match their current gender identity rather than their birth sex? (You could ask the same question for those who have undergone hormonal treatment and/or surgery. In terms of average strength, bone density, and muscle mass, untreated transsexual women should be expected to be similar to men.

Do you know someone who’s transgender? The data are below:

69% of American adults do not know someone who is transgender, but in the 18-29 age group, half of Americans do. That’s because transgender identity is a phenomenon increasing mostly in young people. The older you get, the less likely you are to know someone who’s transgender.

As for whether knowing someone changes your views, the answer is yes. As Gallup says:

Views on transgender athlete policies and right to serve openly in the military are slightly influenced by whether respondents personally know a transgender person. This is similar to what Gallup has found in the past about Americans who personally knew a gay person and their views on gay issues.

Those who know someone who is trans (40%) are more likely to say trans athletes should be able to play on a team of their gender identity than are people who do not know someone who is transgender (31%). Similarly, those who have a transgender person in their life (74%) are more supportive of transgender people’s right to openly serve in the military than are those who do not know someone who is trans (62%).

Given this, the age difference in whether one knows a transgender person predicts that, as time passes, there will be more sympathy for transgender issues, including the military and sports issues. Although the two-year data on military service shows a slight decline in support, I’m convinced that it will increase in the next decade.

And that’s as it should be, at least in my view. Society is better if people are given the chance to fulfill their hopes and dreams.

The sports question is a much thornier one, but ideologically-based reactions that don’t take physiology and sex differences into account may lead to an increase in support for unconditional favoring of transgender women to participate in women’s sports.

The lesson—an old one (see here)—is that if you know someone, you’re more likely to sympathize with their views and their identity. I would take this as militating against the increasing segregation of ethnic groups in colleges, like race-segregated dorms, euphemistically known as “affinity housing”. I think we should try mixing people up rather than separating them by ethnic, religious, or political affinity.

h/t: Enrico

Science-Based Medicine unfairly deplatforms a book review

June 22, 2021 • 9:20 am

Ginger K. called my attention to what seems to me a violation of ethical and journalistic standards by a respected website, all in the name of appeasing the woke. Science-Based Medicine, whose editors include David Gorski and Steve Novella, is a site designed to promote the kind of medicine described in its title, as well as to debunk medical woo. I haven’t read it often, but I’m sure a lot of readers have, and I know the site is greatly respected.

So much the worse, then, that the site removed a book review written by another respected physician, Harriet Hall, known for being one of the Air Forces’s first women flight surgeons as well as a notable advocate for science based medicine and a vociferous debunker of quackery.  And—get this—Hall is one of the journal’s five editors.

Hall’s “mistake” was to write a fair and objective review of Abigail Shrier’s new book, Irreversible Damage (see my post here)  about the sudden increase in transgender males drawn from teenaged girls. (The numbers have increased 4,400% from 2008 to 2018!) Shrier and Hall, who admittedly note that there are very few studies about why these transitions have skyrocketed, and involve nearly all girls who want to transition to males rather than the other way round, call for more research and argue that transitions should be done under “a research setting”. From Hall’s review (it’s been removed, but the screenshot below will take you to an archived copy):

This book will undoubtedly be criticized just as Lisa Littman’s study was. Yes, it’s full of anecdotes and horror stories, and we know the plural of anecdote is not data, but Shrier looked diligently for good scientific studies and didn’t find much. And that’s the problem. We desperately need good science, and it’s not likely to happen in the current political climate. Anyone who addresses this subject can expect to be attacked by activists. Is ROGD [rapid onset gender dysphoria, a phenomenon discussed by Shrier] a legitimate category? We don’t know, since the necessary controlled studies have not been done. I fully expect Shrier to be called a transphobe and to be vilified for harming transgender people, and I’m sure I will be labeled a transphobe just for reviewing her book. [JAC: Yep, Hall got it right!]

She brings up some alarming facts that desperately need to be looked into. The incidence of teen gender dysphoria is rising and appears to be linked to internet influences and social peer groups. The number of people identifying as lesbians is dropping. Therapists are accepting patients’ self-diagnoses unquestioningly, and irreversible treatments are being offered without therapist involvement. We know at least some of these patients will desist and detransition, and we have no way to predict which ones. Children are being instructed in how to lie to parents and doctors to coerce them into providing the treatments they want. Families are being destroyed.

For what it’s worth, I will stress again that I am not a transphobe. I support hormones and gender surgeries for adults who will benefit from them. I care about the welfare of these adolescent girls and it bothers me that some of them may be unduly influenced and take irreversible steps they will later regret.

What to do? I think limiting surgeries to a research setting is a good idea. I think the affirmative care model is a mistake and a dereliction of duty and should stop.

Shrier’s hypothesis is that many of these girls who want to transition do so without proper supervision, and are eagerly and uncautiously urged to do so by peers, some parents, and the medical establishment. Some, she says, may be doing so because of social pressure (presumably the status that transitioning confers) rather than gender dysphoria. Many, she thinks, might be lesbians (whose numbers have dropped precipitously), and some have wanted to detransition once the process is begun, though once you start taking puberty-blocking hormones—the first step in becoming a transsexual male—it’s usually too late. Shrier is not a transphobe at all and fully supports the rights of transsexual people, but is calling for careful evaluation, both sociological and medical, before the drastic step of medical intervention is taken. Instead, the standard is invariably “affirmation, which Hall summarizes in seven “matras” used by the affirmationists. (See her review for the list.)

Neither Shrier nor her reviewer Hall are transphobes, but now they are irrevocably typed as that. The ACLU staff attorney for transgender issues, Chase Strangio, has called for the banning of Shrier’s book from bookstores (odd for the ACLU, no?), and an uproar has arisen—all because Shrier is urging caution about a social phenomenon whose sudden increase demands scrutiny and investigation. To even deny the need for instant affirmation of a wish to be a boy if you’re a girl is to label yourself someone dedicated to eliminating transsexual rights or even advocating the genocide of transsexuals. That is hogwash, of course, and Shrier’s book and Hall’s careful review implicitly show that. She was instantly labeled a transphobe for not damning the book, and Science-Based Medicine got hundreds of outraged comments (see below).

At any rate, read the original version of Hall’s book review by clicking the screenshot below:

The reason Hall’s review was archived is because Science-Based Medicine retracted it—a review by one of its own editors! (I don’t expect Hall will be an editor much longer.) When you go to the site where the review formerly reside (click on screenshot below), you see this note:

I don’t fully believe Novella and Gorski’s claim that readers’ objections had nothing to do with the removal. What else would call their attention to opponents of Hall’s review? Since they didn’t vet the review themselves, how would they find out that the article was “below their standards”? Note, too, how they use the euphemism “quality control” for “censorship”.

I ask readers to look at Hall’s original review (and read Shrier’s book) and see where the “quality” falls off. Hall, after all, calls attention to the lack of research on the epidemic of girls becoming transgender boys, but the data on its prevalence, and the ubiquity and unquestioning nature of “affirmation therapy”, are undeniable.

On Bari Weiss’s Substack website Common Sense, Weiss allows Shrier to respond to Hall’s “cancelation” and her own demonization as the book’s author (click on screenshot below). There’s also a brief intro by Weiss herself; I’ll give one quote from that:

You do not need to agree with Shrier about whether or not children should be able to medically transition genders without their parents’ permission (she is opposed), or for that matter with Weinstein and Heying’s bullishness about ivermectin (I had never heard of of the drug before they put it on my radar). That’s not the point. The point is that the questions they ask are not just legitimate, they are of critical importance. Meantime, some of the most powerful forces in our culture are conspiring to silence them.

That is precisely the reason it is so important to stand up and say: no. To say: progress comes only when we have the freedom to disagree. To say: It is outrageous that tech platforms are censoring such debates and that some journalists are cheering them on. To say, in public: enough. In my case, that means making sure to publish those voices who have been shut out of so many other channels that ought to be open to them.

I’ll highlight just three bits of Shrier’s piece on Weiss’s site. First, the circumstances under which Hall’s review was removed from Science-Based Medicine were dubious:

On Tuesday, one of the blog’s long-time contributors, Dr. Harriet Hall — a family physician and flight surgeon in the Air Force with dozens of publications to her name — posted a favorable review of my book. She examined the scientific claims as well as the medical ones and wrote that the book “combines well-researched facts with horrifying stories about botched surgeries, people who later regret their choices and therapists who are not providing therapy but just validating their patient’s self-diagnosis.” Dr. Hall not only shared my criticisms of “affirmative care” — that is, immediately agreeing with a teen’s self-diagnosis of gender dysphoria and proceeding to hormones and surgeries — but also noted that many physicians and therapists feel the same way but are afraid to say so.

Within a day, Dr. Hall’s article was flooded with nearly 1,000 comments, mostly, she says, from activists demanding the article be stripped from the site, but also from some readers expressing their appreciation. Angry emails from activists swamped the blog’s editors. Within two days, those editors had given Dr. Hall an ultimatum: retract, rewrite, or allow them to add a disclaimer.

“What surprised me was that my fellow editors attacked me, too. Basically what they said was that my article was not up to my usual standards as far as medicine, science and critical thinking went. And I didn’t feel that I did anything but what I always do. That surprised me,” she told me. Considering the editors’ ultimatum, she elected to have the editors who disagreed add a disclaimer to the website. “I told them I did not want it retracted. And the next thing I knew, they had retracted it.”

Let that sink in: a book review by a respected physician was bullied out of existence in America.

Second, there are two copies of Shrier’s book in the Halifax Public Library in Canada, and a line of 146 people waiting to read them. Meanwhile Canadian activists are trying to bully the library into getting rid of the book. (So far the library has not relented.)

It’s not only corporations facing this type of activist pressure. Public libraries now do, too.

Halifax Pride, the annual LGBTQ festival, announced late last month that it would cut ties with the city’s library system over its insistence on carrying Irreversible Damage, calling it “transphobic,” and claiming that it “jeopardizes the safety of trans youth” and “debates the existence of trans people.”

So far, the Halifax Public Libraries have resisted. Their position is straightforward and apolitical: libraries exist to expose the public to the widest array of views, “including those which may be regarded as unorthodox or unpopular with the majority.”

The Halifax Public Libraries tried to compromise with the activists by pasting a note inside the book’s cover, directing readers to a list of “trans-affirming” resources. But the activists were unappeased. No ties with the libraries were restored. They want the book gone from the library and scrubbed from existence. Two copies in a library of nearly 1.2 million volumes are two too many. [JAC: I would suggest that readers buy more copies of Shrier’s book and donate them to the library so people won’t have to wait so long to read it.]

Not even the Nova Scotia Library Association or the Canadian Library Association has come to the library’s defense, though their standing orders explicitly require member libraries “to guarantee and facilitate access to all expressions of knowledge and intellectual activity, including those which some elements of society may consider to be unconventional, unpopular or unacceptable.”

The lack of support by the Nova Scotia Library Association and the Canadian Library Association are reprehensible. Librarians, famous for promulgating free speech and avoiding censorship or making books unavailable, should spring to the defense of the Halifax Public Library. I find it odious that the HPL has even pasted a note inside the books’s cover “directing readers to trans-affirming resources”. Do they do that with other books to which people object? This shows that there’s something about transsexuality that brooks no questioning of the tenets of its enthusiasts, or of “affirmationists”. The topic is simply taboo. If you don’t toe the line of the enthusiasts, you are a “transphobe.”

And what Shrier writes about is, as Weiss notes, worthy of discussion: it’s not like it’s Mein Kampf or anything (and even that book should be available in libraries).

Finally, Shrier (whose book I’ve publicly defended as something worth reading and considering) is now fed up with people supporting her via emails but not doing so publicly, nor revealing their names. She wants people to publicly affirm her right to write such a book, using their names.  The epidemic of transsexual boys is a phenomenon that needs to be examined, and if some young people are making irreversible medical changes in their bodies and lives without proper consideration, or proper caveats, well, that also needs to be examined.

The reasons for private approbation for Shrier but lack of public support is clear: nobody wants to be seen as a “transphobe”, just as nobody wants to be called a “racist.” Such is the power of demonizing labels. From Shrier’s conclusions:

Whether or not most people admit it, what keeps them from speaking up in the face of what they know is wrong is fear. Fear not primarily of unemployment, though that is a pressing concern, but fear of ostracism. This deep and ancient fear is behind our desperate reach for innocence and safety when we virtue signal. By contrast, we stand exposed when we speak unpopular truth. Within your tribe, there will be people who pull away from you, and if you think well of them — and sadly, even if you don’t — this causes pain.

. . . What can make it bearable? According to Professor Williams, getting yourself accepted by another group. This is also the way to confront most of life’s heartaches — surrounded by those you love. And there is no better way to gain respect from those you don’t already know than by being identified with truthfulness.

Fear of ostracism is rational.  But we are now living in a world in which evolutionary biologists are threatened with losing their platforms for engaging in debate about the source and treatment of a deadly virus; in which prize-winning composers have been professionally ruined for saying arson is bad; in which authors are editing already-published books to placate online mobs. That should scare us far more than losing friends or status.

So look to the Halifax Library. Summon what faith you can in those things you know to be right and true: a person is not defined by her race; biological sex is real; scientific research requires ideologically unencumbered investigation; activists shouldn’t bully libraries; and books should not be banned.

The first hundred or so silent supporter emails meant the most to me. They made me feel less crazy and less alone. But the inescapable reality is that defeating this ideology will take courage. And courage is not something that can happen in private. Courage requires each one of us to speak up, publicly, for what we believe in. Even when — especially when — it carries costs.

You are not a transphobe if you read Shrier’s book. You are not a transphobe if you read her book and see that it highlights a problem that needs to be addressed. You are not a transphobe if you refuse to call for the censorship of Shrier’s book. Those who sling about insults without addressing the problem Shrier discusses are not virtuous, nor are they “transphiles”. They are censors, pure and simple, and the embodiment of the Authoritarian Left. They are opponents of free speech, who think that some topics don’t need discussion because their own views are the right views. They are the Big Brothers of our time.

So, Ms. Shrier, here is my public statement of support for your book. My name is Jerry Coyne, and I think your book deserves to be read widely by anybody interested in the new onset of transsexual conversions. And I deplore the ad hominem arguments used to attack it.

Scottish law student persecuted for asserting that women have vaginas and are weaker than men

May 15, 2021 • 10:45 am

Yes, one can argue that transwomen don’t have vaginas, though the strength argument can be backed up with data. Both claims may offend some people, but in the present case they apparently weren’t intended to offend anyone, and, at any rate, nearly all arguments offend someone.

But the assertion given in the title of the Times article below is surely not one that warrants persecution of the speaker. Although the UK doesn’t have a first amendment, the student’s claims do constitute free speech. This being the UK, however, offending someone is illegal.  Click on the screenshot to read:

An excerpt:

Disciplinary action is being taken against Lisa Keogh, 29, over “offensive” and “discriminatory” comments that she made during lectures at Abertay University, Dundee.

The mature student was reported by younger classmates after she said women were born with female genitals and that “the difference in physical strength of men versus women is a fact”. The complaints have prompted a formal investigation into her conduct.

Keogh, a final-year student, fears that any sanction could end her dream of becoming a human rights lawyer. Her case is being backed by Joanna Cherry QC, the SNP MP for Edinburgh South West and deputy chairwoman of the Lords and Commons joint committee on human rights, who described the situation as farcical.

Keogh was astonished to receive an email accusing her of transphobic and offensive comments during seminars on gender feminism and the law. “I thought it was a joke,” she said. “I thought there was no way that the university would pursue me for utilising my legal right to freedom of speech.”

But she also said this in response to some pushback she got:

She was accused of saying women were the “weaker sex” and classmates were “man-hating feminists” when one student suggested that all men were rapists and posed a danger to women.

“I didn’t deny saying these things and told the university exactly why I did so,” she said. “I didn’t intend to be offensive but I did take part in a debate and outlined my sincerely held views. I was abused and called names by the other students, who told me I was a ‘typical white, cis girl’. You have got to be able to freely exchange differing opinions otherwise it’s not a debate.”

Keogh claims that she was muted by her lecturer in a video seminar when she raised concerns about a trans woman taking part in mixed martial arts bouts. “I made the point that this woman had testosterone in her body for 32 years and, as such, would be genetically stronger than your average woman,” she said.

“I wasn’t being mean, transphobic or offensive. I was stating a basic biological fact. I previously worked as a mechanic and when I was in the workshop there were some heavy things that I just couldn’t lift but male colleagues could.”

Even so, when a classmate says that “all men are rapists” and “pose a danger to women”, that is surely at least as offensive as what Keogh is accused of saying. But that classmate isn’t being persecuted, despite that claim also violating University speech codes (see below). And Keogh’s response about “man-hating feminists” can be justified as a response to that statement.

“The weaker sex” argument, though often applied to more than just physical strength, in which case it’s misogynistic, was clearly meant in this case to refer to physical strength and nothing more.

This is exactly the kind of academic issue that can and should be debated in searching for the truth, and certainly not silenced. Yet Keogh (though not the person who said “all men were rapists”) is liable to be prosecuted by the University’s speech code.

The university’s definition of misconduct includes “using offensive language” or “discriminating against gender reassignment”. Punishment can be as harsh as expulsion.

Keogh, a mother of two, fears for her future. “I don’t come from a legal background and have worked incredibly hard to get to where I am,” she said.

“I’m worried that my chance of becoming a lawyer, and making a positive contribution, could be ended just because some people were offended.”

I am baffled why saying that biological women are physically weaker, or have vaginas, can constitute “discrimination”, though we know that there is a strict party line here, and questioning it is more or less taboo.

Keogh has a lawyer on the case:

Keogh, a final-year student, fears that any sanction could end her dream of becoming a human rights lawyer. Her case is being backed by Joanna Cherry QC, the SNP MP for Edinburgh South West and deputy chairwoman of the Lords and Commons joint committee on human rights, who described the situation as farcical.

This case would never stand in a U.S. public university, as persecution of Keogh for speech is clearly a violation of the First Amendment. Nor would any private school be prosecutorial enough to go after Keogh, as they’d find themselves on the wrong end of the stick vis-à-vis FIRE or the Academic Freedom Alliance. Under no circumstance should mere “giving of offense” be construed as “misconduct” unless it is persistent, constituting harassment.  As for “discriminating against gender reassignment”, I can’t see Keogh’s remarks falling into that class, as there was no discrimination, simply an argument.

A new comparison of transgender and transracial identities

April 26, 2021 • 9:20 am

The question of how we compare someone like Rachel Dolezal, who assumed the identity of an African-American although she was white, with someone like Caitlyn Jenner, who transitioned from a male to a female, is a philosophically interesting ethical question that, unfortunately, has been declared almost taboo. If you even raise it, as Richard Dawkins or  philosopher Rebecca Tuvel did, you’re subject to a mass pile-on on social media and deemed a “transphobe”.

But regardless of how awkwardly you’ve asked the question, it’s still one worth pondering. If you change gender because you have a strong feeling that you’re in the wrong body, how does that differ from changing race if you have a strong feeling that you’re also in the wrong body, but one with the wrong pigmentation rather than the wrong gonads?  Just arguing that the former is “biological” and the latter is not doesn’t satisfy me, for in both cases you have neurological wiring that compels you to assume an identity other than the one you’re born with. (I’m assuming that these are genuine feelings.)

Nor does it help to say that you have to dissimulate being black if you’re white, so it’s deceptive to be “transracial”, and that is the relevant difference from being transsexual. But that doesn’t convince me, either. One could argue, for instance, that it’s also being “deceptive” to be transsexual if you don’t tell people that you’ve transitioned. And frankly, I don’t care if a transsexual person is open about it or not; it’s their decision and I’ll respect it, as well as using their chosen pronouns.

Further, I doubt that the people who raise the “deception” argument would fault a black person who tried to “pass for white” to escape oppression, or a person who is, say, one-quarter black—and on those grounds seen as “black”—pretend to be fully white, or just not say anything.

This is an interesting but a tough issue, yet it’s a question that progressives aren’t supposed to ask, as somehow it’s supposed to make you “transphobic.” But it’s not—it simply asks whether the same rationale that deems transsexuality perfectly fine can be used to justify transracialism.  I haven’t fully come down on either side, though I think that some people—and Dolezal may be one—are so invested in the idea that they’re of a different race that we might at least consider regarding them of that race. Many may not, particularly African-Americans in Dolezal’s case, but we still need to know why we think one is okay and the other flat wrong. If we decide that the arguments for regarding them as different are not convincing, we may have to change our opposition to transracialism. Again, I’m assuming that the feeling of being of the “wrong” race is genuine, strong, and persistent.

So when a reader pointed out an argument in the Boston Review about why these two cases are different, and why we should accept transgenderism but not transracialism, I read it carefully. You can, too, by clicking on the screenshot below:

The argument and article are long, and I don’t want to be long-winded here, so I’ll try to summarize their take. But there’s no substitute for reading the original piece.

The authors begin by attacking the argument that there’s such a thing as being a “real” member of a race, or of a “real” sex. This they reject as “essentialism” because there’s no trait that, they say, absolutely defines either one’s race or one’s sex. But they err here, for they conflate sex with gender. Their argument is that sex is not essentialist because there is no one character that pins down people as members of one sex or another. But there is: gamete size. In humans, as in other animals and many plants, sex is indeed virtually binary, although there are cases like hermaphroditism that are intermediate. These cases, though, are vanishingly rare, and biologists have no problem classifying nearly every human, just as we classify fruit flies or cats or birds, as “male” or “female”. Evolution has created this binary as a way to allow sex to take place, presumably for adaptive reasons. Thus Caitlyn Jenner, in her former incarnation as an athlete, was indeed a “real” biological male.

Race, on the other hand, is more subjective for many reasons: mixing of different groups, gene flow between groups, and a lack of discrete races the way we have discrete sexes. So the authors are correct that you cannot specify whether someone is a “real” Asian or a “real” black person. But they err when they say that essentialism crumbles when it comes to sex. And they move so swiftly from “sex” to “gender” in their paper that you barely notice it. Yet sex is important, for what does “transsexual” mean if not the transition from one sex to the other? Of course the transition is one based on something that is malleable: gender—your self concept.

But this is largely irrelevant, because the authors dismiss the “reality” argument in favor of another one that they consider strong.

The main reason they think that transracialism has no merit while transsexualism does is because they see both race and sex (conflated with gender) as not only socially defined, but socially malleable over time. Most important, they see making judgments about whether one category can be accepted and other other (transracialism) should rest on consequentialism or utilitarianism—whether the overall effect on society is good or bad. Allowing people to be transsexual, they argue, has no detrimental social consequences, while allowing people to be transracial does. (All quotes are indented):

Let us make one methodological comment at the start. When considering whether to revise rules for gender or race classification, we think that there are important considerations at both the population level and the individual level. While it is important and good to value a person’s autonomy and respect their identifications, we also think this good must be weighed against the population-level effects of revising our classifications. In cases where revising a classification would have a negative sociopolitical impact that outweighs the good of respecting how an individual identifies, we think that the classification should not be revised. And we think that revising the rules of race classification to accommodate transracial identification into Blackness is a case like this.

The main reason they see transracial identification as socially detrimental is because of reparations. If we want to make amends to a group because they’ve been oppressed for centuries (and I agree that we have to do something like this for groups like African-Americans), you have to identify the people who qualify for reparations.

Ergo, the reason why transracial people like Dolezal shouldn’t have their identities respected is that they should not qualify for any reparations to blacks because they haven’t experienced the historical oppression of being black, i.e., being seen as a member of the black community. (This, they say, is not a form of essentialism.) Why, then, should they benefit from assuming the identity of a black person? The authors conclude that accepting transracialism is detrimental to society.

From the article:

Now return to race. Being Black in the United States is similar to being a person who qualifies for IRSSA [Canadian “Indigenous Residential Schools Settlement Agreement] reparations in at least one important respect: being Black isn’t simply a matter of internal identification; it is also a matter of how your community and ancestors have been treated by other people, institutions, and governments. Given this, we think that race classification should (continue to) track—as accurately as possible—intergenerationally inherited inequalities. More directly, we need conceptual and linguistic tools for identifying those who are entitled to reparations for racial wrongs, where by “reparations” we mean institutional correction of intergenerational inequality. These might include, but are not limited to: affirmative action in employment and education; compensation for past economic and personal exploitation; debt-cancellation for affected populations; medical, home buying, and college aid; institutional apologies for past harms; and the creation of a standardized curriculum which explicitly addresses the role of racial oppression in state-building.

Central to this argument, then, is the observation that in the case of Blackness, inequality accumulates intergenerationally. For example, according to the Centers for Disease Control and Prevention, Black women born in the United States are three times more likely to die from pregnancy-related complications than white women. What explains this? Arline T. Geronimus, public health researcher and professor at the University of Michigan’s Population Studies Center, has argued using a series of empirical studies that the intergenerational effects of racism explain a number of decreased health outcomes for Black Americans, including lower birth weights and higher rates of pregnancy-related complications for Black women. Geronimus famously termed this phenomenon “weathering,” a term that refers to the idea that “Blacks experience early health deterioration as a consequence of the cumulative impact of repeated experience with social or economic adversity and political marginalization.”

This assumes of course that there must be compensations or reparations of a sort, and I have no quarrel about that, though others might.

Now I’m not sure about their claim that “inequality accumulates generationally,” for surely it does not. While there is clearly inequality between blacks and whites that is largely a holdover from slavery, I don’t see the inequality as increasing or “accumulating”.  Legal separation, for example, is completely gone. The fact that there is inequality, and that it’s a holdover, is sufficient to make a good argument for some form of reparations (I see affirmative action in colleges as one form of this). And yes, it does seem wrong that if there are reparations for black people, that Rachel Dolezal should be included.

But shouldn’t she? I’m not going to argue that point strongly, but by becoming a member of the black community she has subjected herself to same historically-inherited racism that devolves upon all members of that community. And she has done so without coercion by others. (She was indeed seen and accepted as black.)

You might be asking yourself at this point, “Well, women have experienced the same historical discrimination, so aren’t some reparations are in order here as well.” (I agree again, in that there should be some attempt to compensate for historical sexism.)

So what’s the difference? If a transracial person doesn’t deserve reparations because their original race wasn’t historically oppressed, doesn’t that apply to transsexual women as well? If Rachel Dolezal shouldn’t benefit from affirmative action because her “group” is wrong, should transsexual women be able to benefit from reparations given to biological women, like those assured by Title IX?

Dembroff and Payton don’t seem to think so, because, unlike racism, they see sexism and oppression of women as different—because sexism does not accumulate intergenerationally:

Notice that this argument does not apply in the case of gender and gender inequality. Gender inequality, unlike racial inequality, does not primarily accumulate intergenerationally, if only for the obvious reason that the vast majority of households are multi-gendered. While parents often are responsible for ingraining patriarchal ideas and rigid gender norms in their children (it is extremely difficult to avoid!), this is not a “passing down” of socioeconomic inequality itself but, rather, of a socialization that perpetuates gender inequality.

This seems to me a distinction without a difference. If one passes down socialization that perpetuates inequality, is that really different from the passing down of socioeconomic inequality itself, which after all is said to derive from racist attitudes? In both cases (and I think Kendi would agree with me for race), there are social attitudes passed down that perpetuate oppression. And in both cases the inequalities need to be rectified. The authors go on to explain the difference further, but it doesn’t convince me any more:

Notice that this argument does not apply in the case of gender and gender inequality. Gender inequality, unlike racial inequality, does not primarily accumulate intergenerationally, if only for the obvious reason that the vast majority of households are multi-gendered. While parents often are responsible for ingraining patriarchal ideas and rigid gender norms in their children (it is extremely difficult to avoid!), this is not a “passing down” of socioeconomic inequality itself but, rather, of a socialization that perpetuates gender inequality.

Perhaps I’m missing something, but whether or not inequality accumulates intergenerationally or arises anew each generation because of attitudes that carry on intergenerationally seems irrelevant.

I’ll draw my discussion to a close with just a few remarks. Yes, it does seem wrong for someone like Rachel Dolezal to benefit from reparations. But is it okay for transsexual people to benefit from reparations? After all, a transsexual woman like Caitlyn Jenner never experienced misogyny like many biological women do.

It may be the case that society would be worse off if everyone were allowed to assume the race they wanted than if transsexuals were allowed to become the gender they wanted, but I’m not talking here about mere “I feel like I’m black” transracial folks. Presumably the feeling would have to be honest, persistent, and deep-seated—just as people who want to switch genders are examined by psychiatrists and doctors before they are allowed to transition. It’s never a matter of mere assertion; it has to be something that is real and embedded in one’s persona and psychology.

Dolezal may be a genuine case of transracialism. Nobody accepts her as black, but if we reject her blackness, I think we need reasons for it that are better than, “she’s not a real black person” or “she shouldn’t be qualified for reparations, because she’s claiming to belong to a group in which inequality accumulates over generations.”

I got the sense from this article that the authors had a preordained conclusion they wanted to support, and then adduced some unconvincing arguments (at least to me) to arrive at this conclusion. But given that much of society has reached the conclusion that, for sex, you are who you feel you are, it’s incumbent upon us to find relevant differences between that attitude and one that allows the same possibility for race—or even other characteristics.

As I said, I remain open to arguments for accepting transsexualism but not transracialism. I just don’t think that this article is that home run argument. There are surely deep gut feelings behind our drawing distinctions here, but I don’t think these authors have brought those feelings to light, nor do I know what they are. They need to be aired.

If you want to read further about this, have a look at the paper that got Rebecca Tuvel in trouble. Click on the screenshot below: