Gender and the Media

How will the debate on gender medicine unfold in the next year?

The year 2022 saw some small breaks in the lock step uniformity with which the liberal and moderate conservative media in North America has covered gender medicine.  There have been investigative reports and commentaries in the New York Times, the Washington Post and Reuters which discuss detransition and raise concerns about how teens as being given hormones and surgeries without adequate psychological assessment. The transgender activist community is furious and it is encouraging to see that their outrage is, so far, having little effect.

However, a few articles do not make for a debate. The articles to date have been mostly very good. They strive to be balance, which is essential to get them published, but they also miss out critical elements of the case against the current affirmative model. In order to begin a real debate four things need to happen.

Hear from the Opposition

A debate needs debaters on both sides but, so far, the liberal media has not been willing to acknowledge the real critics of the gender affirming model. The articles in the New York Times and Reuters quote members of the gender affirming establishment like Erica Andersen, Marci Bowers and Laura Edwards-Leeper who have recently called for a slightly more cautious approach to medical transition of young people.

 There have been very few reports in the liberal media that are willing to engage with the deeper criticisms of affirming care raised by clinicians associated with the Society for Evidence Based Gender Medicine or the Gender Exploratory Therapists Association. One of the few recent exceptions is an article by Rich McHugh of  News Nation which quotes Dr. Julia Mason, one of the founders of SEGM, and Marcus and Susan Evans from the United Kingdom.

Part of the problem is that the media naturally looks for experts with practical experience. Activist clinicians have created a situation in many jurisdictions where it is virtually impossible to work with gender dysphoric minors unless you are an unquestioning supporter of the affirmative care model. Critics are faced with the choice of following a care model they believe harms patients, risking prosecution under conversion therapy laws or avoiding cases of gender dysphoria entirely.

The growing number of detransitioners may eventually change this situation. Detransitioners need ongoing care and the professionals who care for them will be able to speak to the harmful effects of gender affirming care from first hand clinical experience. The recent interest in detransitioners by some advocates of the gender affirming model is no doubt at least partly explained by the hope that it will be possible to avoid this situation by treating detransitioners within the existing clinical model.

Meanwhile, there are critical professionals willing to speak, if the liberal media would talk to them. Many “old guard” clinicians like Ken Zucker, Ray Blanchard and Stephen Levine, with decades of experience working with transgender patients of all ages, are still active and willing to speak out. There is also a “new guard” of clinicians like Sasha Ayad and Stella O’Malley who have experience working with the new population of gender questioning teens.

Critical voices exist, but the liberal media is still reluctant to reach out. The larger problem may be that the liberal media has spent the last five years or so insisting that there is no debate on this issue and anyone who says otherwise is a transphobe and a bigot. It is hard to walk back from that position without losing face.

Sometimes the omissions seem deliberate. The Reuters article on detransition by Robin Respaut, Chad Terhune and Michelle Conlin is obviously the product of thorough research.  The article refers to a research paper on detransition prepared by Elie Vandenbussche. While the Vandenbussche article is good, the Reuters report fails to mention a similar study by Lisa Littman. This is strange when you consider that Vandenbussche is a social sciences student with a BA while Littman is an experienced medical doctor and public health researcher.  However, referring to Littman would mean giving her credibility to her work on rapid onset gender dysphoria and social contagion. This is still a bridge too far for the liberal media.

Eminence to Evidence

Failing to engage with the real critics of gender affirming care means that the media is missing a key component of the debate: the poor quality of the research supporting the affirmative model. Mainstream articles will now usually refer to the studies in Finland, Sweden and the United Kingdom which found that the evidence supporting gender transition of young people is low quality but no one is prepared to admit how bad the research really is.

 A recent article by Ema Abbruzzesse, Stephen Levine and Julia Mason entitled “The Myth of ‘Reliable Research’ in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed” makes this abundantly clear. The starting point for medical transition of minors is two studies conducted at the gender clinic in Amsterdam and published in 2011 and 2014.  The first article assessed the effects of puberty blockers on a group of 70 gender dysphoric teenager. The 2014 article assessed 55 members of this same group after gender reassignment surgery.

The main measurement of outcomes on the study was something called the Utrecht Gender Dysphoria Scale. This was a series of statements with which the patients were asked to agree or disagree on a scale of one to five. There were separate sets of questions for males and females. The problem with the study is that before treatment the patients were given the questions for their birth sex. After treatment they were given the questions for their desired sex. For example, the first question for natal females is “I prefer to behave like a boy.” After gender reassignment surgery the same patient would be given a survey where the first question reads, “My life would be meaningless if I would have to live as a boy.”

The study did not take into account the 15 members of the initial cohort who did not complete the post-surgical study. One patient in this group died as a result of complications of a vaginoplasty. This represents a mortality rate of 1 out of 70 or 1.4%, which would be cause for concern in any normal research program.

Only patients who experienced gender dysphoria in childhood and did not have other uncontrolled mental health issues were included in the study. This means that the study results cannot reliably be applied to the current patient population who often do not experience gender distress until puberty ,and have major comorbid mental health conditions.

The one-year post surgery follow up is very short for a treatment with lifetime consequences. There was no control group, no attempt to eliminate psychotherapy as a confounding factor and no consideration of physical health. Subsequent studies have not been an improvement.

The only American journalist who has consistently challenged the claims that pediatric medicine is evidence based is Jesse Singal. He has been willing to look behind the confident statements of the “big dog” medical organizations that puberty blockers and cross sex hormones are safe and effective and scrutinize the actual studies. His work is exceptionally thorough. In order to expose the flaws in a recent study from the University of Washington he consulted with a leading expert in bio-statistics. It was encouraging to see an article by Jonathan Chait in New York magazine acknowledging his work.

While Jesse Singal deserves special recognition for his investigative work, Jack Turban deserves a dishonourable mention for the number of flawed studies he has foisted on a credulous media. Turban has published a series of articles in various medical journals on the alleged association between “conversion therapy” and suicidality, the benefits or puberty blockers and detransition all based on the 2015 U.S. Transgender Survey. Each study received wide publicity in the mainstream press. All of these studies suffered from errors in methodology that should be obvious to anyone with a basic knowledge of statistics and research methods.

The flaws in Turban’s work have been exposed in detail in readily available articles like this one by Michael Biggs on the puberty blockers study and this one on the conversion therapy study. The transgender survey is a non-random sample which cannot be used to support population wide conclusions. A survey which an advocacy organization conducts of its membership base will tend to generate answers that support the agenda of the organization. Jesse Singal discusses Turban in this article which accuses the media of “gross negligence” in their coverage of gender reassignment.

There is some hope that the media is reaching peak Turban as the distortions in his work are becoming too obvious to ignore. Last October, Psychology Today actually revised an article by Turban which claimed that 16 studies supported mental health benefits from gender affirming care after a fact check by Leor Sapir of the Manhattan Institute showed that Turban and oversold or misrepresented the results of several studies. When the mainstream media starts asking Turban some hard questions, or better yet, stops treating him as a reliable source, the gender debate will truly have begun.

Unpacking the LGBTQ

The third thing that needs to change before there can be a meaningful debate on gender medicine is to jettison the meaningless initialism 2SLGBTQIA and all its variations. You cannot have a worthwhile discussion if you cannot even agree on what you are talking about. The list of initials is constantly changing. Even groups that promote the initialism are not always clear on what each initial means. Does “Q” stand for queer or questioning? The “A” could refer to asexual, aromantic or agender.

The label is meaningless for scientific and clinical purposes. It is simply a political tool and even there it does not describe a consistent community of interest. The main function of the LGBTQ2S+ initialism is to support a strategy of repressing debate through confusion and equivocation. Transgender activists have successfully engaged in forced teaming by attaching their demands to the much more popular political program of the lesbian gay and bisexual community.

A serious debate on gender needs to start with the recognition that lesbians, gays, bisexuals and transgender are different communities with different medical and social needs and that these needs can come into conflict.

Homophobia is hiding in plain sight in many gushing mainstream media accounts of trans kids. Parents who cannot accept the thought of a lesbian, gay or even slightly gender non-conforming child are quite happy to risk their child’s health, fertility and future sexual function to create the appearance of the opposite sex.

The problem in the United States is that there has been forced teaming on the gender critical side too. Radical feminists, lesbians and concerned medical professionals have had work alongside the religious right to campaign for restrictions on gender medicine and protection of women’s sports. Gays and lesbians are naturally wary of groups who have been actively campaigning roll back their hard-won rights.

End Game

Once the media starts to understand the distinction between accepting same sex attraction (the LGB) and denying the material reality of sex (the TQ), the final step is a short one. That is to acknowledge that concern about gender medicine is not simply a right wing talking point and that there is concern at all points on the political spectrum.

Real reform in gender medicine is going to have to be bipartisan. In the United States, the chance of electing conservative Republican majorities in states like New York and California are virtually nil. In Canada, where no major party questions the transgender agenda, the challenge is even more difficult.

So how do you get politicians to change their minds? On Twitter, you can find a lot of lifelong liberals or socialists declaring themselves politically homeless or vote Republican or Conservative. They are not a factor.  If gender ideology is harming a person’s career, health or the health of their children, it may be the most important issue in their life. However, people like this are in a tiny minority. Most committed party supporters, even if they agree with them, will not care enough about this issue to change their vote. Furthermore, their votes is balanced off by the votes of committed transgender activists.

The challenge, and it is difficult, is to get the gender issue to register with the swing voters. Elections are usually decided by small numbers of voters in a few key seats. Politicians are frightened by swing voters because they are unpredictable. They are usually concerned about multiple issues and its hard to tell which one will push them to the other side. Once swing voters start to take even a little bit of interest in an issue, politicians can’t afford to take chances.

For uncommitted voters, the optics of a debate may count for more than the actual substance. In the gender debate, the optics for supporters of affirmative care are bad. The articles on detransition are exposing the extent of the harm caused by the affirmative model. Once the shoddy science that backs it up is exposed, more people will start to ask questions. Politicians who offered unconditional support to gender ideologues will look increasingly credulous and out of touch with their constituencies.

This seems to be playing out in the United Kingdom. Most of the Labour caucus just abstained from a vote on blocking the Scottish gender reform law.  This may not signal a change in policy but it at least shows that the party leadership wants to hedge its bets on gender issues.

However, we still have a long way to go before something similar happens in North America.. As I was finishing this article, the New England Journal of Medicine published a new study which claims to find that hormone therapy leads to improved mental health in trans youth. The study was enthusiastically promoted by ABC News and will likely receive similar coverage in other media. The study contains all the usual shortcomings of this kind of work. The follow up period was only 2 years while it can take 4 to 5 years for regret to set it. There was no attempt to control for other medications or psychotherapy as confounding factors. No improvement was found in natal males. There were 2 deaths by suicide in the study group of 315.  Jesse Singal has tweeted that he is going to write about the study and I am sure he will find many more problems. I am also sure that the rest of the media will ignore his concerns.

If the legacy media starts to report properly on the unfolding scandal of gender medicine, they will eventually have to examine their own culpability in allowing it to develop. There is still a hard struggle ahead.