Trans wrongs

American liberals are getting the message, belatedly, that serious mistakes have been made in the name of progress

Photo by Stéphan Valentin on Unsplash

Truth-telling time

Well, this is an interesting moment. Three major US media outlets—left-leaning and champions of “gender-affirming care,” by and large—have published solid articles unpicking the dogmas and delusions of extreme trans rights and puberty blockers.

On June 26, The New York Times had the headline “How the Gay Rights Movement Radicalized and Lost Its Way.” Meaning, it got badly misdirected by trans-queer ideology. The occasion for the article was the tenth anniversary of a judicial ruling that nationalised same-sex marriage in America, and the author, Andrew Sullivan, was a prime mover in that cause. (The newspaper had prepared the ground for him with a devastating investigative piece the week before by Nicholas Confessore: “How the Transgender Rights Movement Bet on the Supreme Court and Lost”.)

The same day as Mr Sullivan’s guest essay in The Times, The Washington Post published a confessional article by an East Coast liberal philosopher, Alex Byrne, confirming that he was among the anonymous authors of the gender dysphoria review commissioned—and not, it seems, in any way doctored—by the Trump-era US Department of Health and Human Services.

And then, last week, The Atlantic magazine allowed journalist Helen Lewis to utter some uncomfortable home truths in her article “The Liberal Misinformation Bubble About Youth Gender Medicine: How the Left Ended Up Disbelieving the Science.”

The immediate reason for this corrective coverage in the elite liberal press is the US Supreme Court’s refusal to bow down to the American medical establishment’s meme of an “overwhelming consensus” favouring “sex changes” for kids. In the Skrmetti case—involving one of many Republican state bans on hormonal and surgical transition of minors—the rights-driven, hyperbolic movement for gender-affirming care hit a wall.

The majority ruling handed down on June 18 didn’t only testify to poor legal argument. Like the rest of us, the judges have witnessed the steady accumulation of inconvenient facts, leaks and court depositions undermining the gender clinic misinformation campaign. A self-proclaimed authority, the World Professional Association for Transgender Health (WPATH) has had its political agenda and allergic reaction to evidence-based medicine put on the public record. LGB people horrified by the reckless medicalisation of gender-nonconforming children have subtracted themselves from the LGBTQ+ movement, whose “no debate” edict was calculated to shut down an international medical controversy.

The plus symbol in their damaged brand should include the once-revered American Civil Liberties Union, whose lawyer Chase Strangio led the charge against state bans in Skrmetti. Maybe it was unwise to look to this person—a woman who identifies as a man—for persuasive arguments; Mr Strangio once sought to win over sceptics of Transworld by insisting that “a penis is not a male body part. It’s just an unusual body part for a woman.”

That kind of meat-Lego mania had no hope of mainstream acceptance, and it was flatly contradicted by President Trump’s executive order in January “defending women from gender ideology extremism” and affirming “biological truth”. Less predictable, perhaps, was his administration presiding over a meticulous review of the (lack of) evidence for paediatric medical transition—400 pages of it served up with measured language and no Trumpian tirades. Even so, as you’d expect, its publication in May was ritually denounced as “anti-trans”. No doubt some thoughtful liberals are reading it in stealth mode.

In any case, Trump in power amounts to a major setback for the gender-affirming project. So, too, is the credible example of Europe’s partial shift to caution, especially England’s 2020-24 Cass review, which involved the world’s most comprehensive inquiry into the care of gender-distressed minors. Nor should we underestimate the effect of forthright detransitioners willing to relive their ordeal in public so that others may be spared.

Make no mistake, trans ideology and its gender clinic franchise still have institutional depth and breadth. Many medical organisations have failed abjectly to defend the healing profession from the invasion of identity politics. But there is reason for guarded optimism now, five years on from the publication of Abigail Shrier’s call-to-arms book Irreversible Damage.

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The following are lightly edited excerpts from the three breakthrough commentary articles in liberal media, starting with Mr Sullivan in The New York Times

Necessary questions

“The whole point of the new regime of gender-affirming care was that it rejected broad mental health assessments of children that could ensure that mistakes really didn’t happen. The old ‘persistent, consistent and insistent’ model was deemed transphobic and loosened to become an affirmation policy. As soon as a kid said he or she was the opposite sex, further counseling and mental health exploration was deemed problematic, because it amounted to transphobic conversion therapy, we were told. When I said that seemed crazy, and that surely we needed more safeguards, I was sternly told, ‘Children know who they are.’

“But do they? When they are between 9 and 13? I sure didn’t. Does any parent really believe this? Solid long-term data on how many children who transition but decide later it was a mistake is hard to find, in large part because the procedures are relatively new and the studies often have very poor follow-up. But without a doubt, there are some. They are walking around today, testifying in courts and legislatures, opining all over the web, telling similar stories of rushed judgments, minimal safeguards, inadequate gate-keeping and agonizing regret that as children they made irreversible decisions they could not meaningfully consent to.

“I have met many. They break your heart. And so many of the gender-dysphoric kids are gay and lesbian. Of course they are, and there are many more children who will grow up to be gay and lesbian than who will grow up to be trans. When adolescents referred to a British gender clinic were asked about their sexuality in 2012, some 90 percent of females and 80 percent of males said they were same-sex attracted or bisexual.

“And a fix for gender dysphoria for gay and lesbian kids can be puberty itself, as it was for me and many of my gay male friends. Once my own hormones kicked in, my anxieties evaporated. I loved being a boy, I realized. Puberty blockers literally block gay and lesbian kids from the chance at that possible resolution of their gender dysphoria. There is a real conflict here, and it’s obscured by the LGBTQ+ identity.

“We were also told, repeatedly, that transitioning children was drastic, but the alternative could be that they would commit suicide. ‘We often ask parents, Would you rather have a dead son than a live daughter?’ Johanna Olson-Kennedy, a vocal advocate of these treatments, told ABC News in 2011. But even the American Civil Liberties Union’s [Chase] Strangio admitted, when arguing before the Supreme Court last year [in the Skrmetti case], that suicide ‘thankfully and admittedly is rare.’

“In one study from Britain, of some 15,000 adolescents referred for gender care over a decade, there were four likely or confirmed suicides, two who had been seen and two who had not. One suicide is awful—and suicidality is real among kids with gender dysphoria. But that doesn’t mean that suicide is what will happen if you don’t transition a child.

“One concern is specific for boys who transition to girls in early puberty. ‘If you’ve never had an orgasm pre-surgery, and then your puberty’s blocked, it’s very difficult to achieve that afterwards,’ a pioneering trans surgeon, Dr Marci Bowers, has said. Research on this is minimal, and so caution is necessary in jumping to conclusions. But I ask myself: If there is a risk that some people will be denied sexual pleasure for their entire lives because they transitioned very early, is it worth it? And how can a child understand what giving up orgasms for life might mean when he hasn’t experienced a single one? The obvious answer is that he can’t, and it’s profoundly unethical to put him in that situation. And who exactly is looking out for these kids? Certainly not the LGBTQ organizations.

“How did a movement that began with sexual liberation end up doing that? By drift, activist extremism, a social media bubble and suppression of free debate.”

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Podcast: What to make of the US Supreme Court’s Skrmetti ruling?

Next, Helen Lewis in The Atlantic

Liberal bubble

“Advocates of the open-science movement often talk about ‘zombie facts’—popular sound bites that persist in public debate, even when they have been repeatedly discredited. Many common political claims [such as the ‘transition or suicide’ formula] made in defense of puberty blockers and hormones for gender-dysphoric minors meet this definition. These zombie facts have been flatly contradicted not just by conservatives but also by prominent advocates and practitioners of the treatment—at least when they’re speaking candidly. Many liberals are unaware of this, however, because they are stuck in media bubbles in which well-meaning commentators make confident assertions for youth gender medicine—claims from which its elite advocates have long since retreated.

“Trans-rights activists like to accuse skeptics of youth gender medicine—and publications that dare to report their views—of fomenting a ‘moral panic.’ But the movement has spent the past decade telling gender-nonconforming children that anyone who tries to restrict access to puberty blockers and hormones is, effectively, trying to kill them. This was false [and] irresponsible.

“When [Republican state bans on pediatric gender change] are discussed, you will also hear liberals say that conservative fears about the medical-transition pathway are overwrought—because all children get extensive, personalized assessments before being prescribed blockers or hormones. This, too, is untrue. Although the official standards of care recommend thorough assessment over several months, many American clinics say they will prescribe blockers on a first visit.

“Perhaps the greatest piece of misinformation believed by liberals, however, is that the American standards of care in this area are strongly evidence-based. In fact, at this point, the fairest thing to say about the evidence surrounding medical transition for adolescents—the so-called Dutch protocol, as opposed to talk therapy and other support—is that it is weak and inconclusive. Yes, as activists are keen to point out, most major American medical associations support the Dutch protocol. But consensus is not the same as evidence. And that consensus is politically influenced.

“The reliance on elite consensus over evidence helps make sense of WPATH’s flatly hostile response to the Cass report in England, which commissioned systematic reviews and recommended extreme caution over the use of blockers and hormones. The review was a direct challenge to WPATH’s ability to position itself as the final arbiter of these treatments … One of WPATH’s main charges against Hilary Cass, the senior pediatrician who led the review, was that she was not a gender specialist—in other words, that she was not part of the charmed circle who already agreed that these treatments were beneficial.

“Because of WPATH’s hostility, many on the American Left now believe that the Cass review has been discredited.

“Advocates of youth gender medicine have reacted furiously to articles in The New York Times and elsewhere that take Cass’s conclusions seriously. Indeed, some people inside the information bubble appear to believe that if respectable publications would stop writing about this story, all the doubts and questions—and Republican attempts to capitalize on them electorally—would simply disappear.

“Can this misinformation bubble ever be burst? On the Left, support for youth transition has been rolled together with other issues—such as police reform and climate activism—as a kind of super-saver combo deal of correct opinions.

“I have always argued against straightforward bans on medical transition for adolescents. However, the revelations from Skrmetti and the Alabama case [depositions] have made me more sympathetic to commentators such as Leor Sapir, of the conservative Manhattan Institute, who supports the bans because American medicine cannot be trusted to police itself. Once you know that WPATH wanted to publish a review only if it came to the group’s preferred conclusion, Sapir’s case becomes more compelling.

“Despite the concerted efforts to suppress the evidence, however, the picture on youth gender medicine has become clearer over the past decade. It’s no humiliation to update our beliefs as a result: I regularly used to write that medical transition was ‘lifesaving,’ before I saw how limited the evidence on suicide was. And it took another court case, brought by the British detransitioner Keira Bell, for me to realize fully that puberty blockers were not what they were sold as—a ‘safe and reversible’ treatment that gave patients ‘time to think’—but instead a one-way ticket to full transition, with physical changes that cannot be undone.”

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And now, in The Washington Post, Professor Alex Byrne of MIT, who was among the authors of the gender dysphoria review ordered by the Department of Health and Human Services

Ethics 101

“One of the most important chapters [of the review] provides an ethical analysis, arguing that pediatric medical transition is ethically inappropriate because of its unfavorable risk/benefit profile. We agree with the health authorities in Sweden, who reached the same conclusion in 2022. The argument is quite simple—‘medical ethics 101,’ as one of my colleagues put it—and does not rely on contested claims about consent or regret, which is how the ethical debate is often framed.

“After surveying all the evidence, and applying widely accepted principles of medical ethics, we found that medical transition for minors is not empirically or ethically justified.

“Why is the US, as Cass has observed, ‘out of date’ on treatment for gender distress in young people? [One reason, not confined to the US, is that] many adults in the room were driven to prudent silence by aggressive activists.¹

“The price of speaking out no doubt contributed to the collapse of medical safeguarding in the US. A more subtle influence is the language used by proponents of pediatric medical transition, which is euphemistic and often misleading. ‘Gender-affirming top surgery’ sounds entirely positive, and papers over the salient fact that the breasts of physically healthy teenagers are removed.

“Patients who undergo irreversible surgery and later regret it are said to have ‘dynamic desires for gender-affirming medical interventions.’ The usual words to indicate a young patient’s sex are disallowed: female children are ‘individuals assigned female at birth’ or ‘trans boys,’ and are never simply ‘girls.’ This has the Orwellian effect of making plain truths impossible to state.

“The review squarely addresses an uncomfortable topic: the link between childhood-onset gender dysphoria and same-sex attraction. Gender dysphoric young children are gender-nonconforming, and early gender non-conformity is strongly associated with later homosexuality. In a 2011 Dutch study of 70 adolescents, which together with its follow-up forms the scientific foundation of today’s pediatric medicalized pathway, only a single patient reported being heterosexual.

“The days of medicalizing same-sex attraction are supposed to be shameful history. The [HHS] review suggests that the old days are back under the new guise of care for ‘gender-diverse youth.’ Speaking for myself, the progressive embrace of this regressive practice is one of the great ironies of the modern age.”

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More to come

In my view, the three articles sampled above are significant because they potentially reach a large, left-leaning readership which has been bombarded with slogans and denied detailed and informed critiques of paediatric medical transition.

For other post-Skrmetti commentary, some of it catering to smaller or less politically resistant audiences, see—

Journalist Jesse Singal, “Logic Trips Up the Trans Movement,” The Dispatch

Writer Ben Appel, “‘Transgender Kids’ Usually Grow Up Gay,” The Wall Street Journal

Author Lionel Shriver, “‘Trans rights’ Has Never Been a Civil Rights Issue,” The Spectator

Commentator Douglas Murray, “Standing Up to Bullying, Unscientific Transgender Activist Mob,” The New York Post

Physician Farr Curlin, “Transgender Treatments Distort the Purpose of Medicine,” The Wall Street Journal

Nick Cohen’s, The Rise and Fall of the Trans Movement,” Substack

The Citation Needed podcast, “Justice Sotomayor’s Emotional Dissent was Fueled by the Trans ‘Suicide Myth’”

1. As if to affirm the case for anonymity, Professor Byrne is now the target of one of higher education’s illiberal denunciation campaigns via an open letter preaching “professional ethics”. There are quite a few anonymous signatories to this letter, which is addressed to “Dear Professor Alex Byrne.”

The screed goes on: “It was alleged in May that you were among the anonymous authors of the [Department of Health and Human Services or HHS] report on pediatric trans care. The report, among other things, issues the alarming recommendation that trans youth should not have access to gender-affirming care, despite the leading pediatric medical body in the country supporting the efficacy and life-saving potential of these treatments.”

That leading medical body, the American Academy of Pediatrics, is a severely compromised authority.

In his commentary for The Post, Professor Byrne wrote: “Mere hours after publication [of the HHS review], the president of the American Academy of Pediatrics, Susan Kressly, claimed that the review was undermined by reliance on ‘a narrow set of data.’

“A glance at the evidence synthesis (or even just the separate appendix) by anyone familiar with evidence-based medicine would show that this complaint is preposterous.

“The hypocrisy is blatant: the AAP’s policy statement for the treatment of gender-dysphoric youth is unsupported by its own citations.”

The AAP’s 2018 policy statement, which urges an “affirmation-only” treatment model for gender-distressed minors, is the subject of a damning, unanswered critique by the clinical psychologist and researcher Dr James M Cantor.