proclamations that the science is settled are a bold facade on rickety scaffolding.
by Nathanael Blake
Originally published by The Federalist
The transgender misinformation machine is at it again. The New York Times recently published an extensive essay arguing against screening before medical transition — if someone says she wants hormones or surgery, doctors should immediately break out the syringes and prep the operating room.
The article, by Alex Marzano-Lesnevich of Bowdoin College, exemplifies how the transgender movement uses misinformation to advance its agenda. Marzano-Lesnevich asserts, “That gender-affirming health care saves lives is clear: A 2018 literature review by Cornell University concluded that 93 percent of studies found that transition improved transgender people’s heath [sic] outcomes, while the remaining 7 percent found mixed or null results. Not a single study in the review concluded negative impact.”
That seems dispositive — unless you look at the studies. The cited literature review was titled the “What We Know Project” and was directed by the LGBT scholar and activist Nathaniel Frank, who cited it in his own New York Times piece on transgenderism a few years ago, writing that “Our findings make it indisputable that gender transition has a positive effect on transgender well-being.”
Poorly Conducted Studies
These proclamations that the science is settled are a bold facade on rickety scaffolding. When this New York Times article invokes the authority of science, it seeks to evoke the image of careful statisticians sifting through data collected by diligent doctors.
But it is actually appealing to self-selected online surveys with cash prizes, studies with tiny samples, and studies that are missing more than half of their subjects. Stacking a bunch of weak studies on top of each other doesn’t provide a strong result, but The New York Times presumes readers won’t bother to check the details — the editors certainly didn’t.
Back in 2019, I took a closer look at the studies the What We Know Project cites, and found a methodological mess. Many of the studies had serious flaws, beginning with small sample sizes. As I noted, “Of the fifty relevant papers identified by the project, only five studies (10 percent) had more than 300 subjects, while twenty-six studies (52 percent) had fewer than 100. Seventeen studies (34 percent) had fifty or fewer subjects, and five of those had a sample size of twenty-five or less.”
The flaws extended far beyond small sample size, and the largest studies tended to be the weakest, often consisting of little more than online surveys with a self-selecting sample. Nor should we put much faith in a study that recruited subjects for an online survey by advertising “on online groups and discussion forums that were dedicated to FTM [female-to-male] members. . . . Upon survey completion, participants were entered into a lottery drawing for cash prizes.”
Even the better-designed long-term studies were often plagued by poor response rates. A European study had 201 out of 546 respond — just 37 percent. And though missing data is, by definition, missing, it is reasonable to suspect that those with poor outcomes are overrepresented among those who could not or would not respond.
Regret Rates
Nor did The New York Times check Marzano-Lesnevich’s claim that “gender-affirming health care has some of the lowest rates of regret in medicine. A 2021 systemic review of the medical literature, covering 27 studies and 7,928 transgender patients, found a regret rate of 1 percent or less.” But read the paper and it is quickly apparent both that the review has significant weaknesses and that The New York Times allowed its conclusions to be misrepresented.
Of the 27 studies used in their analysis, the review authors ranked only five as “good” and only four as having a low risk of bias. Many of the studies had the same flaws as those examined in the What We Know Project (indeed, some studies were used in both).
Another problem is that the majority of the data in the 2021 review came from a single study conducted by a Dutch group retrospectively examining the records of their own gender clinic. But a retrospective review of medical files will only identify regrets from patients who shared them with the gender clinic that performed their surgeries. Furthermore, the study only identified regrets following gonadectomy, and not those who regretted other surgeries, or who never had surgery but did regret taking cross-sex hormones or puberty blockers.
In addition to the problem of allowing a flawed data set to dominate the 2021 review, this illustrates another persistent difficulty with studies of transgender regret, which is that they are often conducted by those who provide medical transition, rather than independent researchers. People whose livelihoods and reputations depend on facilitating medical transition might be less than diligent and rigorous in looking for regret.
To their credit, the authors of the 2021 review do discuss some of the limits and difficulties of their work, writing that various problems:
represent a big barrier for generalization of the results of this study. The lack of validated questionnaires to evaluate regret in this population is a significant limiting factor. In addition, bias can occur because patients might restrain from expressing regrets due to fear of being judged by the interviewer. Moreover, the temporarity of the feeling of regret in some patients and the variable definition of regret may underestimate the real prevalence of ‘true’ regret.
None of these qualifications regarding regret were even hinted at in the published column. Despite The New York Times’ citing it, the 2021 review does not prove that “gender-affirming health care has some of the lowest rates of regret in medicine.”
As the authors note, regret is not only an imperfect measure, but it is often difficult to measure, with no set criteria defining it. In one Swedish review cited by the What We Know Project, it was defined “as application for reversal of the legal gender status among those who were sex reassigned,” which excludes those who succumbed to depression or addiction, or who lived unhappily after transition without seeking to legally detransition.
Gatekeeping before Transition
Furthermore, even if we uncritically accept the results of the 2021 review, it does not support the argument that gatekeeping before medical transition is unnecessary and harmful. Rather, the authors claim that the low regret rate they found “reflects and corroborates the increased [sic] in accuracy of patient selection criteria for GAS [gender affirmation surgery].”
In short, the review argues that medical gatekeeping keeps regret rates low. That The New York Times allowed this review to be used as evidence against medical screening, and in favor of self-ID for medical transition, exemplifies the persistent practice of American transgender activists using studies of (mostly) carefully screened European adults to argue against screening before medical transition, even for children.
Unfortunately, the aggregation of (often questionable) studies, and the exaggeration of their conclusions by activists, is only part of the problem. These efforts to spread misinformation are augmented by the intimidation of dissenting scientists and the suppression of results that trans activists dislike.
Suppressing Dissent
Researchers have learned to fear the wrath of LGBT activists, and take pains to avoid it. Results that undermine the narrative have to be carefully presented lest the public draw the wrong conclusions. Thus, when scientists concluded that there is no “gay gene” they “worked with LGBTQ advocacy groups and science-communication specialists on the best way to convey their findings in the research paper and to the public.”
With regard to transgender ideology, the intimidation is even more overt. For example, Lisa Littman’s qualitative study describing the phenomenon of rapid-onset gender dysphoria met a ferocious response from transgender activists. Similarly, activists smeared Canadian psychologist Kenneth Zucker and forced him out of his position as the leader of a gender identity clinic, even though he sometimes supported transitioning children. He was just more cautious about it than activists wanted. He was eventually vindicated, but targeting him still sent a warning to any researchers who are seen as insufficiently pro-trans.
As these cases demonstrate, the science is being manipulated to fit transgender ideology. Shoddy studies — often conducted by activists and doctors with a stake in medical transition — are boosted if they support the trans narrative, while results and researchers who challenge it are suppressed. This skewed data is then used by trans activists and their allies to shape the discourse.
Uncomfortable facts and stories are kept out of the official narrative. Insightful and moving first-person accounts of transition and detransition are confined to non-traditional outlets such as Substack, as are the warnings of leading trans doctors about the reckless rushing of children into transition. The information bubble is the point.
Going forward, disagreement will be labeled “misinformation” and banned from social media, and dissidents will be labeled as bigots who should be fired from their jobs. Doctors will be required to practice only according to the approved narrative, and educators will encourage children to transition without parental knowledge and consent. Worse still, the government will take children from parents who do not support transition.
The purpose of the transgender misinformation machine is not so much to persuade, but to provide justification for coercion. The point of the lies and distortions is to impose transgender ideology on all of us, especially children.
Nathanael Blake is a senior contributor to The Federalist and a postdoctoral fellow at the Ethics and Public Policy Center.
