I’ve read all three articles (Urquhart, Ghorayashi, Koren, in that order), and some supporting sources, but I don’t yet see egregious reporting by the New York Times. As the FAIR.org article is direct criticism, I’ll address that:
re: misleading numbers.
It’s not a contradiction for there to be zero patients with adverse physical reactions and a number of patients with adverse outcomes. Adverse physical reactions would mean hormone or blocker treatment leads to bone fractures, nausea, rashes, etc. A patient who de-transitions would not be considered to have an adverse physical reaction. It is not reasonable to infer that WashU is covering something up. The Times never reports that any patient has had an adverse physical reaction and in fact repudiates Ms. Reed’s allegation on the patient with liver damage.
Maybe this is too much nuance to expect from NYT readers, I don’t know. I like to think I’m pretty smart, but full disclosure: I had read Banquet_Bear’s critique before the base article, so that may have guarded me against being mislead.
The red-flag spreadsheet seems to me a very good practice that the University should have incorporated clinic-wide. Since the staff seems to have been so small, maybe a spreadsheet used by two staff was for all practical purposes clinic-wide policy. We had similar devices for tracking groups of patients when I managed a small medical office. That is, a spreadsheet or handwritten list.
Re: disproportional coverage of detransition/regret, and bothsideism
I don’t think this is unethical as I think one of the main questions for the average reader, if not the main question, is whether adolescents detransition after going through gender affirming care. Ms. Ghorayashi reports for the New York Times that it happens, rarely, but we don’t know how rarely. She cites studies ranging from 2 to 30 percent, and another study saying 16 percent. She reports that Ms. Reed at the clinic had a spreadsheet of 16 patients known to have stopped therapy or detransitioned, out of 598. Three of those 16 were reported as corroborated by the NYT, one independently.
Maybe there were other people she reached out to who refused to talk to her or who even pulled out of the story. I’m surprised she could independently corroborate even one patient given the very private nature of medical records. Furthermore this patient was reported as not regretting the therapy, realizing they were nonbinary. Why didn’t she have similar profiles on patients who were happy with their transitions? According to Mr. Urquhart, the family of the patient with the liver issue refused to let the patient speak to Ms. Ghorayashi despite her insistent pleadings. That’s understandable but due diligence doesn’t require a reporter to provide equal coverage to a source that won’t talk on the record… does it? I won’t fault her for refusing to print parent’s testimonials on equal footing with patient testimonials.
re: inaccurate reporting of studies (fair criticism, if true).
Now this, from the FAIR article, is indeed a fair criticism (if true):
The 30% number referenced in Exposito-Campos’ review that the Times uses comes from a study that looked at hormone prescription continuation rates in the TRICARE system for family members of military members. The authors noted in the conclusion that their numbers “likely underestimate continuation rates among transgender patients.” They also pointed out that other studies have shown as few as 16% of people who discontinue hormones do so because of a change in gender identity. (If 16% of the 30% of patients who discontinued hormone treatment did so because of a gender-identity change, that would be 0.5% of all patients.)
I don’t see a problem reporting the 30% at the high end. I read that study and as a layman it seems to have solid methodology. It is not facially unreliable. I also double checked that the NYT meta study cites the TRICARE study, which it does without criticizing it as unreliable. I do see a problem with the 16% figure. This is what Ms. Ghorayashi wrote for the NYT:
The number of people who detransition or discontinue gender treatments is not precisely known. Small studies with differing definitions and methodologies have found rates ranging from 2 to 30 percent. In a new, unpublished survey of more than 700 young people who had medically transitioned, Canadian researchers found that 16 percent stopped taking hormones or tried to reverse their effects after five years. Survey responders reported a variety of reasons, including health concerns, a lack of social support and changes in gender identity.
The reporting is that 16 percent of 700 people who had medically transitioned stopped taking hormones or tried to reverse their effects after five years. It does not tell the reader that the 16 percent applies only to some subset of the 700 people who had decided to detransition. In fact I even clicked the link (goes to a presentation on YouTube) and there they seem to say it is 16% overall. But if the 16% is only of people who decided to detransition, that’s a massive misrepresentation because it would only be a fraction of a percentage overall. Or, maybe FAIR.org is mistaken.
Re: lack of mental health treatment.
I have no reason to disbelieve the reporting on the prevalence of transgender adolescents in the E.R. It was reported as fact in the introduction and I expect them to have verified it. The claim does not cry out to me as needing fact-checking, in fact it is pointed out in the preceding sentence that the clinic only has two psychologists to screen and this is specifically pointed out as a bottleneck for the clinic later in the article.
Likewise I read SOC8 from wpath.org and, again, as a layman it seems pretty clear that it recommends several years before starting hormone therapy. There’s nuance for puberty blockers, but it does seem to say what the Times reports it as saying. There may be a distinction between the formal statements heading off each section and the supporting text but I don’t see a practical difference.
Copy/paste from SOC8, p.S60 (click to show/hide)
Statement 6.12.b
The experience of gender diversity/incongruence is marked and sustained over time.
Therefore, the level of reversibility of a
gender-affirming medical intervention should be
considered along with the sustained duration of
a young person’s experience of gender incon-
-gruence when initiating treatment. Given poten-
-tial shifts in gender-related experiences and
needs during adolescence, it is important to
establish the young person has experienced sev-
-eral years of persistent gender diversity/incon-
-gruence prior to initiating less reversible
treatments such as gender-affirming hormones
or surgeries. Puberty suppression treatment,
which provides more time for younger adoles
cents to engage their decision-making capacities,
also raises important considerations (see
Statement 6.12f and Chapter 12—Hormone
Therapy) suggesting the importance of a sus-
-tained experience of gender incongruence/diver-
-sity prior to initiation. However, in this age
group of younger adolescents, several years is
not always practical nor necessary given the
premise of the treatment as a means to buy time
while avoiding distress from irreversible pubertal
changes. For youth who have experienced a
shorter duration of gender incongruence, social
transition-related and/or other medical supports
(e.g., menstrual suppression/androgen blocking)
may also provide some relief as well as furnish-
-ing additional information to the clinical team
regarding a young person’s broad gender care
needs (see Statements 6.4, 6.6, and 6.7).
re: questionable sources.
The story is about Reed’s allegations so it is only natural that the reporting focuses on them. I mean, the subject matter of the story is in fact Reed’s allegations. The title of the piece is “How a Small Gender Clinic Landed in a Political Storm”, and the factual answer is that one Ms. Reed made some public allegations. Ms. Reed is the most relevant source for the story as she is the proximate cause of the political storm.
I don’t see a problem in not reporting her allegation as to stomach pain, because the Times reported none of the patients had adverse physical reactions, and that the liver damage in one patient was not related to her treatment at the clinic.
re: softening extremism
I note that extremism is relative. I think some twenty states have preemptively banned the practice. That alone moves any Overton window. To a liberal-leaning person moving in liberal-leaning circles, it might seem extreme to suggest a ban or moratorium on gender affirming care for children. But three out of five Americans believe gender is determined at birth. That’s three out of five people who don’t actually believe trans women are women, or that trans men are men. The number is rising, not shrinking. And people living in those circles, especially older ones that would subscribe to the New York Times, would likely (I have personally heard some older Floridians who definitely do) view hormone treatment as extreme. Surely a similar if not higher percentage is against gender affirming care for minors?
~Max