Thanks, that’s a really good article from fair.
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
You might be confused, or you might be misstating a true statistic. But there are some trans people who believe their true gender was determined at birth and mis-assigned on the birth certificate. They believe that gender is determined by the brain, not the external genitalia, and note that it’s not possible to query the brain’s gender for a few years.
So I guess this thread is no longer the magellan show and has reverted to something more productive?
To reiterate what @puzzlegal said, you can count me (broadly speaking) among the 3/5 in your first sentence. But your second sentence absolutely does not follow. Perhaps that implication was the intent of an ignorant ill-stated survey question, but it derives from the misconception that a trans person “used to be a man, and changed to a woman” or vice versa.
Gender identity is a mental state, a neuron configuration has just the same objective physical reality as chromosomes or genitalia. And it is almost certainly present (or precursor determinants are present) at birth, since in a significant number of people the gender identity that emerges is refractory to strong social pressure to conform to a cis identity mistakenly assigned at birth by inspecting the genitalia.
Right. At birth, for record-keeping purposes, we use our “best estimation” by the available tools of what gender to attribute to the newborn. Actually, we identify their apparent biological sex by morphological and chromosomal characteristics – and it’s the society and the family that based on that then presumes a baseline gender under which to relate to the child. Which, given that the very large majority of cases it does turn out to be the cisgender correspondent to the bio sex, it’s not an unreasonable default for the time being. But it does not exclude everyone adjusting that, based on new information as becomes available.
However let us not be too enthusiastically optimistic: a very large fraction of the population does deny the trans reality. Enough to make it politically useful as a wedge.
Maybe I misread the source. I double checked but I think I read it right. The wording is the sex they were assigned at birth. The poll question, from Pew, reads:
Which statement comes closer to your views, even if neither is exactly right?
Whether someone is a man or a woman is determined by the sex they were assigned at birth Someone can be a man or a woman even if that is different from the sex they were assigned at birth No answer May 16-22, 2022 60 38 1 Jun 14-27, 2021 56 41 3 Sep 14-28, 2017 54 44 2
n=10,188 U.S. adults, +/- 1.6 percentage point margin of error at 95% confidence level.
Apparently that fraction is 3/5 and growing…
~Max
Your conclusion that this survey indicates that 60% of Americans deny the existence of trans people was correct.
But your derivation of that conclusion was not. You first said that the survey showed…
Do you understand that “someone is a man or a woman is determined by the sex they were assigned at birth” and “gender is determined at birth” are completely different claims?
Yup. You misread the source. There’s a large difference between “gender is determined by the sex a person was assigned at birth” and “gender is determined at birth”.
Yes, after you and puzzlegal pointed that out I wasn’t sure if I misread the survey or just didn’t accurately summarize it.
A revision is in order,
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 by the sex a person was assigned 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 significant
similar if not higherpercentage is against gender affirming care for minors?
~Max
never mind
That’s (eta: was) a fair criticism. If you have reading material, I’ll find some time to read it.
~Max
No, it was overly harsh, that’s why I deleted it. It’s no secret that I’m not a fan of your style, but I think you are engaging with this in good faith.
Lots of people don’t really understand gender identity. There are likely lots of people who are generally tolerant towards trans people and believe trans women are women and trans men are men who still answer a survey that way because they don’t understand what they’re being asked.
Heck, I don’t really understand gender identity, either. Fortunately, understanding isn’t necessary, only respect.
If someone says “I prefer to be referred to by these pronouns”, or “I prefer to use this restroom” or “I prefer to be called by this name”, I don’t need to know all of the details of their internal thought processes that led to that preference. Most likely, it’s not possible for me (or any other human) to completely understand all of the details. But I can know that that’s their preference, because they tell me. That part is easy. And even if I don’t understand it, I can understand that it’s important to them, and respect that.
This. So much this.
I honestly don’t get it. I have some discomfort with my gender assigned at birth, too, but I really don’t care what pronouns you use, and I’ve never felt the need to change the gender I present as. (That is, I present as a butch woman, not as a man or a nonbirnary person.) BUT, it’s really obvious that it matters a lot to some of my friends. And I don’t want to be an asshole. It’s really that simple. Don’t be a jerk.
I’ve spent considerable time and effort attempting to understand trans gender issues. Intellectually I think I have grasped it, but it continues to elude me on an emotional level.
The important thing is to be kind to others, which includes avoiding causing pain to other people. Addressing people as they wish to be addressed costs me nothing and is a kindness. The rest is details that are largely or entirely none of my business.
This is tough. I don’t think there’s only one way of being trans and that it works the same for everyone. And insisting that things are set at birth cedes too much ground to bigots. I felt (and feel) the same way about sexual orientation when there was such an emphasis on being “born that way.” Whether it’s inborn or something that can change or something one has some degree of choice over, a person’s gender (or sexual orientation) is their business to express and identify. I think that’s the message to emphasize.
If we focus on gender being predetermined for everyone at birth, that sets up a possibility of people having to prove it, it potentially denies the experience or existence of gender fluid people, and accepts a premise that gets used against us far more than it serves us.
I think pretty much nothing you have said there follows from the presence of early determinants of gender identity. (In saying “early determinants” I am including non-social environmental factors along with genetic factors.)
Why would the presence of determinants of gender identity early in life imply less diversity in gender identity? I think you’re imagining that I’m advancing some caricature of rigid genetic determinism. Early determinants may themselves be highly diverse; and the identity that ultimately emerges will certainly also be influenced by subsequent highly diverse social factors.
And why would the presence of early determinants specifically deny fluidity? Fluidity is itself an identity, and early determinants may predispose a person toward fluidity.
I have no idea what you mean by “ceding ground to bigots”. Bigots generally assert that it is impossible for someone to have a gender identity (mental state) that is not congruent (i.e. cis) with chromosome configuration or genitalia. They are not concerned with the causal factors that give rise to something that they claim does not exist.
I’m talking about early determinants of gender identity - determinants that reside entirely in neuron configuration, entirely in the mind, not in the chromosomes or genitalia. The point is that people can naturally be predisposed to a gender identity that is not congruent (i.e. trans) with their chromosomes or genitalia, this is the diametric opposite of “ceding ground to bigots”.
Again, you seem to be arguing against the straw man of some caricature of genetic determinism. Nobody is suggesting that the presence of early determinants rigidly dictates an identity that does not emerge and evolve over time and that is not also influenced by social factors. So what do you imagine this implies about people having to “prove” anything?
What you emphasize depends on context. When people ignorantly claim that the non-existence of trans people is a “biological fact”, I think it’s important to provide a coherent scientific account of why the existence of trans people is perfectly consistent with everything we know in biology.
Finally, I think part of the difficulty here is that the social sciences have dogmatically insisted that virtually everything is a social construct, based on a misguided view that the existence of any innate causal factor is somehow regressive. This approach was always idiotic, it is just as preposterous as the opposite extreme of rigid genetic determinism. Everything in biology is both genes and environment. And the very existence of trans people undermines this worldview that everything is a social construct. I think that leads to a certain amount of cognitive dissonance among progressives in the social sciences, who want to be allies but don’t want to concede that there may be non-social causal factors for gender identity. But if gender identity is determined solely by social factors, why do non-cis people exist (in similar numbers) and persistently assert their non-cis identites in societies that are so strongly cis-normative that they can literally be murdered for doing so?
Gender IS entirely a social construct.
This question only makes sense if asked by someone who doesn’t understand what gender being a social construct means.
Pro tip: something being socially constructed doesn’t make it not “real”.
I have no idea what this gotcha is supposed to be. You seem to be projecting some silly easily refuted straw man onto me. Many things are certainly social constructs, including gender expression. But the very existence of trans people in societies that persistently persecute them means that it makes little sense to claim that gender identity is a social construct.
If gender identity is a social construct then that (by definition) implies that the only contributing causal factors are social. What do you imagine are the social factors that make someone trans rather than cis in a society that will literally kill you if you assert a trans identity? Why are there always trans people in all societies even when there is massive social pressure to conform to cis norms? How are trans identities being socially constructed in societies that explicitly want to destroy them?