Several Problems Special #23: “As kids, they thought they were trans. They no longer do” (14 February 2024)

On 14 February 2024, The Australian Financial Review republished a piece from The New York Times, “As kids, they thought they were trans. They no longer do,” by Pamela Paul (2024b).

This piece has several problems.

Here are a few.

Headnotes

Paul’s piece was originally published in The New York Times (“The Times“) on 2 February (Paul, 2024a). I didn’t do a Several Problems of it then because I was exhausted and because United States-based subject matter experts like Erin Reed (2024), Assigned Media‘s Evan Urquhart (2024), and Whipping Girl author Julia Serano (2024) had already jumped on it and done a great job. However, Nine went out of their way to syndicate the piece into a local masthead and put it in front of Australian readers, and I felt like that made it my problem.

For my Australian readers, The New York Times has a consistent record of polite, “just asking questions”-style transphobic propaganda (Yang, 2023) which has already attracted fierce resistance from trans people, allies (Accountable for Equality et al., 2023), and its own contributors (Andrews et al., 2023). Paul is the hand they use to do it (Bibi, 2023). She was already The Times‘ book editor, but became a regular opinion columnist in April 2022, two weeks after The Times dropped its only trans regular columnist, Jennifer Finney Boylan (Hollar, 2022; GLAAD, 2023). The Times Company press release announcing her onboarding in the role (“Pamela Paul’s next chapter,” 2022) uses language like “her keen desire to write about what people really think and believe but are often too afraid to say” — skating, not for nothing, very close to a slogan by Senator Pauline Hanson (PHON–QLD) about “ha[ving] the guts to say what you’re thinking” (Harris, 2020).

For my foreign readers, Nine Entertainment Company, the publisher of The Australian Financial Review (“the Financial Review“), also have a record of this kind of bullshit. Offhand I think it is the biggest single Australian contributor to the Several Problems Special corpus, and that’s in Australia, the company that gave us News Corp and modern Fox. Nine’s newspapers, including the Financial Review, used to be published by John Fairfax and Sons, which Nine acquired in 2018; under Fairfax management, they accumulated a lot of prestige and became newspapers of record. Since Nine acquired them, the editorial orientation of the ex-Fairfax, now “Ninefax,” newspapers has taken a sharp right turn, but they still retain enough prestige that bad actors find them very attractive.

1

The narrative [Powell] had heard and absorbed was that if you don’t transition, you’ll kill yourself.

First, there is no such narrative. There is no “narrative,” because that implies someone put one together. What there is is the common understanding that access to gender-affirming care is associated with lower depression and suicidality. That understanding is based in solid empirical fact (Bauer et al., 2015; Turban et al., 2020; Green et al., 2021; Tordoff et al., 2022; etc.).

Second, there’s clearly no broad message that “no matter who you are, if you don’t transition, you’ll kill yourself,” because if there were, a hell of a lot more people would be transitioning. There may be a common understanding that “if trans people don’t transition, they’ll kill themselves,” because that would make sense as a simplification of the actual facts. If Powell heard that as “if you don’t transition, you’ll kill yourself,” then that reflects something material about her internal experience. It does not demonstrate the existence of a broad spray of pro-trans propaganda in all directions.

2

At 160cm, [Powell] felt she came across as a very effeminate gay man.

This is a cute little jab because this is clearly intended to play on trans men’s and transmascs’ dysphoria — “No matter what, Powell’s transition was doomed from the start! No italics real end italics man is that short!”

In reality, that’s approximately the 4th percentile for male height in the United States (U.S. National Center for Health Statistics, 2017). Does that sound extremely low? Yes, it does. But if you divide a very large number, like the number of people in the US, into 100 pieces, each of those 100 pieces is still going to be very large. Being at the 4th percentile means Powell is taller than about 7 or 8 million men in the United States alone; about 300 million in the world (Jelenkovic et al., 2016). Height dysphoria, or the attempt to inflame it, cannot be treated as neutral, objective fact.

3

At no point was [Powell] asked about her sexual orientation

Why would she have been? Queerness isn’t transness (Human Rights Campaign Foundation, “Sexual orientation and gender identity definitions,” n.d.). The only people who think it is are cisgender men who call queer women “men” for having the temerity to fuck women who those men consider to be theirs.

4

neither the therapists nor the doctors ever learned that she’d been sexually abused as a child

I’m going to take the mask of sarcastic, laconic criticism off for a moment and say this: Powell’s experience of child sexual abuse (CSA) victimisation is both horrifically broadly shared (Pereda et al., 2009; Mathews et al., 2023, Box 1) and, individually, simply horrific. I sincerely hope that she’s been able to get care and that she has some kind of peace.

With equal sincerity, I do not believe Pamela Paul cares a jot. She’s leveraging Powell’s trauma to restate an old homophobic canard, namely that queerness — or, in this updated form, transness — is caused by CSA (Schlatter & Steinback, 2011). At the time I wrote the Twitter version of this piece, there was a meme on the topic by fascist webcartoonist Stonetoss merrily doing numbers. Bluntly put, this is Nazi shit.

5

Many … well-meaning liberal … people … have been attacked … and intimidated into silencing their concerns.

Who? By whom? Given how potent a weapon this claim is for the article’s central ideological line of attack, it would be really helpful to back it up with a source.

6

Laura Edwards-Leeper, the founding psychologist of the first pediatric gender clinic in the United States

I have always found this kind of appeal to authority really interesting, because it sounds great if you’re not the patient. It sounds great because of certain beliefs we have about healthcare as a “caring” occupation and therefore about what personal qualities must be required to accrue medical authority. If you are the patient, at least if you’re the patient for long enough, it becomes more apparent that that the personality traits with which medical authority is associated are only those which are associated with authority everywhere else — the propensity to seek it and the competence to do so successfully. People may want medical authority for good reasons, like effectively assisting patients they care about, or they may not, but there is no way to know in advance. The proof of the pudding is in the eating.

Given the tone of the last paragraph it will probably therefore come to you as no shock that Laura Edwards-Leeper is not actually being quoted here for her genuine concern for the wellbeing of trans kids. She’s being quoted here because she’s a conservative clinician who has been a dial-a-quote for other conservative and anti-trans commentators since no later than 2018 (James, 2024a), and has done a little bit of anti-trans commentary herself (see, e.g., Edwards-Leeper & Anderson, 2021).

7

Others refer to this phenomenon, with some controversy, as rapid onset gender dysphoria

I would imagine that these references are controversial because rapid onset gender dysphoria (ROGD) doesn’t exist. By “it doesn’t exist,” I mean that there is no scientific evidence of its existence (Brandelli Costa, 2019; Kesslen, 2022; Littman, 2019); there is an increasing body of evidence against its existence (Bauer et al., 2021; Turban et al., 2023); and it has been decisively, emphatically rejected by every organisation which has the power to formally decide what constitutes a real condition (WPATH Global Board of Directors, 2018; Coalition for the Advancement & Application of Psychological Science, 2021).

8

Frequently, they have mental health issues unrelated to gender

The intentionally ambiguous wording, “mental health issues,” is supposed to imply that they have diminished capacity to give informed medical consent. Of course, they’re always just talking about stuff like anxiety and depression, using its commonness among trans people (Wanta et al., 2019) as a lever.

Of course, sometimes it’s stuff like autism, again because it’s common (Strang et al., 2018). In that case, the lever is that a lot of allistic people think that autistic people are too childish or eccentric to make decisions. There is no actual evidence to support this position. For instance, there is no evidence of increased transition regret among autistics (Gratton et al., 2023). The only material impact that autism has on transition is that allistic practitioners use it as a pretext to improperly deny care to autistic trans people based on vibes (Strang et al., 2016, p. 5).

And, of course, what all this is missing is that even disorders that do compromise decisional capacity — psychotic disorders, those that include delusion or hallucination — don’t automatically disqualify you as a medical decision maker, because it would be fucked up if they did. The direction given in the WPATH Standards of Care is that a patient who has such a condition should be assisted in stabilising it and then allowed to proceed with transition (Coleman et al., 2022, pp. S36–S37); this is consistent with the capacity standard in every other field which has to consider this scenario (Morris & Heinssen, 2014). I realise that it would be very convenient for the right if there were a category of people who they could use as precedent for a blanket permanent all-circumstances denial of healthcare that they don’t like, but there isn’t! The world doesn’t work that way!

9

several researchers have documented [rapid onset gender dysphoria]

There are several hyperlinks in The Times‘ source copy of this passage. Those links lead to, in order:

the website of Lisa Littman, a professional anti-trans disinformation operator (Billard, 2023);
a paper by two other such operators, J. Michael Bailey (on whom more later) and Suzanna Diaz, in its republication (Diaz & Bailey, 2023c) in the fringe Journal of Open Inquiry in the Behavioral Sciences, neatly concealing the fact that its first publication (Diaz & Bailey, 2023a) in the Archives of Sexual Behavior — on which more later (#25) — was retracted for research misconduct (Diaz & Bailey, 2023b);
a paper by Littman (2021) which, as Lee Leveille (2021b) notes, relies heavily on extremely biased sampling for politically reliable subjects, leading questions, and p-hacking, and still fails to massage its data into supporting its conclusions, which have no obvious factual basis.

However, while I’m including these findings to illustrate the depth of Paul’s duplicity here, it’s actually not strictly relevant to my critique of the Financial Review‘s copy of the piece, because in the Financial Review‘s copy, those passages do not contain those links. More on this later (#66).

10

many healthcare practitioners have seen evidence of it in their practices

The plural of anecdote is not data.

11

Britain’s Tavistock gender clinic, which … until it was ordered to be shut down, was the country’s only health center dedicated to gender identity

This feels incidental compared to everything else, but fuck it, I’m a completionist: it’s not true. The Tavistock was the only paediatric gender clinic in England and Wales. Scotland, which geography enjoyers will remember is also in Great Britain, has the Sandyford paediatric gender clinic. The UK as a whole has the adult Gender Identity Clinic (GIC) system, which is still running, insofar as it has ever run at all. It wouldn’t suit Paul’s angle to note this, though, so she simply lies about it.

12

[The Cass Review’s Interim Report] noted that ‘primary and secondary care staff have told us that they feel under pressure to adopt an unquestioning affirmative approach’ …

From the way this is placed, you’re clearly supposed to think it’s a key finding. It’s not. It’s in there (The Cass Review, 2022, p. 17, clause 1.14) but it’s in there as evidence, without a judgement on its veracity. The finding would still be in the report, in the same place, even if, for example, the review’s chair Dr Hilary Cass and her team knew that it was false, because the existence of a false assertion of that nature would be relevant to the Review.

Can we assume it’s true? No, not really. While the NHS England Gender Identity Development Service (NHS GIDS) — the paediatric gender clinic at “the Tavistock,” which is a broader medical entity which provides non-gender-related care — was still operating, there was deep political division between evidence-based providers and anti-trans clinicians, broadly acknowledged by both (Moore, 2021a) sides (Brooks, 2023).

Paul obliquely admits to knowing this later in the article by way of her casual mention of Grace Powell’s therapist, who she describes as a non-gender-affirming practitioner from the Tavistock. Paul therefore knows about the political division at the Tavistock, and knows that the mere fact that someone at the Tavistock said this means nothing. But she lies about it anyway.

13

In 2021, [Stephanie Winn] spoke out in favour of approaching gender dysphoria in a more considered way

Did she, though? I had the temerity to click on the link that Paul provided and it looks like what Winn actually spoke out in favour of was forcing trans men onto estrogen:

Furthermore:

When a natal female tells us she feels unfeminine & dysphoric, & thinks this might mean she’s trans, shouldn’t a doctor first check her hormone levels? Could low estrogen/progesterone be the cause of both her depression, and her sense of being less feminine?

This is more likely to occur if she has experienced complex trauma, especially early sexual trauma, which would also correlate with feeling disconnected and unsafe in her body.

Could it be that women who want testosterone actually need estrogen instead?
Winn (2021a & 2021b)

That seems like a different thing from what Paul described! Actually a totally different thing! And also kind of evil!

14

Some threatened to send complaints to [Winn’s] licensing board, saying that she was trying to make trans kids change their minds through conversion therapy

Winn’s licensure is in Oregon, meaning she is banned from practicing conversion therapy on people under 18 under Oregon Revised Statutes (Or Rev Stat) § 675.850(1) per Or Rev Stat § 675.850(2)(b)(A)(v). The definition of “conversion therapy” in Oregon state law is in Or Rev Stat § 675.850(2)(a)(A): “attempting to change a person’s … gender identity, including behaviors or expressions of self”.

But who says Winn was “attempting to change [any] person’s … gender identity, including behaviors or expressions of self”? Well, Winn, for one thing, who as well as proposing to subject trans kids to the Alan Turing treatment (see Meyer, 2013) also, for example, advised parents to put them through acupuncture in the hopes of provoking a hatred of needles because “the child’s hatred of needles could also help spark desistence [sic]” (Winn, 2022).

Winn stated an intention to engage in conversion therapy, and, to my understanding, actually did so. Oregon law says this is the point where, at minimum, the Board should get involved. Call me crazy but I actually think it is good when people Pamela Paul doesn’t like and people she does are equally bound by the law.

15

which has left [detransitioners] open as attacks as hapless tools of the right

If they are choosing to allow themselves to be used to achieve the right’s broader strategic ends — which the detransitioners with the most media prominence verifiably are (Alfonseca, 2022; Doyle, 2023; Henry, 2024) — then they are, objectively, tools of the right, regardless of any other quality of the relationship.

Under those circumstances, assuming that they are simply hapless — unfortunate — is the charitable, reasonable thing to do. The alternative would be assuming that the very specific and by no means representative subset of detransitioned people who engage in this activism are actually intentionally complicit.

16

These are people who were once the trans-identified kids

To me, this is a revelatory phrase, because it really cuts to the heart of what Paul is trying to pull here.

Transness is an internal experience with no empirical test. The way you know if someone is trans is if they tell you — if they identify themself to you as trans — if they “trans-identify,” if you like. The hostile “trans-identified” (TransActual, n.d., 3(d)) and the neutral “trans” overlap 1:1.

Paul wants you to think that her angle is that it was wrong to treat these specific people, and that it was wrong ab initio, from the start, because sufficient care wasn’t taken to ensure that they were trans — which logically requires that there must be a level of care which would be sufficient for that purpose.

However, Paul also says that these people “were,” without condition or qualification, “trans-identified kids,” i.e., trans kids. So there is no distinction between these people when they were kids, and trans kids. There may be a standard which could be used to distinguish the two but that standard has in all of human experience so far failed to do so.

That’s interesting, because that leads us inescapably to another conclusion: that all actually existing trans kids, jointly and severally, can’t be distinguished from these people by any measure. Meaning that no trans kid has received sufficient assessment to make sure they are really trans. Meaning affirming any trans kid is wrong. This isn’t an argument for more careful care, this is an argument for total prohibition, now, everywhere.

17

that so many organisations say they’re trying to protect

I couldn’t help but roll my eyes at the “say” in this passage, dropped in with such pointed lightness and delicacy. Read: “But they’re lying! They’re filthy degenerates who have designs on your children! I tell you they’re lying!”

18

Several of those who questioned their child’s self-diagnosis …

Paul calls knowing you’re trans a “self-diagnosis” to make it sound complex and technical. Note that she could also have used this argument with homosexuality when it was in the Diagnostic and Statistical Manual of Mental Disorders (DSM) (American Psychiatric Association, 1952; American Psychiatric Association, 1974) and the International Classification of Diseases (World Health Organization, 1977). Note that in fact nobody left of say Nick Fuentes would now bother pretending that “mum, dad, I’m gay” is a “self-diagnosis”.

Paul can only get away with this kind of obfuscatory bullshit because she and people like her have, with significant funding and institutional backing, been able to present transness, including in kids (Gill-Peterson, 2021) — a phenomenon which has been present for literally all of human history (Daniels, 2021) — as “new”.

19

… say it has ruined their relationship

Yeah, telling your child they’re wrong about something only they’d know will have that effect, especially when you deny them medically necessary care as a result. A key element of love is trust. Parents are not exempt from having to act like they actually love their kids. I don’t know what these folks expected.

20

How would hormones help a child with obsessive-compulsive disorder or depression? she wondered

I mean I could argue against the easy version of this position: depression and obsessive-compulsive disorder (OCD) can both be secondary to (caused by) dysphoria. They can also both be exacerbated by it; the mood state dysphoria, with which specific gender dysphoria intersects, is also a core symptom of depression (Morin, 2023), while as an anxiety disorder (Better Health Channel, 2022), OCD is susceptible to gender dysphoria’s anxiogenic effects (Dhejne et al., 2016). Hormones relieve dysphoria. Therefore, hormones can relieve depression and OCD — voila.

So the only way this position holds up any better than that is assuming that she means depression or OCD which is primary (of no other cause), or at least not secondary to dysphoria. So the immediate question obviously is why — as the framing implies — would you have expected this answer to come up in a group of people whose connecting element is that their kids experience dysphoria? Why would it be their job to know?

But more broadly, as someone with primary major depression and OCD, I can take this one: the answer to “how do hormones help with those things?” is they don’t; that’s not what they’re for, which doesn’t make them any less useful for what they are for. It’s like saying “How does ibuprofen help with ADHD?” It doesn’t! Why would it? Why would it have to?

21

Others say their child learned these ideas in the classroom … through curricula supplied by trans rights organisations

Okay, look, I’m sceptical about this given the furore that ensues every time the possibility of “curricula supplied by trans rights organisations” or anyone close to them comes up — anybody remember Safe Schools (Law, 2017; Louden, 2017; McKay, 2019)? — but since I don’t have the evidence to dismiss it out of hand I have to press on.

Which I will do like this: yeah it’s expected for school curricula to be informed by current knowledge from subject matter experts. It’s considered good even!

22

The meeting was brief and began on a shocking note. ‘In front of my son, the therapist said, “do you want a dead son or a live daughter?”‘

Strictly speaking I can’t dismiss this out of hand either because I wasn’t there but I have my limits. Let’s be real: this didn’t happen. I changed my pronouns to they/them in 2013, changed them again to she/her and started HRT in 2020, and started doing Several Problems-type work in or around 2021. In over a decade of being increasingly engaged with trans issues, I have never heard or read of this phrase being used in a clinical context except in pieces like this one. If I Google it, I don’t get results from providers or LGBTQ+ advocacy groups; I get them from Newsmax (Cacciatore, 2022), Ben Shapiro (2022), and Transgender Trend (Biggs, 2018) — people who share Paul’s views, to a one. To the extent that it intersects with reality at all, it’s parents describing their own thought processes (e.g., Hirt-Manheimer, 2021), not providers trying to coerce them.

As an aside, I actually disapprove of this formulation anyway. Like it’s fair but I also think it’s oversimplified and reductive. Your child is statistically more likely to die if you don’t let them access care, but it’s not a given. They might simply breathe their last in eighty years having never truly lived.

23

Parents are routinely warned that to pursue any path outside agreeing with a child’s … gender identity is to put a [trans] youth at risk of suicide

That’ll be because it’s objectively the truth (Bauer et al., 2015; Klein & Golub, 2016; Marquez-Velarde et al., 2023; etc.). Hope this helps.

24

which feels to many people like emotional blackmail

When someone tells you, with bulletproof evidence, “you are actively increasing your child’s risk of suicide,” the well-adjusted and normal thing to do is, obviously, to go “you know, the real problem here is that what you said made me feel bad”.

25

But those studies were found to have methodological flaws or have been deemed not entirely conclusive

In The Times‘ copy, this passage contains two citations. The second one goes to Edwards-Leeper & Anderson (op. cit.), which is an op-ed so I’m not fisking it here (get your own primary sources, Pamela!). The first one, ‘methodological flaws,’ however, goes to an apparently peer-reviewed paper, Abbruzzese et al. (2023) … which was published in a Clarke–Northwestern journal, and written by three members of the Society for Evidence-based Gender Medicine (SEGM). In a just world, citing this bullshit would get Paul’s article taken down and me paid $50,000 for the number of brain cells I lost reading it.

The Clarke–Northwestern clique is a group of anti-LGBTQ+ disinformation operators and pseudoscience extruders who coalesced at the Clarke Institute of Psychiatry (Toronto, Ontario, Canada) — which later became the core of the merger that formed the Centre for Addiction and Mental Health (CAMH) in Toronto — and Northwestern University (Evanston, Illinois, United States) in the early 1980s. Core members are considered to include (Abernathey, n.d.; James, 2019):

J. Michael Bailey, on whom more later;
Ray Blanchard, who formulated Blanchard’s transsexualism typology, which heavily pathologises trans women (Serano, 2020) and separates them into two groups, homosexual–transsexual (HSTS; in brief, “gay men so gay they want to be women to fuck more men”) and autogynaephilic¹ (AGP; “straight men with an all-consuming fetish for being women”);²
Alice Dreger, an acolyte of Blanchard, and a major influence on the “irrational censorious trans activists vs. innocent scientists” media narrative which Paul leverages here (Jones, 2016; Serano, 2021);
Dr Kenneth J. “Ken” Zucker, disgraced former director of the CAMH Gender Identity Service who used it to do conversion therapy (Zinck & Pignatiello, 2015, p. 21, clause 14), now a conversion therapy promoter and anti-trans dial-a-quote (James, 2024e).

The best-known Clarke–Northwestern-aligned journal is the Archives of Sexual Behavior, founded by fellow conversion therapist Richard Green (Ashley, 2019) and published by Springer Nature for the International Academy of Sex Research (IASR). Ken Zucker has been its editor since 2000 and uses it, according to veteran trans affairs analyst Andrea James (2024f), as a “bully pulpit” for his views. Zucker’s editorship has notably been characterised by a rather laissez-faire attitude to peer review for authors who share his political views (see, e.g., Carey, 2012).

The Archives is not the journal cited here. The journal cited here is the Journal of Sex & Marital Therapy (JSMT), another Clarke–Northwestern journal edited by trusted Zucker associate (Abernathey, n.d.) Robert Taylor Segraves (Taylor & Francis Online, n.d.). The editorial board under Segraves’ editorship includes (Taylor & Francis Online, op. cit.) Zucker himself, as well as Stephen Levine, an advisor to conversion therapy promotion group Genspect (Duval, 2021) also known for his work helping to deny trans prisoners medically necessary care (Stahl, 2021).

With regard to trans healthcare, JSMT serves as a nominally peer-reviewed platform for the Society for Evidence-based Gender Medicine (SEGM), an opaquely funded anti-trans disinformation operation (Moore, 2021b) with members on several continents, including Australia (Turner, 2023). The authors of the paper cited by Paul are

Evgenia Abbruzzese, who discloses her affiliation with SEGM in the paper;
Levine, mentioned above, who does not here disclose his affiliation with Genspect;
Julia Mason, who does not here disclose her affiliation with SEGM.

The substance of the paper itself would take me another entire article to properly dissect; I have focused mostly on the context here because that context, unlike the specific contents of this paper, remains relevant throughout the article. In short, its three key criticisms are that

the study had uncontrolled confounding (it didn’t);
it didn’t report all relevant adverse outcomes (it did), and
it doesn’t count today for Secret Reasons (it does; this is discussed further below).

For anyone who’s bothered to actually read the article and follow up its citations it is a transparently specious and baseless critique. Not that that stops Paul.

26

Pediatricians, psychologists, and other clinicians … dissent from this orthodoxy, believing it is not based on reliable evidence

There are climatologists who say this about climate change (Benestad et al., 2015). That doesn’t change the fact that in both cases the scientific consensus is absolutely unequivocal (What We Know Project, 2018; Powell, 2019; Boerner, 2022; Turban, 2022).

27

In 2021, Aaron Kimberly, a 50-year-old trans man and registered nurse …

Paul forgets to note that Kimberly is also an advisor to Genspect (“Genspect advisor Aaron Kimberly,” 2022).

28

[Kimberly] subsequently founded the Gender Dysphoria Alliance and the LGBT Courage Coalition …

One man, two supposedly full-fledged advocacy groups. I personally think I’d be satisfied with one but that’s just me. I am familiar with the Gender Dysphoria Alliance — its membership consists largely of conservative trans men and transmasculine people who pursue a self-interested but broadly anti-trans politics founded in transmisogyny, the hatred of trans women. Their 2021 open letter Trans Men Fight Back (Kimberly et al., 2021) is particularly edifying reading on that subject.

I was not previously aware of the LGBT Courage Coalition, but upon review it appears to consist entirely of established, mostly cis, anti-trans activists, and conducts its activism entirely through two social media accounts, one on Substack and one on Twitter. Notably, it shares a significant noun with the Catholic Church’s ex-gay apostolate, Courage International — perhaps coincidental, but then again (#30), perhaps not.

29

and before sexual maturation

The fact that Pamela Paul and her allies believe it is obligatory for children to “sexually mature” in the way Paul and co. would like, even against any wishes the child themself might have on the matter, has implications I would prefer not to think about.

30

and that gender ideology can mask and even abet homophobia

For anyone not as in the weeds as I am, “gender ideology” is a flag. I would call it a dogwhistle but it gets used so often and with such obvious vitriol very quickly descending into the range of the human ear.

Specifically, it’s a snarl word originally developed for political work by the Roman Curia, the central administration of the Catholic Church. The actual origin is from the strain of Catholic social teaching expounded by Pope John Paul II starting with his Theology of the Body lecture series of 1979–1984, which treats men and women as different in an essential way, complementary (intended by God for different roles), and immutable.

The concept was developed and fleshed out by Joseph Cardinal Ratzinger, later Pope Benedict XVI, who was at that time the Prefect of the Congregation for the Doctrine of the Faith, the Church’s senior doctrine officer and internal investigator. The catalyst for Ratzinger’s interest appears to have been the proceedings surrounding the Federal Republic of Germany’s Transsexuellengetz (Transsexual Act) of 1980, which ultimately passed and established Germany’s current legal gender recognition regime (Case, 2019).

“Gender ideology,” as used by the Holy See and other people who have picked it up — I’m not suggesting this is a solely Catholic conspiracy, I’m not Dan Brown — is an empty signifier (Reid, 2018). It has no fixed denotative (literal) meaning: if you ask “what is it?” or “show me an example of it,” the speaker can define it however they want. It does, however, have a connotative (felt/implied) meaning: that trans gender is an ideological project; that trans people say, act as if, believe they are trans because we have been convinced certain political propositions are true.

This doesn’t make any damn sense. Historically, practitioners who would be ultraconservative by modern standards have felt free to admit in the privacy of journals (see, e.g., Lebovitz, 1972, p. 105; Davenport, 1986, p. 515) that plenty of kids come out as trans practically the instant they can talk. If humans had the capacity to just pop out kids capable of that level of leftist political sophistication at that age right and left, this article would be in Russian. On the other hand, “gender ideology” is 2 words and so far I have spent 4 paragraphs explaining it; in the much less verbose Twitter version, I still needed 5 Tweets. You can see therefore how the term might be useful for its proponents.

Incidentally, like Paul’s accusation of trans “institutional capture,” the reas: in German academic use, the term “gender ideology” (Geschlechterideologie) has an established meaning that does not refer to trans people — namely “an ideology that regulates sex and gender” (see, e.g., Knapp, 1988, p. 12; Rohde-Dachser, 1991, p. 143; Kuhn, 1994, p. 6). The Catholic Church’s appropriation of the term “floods the zone” (see Stelter, 2021) of an entire strain of sociological discussion — one whose conclusions in the cold light of day look rather inconvenient for institutions like the Catholic Church. As with most right-wing canards, every accusation is a confession.

31

I transitioned because I didn’t want to be gay

According to Reisner et al. (2023), the proportion of respondents in a sample of United States trans people who described themselves as straight was 17.6% (versus 90.1% of cis controls), so I am forced to tactfully suggest that this may not have been a very clever idea.

32

says Kasey Emerick

I was surprised to discover that I know, or at least directly know of, Kasey Emerick. We are not acquainted, but she (I am following the article’s guidance on pronouns) is an established ideologically motivated detransitioned activist who was previously active on Twitter under the name “KC Miller”.

Because I was active at the same time as, and adjacent to, Emerick, I can’t help but notice that some of the particulars of her story appear to have changed. For instance, Emerick says she detransitioned because she realised she had been “living a lie”. She joined Twitter after her detransition, yet at that time, she said that she was “comfortable living as a man”:

She also mentioned at the time that she didn’t have any intention of stopping testosterone — which is why it’s somewhat surprising that Paul’s narrative now indicates Emerick had stopped testosterone around that time. Actually, Paul indicates that Emerick said that; there may be a reason Paul isn’t confident enough in the claim to put it in the authoritative editorial voice. But maybe not.

33

Raised in a conservative Christian church, she says ‘I believed homosexuality was a sin’

As someone who’s estranged from a birth family which (apart from a few escapee atheists) consists of several generations of Latter-day Saints and a handful of Pentecostals, I’m entertained by the suggestion that conservative Christianity doesn’t also teach that transgenderism is a sin. What about the Nashville Statement (2017, Art. VII) or the SBC’s 2014 Resolution on Transgender Identity (Burk, 2014)? What are they, a pork chop?

34

To the trans activist dictum …

The use of “dictum” here is intentional. Who issues dicta? Logically, a dictator. Paul is endeavouring to suggest that the filthy trans are attempting to assert a deeply unwholesome authority over your kids.

After I published the original version of this piece on Twitter, a friend suggested I might be giving Paul too much credit — it could quite simply be intended to evoke “dick,” which in context would be equally grim.

35

… says Sasha Ayad, a licensed professional counsellor based in Phoenix

Paul forgets, once again, to mention precisely who her subject is. Ayad is an anti-trans disinformation operator in the same small, tightly-bound network as the other such operators named in this article, and is a core member of it: she is a member not only of Genspect (n.d.) and SEGM (James, 2024c), but of a number of others, including the Gender Exploratory Therapy Association (GETA) (Murphy, 2024) and Sex Matters (James, 2024c). GETA’s stock in trade may be inferred from the fact that “gender exploratory therapy” was previously named “gender reparative therapy” (Countering Hate Speech Aotearoa, 2023) — a euphemism presumably abandoned when it became too well known that “reparative therapy” is simply another name for conversion therapy (Human Rights Campaign Foundation, “The lies and dangers of efforts,” n.d.). Of Sex Matters — more later (#61).

36

[Ayad is] a co-author of When Kids Say They’re Trans: A Guide for Thoughtful Parents

The other two co-authors, not named here, are Genspect founder Stella O’Malley and GETA cofounder Lisa Marchiano (Reed, 2023; Amazon Australia Services, 2023).

37

Studies show that around 8 in 10 cases of childhood gender dysphoria resolve themselves by puberty

Wrong! This is an old canard, and I, being a fool, am constantly surprised that it’s still in circulation, but I guess with mastheads as complicit as The Times (and the Financial Review) there was no need to come up with anything new.

The trail of citations here is indirect: Paul cites Kaltiala-Heino et al. (2018), who cite Ristori & Steensma (2015). The figure in question is indeed present in Ristori & Steensma (op. cit., p. 3) — actually 85.2%, by their reckoning. That does not mean it is true. In fact, it is manufactured through what I can only describe as scientific fraud.

Here is how. Gender dysphoria is a common experience that a lot of trans people have. “Gender dysphoria” (GD) is also the name of the clinical proxy for transness, i.e., the concept the medical and psychiatric professions use to understand and interact with transness. We’re going to call this second sense “construct gender dysphoria” (“construct GD”) for the purposes of this article. The strict definition of construct GD is given in the DSM-5 (American Psychiatric Association, 2013); any post-2013 academic work referring to “gender dysphoria” is assumed to be referring to the DSM-5 category.

Ristori & Steensma (op. cit.) present their work as a literature review on “gender dysphoria in childhood,” defining GD explicitly with reference to the DSM-5, i.e., defining it as construct GD. They include 11 studies in the review, claiming that those studies pertain to (construct) GD in children.

This is unambiguously not the truth. The studies used wildly recruitment criteria, some informally using the term “gender dysphoria,” but all using a rubric which was approximately or exactly the pre-DSM-5 construct which included transness in kids, gender identity disorder (GID).

This may not sound like a big deal. This is a huge deal. GID included trans kids, but it also included a far, far larger population of cis kids who were gender-nonconforming (GNC): “sissy” cis boys, tomboy cis girls, and any other kid who was GNC in a way considered troublesome, inconvenient, or annoying — and therefore of course obviously pathological — by the medical, psychiatric, and social authorities of the time.

The studies in the review were longitudinal, meaning they collected data on the same variables at one or more points after initial subject enrolment and data collection (Coggon et al., 2003, ch. 7); the studies in this review typically used a single later point (“follow-up”). They uniformly enrolled and collected initial data from participants recruited based on GID-like criteria. At follow-up, however, they investigated (in some cases among other things) how many participants met a set of criteria far more narrowly centred on what we would recognise as transness — typically “transsexualism,” the pre-DSM-5 construct for transness in teenagers and adults. They then determined what proportion of participants with GID were not trans at follow-up and declared that the rate of what, after later work by the VU University Medical Center clinical research group that included Steensma, came to be called “desistance”.

The problem here is obvious. The initial sample can be characterised as “cis and a little fruity with it, or trans”. There are far more cis people than there are trans people; there are still far more GNC cis people than there are trans people total. Studies that have attempted to ascertain what proportion of the general population are trans, even by the broadest possible definition(s) thereof, have not come anywhere close to 20% (Collin et al., 2016). The most likely reason a “GNC cis and trans” sample was still 85% cis at follow-up isn’t that a big chunk of it stopped being trans, it’s that it was circa 85% cis to begin with.

The authors of the studies reviewed perhaps may be forgiven — loath as I am to do so — because the way cis people understood transness at the time was still evolving. Ristori and Steensma, however, were, and remain, leading authorities in trans healthcare, including in paediatric trans healthcare, to the point that they were co-authors of the current WPATH Standards of Care (Coleman et al., op. cit.). Given that — and given that Steensma separately has a record of very interesting data analysis that “just happens” to boost the apparent desistance rate into the stratosphere (Brooks, 2018) — it is not plausible that this was unintentional. Nor is it plausible that Paul herself didn’t know, because she’s clearly au fait enough with this game that, at this point in the article, she’s about to try some statistical sleight of hand herself.

38

and 30 percent of people on hormone therapy discontinue its use within five years

What Paul is employing here is a different but equally time-honoured propagandistic device — incidentally, a trademark of Tom Steensma (Brooks, op. cit.). I’ve taken to calling it the “lost to follow-up” trick.

Here is how it works. Every longitudinal study which is big enough and runs for long enough has attrition. Attrition is when, at some point after initial enrollment and data collection, one or more participants becomes unavailable for further collection. The term of art is that they become “lost to follow-up”. Attrition can compromise the validity of the study (Bankhead et al., 2017).

One way it can do so is through nonresponse bias. This happens when the likelihood of participation has a direct causal link to a variable of interest in the study, i.e., when whether you are part of a certain subgroup of interest to the study is something, or is caused by something, that determines whether you can respond to the study at all (Turk et al., 2019). For a straightforward example of a survey consisting of a single question, “Do you have time to answer a survey? (Y/N)” is going to return a higher apparent “Yes” rate than exists in the general population, because only the people who would answer “Yes” are participating at all.

It is necessary to be aware of attrition and nonresponse bias. What you cannot do is arbitrarily assume that attrition entails the specific kind of nonresponse bias you want. So of course Paul is doing exactly this.

The study cited, Roberts et al. (2022), examined a sample of trans and gender-diverse patients who were getting hormones through Tricare, the United States military’s health insurance program, between 2009 and 2018 inclusive. It concluded that “>70% of TGD individuals who start gender-affirming hormones will continue use beyond 4 years”.

Paul asserts that this by definition means the other 30% stopped hormones altogether, implying that they did so because they realised they weren’t trans. That’s not how “lost to follow-up” works; the only thing you by definition know about people who are lost to follow-up is that they’re lost to follow-up.

It may be possible to determine why you lost who you lost, and who you never had in the first place. Erin Reed (2024), for instance, notes several reasons the study may have overestimated discontinuation rates or failed to capture all eligible trans people, based on the social and political context that existed during the study period (2009–2018);

increasing movement of trans customers toward online pharmacies, which have grown more popular, as well as GoodRx plans, which offer more privacy;
political pressure from the Trump administration (2017 onward), which had executive control over Tricare and which had begun pursuing trans service members, and other decisions by U.S. military leadership which may have forced study subjects off HRT other than voluntarily;
Tricare’s notoriously poor trans health coverage even under ideal circumstances and without active political interference.

The study’s authors, meanwhile, note in their ‘Discussion’ section several limitations which are inherent to the study itself as designed:

“We only collected information on medication refills obtained using a single insurance plan. If patients elected to pay out of pocket for hormones, accessed hormones through nonmedical channels, or used a different insurance plan to pay for treatment before and/or after obtaining gender-affirming hormones using TRICARE insurance, we did not capture this information”; and
“We would miscategorize patients as terminations if patients elected to obtain their gender-affirming medications using alternative payment options while continuing to receive other medical care using TRICARE,”

and, significantly, conclude that “our findings are likely an underestimate [of] continuation rates among transgender patients”.

Paul could have done the same as either of these, drawing on the sociopolitical environment or the study design to contextualise the results. She simply asserts what is most advantageous to her, and then sails onward, knowing that the preconceptions of her mostly cis readership will carry her the rest of the way.

39

At the end of her freshman year of college, Powell, horrifically depressed, began dissociating, feeling detached from her body and from reality, which had never happened before

This is an interesting one because the framing is a variation of accusation in a mirror. Paul appears to be trying to dogwhistle toward the right-wing “body dissociation” theory about trans healthcare, which has been floating around for a while (Leveille, 2021b). This theory, in turn, appears to function as a mirror-propaganda-type response to the observation, made by both trans people — notably and rigorously by Gender Analysis’ Transgender Depersonalization Project (Jones, n.d.) — and to a lesser extent by the cis clinicians studying us (Fisher et al., 2014; Colizzi et al., 2015), that unmanaged dysphoria is attended by symptoms similar to depersonalisation/derealisation disorder (DP/DR).

The Project corpus and others like it reflect that the DP/DR aspect of dysphoria is relieved by access to medical transition. The conspiracy theory — the one in whose direction Paul is winking here — therefore holds that access to medical transition causes dissociation. But that accusation can’t work with this timeline: on the dates in the article, Powell started dissociating, seemingly quite abruptly based on the wording, more than a year after she started testosterone, and indeed more than a year after the last change of any kind in her regimen of gender-affirming care. It therefore does not make sense to assume that gender-affirming care caused it.

40

“I expected it to change everything, but I was just me, with a slightly deeper voice,” she adds.

Yes, that’s, uh, that’s the value proposition. T stands for “testosterone,” not “transsubstantiation”.

41

[Powell] tried in vain to find a therapist who would treat her underlying issues, but they kept asking her: how do you want to be seen? Do you want to be nonbinary?

This is interesting, because what this passage says and what it wants you to think it says are different. You’re supposed to read it fast enough that you take away the meaning that Powell’s therapists were trying, through intrusive, repeated questioning (“they kept asking her”), to push her into a specific, presumably begin rainbow text gender-ideological end rainbow text, way of thinking about herself.

What the words actually say, however, is that “she tried in vain to find a therapist … they kept asking her,” which means: she went to more than one therapist, and each one asked her at least one of these questions at least once. If these questions are asked repeatedly by the same therapist, of the same person, they sure do look like inappropriate browbeating, because just about any questions repeated in that way would be inappropriate browbeating in that context. But what Paul says is just as open to the interpretation that Powell’s therapists asked her basic framing questions or questions that logically followed from what she’d been through, and the issue is simply that the questions were trans-friendly at all.

42

Powell wanted to talk about her trauma, not her identity or her gender presentation

As a sometime adherent of feminist theory, I am intrigued by the contention that trauma, identity, and gender presentation can be separated with such surgical neatness. It seems inconsistent with the fact that, for instance, trans people are 4× as likely to be victims of violent crime, including sexual violence (Flores et al., 2021) — both typically fairly traumatic by nature.

Drawing even closer to the core of the issue, trans people are about twice as likely as cis people to have experienced sexually violent victimisation in childhood (Thoma et al., 2021) — the exact kind of victimisation of which Powell was a survivor. I am inclined to say it would have been very nearly a breach of due diligence for therapists not to at least have inquired about the subject.

43

The [ex-Tavistock] therapist asked questions like “Who is Grace? What do you want from your life?”

The thing is, these are substantially the same questions Powell’s other therapists were asking her, so the difference can’t be the questions. “Do you want to be nonbinary?” is extremely clearly a subset of “Who is Grace?”. Similarly, “How do you want to be seen?” is extremely clearly a subset — and not a small subset — of “What do you want from your life?”

What Powell, as Paul represents her, seems to want, is for therapists to simply completely avoid any conversation which might lead to mention of her transition. I am also of the view that your average psychiatroid should be kept on a leash, but given the outsized role that Powell’s transition played in her life — enough so that she is now speaking about it to The New York Times! — I do not see how that is a viable ask.

44

Many detransitioners say they face ostracism and silencing because of the toxic politics around transgender issues

Ah yes, the toxic politics. Not otherwise specified.

The thing is that when Paul says “detransitioners,” she’s talking about a very specific kind of detransitioned person. I know a number of detransitioners and retransitioners myself — they decided transition wasn’t for them after all, or that it was for them but they didn’t want it to develop any further, so they stopped HRT, or went onto different HRT, and/or changed their gender presentation, maybe back to the one they had before HRT, maybe to a different one.

Those aren’t the people Paul is talking about. It’s not particularly true that detransitioned people can’t get a platform in liberal media, but it is absolutely true that right-wing media both can, and are willing to, provide them a disproportionately large and loud platform. Consequently, the kind of detransitioners most represented in media narratives, with the complicity of people like Paul, are a very specific, in my experience politically nonrepresentative subset. When you know that, you can really see the classic conservative routine at work here. “They silenced me for my views!” “Which views?” “Oh, you know …” “On taxes?” “No …”

45

“It is extraordinarily frustrating to feel that something I am is inherently political,” Powell says.

And to think that the trans-exclusionary radical feminist (TERF) movement arose from second-wave feminism, she of “the personal is political”. We’ve come so far.

46

In a recent study in the Archives of Sexual Behavior, about 40 young detransitioners out of 78 surveyed said they had suffered from rapid onset gender dysphoria.

Oh, look, it’s the Archives. Even if that weren’t the case, though, simply knowing this study’s authors would give me an idea of its quality. Lisa Littman and Stella O’Malley I have already mentioned. Helena Kerschner is an advisor to Genspect (n.d.) — no surprise there at this point. J. Michael Bailey, for his part, is a disgraced ex-Northwestern psychologist, who Andrea James (2024g) calls, in an extensively researched entry for Transgender Map, “one of the most unethical sexologists in history,” which I think is laudably restrained given the account she then provides of his career.

Of course, this is all just ad hominem. Don’t worry, there are also huge glaring problems with both the study and its use in this context. To name three:

Sampling was non-random. Of the three named recruitment sources, one was Pique Resilience Project, a since-dissolved “ex-transgender” organisation which worked with conservative politicians and media (James, 2024b), and /r/detrans, a large reddit community infamous for its anti-trans bent, which at and until some time after the time of the survey had an overwhelming majority of non-detransitioned subscribers, according to its own internal polling (DetransIS, 2022).
A central part of the survey instrument was based on the proposal that “traumatic events can contribute to the occurrence of gender dysphoria” without any more evidence than that this is “[a] common belief among clinicians who favor ROGD theory”.
Finally, as you might expect from all of the above, the study unquestioningly treated Littman’s ROGD — as well as Ray Blanchard’s autogynaephilia and autoandrophilia — as real conditions, despite the complete absence of evidence for their existence. The study does not prove the existence of ROGD because it did not set out to do so — it took the existence of ROGD as an unquestionable fundamental assumption.

(To be fair, “I assume things therefore they are real” appears to be Paul’s methodology, too.)

47

Trans activists have fought hard to suppress any discussion of rapid onset gender dysphoria

As Zinnia Jones has pointed out, this is not the case. I will append that it’s also another case of projection. Trans people are an underrepresented (Vyse, 2019), impoverished and economically marginalised (Carpenter et al., 2020) group. We do not either individually or collectively have the power to suppress anything.

What trans people have actually done is confront the pseudoscientific spectre of ROGD and show it to be completely baseless and without merit, time and time again (Duck-Chong, 2018; Restar, 2019; Ashley, 2020). We’re participating in the public discourse and, despite being constantly stomped on, we’re winning because we’re right. But this is inconvenient for Paul, so she decides to lie instead.

48

the activist organization GLAAD warns the media against using the term [ROGD] as it is not “a formal condition or diagnosis”

Given that this is true it seems like a good reason to me. Things do not become untrue simply because advocacy groups are saying them. Granted throughout this very piece I’ve cited Genspect and SEGM affiliation as the first line evidence that a source is biased, but in every single case I have then gone on to show that it is in fact biased. Paul is just citing the fact that GLAAD is an activist group as if that means something on its own. Should we, as a matter of principle, take the position that elephants don’t exist simply because the Republican Party has one in its logo?

49

a group of professional organisations put out a statement urging clinicians to eliminate the term from use

I’m familiar with the group in question, the Coalition for the Advancement & Application of Psychological Science (2021), and I must say that “a group of professional organisations” is masterful downplaying of “both APAs — the American Psychological Association and the American Psychiatric Association — and several of their major international peers”.

50

But those studies, which often rely on self-reported cases to gender clinics, probably understate the actual numbers. None of the seven detransitioners I interviewed even considered reporting back …

See? Paul knows very well what attrition and non-response bias are, and therefore, as above, knows full well she’s full of shit. But sure — let’s do this.

First, 7 people is a comically small sample size to be asserting anything at all. Even if this were a peer-reviewed paper instead of a hit piece in The Times, you couldn’t call it evidence of anything. With an extremely sympathetic funder you might be able to make the case that it was grounds to give you more money to do a pilot study for further research. But it is nowhere near a result on its own.

Second, the mere fact that attrition is present at all does not automatically invalidate a study, as Paul is implying. It is present in pretty much every study, including every randomised controlled trial, and they’re still considered the gold standard (Hariton & Locascio, 2018). Paul even goes on to advocate for them later in the argument. Attrition becomes a problem when it rises to an unsustainable level (Bankhead et al., op. cit.).

What Paul would have to be alleging for her position to make sense is that trans healthcare research has a systematic problem with attrition at an invalidating level. You cannot make this claim without pointing to some actual studies and their attrition rates. You need a more solid basis for alleging that a systematic problem is present than “it would be politically convenient for me if it were”.

Moreover, you could have a hundred detransitioners — which honestly I think is about as many as the right has managed to scrame up between them worldwide — and it still wouldn’t mean shit because their existence alone does not prove compromising attrition bias. If I’m running a longitudinal study at a gender clinic in Australia with a sample of 1,000 patients an attrition rate of, say, 3% — well within the “perfectly fine” zone (Bankhead et al., op. cit.) — then the fact that someone in Idaho stopped T and didn’t tell their doctor affects the validity of my findings not at all.

51

Unlike the current population of gender dysphoric youth, the Dutch study participants had no serious psychological conditions

This is a lie (of omission). Paul’s argument here is lifted directly from Abbruzzese et al. (op. cit.), the SEGM paper previously cited. The SEGM paper notes that the two Dutch studies to which Paul refers here (de Vries et al., 2011; de Vries et al., 2014) were carried out with a cohort of gender clinic patients who had previously been screened using criteria including the following:

Second, they must be psychologically stable (with the exception of depressed feelings, which often are a consequence of their living in the unwanted gender role) and function socially without problems (e.g., have a supportive family, do well at school).
Cohen-Kettenis & van Goozen (1997), p. 265

Personally I think this is a stupid set of criteria to gatekeep youth transition anyway but as I’m arguing against the strong form of Paul’s argument, which is the form made by Abbruzzese et al., let’s see what these new “serious psychological conditions” are that the Dutch team failed to consider:

… significant preexisting mental illness such as depression and anxiety or neurocognitive challenges such as autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) …
Abbruzzese et al. (op. cit.), p. 684

So, to recap: the “significant preexisting mental illness” that the SEGM paper refers to — which is the same as the “serious psychological conditions” to which Paul refers — consists in part of two neurodivergences that are not at all incompatible with the Dutch clinic screening criteria. The actual mental illnesses that Abbruzzese et al. contend makes modern trans kids meaningfully different from the Dutch gender clinic cohort are … depression and anxiety, i.e., the specific disorder cluster which the Dutch clinic explicitly, and for very good reason, considered OK.

In short, Paul’s argument here is directly and unambiguously false — “the current population of gender dysphoric youth” and “the Dutch study participants” are not different at all and there’s zero possibility that she doesn’t know that. She’s just relying on you not to look.

52

There was no evidence that any intervention was lifesaving

This argument is also lifted from the SEGM paper, which cloaks its point in the more comfortably detached language of “lack of research equipoise”. In both guises, this point is based on the contention that any and all research showing that trans healthcare is lifesaving is invalid because it doesn’t have a control group. That’s dark. Really dark. Like “at this point, maybe this person should be arrested” levels of dark.

Studies of new medical interventions typically have two groups of subjects, the experimental group and the control group. The experimental group receive the novel intervention. The controls are selected for statistical similarity to the experimental group, but don’t receive the intervention; they provide a “normal” baseline against which the performance of the novel intervention can be assessed.

The control and experimental groups are “blinded,” prevented from knowing who’s receiving the treatment and who’s not. The way this is typically achieved is with a placebo, a treatment which resembles the novel treatment but doesn’t do anything (Kendall, 2003). However, the principle of nonmaleficence in research stipulates that an experiment is unethical and therefore impermissible if it places subjects at risk of harm (Alele & Malau-Aduli, 2023). Where a placebo would do that, the control group must instead be provided with the existing standard treatment (Millum & Grady, 2013).

In this case, though, the treatment being disputed is the existing standard treatment, because decades of reactionary propaganda have been able to successfully present interventions that have been used, in one form or another, for over a century, as “novel”.

What Paul and SEGM are saying, consciously, with clear eyes and no regrets, is that every study showing that trans healthcare saves lives is invalid because they didn’t take an equal-sized, equally miserable and desperate control group, give them sugar pill “E₂” and saline “T,” and count the corpses at follow-up. Couched in technical language though it might be, I cannot help but regard this as hate speech. Use as many five-dollar words as you like, but this is incitement to murder.

53

There was no long-term follow-up with any of the [Dutch] study’s 55 participants

Both Dutch studies — Paul does not seem to have been paying close enough attention to remember that there were 2 — were longitudinal studies which took place over a set time period. Any rubric which invalidated them for having “no long-term follow-up” would also invalidate any other study that didn’t run literally forever. (Notably, Paul does not attempt to apply this standard to any of the studies she actually likes.)

54

or any of the 15 who dropped out

Per de Vries et al. (2014, p. 697), no one dropped out. 70 people were invited to participate. 15 didn’t: 1 had died, 1 had left that clinic, 4 were medically ineligible for various reasons, 2 didn’t reply, and 2 refused to participate. Post-enrolment attrition was 0.

There were a further 15 participants who did not contribute complete data. There was a set of 5 survey instruments which were not completed at initial collection by 8 participants because those instruments were added to the study after initial collection. There was 1 survey instrument for which 10 participants did not ultimately have complete data at initial collection due to unspecified “clinician error” (ibid., p. 699). None of those further 15 participants even temporarily “dropped out” in any sense of the term.

55

A British effort to replicate the study said that it ‘identified no changes in psychological function’ and that more studies were needed

Paul intentionally does not mention which of the Dutch studies was replicated because it would destroy her argument. de Vries et al. (2011) was concerned with puberty blockers; de Vries et al. (2014) was concerned with HRT. The British replication (Carmichael et al., 2021) is of the 2011 study.

The thing with puberty blockers is that they’re not supposed to cause changes in psychological functioning; they’re supposed to stop them where they are and give trans kids “time to decide”. (Editorially: The fact that circa 100% of trans kids decide to continue reveals that this is, more than anything, an artifact of cis people desperately hoping the trans kids in question can somehow be led to “decide otherwise”.)

Some of the participants in the British replication started blockers before Tanner stage III, i.e., the point where puberty de facto really kicks in. Most did not. The reason for no psychological change in the pre-Tanner III kids is that they went from “never really having experienced puberty” to … “still never really having experienced puberty”.

Carmichael et al. themselves give measured support to this position, saying that a situation where “[puberty blocker] treatment brought no measurable benefit nor harm to psychological function … is consonant with the action of [puberty blockade], which only stops further pubertal development and does not change the body to be more congruent with a young person’s gender identity” (Carmichael et al., op. cit., p. 20).

The reason for no psychological change in the post-Tanner III kids, meanwhile, is likely that puberty suppression has its own set of unpleasantnesses literally regardless of where you go from there. Sex hormone blockade without hormone replacement sucks — as Carmichael et al. (op. cit., p. 5) note, its “anticipated side-effects … includ[e] … headaches, hot flushes, fatigue, loss of libido and low mood”. It’s a compromise by trans people, not a concession to us.

56

Britain’s Tavistock was ordered to be shut down in March after a[n] investigation found deficiencies in service and “a lack of consensus … about the nature of … dysphoria and therefore about the appropriate clinical response”.

Oh, “after”, my old friend. Paul is trying to dog-walk her readers into inferring a causal link: “after, therefore because of”. Paul is leading the reader to believe that the Tavistock was seeing too many kids, some sensible and moderate individual pulled the fire alarm, credible authorities verified that this was the case, and the clinic has been shut down as a result.

But in this case, the truth is quite the opposite. The Tavistock was shut down because, according to the Interim Report:

It has become increasingly clear that that a single specialist provider model is not a safe or viable long-term option in view of concerns about lack of peer review and the ability to respond to the increasing demand.

Additionally, children and young people with gender-related distress have been inadvertently disadvantaged because local services have not felt adequately equipped to see them. It is essential that they can access the same level as psychological and social support as any other child or young person in distress, from their first encounter with the NHS and at every level within the service.
The Cass Review (2022), ss 1.33–1.34

In short: the Tavistock was shut down not because it was seeing too many kids, but because it was seeing too few. This admission is all the more remarkable because it comes from a Review which is now known to have been compromised throughout by Paul’s ideological allies (Jones, 2023; Ruuska et al., 2024³). The Review could not avoid admitting this much despite having a very clear interest in not doing so.

But, of course, Paul can’t mention any of this, and wouldn’t if she could. So she simply implies that things are as she wishes they were, and leaves the reader to fill in the blanks.

57

The American Academy of Pediatrics only recently agreed to conduct more research

None of these words are untrue and yet it is a lie anyway.

The lie is in the words “only recently” and “agreed”. “Agreed” implies the decision was made as a concession after being prevailed upon by another party. “Only recently” implies that the concession was secured through several years of such prevailing. The use of both terms falsely links the AAP agreement to several years of semi-publicised internal anti-trans agitation by clinicians such as, e.g., paediatrician and SEGM member Julia Mason (Block, 2023).

In reality, the “agreement” was a measure adopted by a vote of the AAP Board of Directors on its own initiative. In the measure, the AAP specifically reaffirmed its commitment to the principles Paul and her allies politically oppose, reiterating its “support [for] giving transgender adolescents access to the health care they need,” and indicating that the measures were a practical decision intended to address “restrictions on access to health care with bans on gender-affirming care” (Wyckoff, 2023).

Second, Paul makes the assertion that the AAP is “conduct[ing] more research” because it implies more primary (original) research, which in turn implies that the AAP is materially conceding the common anti-trans claim that the current evidence base is insufficient to support its position. This is incorrect. The AAP authorised a systematic review, a scholarly synthesis of the existing evidence. In effect, the AAP is reorganising the existing research for more efficient use.

58

in response to years-long efforts by dissenting experts including Dr Julia Mason, a self-described ‘bleeding-heart liberal’ …

As noted above, and as not noted by Paul, Julia Mason is, among other things, an advisor to Genspect (n.d.) and a co-founder of SEGM (Block, 2023).

59

politics should not influence medical practice, whether the issue is birth control, abortion or gender medicine

And yet, observably, they do. Politics determines how and what laws are made. Medical practice is subject to those laws. Politics therefore influences medical practice. It’s not a matter of “should” — the fact that it does so is both unavoidable and cannot be attenuated in any way, and Paul knows that.

This means this statement does not serve the ends it pretends to. Rather, when authors like Paul say, with an affectation of high-minded idealism, that certain matters bound by law should be ‘above politics,’ what they’re really saying is that those matters should be bound by only those politics that have already become embodied in the law prior to now, without right of appeal, in perpetuity.

60

Last year, The Economist published a thorough investigation into America’s approach to gender medicine. Zanny Minton Beddoes, the editor, put the issue into political context.

Ah yes, The Economist. That place where Helen Joyce used to hang out. For anyone not in the loop: for most of the two decades to 2023, The Economist employed and platformed columnist/editor Helen Joyce, who formally quit in 2023 to devote more time to her work as advocacy director at Sex Matters (“Helen Joyce joins Sex Matters,” 2022), an extremist anti-trans advocacy group (Trans Safety Network, 2023). She is on record with the following view of trans people:

… we have to try to limit the harm and that means reducing or keeping down the number of people who transition. That’s for two reasons — one of them is that every one of those people is a person who’s been damaged. But the second one is every one of those people is basically, you know, a huge problem to a sane world.
Joyce, in Prior (2022) and Kelleher (2022)

I am not overfamiliar with Zanny Minton Beddoes, who became editor of The Economist in 2015 (Kemp, 2015). However, Joyce has consistently said she was introduced to anti-trans politics by her editor (Jones, 2021; Joyce, 2022). Joyce herself joined The Economist‘s editorship in 2014 as international editor (Australian Broadcasting Corporation, n.d.), meaning that at the time she says this happened, in 2017 (Jones, 2021), there is only one person of whom I am aware who could credibly have been described as “her editor”.

61

Paul Garcia-Ryan is a psychotherapist in New York who cares for kids and families seeking holistic, exploratory care for gender dysphoria

(Pamela) Paul neglects to mention that Garcia-Ryan is a member of GETA (James, 2024d). There are no empirical claims here to disprove; since Garcia-Ryan’s contribution to the article consists solely of his personal and clinical opinion, the fact that he is a member of a conversion therapy promotion group discredits his entire contribution.

62

Instead of promoting unproven treatments for children, which surveys show many Americans are uncomfortable with, transgender activists would be more effective if they focused on a shared agenda

Read: Persuading people is good when I do it in The Times, but not when the troons do it on the internet and in the streets.

63

Most Americans across the political spectrum can agree on the need for legal protections for transgender adults

This claim is sourced to two different graphics from the same Pew Research Center poll (Parker et al., 2022). For the sake of argument, let’s put aside that this data, which is polling data and therefore by nature has a short shelf life, is two years old. The first source, which superficially appears to support Paul’s point, is a simplified, summarised version of the second, which doesn’t. Let’s look at the second.

This section of the poll is concerned with whether respondents favor or oppose particular types of laws being imposed on trans Americans across the country at the time of the poll. Paul is leaning on the headline figure, which shows that 64% of Americans Strongly favor/Favor laws that will “Protect transgender people from discrimination in jobs, housing and public spaces,” while only 10% of Americans Strongly oppose/Oppose them, a margin of 54%. (25% of Americans neither favoured nor opposed.)

Sounds good, right? Now let’s look at the other questions— oh.

Require that trans athletes compete on teams that match the sex they were assigned at birth: Strongly favor/Favor (41% margin);
Make it illegal for health care professionals to help someone under 18 with medical care for gender transition: Strongly favor/Favor (15% margin);
Require trans individuals to use public bathrooms that match the sex they were assigned at birth: Strongly favor/Favor (10% margin);
Make it illegal for public school districts to teach about gender identity in elementary schools: Strongly favor/Favor (3% margin);
Investigate parents for child abuse if they help someone under 18 get medical care for gender transition: Strongly favor/Favor (1% margin).

As you may have noticed, the other laws which Pew respondents favour are not quite as benign in their effects as the one to which Paul was so keen to direct her readers’ attention. But this last one sounds nice, what about—

Require health insurance companies to cover medical care for gender transitions: Strongly oppose/Oppose (17% margin).

—ah. So, to clarify, Americans think we should be protected from discrimination. They also want to ban us from sports — just for the hell of it, since there’s no actual evidence (Pérez Ortega, 2023). And make us out ourselves to anyone in sight if we need to piss in public. And schools shouldn’t be able to talk about us, and if parents support their trans kids and let them get medically necessary paediatric care then it’s child abuse. And if we want to transition when we’re adults then it should be made as expensive as possible to make sure we can’t. Does that sound like “protection” to you?

What this graph shows is that Americans are fine with anti-discrimination protections for trans people on general principle — no one wants to think of themselves as a bigot. But they resolutely oppose any measure that might actually ameliorate that discrimination in any way. In a way, they want trans people to have equal rights — they don’t want trans people to have any rights they can’t imagine wanting themselves.

This is ultimately about equality vs. equity. As a queer teenager in the 2000s, I often heard a particularly insufferable strain of right-winger say, in the most self-satisfied imaginable tone, “Gays already have equal rights — the right to marry the opposite sex” (see, e.g., Prell, 2009). Anatole France put the quandary slightly more elegantly:

… la majestueuse égalité des lois … interdit au riche comme au pauvre de coucher sous les ponts, de mendier dans les rues et de voler du pain.

… the majestic equality of laws … prevents rich and poor alike from sleeping under bridges, begging in the streets, and stealing bread.
France (1894, p. 118)

Vulgar equality, being as able as the majority to do only those things that are necessary for the majority, is no equality at all. What is required is equity — the ability to do those things that are necessary for one to live as well as the majority does without needing to do them. Trans people need rights that cis people don’t.⁴ There is no serious debate on the necessity of those rights, simply a political and media establishment which is implacably opposed to our getting them.

But enough about that, let’s get back to Paul. Paul pretends she believes she’s advocating a sensible moderate agenda focusing on a core demand. But she cited this graph herself, so she read it, and she therefore knows as well as I do that this poll says Americans are not up for any actual substantial relief of discrimination at all, no matter how minor. If that’s the case then the agenda that Paul proposes we should rally around is no more survivable than the “maximalist” agenda, of demanding the basic human rights and care we are owed, which she opposes. And she knows it. But she chooses to lie anyway.

64

They would also probably support additional research on the needs of young people reporting gender dysphoria so that kids could get the best treatment possible

As a former trans kid, I’d love that too! If only that was what Paul actually meant.

Unfortunately we are caught in a catch-22 where everyone wants more data, but any attempt to actually get it is immediately seized upon by the media as superficially plausible “proof” that the existing knowledge base is insufficient and all current care should therefore be stopped regardless of the consequences.

We’ve also seen what “research on trans kids” looks like under the aegis of current institutions: for instance NHS England (2023), which has advised “the intention that the NHS will only commission puberty supressing [sic] hormones as part of clinical research” and that “outside of a research setting, puberty suppressing hormones should not be routinely commissioned”. This means trans kids will be under constant surveillance for an excuse to forcibly detransition them and/or their peers. It also suggests that if NHS England feels it has enough data, or that at any rate it has no need for any more research, then your child can go jump off a bridge.

65

It would require rising above culture war politics and returning to reason

The intimation here is clearly that the burden of doing these things is on trans people. To that I am forced to say: asserting that trans people should “return to reason” is pretending we didn’t have a demonstrable monopoly on it in the first place. What Paul has is bias, junk science, and vibes.

As for “culture war” politics: the thing about trying to “rise above” a war is that if the other side haven’t stopped firing you just get shot down — and in this case it is very much Paul’s side which is doing the firing. I would say that for the war to stop Paul’s side needs to choose to stop it but that’s not quite true. It is a fact that the war will eventually end. Paul’s faction can choose to stop now, or be compelled later to stop on much worse terms, but one way or another, they are going to stop whether they want to or not, and on that day the “culture war” will have ended.

I’m done with my critique of Pamela Paul. Let’s move on to the Financial Review.

66

This piece was a flaming bag of shit that The Times should never have published, but they did. Nine decided to bring it here, so now it is just as much their flaming bag of shit.

When Nine acquired Fairfax Media, it reaffirmed the 1988 Charter of Editorial Independence, whose jurisdiction includes the Financial Review. The Charter stipulates

that editorial staff shall not be required to work other than in accordance with the Media, Entertainment and Alliance journalist code of ethics and in line with rulings of the Australian Press Council
Nine Publishing (2022), clause 3

Now, there is some controversy over whether the Charter of Editorial Independence actually applies — Anthony Klan (2020) alleges Nine never actually signed it and therefore it is not legally binding, which would not surprise me; as he notes in another article, it would be consistent with the state of affairs which has persisted since no later than 2006 (Klan, 2022). The synchronised right turn of the Ninefax mastheads suggests the question of the Charter‘s legal effect is moot: whether or not they are bound by it de jure they clearly do not treat it as binding de facto.

However, despite all of that, clause 3 of the Charter is automatically true. Editorial staff cannot be made to work other than in accordance with the MEAA Journalist Code of Ethics (2018) or the rulings of the Australian Press Council (“Press Council”) because they can simply quit. Given the importance and prominence of their job I would go so far as to say they are obliged to. There is a commonsense ceiling to the stringency of the ethical scrutiny that people are obliged to apply to their employers — Gerry Harvey is a repellent human being who uses the immense influence that his wealth gives him to advocate an actively anti-human politics (Evans, 2008; Godfrey & van den Broeke, 2014), but nobody is suggesting that Harvey Norman cashiers with no influence over corporate policy should quit their jobs and starve. This analogy, however, does not apply here. When you are a member of the editorial staff of a Nine masthead, what you do matters.

Now of course you could simply say that you meant well — you could say that this piece was syndicated from another paper, that you can’t expect every editor to be a world-leading expert in trans healthcare, paediatric psychology, paediatric endocrinology, and so on and so forth, etc. But the thing I noticed is that someone at Nine cleaned this up.

The day I first read this piece, 16 February, I took a snapshot of the Financial Review‘s copy at 01:55 AEST (Australian Eastern Standard Time, UTC+10; 15 February 15:55 UTC). I took a snapshot of The Times‘ copy at 02:32 AEST (15 February 16:32 UTC). Both are available through the “Archived copy” link in their reference list entries (Paul, 2024a & 2024b). No changes to either piece were made in the interim.

As discussed throughout this essay, Paul’s assertions are “substantiated” in The Times‘ copy with external links to various sources, however dubious those sources might be. In the Financial Review‘s copy, however, several of those links have been removed. It’s not, as you might expect, a case of accidentally purging all links during the syndication process — links have been selectively removed. Specifically and precisely those links, in fact, whose veracity has been identified as an issue.

Check out, for example, the passage referred to in #7. In The Times‘ copy, as I — and Erin Reed (2024) and Evan Urquhart (2024) — mentioned, two phrases are hyperlinked. The words “some controversy” link to Diaz & Bailey (2023a), which did not bother to solicit its participants’ “wr’tten informed consent to participate in scholarly research, … to have their responses published in a peer reviewed article, … [or] to have their data included in this article,” a consent violation sufficiently severe that publisher Springer Nature twisted the Archives‘ arm into retracting the paper (Diaz & Bailey, 2023b).⁵ To put in perspective how huge of a fuckup this is on Bailey’s part — and therefore how huge of a fuckup it is for Paul to cite him — the Archives never retracts anything. I mentioned above a study by Robert Spitzer which benefited from a laissez-faire approach to peer review on Zucker’s part; Zucker refused to retract that study even when, years later, Spitzer — having recognised the methodological unsoundness of the study (Arana, 2012) — personally asked him to (Dreger, 2012).

The words “tween and teenage girls” link to the article (Littman, 2018) that made Lisa Littman famous — because, as previously noted, it was forced, amid massive scandal (Heber, 2019), to correct out its major “finding”: that “rapid onset gender dysphoria” exists (Littman, 2019). This is the precise finding for which Paul is citing it as a source.

It is a truism that newspapers don’t care, and have cared less and less over at least the course of my life — born 1994, for reference — whether what they print is true. But fuckups this large have a great deal of potential to be converted into the kind of leverage that can force newspapers to care.

Someone at Nine clearly understood this. How do I know? Because those two hyperlinks have silently, without a printed correction, or any other editorial notation, been removed. The assertions they were sourcing, however, remain in the piece unaltered.

There were almost 2 weeks between The Times‘ publication (2 February) and the Financial Review‘s syndication (14 February). Maybe whoever changed it read Evan’s teardown, or Erin’s. Maybe they evaluated the sourcing themself. How they knew is immaterial. What matters is that they knew. Someone at Nine knew that this piece was a tissue of hate speech and lies, and they actively, consciously, decided to deal with that not by retracting it and apologising, not by correcting it, but by making it harder for Australian readers to realise what it was.

Nine is a member of the Australian Press Council. Running this piece, and actively helping to launder it, clearly violates General Principles 3 and 6, which are binding (Australian Press Council, n.d.). For all the good it will do, I have therefore initiated a complaint with the Press Council, and sent a similar but shorter editorial complaint to Nine directly. I have also judged that since someone at the Financial Review could read Paul’s 4,500-word piece closely enough to pick the sunflower seeds out of its teeth, they are therefore capable of reading this one too. Accordingly, I have publicly asked Nine and the editors of the Financial Review the following questions (Moreton, 2024):

Who made the decision to run this piece?

Who made the conscious decision to launder it?

Why?

What are you going to do about it?

If you found this piece useful or interesting in any way, please consider supporting me via Patreon, Ko-fi, or PayPal.

Footnotes

1 — In virtually all literature on the topic, including I believe Blanchard’s, the concept is spelled “autogynephilic,” but I’m Australian, so I spell it “autogynaephilic,” with an a.

2 — This is a long as hell article so here’s a fun little experiment to break it up: remember that Lana and Lilly Wachowski, creators of The Matrix, are both trans women. Look up The Architect (Helmut Bakaitis) from The Matrix Reloaded. Now look up Ray Blanchard. Go on, I dare you.

3 — The relevant part is the interest disclosure by Riittakerttu Kaltiala-Heino, uncharacteristically modestly credited as the fourth author, who gives “The Cass Review, member of advisory board” as one of her competing interests. h/t Zinnia Jones, who Tweeted about this about a day before I published this article.

4 — Cis people will of course get any rights that trans people get that cis people didn’t already have; that’s the nature of the game. But they still won’t need them.

5 — Bailey has form for violating research subjects’ consent, by the way, the same thing got him fired from Northwestern (Conway, 2004/2005).

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References

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