The Misplaced Outrage at The New York Times’ Gender-Affirming Care Article
Why we need to talk about false positives.
Last week, The New York Times committed a radical act by printing an article that hinted at the remote possibility that perhaps there was a tiny inkling of something slightly amiss with the exponential increase in kids—mostly teens, and mostly girl teens at that—being diagnosed with gender dysphoria, or identifying as trans, and pursuing gender-affirming treatments like cross-sex hormones and double mastectomies. The piece explores a battle between opposing approaches to care amid the backdrop of potential bans and impending new standards of care released by the World Professional Association of Transgender Health, or WPATH. (WPATH, by the way, was originally named for Dr. Harry Benjamin, who stumbled upon hormone treatments and went in search of a problem they could cure, after trying and failing to sell them as rejuvenation treatments for years.)
Unsurprisingly, the reaction was swift and intense. The outrage machine sprung into gear to claim that the author, Emily Bazelon, was committing genocide by questioning anything about “gender-affirmation” therapy, the recent and current model of treating gender dysphoria that trusts the patient to self-diagnose and in which informed consent replaces rigorous evaluation. Affirmation has supplanted the original Dutch method called watchful waiting, which carefully screened children over many years—though even that work has been called into question, which wasn’t mentioned.
There were other, milder criticisms—with which I agree—including that the author painted the controversy as a political battle of Left versus Right, when in reality there are thousands of parents, and a strong feminist movement, trying to disrupt this dominant paradigm from within the Left. (They spoke up in the comments.) This tiptoeing piece didn’t stomp hard in the place that I, as someone who’s been writing about gender for the last five years, have seen the Left-wing press mostly skip over.
For instance, the two experiences—identifying as trans and then medicating—are linked in the piece, and in the left press generally. But should they be? We know that not everyone who identifies as trans claims to experience gender dysphoria, but is everyone with gender dysphoria necessarily trans, and should thus be medicated? This should be the central question that clinicians, journalists, and the public ask as we assess how best to help this exploding population, because the result of incorrectly linking those two things—a false positive—has dire consequences.
Those who were outraged noted that the author doesn’t show any child being misdiagnosed or rushed to transition, which gave the impression of a moral panic over nothing. I agree. This issue of false positives—kids and young people approved for transition who shouldn’t have been—was largely left out of the piece, but is the whole reason clinicians are battling. The piece mostly makes the case for the medical transitioning of kids without concentrating on what happens when that’s the wrong decision.
The author gives detailed accounts of two youngsters who transitioned and are thriving, and mentions one diagnosed early and quickly, in a way that shocks the child’s mother…but turns out to be correct. There are three brief mentions of detransitioners, which the author refers to as a “small group of people” who “stop identifying as transgender” and “return to their cis identities.” Here’s where some push-back is warranted.
First of all, the detransitioners I know don’t have “cis identities.” Most do not believe in the theory of gender identity—that everyone has a gendered soul, and for some people it matches their body and for others it doesn’t. Thus, they don’t “identify” as cisgender. Second, I would not define the word detransitioner that way. Ceasing to identify as transgender is desistance, a word associated with the 60-90 percent of people with childhood onset gender dysphoria who grew out of it by the end of puberty without medical interventions—so long as they weren’t socially transitioned. But detransition, the way the growing cohort of regretters use it, refers to people who medically transitioned with hormones, surgeries, or both, only to realize they’d made a mistake. You can read hundreds of their testimonies on Twitter or Reddit, though we have absolutely no idea how many there are or what percentage of young people make up this group; we’re not keeping track in this country.
The author has two sentences about Grace Lidinsky-Smith, “who has written about her regret over taking testosterone and having her breasts removed in her early 20s,” and suggests that the problem was that her clinicians weren’t following WPATH’s Standards of Care.
In fact, Grace—who does not identify as cisgender—has written extensively about her traumatic experience of doing something incredibly radical to her body in the hope that it would make her feel better, only to find that it made her feel worse. This experience is glossed over in The New York Times piece, and no other exploration of false positives is offered.
Many of those sharing stories similar to Grace’s these days note that they should have had exploratory therapy, not affirmation, and should have been screened for comorbidities, internalized homophobia, and other issues. One of them is Ritchie Herron, who transitioned as a young adult only to realize—after undergoing “bottom surgery”—that he was a gay man with deep shame over his sexuality. On Twitter, he detailed his lack of genital sensation, the end of his sex drive, the nub of penile shaft left behind, and his inability to properly urinate. (He’s now suing the NHS.)
His story isn’t uncommon. I’ve now met several men who realized they were gay only after having their penises removed. The stakes when someone is wrong are incredibly high and must be named. A gender clinician recently said to me, “There will always be false positives and false negatives. That’s part of any patient cohort, any procedure.” But it’s important to be very clear at what a false positive truly means when it comes to medical gender affirmation.
In a follow-up Twitter thread, the author claims that she simply went where the facts led her, but that’s misleading. Because I feel it’s important that we on the Left report this story more accurately, I supplied her with some facts and steered her toward people and families who’d gotten hurt. She painted those families as ban-happy and unsupportive, rather than as parents of children with complex mental health issues who felt the affirmative model of care was inappropriate for their child, in part because of stories like Ritchie’s and Grace’s. Some of those parents, who don’t want to socially or medically transition their children, have been investigated by CPS; two that I know of have lost custody of their kids. That wasn’t mentioned, either. It’s important that when journalists write about this issue, they’re willing to look at the excesses, and the ideological capture, on both sides.
I applaud the piece for daring to dispel some of the myths that have pushed the affirmative model forward too far too fast, without scrutiny. Perhaps the most devestating claim the author made to proponents of gender-affirming care is that deaths by suicide are rare and, per one study, “occur during every stage of transitioning.” Thus, it’s difficult to uphold the oft-cited claim that transition mitigates suicide risk, or that a parent must choose between having a dead child or a trans child. The author notes the rates of suicide attempts are “terribly high” compared to the cisgender population (hard to tell if that’s the population that doesn’t identify as transgender or doesn’t have gender dysphoria), but fails to note that the high rates are the same as those of kids with other mental health problems, and many kids diagnosed with gender dysphoria today do have other mental health problems.
It’s not fair to assume someone’s motive—I know how much it bothers me when people assign intent to me, to which my objections only cause critics to further dig in. But I do think the fear of angering trans activists might have had something to do with how the author largely ignores false positives. But she is now learning the hard way that it doesn’t matter if you put just one pinky toe over the line; any defection from absolute loyalty brings on the ire in full force. And I’m deeply sympathetic to how discomfiting that is. I’m grateful to Bazelon, and The New York Times Magazine, for being willing to address this subject, even if I think they left out the most important reason we need to do so.
I spoke to friends over the weekend who knew little about this issue and appreciated the nuance of the article. It brought up enough issues for them to ask more and better questions, to wonder, to worry. It allowed for curiosity, something verboten in this political climate. Their reactions tempered my disappointment.
I had hoped this article would open the door for other journalists to follow and to replace the goal of “Social Justice” with one of truth-seeking. Maybe it still will.
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Bazelon and the NYT's led us to the river, let us see the water, but didn't quite let us drink. I took great comfort in reading the rational comments from the readers.
Thank you, Colin, for publishing this, and thank you, Lisa, for writing it. I have to admit, the one before last paragraph got me completely choked up. “It brought up enough issues for them to ask more and better questions, to wonder, to worry. It allowed for curiosity, something verboten in this political climate. Their reactions tempered my disappointment.”
This is exactly how I feel about the article. It didn’t go where I wanted it to go, but it put a crack in the veneer and I, too, had a couple of unexpected people reach out to me, almost in a whisper to say “can you tell me more?” For that, I am grateful. We must just keep delicately chipping away.