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A Reader Makes an Excellent Point about Trusting Experts: Who Pushed Transition?
Recently I wrote Information Can Be Both Factually True and Very Misleading. If social media and highly politicized communications existed in the 1940s when antibiotics were introduced, many parents would have shied away from antibiotics just as they do covid vaccines, based on information that was technically “true” but also misleading.
True information doesn’t always lead to good decision making. Context matters. Expertise matters.
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One of my points was this: If we encounter a problem we can’t fix ourselves, our best bet is probably to consult an expert and follow that person’s advice, versus say, a your own interpretation of data from the CDC or a tweet from an unknown doctor. But then a reader, Spruce, offered these insightful comments:
The one thing that still worries me though is the "trust medical experts" heuristic might have given the wrong answer to an important question a couple of years back in the UK. Imagine you're a parent and your child comes home from school one day and tells you they're transgender and want to go on puberty blockers. You panic at first, but decide you're going to apply the "trust experts" heuristic. The website of the National Health Service tells you that puberty blockers are safe, fully reversible, and have no long-term negative effects - more or less as safe as antibiotics. But the NHS was later forced to change that wording after a court case, where among other things they had to admit that there were no long-term studies because these drugs had not been in wide use for long enough to tell (except for specific, rare, non-gender-related conditions). The guidance has now been changed to "Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.”
If you'd gone along and got your child referred to the Tavistock clinic - the national "gender identity development service" so surely that's where you'd find genuine experts, as opposed to online - you would have been told by everyone you asked there that all experts agree on the "gender-affirming" model of care. Except that "the Tavistock" has now all but been shut down (they're not accepting new referrals) and they're facing a lawsuit.
So as a parent, going with the experts would be good advice for antibiotics, covid vaccines (and other kinds of vaccines like MMR), but the best I can say without openly taking a side is it's to early to say if the same is true for puberty blockers.
Spruce is right that a parent who simply trusted the experts in this case would have been led to believe falsely that puberty blockers were benign. The more I thought about Spruce’s comments, the more I wanted to dissect what happened with child transition — how could experts have gotten it so wrong? How could a parent do better than a simple “trust the experts”? It seems worth trying to understand.
Definitely Not the Parents’ Fault
If you were a parent with no medical or psychological background (that is, if you were like most parents) and you’d been seeing newspaper or magazine articles, TV shows, YouTube videos, and social media posts about how transition is the latest thing for kids who are distressed and believe they’re the wrong gender, of course you would take your gender-distressed child to the doctor. This is not something the typical parent would feel qualified to handle at home, especially if their child threatened suicide if transition were delayed or denied.
This is not a mistake the parents made. They went to the self-proclaimed experts — and sometimes they were referred there by their own trusted pediatricians.
But Who Are These Experts and What Do They Advise?
The gender experts advise “affirmation” as the only approach to gender dysphoria. That is, if your child is so extremely unhappy with their body that they want to take on the appearance of the other sex, the new gender experts believe that the best clinical approach is to agree that the child’s extreme emotional distress is correct and appropriate, and their wish to take on the appearance or identity of the other sex is the solution.
We’re all told, in absence of any research comparing it to the old way of doing things (“watchful waiting” — i.e., “Be supportive of your child but expect that by adulthood they, like the vast majority of other kids, will grow out of it”) that affirmation is the only correct way to do things now.
It’s worth mentioning that in no other instance do psychiatrists or psychologists seem to believe that affirming someone’s unexamined emotional distress is the best approach to treatment.
If there’s no medical evidence that a person can be “in the wrong body” Kafka-style — and there’s not: there’s not even any solid evidence to support the oft-heard claim that “Trans brains are different, though!” (see for example here and here) — then the emotional distress that comes with hating your body must have a root cause other than “wrong body.”
That root cause is worth examining. Encouraging someone’s emotional distress and insisting that it not be examined is reckless and counter to everything we know about therapy and emotional wellness.
The new gender experts portray puberty blockers as a benign “pause button,” fully reversible with no bad lasting effects, which gives the child time to decide what they want. In reality, years before these drugs were used on kids with gender dysphoria, it was already well established that puberty blockers were strong drugs with many damaging effects.
“According to ABC News in Las Vegas (ktnv.com, 10/30/09), [Takeda Abbott Pharmaceuticals] pleaded guilty in 2001 to criminal charges that it violated the Federal Prescription Drug Marketing Act.… Dr. Andrew Friedman admitted that he falsified and fabricated 80 percent of the data in leuprolide acetate (Lupron) research reports.”
The same story also quotes statements made in 2008 by Dr. John Gueriguian, a former medical officer with the FDA:
"After years of use of [Lupron] in a great number of patients, the evidence is clear that [Abbott]…didn't study [Lupron] adequately before marketing…. After its introduction into the marketplace, [Abbott] did not perform enough long-term studies to detect potential long-term and irreversible side effects of [Lupron], which has been shown, through independent observations and studies, to be able to cause irreversible side effects and permanent severely disabling health problems.”
The article continues:
“Dr. Gueriguian alleges that that [Abbott] intentionally suppressed knowledge about the risks associated with Lupron, including bone density loss (leading to permanent disability in some cases), generalized pain, headaches, fluid retention, depression and immune and nervous system problems, including spinal fracture, convulsions and paralysis.
“Drugs whose risks outweigh their benefits should be pulled from the market, the report concludes.”
So a former medical officer with the FDA was saying in 2008, well before the current wave of gender-questioning kids, that Lupron should not be used on anyone. What might he say about the benefits of using this drug off-label on children with emotional and not medical problems? As a bonus, giving the drug to children disrupts their natural puberty and causes sterility.
A cynic might suppose that after all these years Abbott still hasn’t conducted any clinical trials in children to get the drug approved for gender dysphoria, because it would never pass muster. They just collect the profits for this off-label use, year after year.
So if Spruce tells us that the NHS website — the ultimate medical authority in the UK — was telling parents that “puberty blockers are safe, fully reversible, and have no long-term negative effects,” the website was just plain wrong. That’s horrifying. How are parents to know?
And a lot of other stuff
I wanted to highlight puberty blockers, since Spruce mentioned those specifically, but there are a lot of other not-evidence-based practices with regard to treating “trans kids.” Social transition. Cross-sex hormones. Removal of healthy body parts. None of it — none — is supported by high-quality research.
But why not? A decade into these increasingly common medical and surgical treatments, there should be abundant research by now — if the people who believe transition is wonderful had the interest in doing the research, which apparently they don’t. Their idea of “research” is giving surveys to people shortly after their treatments when they still think they’re glad they did it (or when the sunk-cost fallacy is in play: are you going to go so far and then admit to yourself that it wasn’t all you hoped?) Such “research” is considered low-quality at best.
We need to look at long-term outcomes, and until we do, child transition is correctly classified as “experimental” — but how many parents are told transition is “experimental” and not supported by research and evidence? Quite the opposite: They’re told it’s the only choice.
Many detransitioners say it takes years for the reality to sink in that they’ll never be the opposite sex; that they don’t enjoy obsessing about their gender, about passing, or about how other people perceive them, year after year; and that the “treatments” didn’t provide what they really wanted.
What about the Dutch Protocol?
Even doctors who are a bit more skeptical than average — those who are not sold on treatment-on-demand for all who seek it — often believe that for some small number of kids, transition is appropriate, and they usually mention the “Dutch protocol” as being the gold standard of care.
But alas, the Dutch model is not a sturdy evidence-based model for treating gender-dysphoric kids, either. Anyone who doubts this should read “The Myth of ‘Reliable Research’ in Pediatric Gender Medicine” published this month in the Journal of Sex & Marital Therapy (a peer-reviewed journal).
And Then There’s WPATH
WPATH seems to be widely perceived, even among doctors, as a medical organization that responsibly publishes, based on evidence, the “standards of care” for gender-questioning people.
You can imagine how that belief came about. Say you’re a pediatrician. You belong to your pediatric medical organization — and you read the journals — which give you the latest evidence-based information about how to treat sick kids. You trust that information.
But if you have a kid with a complex problem — say a serious heart problem — you refer them to the pediatric cardiologist, with every expectation that that person has completed a challenging fellowship in pediatric cardiology and knows a lot about children’s heart problems.
As a pediatrician, you might not know exactly what the pediatric cardiologist does all day, and you don’t have the knowledge she does, but whatever she does, you assume it’s evidence-based and the child will be in good hands. She knows more than you about kids with heart problems, right?
I think many doctors, without knowing a thing about gender issues, only know that it’s something that they simply weren’t trained to address — and they assume, incorrectly, that there’s good evidence-based information out there, and the experts are to be found at the local gender clinics, which have sprung up everywhere. They send kids to the experts and believe they’ve done something helpful.
But that simply isn’t true. When doctors refer kids to the gender experts, they are sending them to people who see a one-size-fits-all solution to every child who questions their gender or is distressed by their body. It’s all affirmation and transition, and parents are threatened with the specter of suicide if they don’t comply: they’re asked if they’d prefer “a live son or a dead daughter.”
In reality, while the risk of suicide is real among kids with mental health problems, with no other mental health condition are parents threatened with the possibility of their child’s imminent suicide if they don’t go along with the child’s demands.
“Standards of Care” That Aren’t
You can find many critiques online of what’s wrong with the World Professional Association for Transgender Health’s (WPATH’s) “standards of care” (and why they are not really “standards of care” at all — because to be standards of care, they would need to be based on high-quality research and evidence and outcomes).
One critic of WPATH is ECRI, an organization that describes itself as “an independent, nonprofit organization improving the safety, quality, and cost-effectiveness of care across all healthcare settings worldwide.” One of ECRI’s projects is called a TRUST Scorecard, “which evaluates the rigor and transparency of a guideline to see how it stacks up against the Institute of Medicine standards for trustworthiness.”
Dr. Marcus Schabacker, president and CEO of ECRI, described the need for the TRUST Scorecard project this way: “Trustworthy clinical practice guidelines are essential to medical professionals who need to deliver safe and effective patient care. Since ECRI Institute’s mission is to advance effective, evidence-based healthcare globally, we are taking the lead to provide free access to trusted guideline resources.”
When a Canadian journalist asked ECRI why WPATH was not included in the TRUST Scorecard project at all, the reply was that WPATH “did not use a systematic review to process” their guidelines. Basically, ECRI is saying WPATH’s guidelines are so baseless that a TRUST Scorecard can’t even be made for them.
One recent critique of the newest edition of the WPATH standards of care can be found here on the Genspect website, which goes point by point by point, finally concluding:
“WPATH’s decision to remove a chapter on ethics which was included in the draft version of [its latest standards of care] suggests that they have become a wholly activist-led organization unconcerned with a careful… approach to gender care and instead focused on promoting gender ideology.”
What About Other Countries?
Other countries that have recently given child and adolescent transition a careful look have found the cost-benefit lacking. Sexologist James Cantor sums it up:
“The health care systems of the U.K., Finland, and Sweden have each conducted systematic, comprehensive reviews of the safety and effectiveness of puberty-blockers and cross-sex hormones on adolescents with gender dysphoria. Such reviews are the standard procedure when developing health care policy. All three reviews concluded that there is little evidence of benefit off-setting the known and unknown risks of medicalized transition of minors.”
Accordingly, those countries have halted nearly all child and adolescent transition.
The Problem with Gender Experts Is That There Is No Such Thing as a Gender Expert
There is no branch of medicine that solves “gender problems,” akin to how dematologists treat skin problems and cardiologists treat heart problems. WPATH is not a medical organization in the usual sense and its standards of care are baseless. There is no such thing as a medical fellowship specializing in gender. It’s not even a subspecialty of psychiatry, or a sub-subspecialty under child and adolescent psychiatry. There’s no such thing as a gender expert.
Even among psychologists, if psychologists are trained to affirm whatever the patient says about their beliefs and wishes regarding gender, they are not doing psychology at all. They are not doing what a therapist would do with literally any other problem that a patient presented. There’s no special training. There’s no training at all.
If there are no real experts, no real standards of care, and a glaring lack of research and evidence to support any of what’s being done — and if several other countries have essentially abandoned child transition — how is child transition still such a Big Thing in the United States?
It’s the Politics…
Even as recently as 20 years ago, it was permissible — not just permissible, expected — for liberals and progressives to engage in lively debate on any issue that affected us. It was part of our Enlightenment heritage to question things, to arrive at our best and evolving understandings of truth based on sharing information, learning new things, engaging with each other, and at times, fighting it out.
Today the “left” (or what calls itself the left in the United States) has become an unrecognizable, authoritarian force, with very entrenched ideas of right and wrong.
When it comes to the trans issue, the only right thing according to the new authoritarian left is affirmation. The only right thing is to adopt a distressed teen’s pronouns and new name right away, and begin transition if they want it.
If you question any of it, not only do you risk your liberal / progressive credentials, but you’re on the wrong side of history. You’re transphobic. You’re literally harming trans people. Why is your heart so full of hate? When did you turn into a bigot? You’re actually…evil. Bad inside.
To question what is happening, even a little, is to risk being cast out of your political tribe. You risk losing friends. You risk losing family members. You risk losing your job. Just for questioning.
The new authoritarian left has discovered an effective way to keep most people in line. If you just go along with them, you’ll be OK — as long as your kid isn’t the next one to demand sterilization and a double mastectomy.
…And the Politics Leads to Bad Information, Bad Decisions, and the Destruction of Trust
To me, the biggest scandal is not that thousands and thousands of regular people put their trust in these non-experts posing as experts. To me, the real scandal is that WPATH could put itself out there as having created “standards of care” that are not standards of care in any meaningful sense, and “gender clinics” could pop up everywhere like fungus, and the medical community just …went along with that. And the media and institutions just … promoted it as this great new treatment approach.
And so the left-leaning public, unless they made enormous efforts to delve into the specifics and discover that there’s no evidence-based reason to adopt any of these practices and beliefs, just…agreed with all of it. That must be the best new way to help people.
Conservatives are no better, though. It’s not as if they delved into the specifics, either. More typically, their version of critique has been to make fun of gender-questioning people and “the libs” in general. Girls are girls, boys are boys, case closed; it’s that simple. It’s more a political battle than a fact-based discussion. It’s fodder for the Daily Wire and Twitter trolls with flag emojis.1
Each side is convinced that the others are malevolent idiots.
Bad information, information based on politics rather than facts, often leads to bad decisions. And once people realize their bad decisions, they are often angry at the “experts” who led them wrong (Chloe Cole is one recent example), and the experts’ credibility is compromised. Trust is destroyed.
Five years ago there were only a few hundred people on the r/detrans subreddit. Now there are almost 44,000. We have thousands of people now spreading the message that the experts led them wrong, the experts didn’t address their underlying issues, the experts aren’t to be trusted. What happens the next time they have a problem? Will they trust any expert, ever again?
False Information Can Be Misleading, Too
If the topic of the last post was “Information Can Be Both Factually True and Very Misleading,” the topic of this one might be “False Information Can Be Misleading, Too.”
That’s not very satisfying, is it? But false information coming from experts can be the most dangerous and corrosive of all. We saw it during covid — politically motivated messaging which seemed to change without clear explanations led to a completely deserved loss of public trust. It would take a lot to restore that trust, and it doesn’t look as if our leaders are making a particular effort to do that. If MERS-2 or Super-Ebola2 lands on our shores tomorrow, we’re in big trouble.
Unless you make it your second full-time job to investigate every difficult decision you need to make, what can you do?
The anticlimactic answer is, “I don’t know.” For all its flaws, if you really don’t know how to solve a problem — and none of us are experts in everything — it’s still probably the best bet to hear what the experts have to say.
But as Spruce pointed out, that’s too simple. It’s also important to do some reading and some thinking. It’s important to look around at how a wide variety people around you, of all political leanings, maybe even in other parts of the world, are handling the same thing. Perhaps most of all, it’s important to trust your gut and not immediately believe everything you’re told.
You might — maybe — trust your gut and give your child the covid vaccine if every doctor you ask is giving his child the covid vaccine, too, and you know that billions of doses have been given around the world and not a single country has sounded the alarm.
You might — maybe — trust your gut not to give your child a binder and hormones if you know your kid was never gender-nonconforming in the past, you know she has other unexplored emotional or social issues, and your gut tells you to take it slow and do some reading first. Maybe even do some of that old-fashioned “watchful waiting” that the experts recommended until a few years ago.
It might make sense, on a gut level, to give your child the covid vaccine if you’re comfortable with other vaccines, and you have experience with those. It might make sense, on a gut level, not to transition your child because what’s being described to you doesn’t look much like the path to self-acceptance, happiness, and fulfillment. If things don’t quite add up or make sense, your gut will probably tell you that.
Listen to what experts have to say, but also go with your gut.
I’m sorry. It’s not the best answer, but it’s all I have.
What do you think?
One notable exception is Tucker Carlson. I’m no Tucker Carlson fan, and he’s not familiar in detail with all the issues, but I’ve seen him explore the issue seemingly in good faith with good intentions, for example here. In fact, at times in this interview he sounded like a New Deal Democrat. It’s worth watching for the cognitive dissonance.
MERS-2 and Super-Ebola are not real things. Yet.