In the fight over transgender treatments for kids, everyone from President Joe Biden to national medical organizations are defending these life-altering therapies as "necessary." Just this week, a court reinstated its temporary ban on Texas's protections for children, arguing that they could cause "imminent and irreparable harm." Even the state's Leftist medical association is throwing its support behind drugs and therapies that can destroy a young person's body, insisting that it's "developmentally appropriate care." Other doctors and experts argue that laws putting a pause on gender transition are supported by basic scientific facts. Who's telling the truth?
Sadly, when it comes to this issue, ideology is driving science more than science is driving itself. Statements like that of the White House avoid the facts about gender transition for children and instead employ a communications campaign fraught with hyperbole, misinformation, and inadequate research that is more emblematic of a bait-and-switch tactic rather than the gold standard of scientific inquiry. What are we to think of all this?
In the midst of the confusion, it's appropriate to recall a few basic facts about the scientific method:
1. The scientific method is just one way of learning about the world around us. It is not an infallible approach to knowledge, and there are always errors associated with any study. The question, then, is not whether error is present, but how loosely do we hold the findings because of the amount of error in the study.
2. Confidence is gained in the study's outcome when error has been reduced. One way error is easily identified is by looking at how the study was designed. This means assessing the methods (e.g., web-survey, experimental study), how the sample was gathered (do the people in the study have the same characteristics as those the researchers are trying to apply the findings to), the financial associations of the researchers, and any vested interests the researchers have in a certain outcome.
3. A particular finding is also strengthened when multiple studies draw the same conclusion. It is normal for a research agenda to start with a wide scope and ask a question such as, "What are the experiences of youth who identify as transgender?" As this information solidifies, the research questions narrow, and the methods typically become more rigorous and directive. For example, the methods and question might move to the commonly known clinical trial phase and ask, "What interventions reduce gender dysphoria?"
4. As a research agenda grows, knowledge on a subject matter strengthens. In this way, a fuller picture might emerge, giving insight into the conditions that create an outcome. In this case, it's clear that the transgender-identifying population has higher rates of childhood trauma, mental health distress, and increased suicidality. When there is clear knowledge about the factors that create a ripe environment for an outcome, it would be remiss to leave those concepts out of research study without a very clear logic for doing so.
With these basic research concepts in mind, there's no escaping a need to be critical of transgender literature. Transgender studies have been used to make big claims about the effects of medicalized interventions, but these studies lack solid empirical evidence to back up the assertions that these practices are efficacious. It is critical to keep in mind that these procedures are some of the most intrusive physiological practices used to address any psychological condition listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; and soon 5-TR) and should demand the most rigorous scientific backing rather than the least. Here are four key things we should be aware of regarding the current transgender literature:
1. First, transgender literature is in its infancy stage of a research agenda. The types of research methods and questions asked in the peer-review literature reveal that these studies are only at the exploratory phase. This means that the approaches used to investigate the experiences of the transgender population cannot establish a causal relationship between claims that are made, such as the claim that the use of cross-sex hormones will reduce suicidal thoughts. The research methods, alone, prohibit such a claim from being made.
2. Much of the research scaffolding the idea that "transgender procedures save lives" is based on web/survey data, which captures people's opinions from one moment in time. These data points do not account for suicidal thoughts or mental distress over time or long term. By design, these studies cannot establish that hormones/surgery are responsible for a reduction in negative mental health outcomes. The methods themselves give us this answer, regardless of how many advocacy, medical, academic, or professional groups say it's true.
3. The transgender literature has recycled some of the same web survey data from participants who were enlisted from the social media platforms Facebook, Instagram, and Snapchat. Although this isn't necessarily a bad method approach for an exploratory study, in the initial phase of a research agenda, it is unconscionable that this level of inquiry would be explicated to a recommendation for removing healthy organs, particularly for children.
4. This body of literature asserts a causal link between gender affirmative medical care and mental health outcomes. This conclusion is erroneous because the research methods don't allow for it and the variables known to affect the transgender-identifying population and suicide rates in general have been omitted from the investigations. That is, no study to date can claim that gender affirmative medical care clearly reduces:
- Suicidal ideation
- Suicide attempts
- Gender dysphoria
Would you have any of your vital organs, such as a kidney, removed because a few studies by advocates for kidney removals launched web surveys and found that some people felt less mental distress at the idea of an organ removal or because some people accessed services to remove their healthy kidney?
At this point, we must ask: Where are the research methods to establish the conclusion that access to transgender medical interventions bolsters mental health? There are none. But we still hear from our highest political offices that these practices "save lives." Such a claim is both dangerous and patently false, and it is based on a body of data that is immature, to say the least.