Sunday, 27 September 2015

It’s telling when people claim the current scientific consensus is an ideology

Heya everybody,

I have come across a blog called The truth about autygynephilia, which reminded me that I really need to find the time to finish my write-up on autogynephilia. The objective of the blog seems to be to aggressively push the autogynephilia hypothesis.

Interestingly, the subtitle by far the most common reason why male transgenderists attempt to become ‘women’ already seems to shift the goalposts of the hypothesis as defined by Ray Blanchard in the 1990s. I guess the proponents of the hypothesis have accepted that a gender-identity driven pathway to transsexualism exists and now offer autogynephilia merely as an additional, alternative pathway. I so wish they would write a proper peer-reviewed article on what their hypothesis actually is! Anyway, if that is their claim, they need some studies to support the existence of this additional pathway leading to transsexualism.

But I didn’t want to write about autogynephilia today, what has raised my interest is the latest blog post on that website, called Top pediatricians REJECT puberty-blockers, ‘ideology-driven social experiment on vulnerable children and their families’. It quotes a letter written by three American pediatricans, two of them in leading positions, to the journal Pediatrics. In this letter, they object to treating gender-dysphoric adolescents with puberty blockers.

At face value, this seems to be an entirely reasonable thing to do. It is the essence of science that the pros and cons of positions are being discussed in order to come to a conclusion on what describes reality best. Here, the issue is that we have adolescents who have a condition (gender dysphoria) that reduces their quality of life (both self-reported and objectively measurable), and that we need to find a treatment that reduces their suffering.

The current scientific consensus is that some of these adolescents are transsexual. Hormone blockers are prescribed to block puberty (a reversible procedure) until the patient in question is mature enough to be confident that his or her gender identity will not change and is fully able to understand the impact of non-reversible procedures, such as surgery. If these conditions are met, the treatment for transsexuality is applied (i.e. irreversible hormone treatment and surgery). For the effectiveness of hormone and surgical treatment for transsexualism, please have a look here.

What do the letter writers offer in terms of evidence for their position? In their first paragraph, they are off to a bad start, labelling gender dysphoria as a delusion and attacking the current consensus on prescribing puberty-blocking hormones because it treats puberty as if it were a disorder. This is a clear straw-man argument. Nobody says puberty is a disorder. The disorder is the conflict between biological sex and psychological gender identity. This introduction to their letter already casts some doubt on their neutrality and expertise.

So what evidence do they cite? Unfortunately, and fatally for their point of their view it is the well-discussed Swedish study by Dhejne, Lichtenstein, et al, published in 2011. The study with 324 participants looked at transsexuals after surgery and found they were worse off than controls. However, the study was not designed to compare the situation of transsexuals before and after treatment. That was simply not part of the study design, and to imply otherwise is dishonest.

However, we do have studies that do just that (check whether transsexuals are better off after treatment). For example one by Dhejne, et al from 2014 with 767 transsexuals (including the same individuals from the 2011 article) showing that 97.8 % of transsexuals were satisfied with having the surgery done – implying they judge their situation to have improved. For more information, see here. There is more I have written about the study quoted, but it’s tiring having to discuss the same issue over and over again.

In addition, they criticise the lack of a good body of research on the subject (see here for relevant studies) and propose the hypothesis that puberty brings relief for the vast majority of children receiving therapy for GID, because hormone surges propel the development of their brains as well as their bodies and they come to identify with their biological sex.
To support this claim they quote two studies (Zucker, 2005 and Vigil, Oreallana, et al, 2011). The second study doesn’t address gender identity at all, and the first is simply an overview of measures pertaining to gender and sexual orientation. I fail to see how these two studies prove their point. Ideally, they’d need to have two large age-matched groups of gender variant children, one with early onset of puberty, one with late onset (natural or through puberty blockers) and show that the former group becomes more gender-conforming earlier than the latter one, all the while controlling for social and cultural factors.

Anyway, from what I understand the content of their letter is highly dubious and it might not even have been argued in good faith. Show me some evidence that a different type of treatment helps transsexuals more than the current treatment, and I’ll be all ears.