Trans rights

I emphatically reject the author's opinion that "it’s not ridiculous to suggest, for example, that a randomized trial of puberty blockers would be a good idea." (Why not a randomised trial of ambulances? We'll send half of emergency callers an Uber instead.) But he's certainly thorough, and excepts like this are astounding.

The Cass review was an interesting juxtaposition. Some of the scientific arguments were very reasonable, and the York team generally did a decent job with the systematic reviews that informed the document. However, the review itself often positioned bizarre theories about gender dysphoria alongside data and evidence. I’ve recounted quite a few examples of this during my pieces, but I thought I’d share one more that I found recently:

“Research commentators recommend more investigation into consumption of online pornography and gender dysphoria is needed. Some researchers (Nadrowski, 2023) suggest that exploration with gender-questioning youth should include consideration of their engagement with pornographic content.” (Cass review, page 110)

This paragraph suggests that porn can potentially turn children trans. If you look up the reference, it is to this opinion piece from a psychiatrist. The paper itself contains no data connecting gender dysphoria to pornography, but basically argues that teen girls may view porn and become so disgusted with being women that they choose to instead become men. The paper also notes that “Girls affected by autism might be at higher risk because of their reduced mentalization capacities.”, although it does not provide any evidence that this is true.

The author of this opinion piece is a psychiatric trainee who lists their affiliation as Therapy First. Therapy First is an explicitly anti-medication group which campaigns to prevent children from being given hormones or puberty blockers for gender dysphoria - instead, they recommend psychotherapy as the first and in many cases only option. This is not evidence. It’s barely even an opinion. There is no reasonable excuse for the Cass review having included such a completely bizarre and unsubstantiated theory, especially without noting that it is entirely unsupported by even the most vague of evidence.

Seriously: would you test the effectiveness of chemotherapy by giving a control group of cancer sufferers saline water? I mean, assuming you're not a raving lunatic who insists that cancer is a fashionable lifestyle choice spread by social contagion on TikTok?

The absence of RCTs studying the impact of gender-affirming care on the mental health and well-being of transgender adolescents does not imply that these interventions are insufficiently supported by evidence. Although RCTs are considered high-quality evidence because of their ability to control for unmeasured confounders, the impossibility of masking which participants receive gender-affirming interventions and the differential impact of unmasking on adherence, withdrawal, response bias, and generalizability compromises the value of RCTs for adolescent gender-affirming care. RCTs are methodologically inappropriate for studying the relationship between gender-affirming interventions and mental health. These methodological considerations compound the serious ethical concerns raised by RCTs in adolescent transgender healthcare. Given the limitations of RCTs, complementary and well-designed observational studies offer more reliable scientific evidence than RCTs and should be considered of sufficient quality to guide clinical practice and policymaking. Adolescent trans healthcare is on solid footing.

a periodic reminder that these places exist:

• https://genderdysphoria.fyi/
• https://diyhrt.wiki/
• https://diyhrt.info/
• https://hrtcafe.net/
• https://transharmreduction.org/
• https://transfemscience.org/
• https://gtrr.artemislena.eu/
• https://diyhrt.market/transfem-hrt-guide
• https://www.reddit.com/r/estrogel/wiki/

and places like these:

• https://diyhrt.market/
• https://www.unitedpharmacies-uk.md

and some country specific things (please recommend more):

• https://genderkit.org.uk/

feel free to boost, and reply with other useful links for #trans people

NCAA President Charlie Baker told a Senate panel there are fewer than 10 transgender athletes he is aware of who currently compete in college sports, pouring cold water on an issue Republicans have said is a nationwide problem and one that is increasingly fraught territory for Democrats.

“How many athletes are there in the U.S. in NCAA schools?” Sen. Dick Durbin (D-Ill.) asked Baker during a Senate Judiciary Committee hearing Tuesday on federal regulations around sports gambling.

“Five hundred and ten thousand,” said Baker, a former Republican governor of Massachusetts who has served since 2023 as president of the NCAA, which governs intercollegiate athletics at more than 1,000 colleges and universities across the country.

“How many transgender athletes are you aware of?” Durbin asked.

“Less than 10,” Baker said. He did not say whether that number includes transgender men. 

[…]

A recent cross-sectional study published in the British Journal of Sports Medicine found that transgender women who completed more than one year of hormone replacement therapy performed worse than cisgender women in tests measuring lower-body strength and lung functioning.

Trans women’s bone density, which is linked to muscle strength, was found to be equivalent to that of cisgender women, and there were no meaningful differences in levels of hemoglobin, which facilitates oxygen delivery to muscles and is related to greater aerobic performance.

An earlier study, also published in the British Journal of Sports Medicine, found that transgender women who went through male puberty retained an athletic edge after one year of hormone therapy. The study’s lead author has cautioned against using the results to categorically ban transgender athletes from competitive sports. 

I'm shocked, I tell you. Shocked!

The researchers found that respondents who viewed female athletes as less deserving of attention, support, and media coverage were more likely to oppose transgender inclusion in sports. For example, individuals who disagreed with statements like “Women’s sports deserve the same amount of media coverage as men’s sports” were significantly less likely to support transgender athletes’ rights.

The researchers also found that adherence to traditional standards of femininity—such as prioritizing thinness and attractiveness—was a strong predictor of opposition to transgender athlete inclusion. For instance, respondents who endorsed the idea that women should be thin or that women’s muscles were less attractive were less supportive of transgender athletes competing in alignment with their gender identity.

Similarly, those who agreed with statements like “Female athletes will never be as good as male athletes” were more likely to oppose allowing transgender athletes to compete according to their gender identity and to support sex testing.

Negative attitudes toward homosexuality were another powerful predictor of opposition to transgender athletes’ rights. Participants who expressed homophobic views, such as agreeing with statements like “I would be disappointed if I found out my child was homosexual,” were significantly more likely to support sex testing and oppose transgender inclusion.

According to the researchers, the findings suggest that opposition to transgender inclusion often reflects efforts to uphold traditional gender norms and maintain the existing gender order rather than a genuine commitment to advancing women’s sports.

In May 2023, Newsweek interviewed researcher and medical physicist Joanna Harper, and asked her to estimate the number of transgender athletes competing in US sports.

“While we don’t know the exact number of trans women competing in NCAA sports, I would be very surprised if there were more than 100 of them in the women’s category,” Harper replied.

That number is even smaller when it comes to middle school and high school athletes. Newsweek also spoke to Gillian Branstetter, a spokesperson for the American Civil Liberties Union (ACLU), who told Newsweek that Save Women’s Sports, a leading voice in the bid to ban transgender athletes from competing in girls’ sports, identified only five transgender athletes competing on girls’ teams in school sports for grades K through 12.

Yes, that’s right. Not 5000, not 500, not even 50 – just five trans student-athletes. All of this legislation, work, lobbying and anger – is aimed at preventing a tiny handful of young people from playing school sports. 

This is a tough read.

Judge Allen Winsor, a Trump appointee, justified his preliminary ruling in Keohane v. Dixon under highly questionable legal and scientific grounds. He repeatedly misgendered the plaintiff while citing nonsensical claims about the medical treatment for trans people that go against WPATH guidelines and all known medical science on gender-affirming care, such as labeling gender dysphoria a “short-term delusion.”

Winsor also professed support for “psychotherapy” practices that are much more akin to “conversion therapy,” a long-debunked practice which doubles the risk of suicide of trans people forced to take part.

[…]

Under the new FDC policy, women face having “their heads forcibly shaved and receive disciplinary action for possessing any female undergarments and makeup.” According to a legal declaration filed on behalf of Michelle Ward, a trans woman in a Florida prison:

   The loss of my hair, along with female undergarments and makeup, has been earth-shattering for me…I stay awake crying many nights.

Forced head shaving beckons back to the dark history of Native American residential schools in the US in the late 19th and early 20th centuries, which mandated Native American boys have their hair cut to conform their appearances with Western gender standards.

The purpose of this policy was to humiliate Native American children and rob them of their basic humanity and connection to their culture and tribal identities. The stories of the women described in this article show that the intentions behind the FDC policy are no less cruel or dehumanizing in their nature. 

The executive director and publisher of Baptist News Global challenges his readers:

The transgender community accounts for less than 1% of the U.S. population, which makes them an easy and “safe” target for persecution. But these are real people from real families.

Taking away their rights, taking away their health care, shaming them, scapegoating them — this is truly a death sentence. And if you gave a damn, you would speak up for them.

Whatever you think you know about transgender people is probably wrong if you don’t actually know any transgender people. If you heard their stories, you would know they are sincere. They do not seek attention; it’s only the people attacking them who seek attention.

Here’s the main thing I want to impart for now: Transgender identity is real. It is authentic. You do not have to understand it to accept it. And even if you won’t accept it, what harm is there in letting other people live peacefully and in good health? How does the existence of transgender people threaten you other than challenging your too-small view of the world?

The French Society of Pediatric Endocrinology and Diabetology (SFEDP) recently commissioned its own version of the Cass Review, and this study reached almost the exact opposite conclusions of Cass […]

Upon reading both the Cass Review and the SFEDP Review, what immediately jumps out is the very different tone of each—Cass takes a tone that feels skeptical to the point of excess, offering mysteriously curt phrasing, statements rife with implications of harm or conspiracy by mainstream providers, and an overall sense of invalidation. By contrast, the SFEDP Review reads like a scientific paper—its language is straightforward and sterile, and there is none of the innuendo of Cass. Reading both side by side feels almost like traveling from a land of paranoia and conspiracy into levelheaded reality.

These basic differences in language imply very different approaches to working with trans minors—gender-affirming vs gender-critical.

[…]

Perhaps nowhere is the difference between the Cass Review and the SFEDP Review more clear than here: Cass bemoans the lack of good evidence and recommends generating it, whereas SFEDP declares that it is ready to follow the science by supporting minors in their transition. One cannot help but suspect that even if further research is conducted, in another 20 years another Cass will come along and demand another round of research into trans youth.

One idea that Tennessee has floated — that sex-based laws related to biological sex difference are shielded from scrutiny — is particularly pernicious. As I have shown in research, this has never been the court’s approach. And for good reason. Throughout the history of sex discrimination, hiding bias behind biology has been a common tactic. Many sex-based lines that have been challenged in the court — from a male-only university admissions policy to rules distinguishing mothers and fathers when it comes to the citizenship of their children — have been couched in terms of physical sex differences. Upon examination, the court has acknowledged that sex stereotypes and not biological differences drive these laws. Without requiring that courts take a close look at all sex-based laws, we make it far too easy to legislate on sexual prejudice.

Just as important as addressing women’s subordination, equal protection has been a key tool in striking down laws that confine not just women, but men, to traditional roles and expectations. Equal protection has been used to invalidate laws that exclude men from caregiving or that require anyone to conform their behavior or appearance to sex-based conventions. In doing so, the doctrine helps to free all of us from limiting sex stereotypes.

Seen this way, it is not hard to appreciate that the law at issue here strikes at the heart of sex equality. The Tennessee law — and trans discrimination more generally — is not only about discrimination against trans people, but about ensuring that we all keep in our gender lanes. As Prelogar explained, the law here is “one that prohibits inconsistency with sex,” requiring that children born as boys and girls “look and live like boys and girls.” Tennessee’s argument would call into question the longstanding freedom we all enjoy to live our lives as we wish, regardless of sex.